Helping Others

ACT

If You Know Someone Who Might Be Suicidal
“ACT - Better an angry friend than a dead friend” 

If you think someone is suicidal—ACT. NOW. You don’t need to be an expert to make a difference. In fact, few of us are. What you have to overcome is a set of natural reactions to the challenge:

  • You may not know what to do. 
  • You may be afraid that you will make the person angry (or angrier). 
  • You may feel that talking about suicide will make it worse. 
  • You may be afraid of being clumsy or awkward and making a mistake that makes matters worse. 
  • You may feel that getting involved will make you responsible for whether the person lives or dies.

Unfortunately those are all natural responses to facing the potential suicide of another person. Few of us are trained and experienced in supporting someone who is suicidal. That’s the bad news.

The Good News. The good news is that, to be an effective supporter, you usually don’t need to know a lot or have a lot of experience. The critical elements in supporting someone that is suicidal are:

  1. Making the connection—being yourself and listening
  2. Letting them know you care
  3. Letting them know that you won’t desert them
  4. Letting them know you will figure out what to do together (even if that is really unclear at the moment)
  5. Taking actions required if the person is in immediate danger or has already injured themselves

Start Here—Notes to a Suicidal Teen

Here is an excerpt from the beginning of the section written for teenagers who are feeling suicidal. It’s a good place for you to start in understanding what a suicidal teen is facing as well as some of the things you can talk about. There are sections that follow that look at causes, signs, how to assess risk and what to do.

If You Are Feeling Suicidal
Remember 5 Things

  1. The pain of life can sometimes feel like it’s overwhelming your capacity to deal with life. This is particularly true if you are suffering from depression, which is distressingly common among teenagers.
     
  2. Feeling Suicidal Does Not Mean That You Are
    • Bad
    • Weak
    • Selfish
    • A loser
    • Incompetent
    • Unworthy
       

      It Does Mean That You Are Probably

    • Temporarily overwhelmed by the pain of your life
    • Worn out from expending lots of energy to cope
    • Feeling hopeless, unconnected and out of options
       
  3. Suicide is a permanent solution for temporary problems. This is true even for the problems that feel overwhelming.
     
  4. Growing up is hard and the teenage years are an emotional rollercoaster. Remember that with rollercoasters it can be terrifying on the steep drops, but if you don’t jump off (a bad thing to do), you then head back up. Rollercoasters can be intimidating at first, but as you get more experience with them, they lose much of their power to intimidate. Life is like that, so don’t jump off right now – there will be an upturn.
     
  5. There are effective solutions for dealing with the temporary problems, even the severe ones. It doesn’t seem that way when you are feeling suicidal, particularly because you are in extreme pain, are worn out from trying to find solutions and the solutions may not be obvious—but they are there and there are people that will be very willing to help you find those solutions.

 

So—Stay on the Rollercoaster and take the following 5 steps in taking charge of your life in a way that doesn’t end it.

Causes of Teen Suicide

There are a lot of factors and feelings that can lead a teenager to take his or her life and they often gang up. Some may have been going on for a long time, which can be exhausting. Complicating these factors is the fact that most teenagers considering suicide are suffering from a mood disorder—particularly depression. 

The mix of possible feelings is impressive, for example:   

  • Feeling overwhelmed and unable to cope
  • Hopelessness
  • Anxiety
  • Being worthless
  • Being worn out
  • Unconnected
  • Being a failure

The mix of possible factors leading to suicidal thoughts and actions is also impressive:

  • Break-up of friendships
  • Divorce of parents
  • Violence/abuse in the home
  • Inability to find success at school
  • Feelings of worthlessness
  • Rejection by friends or peers
  • Substance abuse
  • Death of someone close to the teenager
  • The suicide of a friend or someone he or she "knows" online
  • A move to a new community/school with trouble connecting
  • Rejection by a college
  • Being bullied

Signs of Suicidal Intent

What is problematic about some of these warning signs is that many of them are similar to behaviors that are natural for teenagers. The rollercoaster of the teenage years can easily generate behaviors that look like signs of an intent to be self-destructive. Plus, teenagers are different. Some teenagers can show a number of these signs and not be suicidal. On the other hand, some teenagers will show little and be in extreme danger of suicide.

 Don’t wonder—Ask. If you are unsure about whether someone is thinking of taking their own life—ask them. Let them know you are concerned, that you care and that you are willing to risk their anger rather than leave them unconnected.      

Statements—Direct and Indirect
People who talk about suicide, threaten suicide or call suicide crisis lines are 30 times more likely than average to kill themselves. Take suicide threats seriously.

  • "I hate my life.”
  • “I’d be better off dead.”
  • “There is no way out for me”
  • “Things will never get better”
  • “Nobody will miss me anyway”
  • “I won’t be bothering you much longer.”
  • ”You’ll be better off without me.”
  • “I wish I hadn’t been born”
  • “I’m just a burden”
  • “No one cares”
  • “What’s the point of living anyway?”
  • “I am going to kill myself.”

Note. Suicide threats can be spoken, in print (including lots of social network channels), symbolic (for instance drawings or tattoos), etc.

Previous Suicide Attempts

  • One out of three suicide deaths is not the individual’s first attempt
  • The risk for completing suicide is more than 100 times greater during the first year after an attempt

Preoccupation With Suicide
This is similar to the “statements” section, but worth teasing out. Preoccupation can be evidenced by:

  • Frequenting internet sites about suicide or death
  • Poems or stories about death, suicide or other dark themes
  • Artwork depicting dark themes
  • Consistent conversations about dark themes

Changes in Mood or Behavior
This is one of the potentially confusing areas as a lot of these feelings are a natural part of the rollercoaster of the teenage years. There is no magic advice, unfortunately. Just trust your instincts and if any are particularly intense or become chromic or too many start showing up—ACT.   

Mood

  • Sudden, abrupt changes in personality
  • Expressions of hopelessness and despair
  • Increased irritability and aggressiveness
  • Listlessness
  • Helplessness and hopelessness
  • Feeling overwhelmed
  • Feelings of loneliness or abandonment
  • Feelings of shame, guilt, humiliation or rejection
  • Difficulty concentrating, focusing, paying attention
  • Lack of interest in activities once enjoyed
  • Increased desire to stay home from school

 

Behaviors

  • Self-injury, such as cutting
  • Declining grades and school behaviors
  • Withdrawal from family, friends and other relationships
  • Decreased interest in appearance
  • Changes in eating and sleeping habits
  • Frequently complaints of being sick, particularly headaches, stomachaches or lack of energy
  • Significant weight gain or loss
  • Increased use or abuse of alcohol or drugs
  • Taking excessive risks, being reckless
  • In trouble with the school or the law
  • Sudden calm after a period of heavy stress or depression
  • Increased interest in guns/knives or gunplay/knifeplay

Making Final Arrangements
If someone is making final arrangements, this is a red flag. Not everyone who decides to commit suicide makes final arrangements, but if someone is doing so—ACT.

  • Saying good-bye to family and friends
  • Giving away favorite possessions
  • Talking about or making funeral arrangements
  • Generally putting their affairs in order

What to Do—Emergency/Crisis

If the person shows significant suicidal signs, has a specific plan and the means to accomplish it and says that they will commit suicide, some combination of the following actions is necessary.

The Basics

  1. Make the connection – in person if at all possible, but by phone at least
  2. Let them know you care
  3. Let them know that you won’t desert them
  4. Let them know you will figure out what to do together (even if that is really unclear)
    AND
  5. Get key adults involved
  6. Make the immediate environment safe (removing/locking drugs, guns, or knives) – or get to a safe environment
  7. Contact emergency personnel for immediate help

What to Do—Immediate Response—Non-Crisis

If the person is not in an immediate crisis, they may fall into one of the following categories of risk.  All of these categories should be taken seriously, but you will need to be more active for the higher risk categories.

Note. People can move from one risk level to a higher level rapidly, so stay alert.

 

Low Risk. The person has some suicidal feelings, thoughts and behaviors, but does not a have a plan and says they won’t commit suicide.

Moderate Risk. The person has some suicidal thoughts, feelings and behaviors and has a general plan, but denies that they will commit suicide.

High Risk.The person has significant suicidal thoughts, feelings and behaviors and specific plan, but denies that they will commit suicide.

Actions You Can Take

  1. Make the connection. Be pro-active. You may need to make several tries initially as people who are suicidal often don’t think they can be helped or will resist help.  You can use the phone, texts and such, or notes as well as face-to-face contacts. 
  2. Let them know you care. You may get rejected initially on this also, but you can trust that the message is getting through. Keep at it.
  3. Let them know that you won’t desert them. This needs to be stated directly and then find ways to stay in tough—the message being, “I’m still here for you.”
  4. Let them know you will figure out what to do together. This does not mean that you know what to do, but that you will walk down the path with them to find some solutions to the problems that are currently overwhelming them.  
  5. Get others involved, particularly key adults. This is critical as you should not take on the support responsibility by yourself. You can start with one trusted adult.  You can also engage appropriate peers. If possible, also help the person get connected to professional help. This is particularly important if they are suffering from depression (which will be likely). The key is to build as much of a support network as possible. Do not carry the load by yourself and do not wait to do this.
  6. Make the immediate environment safe. Even someone who does not have a significant plan and denies that they will commit suicide could be in a dangerous environment. They may have access to dangerous drugs, firearms or knives. Do what you can to work with them to make the environment safe. A sudden change in risk or impulsiveness can be deadly in an unsafe environment.

Make no deals. Never make a deal to keep a friend’s suicidal thoughts, feelings, action, or plans a secret. You cannot promise that you will not engage anyone else. You must get others involved to save your friend.

Another Resource. In the section for teenagers who are suicidal, there are five steps that are recommended for them to take in the short term. These five steps are compatible with the actions you can take (above), so you can use them as part of your work with your friend. 

Step #1: Promise Not to do Anything Destructive Right Now

Step #2: Connect with Others—Don’t Keep Suicidal Thoughts/Feelings to Yourself

Step #3: Take Heart and Remember Who You Are—People Do Get Through This

Step #4: Avoid Drugs and Alcohol

Step #5: Make Your Home a Safe Place

Pitfalls

There are a few pitfalls to avoid in supporting a suicidal friend.

  1. Don’t argue with a suicidal person about or whether they should commit suicide. You can let them know that you care and don’t want them to commit suicide and that suicide is a permanent solution to temporary problems, but don’t get into an argument.
  2. Don’t lecture about the value of life or judge them for being temporarily overwhelmed. Judgment is the last thing they need.
  3. Don’t promise complete confidentiality. You need to get at least one adult involved and may have to hold a tough line on that as a life is at stake.
  4. Don’t get into too much problem solving too soon. The problems have become overwhelming (or the person wouldn’t be suicidal), so you can be confident that they will defeat efforts to find quick solutions. You can commit to helping find solutions, but that’s going to take time. 
  5. Do not fail to take care of yourselfSupporting a suicidal person takes a lot of courage and a lot of energy. It can also be emotionally taxing and can stimulate difficult emotions for you. It’s important for you to talk with others that you trust about your experience as well as getting rest and eating well. 

AND 

Do not blame yourself if your efforts to help are not enough to prevent a suicide. Do not take responsibility for making your friend well. You can offer a lot of support, but you can't get better for a suicidal person. He or she has to make the commitment to recover.

What To Do – Longer Term

Getting past a crisis is only part of the journey.  Your friend will also need to employ some longer-term strategies to manage his or her life in a healthy way. You can support them (and they will need support) by simply staying connected and helping them implement the healthy strategies.  Those strategies (from the section devoted to teenagers feeling suicidal) are the following:

  1. Build—and use—your support network
  2. Identify the triggers that can lead to feelings of despair and suicidal thoughts
  3. Make a safety plan
  4. Take care of yourself and manage your stress
  5. Continue, restart or develop new activities and interests
  6. Get treatment for medical conditions, particularly depression

More details on these strategies can be found in the section for people who are suicidal.

Myths and Statistics

Statistics

  1. More than one in every 10 high school students reported having attempted suicide; nearly 1 in 6 students between the ages of 12-17 have seriously considered it.
  2. Suicide is the second leading cause of death for ages 10-24 - after unintentional injury
  3. There are approximately 5500 suicide attempts every day by students in grades 7-12.

LGBT Youth

  1. More than 30% of LGBT youth report at least one suicide attempt within the last year.
  2. More than 50% of Transgender youth will have had at least one suicide attempt by their 20th birthday.

Gender Disparities—All Ages

  1. Men die by suicide four times as often as women and represent 78.8% of all U.S. suicides.
  2. Women attempt suicide two to three times as often as men.

Racial and Ethnic Disparities

  1. The highest suicide rates are among American Indian/Alaskan Natives and Non-Hispanic Whites.
  2. Asian/Pacific Islanders have the lowest suicide rates among males while Non-Hispanic Blacks have the lowest suicide rate among females.

Common Myths

“People who talk about suicide won’t really do it.”
False: Almost everyone who attempts or completes suicide has given warning signs through their words or behaviors. Do not ignore any suicide threats. Statements like “You’ll be sorry when I’m dead” or “I wish I was dead”—no matter how casually or jokingly said—may indicate serious suicidal feelings.

“If a person is determined to kill him/herself, nothing is going to stop him/her.”
False:
Even the most severely depressed person has mixed feelings about death, wavering until the very last moment between wanting to live and wanting to die. Most suicidal people do not want to die; they want the pain to stop. The impulse to end their life, however overpowering, does not last forever.

“Talking about suicide may give someone the idea.”
False:
You do not give a person ideas about suicide by talking about it. The opposite is true. If a person is depressed or unhappy, discussing their feelings openly and allowing them to express how they feel is one of the most helpful things you can do. Even if they have had suicidal thoughts, giving them permission to express those thoughts can relieve some of the anxiety and provide an avenue to recognize other ways to escape their pain and sadness.

“People who attempt suicide and do not complete suicide are just trying to get attention and are not really serious.”
False:
To a certain degree, they are trying to get attention and help for the pain that they are experiencing. A suicide attempt, even half-hearted, is an attempt to seek help. If the person perceives their action to be a suicide attempt, then that is what it is. Any attempt, regardless of severity, must be taken seriously and help must be sought for the individual.