Suicide Prevention: A brief intro for recovery ministry leaders

by Teresa McBean

“Suicide is not chosen;
it happens when pain
exceeds resources
for coping with the pain.”

Introduction

Suicide is a challenging topic, made more difficult if we aren’t clear about the limitations of any article on the subject. Before we get into the body of the article, I want to make two things clear. First, this is not a discussion about how friends, family, recovery ministries and congregations grieve over the loss of a loved one who has committed suicide. The narrow scope of this article is to simply share some thoughts about how we might think about suicide in ways that could perhaps be more helpful than harming.

Secondly, this article can provide suggestions for things to do (and avoid doing) that can be helpful or potentially not helpful in the life of a person who is considering suicide as an option for ending their suffering. I can talk about perspective and suggest a few things that exacerbate the loss of hope. I provide suggested tools for rebuilding a life that is shattered and feels as if it is beyond redemption. But at the end of the day, part of our work, our collective work as people living on planet earth, is learning how to accept the reality that we only have one life we are responsible for living and that is our own. Sometimes, in spite of our best efforts, people succeed at suicide. Suicide can actually occur without advance notice. Family members may struggle with blame or guilt. In spite of all our efforts, some people commit suicide.

But. And this is a BIG but that doesn’t mean we are powerless to do anything at all. This article hopes to provide some information and recommendations that others have reported as helpful to those seeking to intervene in the life of someone that they fear is depressed and suicidal.

Know the risk factors, make choices that reduce them

• Suicide attempts are usually made when a person is seriously depressed or upset, feels as if there is no other escape from emotional pain or their problems, or believes they have no other way to communicate their desperate unhappiness. For many, depression is a passing mood. Sadness, loneliness, grief and disappointment are normal reactions to life.
• Substance abuse heightens the risk of suicide.
• High risk taking behaviors are associated with increased incidences of suicide.
• Access in the home to risky influences (alcohol, drugs, guns) are risk factors.
• Absence of meaningful connectivity in relationships (isolation, superficial relationships, no extended family connectors, etc. ) is risky business.
• Specific events (divorce, a breakup with a boy/girlfriend, death of a loved one) are triggers.
• Hopelessness relates to suicide.
• Family history of depression, anxiety, substance abuse, or a recent traumatic event are risk factors.
• Divorced, single or double-income parents who provide reduced supervision increases risk

Warning Signs

• Withdrawing from friends or family and losing interest in favorite activities
• Trouble thinking clearly
• Changes in sleeping and eating habits
• Major appearance changes
• Talk of feeling hopeless, guilty, suicidal, death, “going away”
• Self-destructive/high risk behavior (driving too fast, substance abuse)
• Parting with favorite possessions
• Sudden swing to happy, cheerful mood after long term sadness
• Writing a suicide note
• Telling a friend about plans
• Previous attempts
• Having a suicidal plan

How do I assess if someone is depressed?

Depression distorts a person’s state of mind, allowing focus to shift entirely onto failures, disappointments and exaggerated reality of negativity. Hopelessness, loss of pleasure, helplessness, low energy, sleep disturbances, loss of interest in other things that used to bring pleasure leading to withdrawal from people and regular activities, neglect of appearance, drug and alcohol use, personality changes, difficulty concentrating, boredom, decline in performance at school or work, complaints of physical symptoms like fatigue, headaches, stomachaches, intolerance for pleasure or rewards are all symptoms. These symptoms should be addressed and professional help should be sought sooner rather than later.

Not all suicidal people give loved ones clues about their suicidal thoughts. It’s not always easy to distinguish between normal life stressors and a person who is losing hope. It might be helpful to realize that we as family and friends do not assume responsibility for diagnosing other health issues. . . so why would we rely on our own intuitions about a person’s mental health? Seek professional help if you are concerned. Don’t remain silent. Talk about your concerns to others who might help you help the one you’re concerned about.

Ask the person you are worried about. Many people are willing to discuss their suicidal thoughts. Just talking about it may help a person feel less alone (Remember that risk factor of feeling as if no one listens?). It provides an opportunity to present alternative solutions. It may give you the information you need to seek help.

Decent next right steps

• Get help right away if you start thinking about suicide. Don’t just hope it goes away. Call 1-800-SUICIDE. All calls are confidential. If you have a friend who is considering suicide, get help right away. If one person doesn’t take you seriously, keep trying until someone will listen to you. Find other adults to help. And, if those adults minimize, deny, or spiritualize the problem, go to other adults.
• Don’t leave acutely suicidal people alone.
• Seek professional help for depression, anxiety, or situations where it appears that one is “stuck” in problem solving. This may require a certain amount of trial-and-error and diligence that will not be easy for someone who is already stressed out and having trouble getting out of bed (or sleeping). If a loved one is in this situation, supporting their work to find people who can provide healthy support, encouragement and problem solving that does no harm AND actually is helpful to the person is excellent. This support system may not be a loved one’s personal preference (after all, we don’t all like the same shoes), but it is vital that the person have a support system that provides them what they need: a person they feel listens to them and hears their suffering, alternative plans for moving beyond problems and pain.
• Remember that people most in need of outside assistance are often the most reluctant to seek it. Advocating for this, rather than supporting withdrawal, is helpful.
• Substance abuse problems exacerbate suicide risk. Particularly as it relates to teens, take using seriously. The younger the person is when exposed to using, the more risky the using. Alcohol and drugs have a depressive effect. They interfere with decision-making and problem solving. The “everybody’s doing it” mentality is not helpful. There is a correlation between using and suicidal thoughts. Sometimes we think our loved ones are using because they are depressed; but it is also true that using feeds depression.
• Stress is a very cool Western lifestyle; it is culturally appropriate to be over-busy, super-productive, and on the go. As a community, we need to increase our consciousness about the deleterious effects of stressed-out living.
• Modeling interpersonal connectivity is key; making space and place for valuing relationships, service work, inconveniencing self for the sake of community (without it becoming an unhealthy distraction from family life); making and keeping friends are all helpful.
• Connect with folks regularly who are experiencing crisis. The key is to listen, hear, and reflect back what you have heard. (Trying to jolly someone out of their suffering precipitously is harmful, it contributes to feelings of isolation and not feeling heard.)
• If you or someone you love is demonstrating a pattern of risk-taking behaviors, screen for depression. Our temptation is to moralize bad behavior, and of course, speaking of right versus wrong is appropriate. But beware that only addressing poor behavior from a moral standpoint may be missing a deeper issue.
• Remember that we should be alert to the severity of the problem from the suffering person’s perspective, not our own.
• NEVER EVER agree to keep the discussion of suicide a secret.

An ounce of prevention equals a pound of cure: what to do when not in crisis!

• Work toward resilience as a core competency; value this for yourself, and you will be able to help others work toward resilience too.
• If we are people who have the skill set of resilience, we can model this capacity for others. When we are given the privilege of coaching, mentoring, parenting, it will be our experience that will be most helpful. Resilience in the face of suffering is a skill we can work on.
• Develop decent coping skills for life problems. Learn how to navigate conflict, interpersonal relationships and heal past wounds and, as we get proficient at coping well with life, we can pass it on.
• Hope and faith–the belief that there is a better day ahead–is not just a theological concept, it needs to inform how we interpret life events. Again, figuring this out helps us help others.
• For ourselves and our sphere of influence, we need to jump off the bandwagon of “more is more” and learn how to de-clutter our inner life. As we can, we must encourage others to take breaks, turn off technology, relax, practice spiritual disciplines, good nutrition, exercise, etc. Experts in the field tell us that we are creating a generation of folks who are building brains that cannot attend to anything for any length of time. We need times of quiet and peace to recharge and connect with the parts of life that create resilience, hope, and purpose.
• Building relationships, friendships, family connections is exceedingly important. Learning how to serve others, and modeling conflict resolution, respect, deep listening . . .all good stuff.
• People who engage in abstinence of risky behaviors have significantly lower incidences of suicide attempts. No one knows which comes first–poor mental health or sex and drugs–but there is a correlation. We can advocate for learning how to work toward healthy mental health, and not encourage, condone, or inappropriately cope with risky behavior in self or others as a proactive measure of wellness.
• Provide appropriate supervision for children, youth, and each other. We need to stay connected!
• The combination of faith and wellness cannot be understated as a component of mental health and suicide prevention. Inspired by a certain way of seeing (our faith provides us many perspectives for both hope and dealing with suffering), we must also take the next right step and move beyond what we believe to congruent action. In other words, if we fail to practice what we preach, we discourage those who are following in our faith footsteps. We may unconsciously be disheartening folks by not understanding our own maladaptive coping skills, and how they act as disconnects and discouragement to others who know that we are also people of faith. Children and young adults are particularly attuned to our incongruent ways. So if we are fortunate enough to have someone tell us that our preaching and practice are out-of-step, consider it a God thing, and move to more consistency between our insides and outsides!

Myths

• MYTH: If someone is going to commit suicide nothing can stop them.
  TRUTH: Suicidal people are usually ambivalent. No matter how negative their tone and manner of talk about suicide, if someone is talking, they’re asking for help. If someone is talking there is still hope.
• MYTH: If they tried once, they won’t try again.
  TRUTH: Half of all children who made one suicide attempt will make another, sometimes as many as two a year until they succeed.
• MYTH: It’s just an attempt to get attention.
  TRUTH: The majority of suicide attempts are expressions of extreme distress and not harmless bids for attention. No talk of suicide should be taken lightly. It indicates the need for immediate professional help.
• MYTH: Talking About suicide can make matters worse.
  TRUTH: Talking doesn’t “give” a suicidal person the idea to think about suicide. The thought is already there. Talking helps them explore other possibilities.
• MYTH: People who drink and use drugs are hood rats, not people like my child.
  TRUTH: Substance abuse does not discriminate. It is an equal opportunity killer. Sometimes people use substances to relieve depression. Unfortunately, alcohol is a depressant! It makes things worse. Using also increases the odds of self-injurious behavior as it further reduces cognitive function.
• MYTH: Only a professionally trained person can be helpful in situations like this.
  TRUTH: Getting professional help is a really, really good idea. But that does NOT mean there is no role for friends and family. If we can give our loved one a chance to unburden their troubles and feelings without the impediment of trying to change or fix them, it can be very helpful. Let people know you are glad they turned to you. Lean into: patience, sympathy, acceptance. Avoid: arguments, advice-giving.

Talking with someone about suicide

Do not hesitate to be straight forward in bringing up your concern that someone you are talking to might be suicidal. You can simply ask, “Have you ever thought about taking your own life?” or “Are you having thoughts about suicide?”

If the answer is “No,” you can ask “What would keep you from taking your life?” This gives you a chance to hear what helps them hang on. And it gives them a chance to hear themselves say this. The reason people usually give has to do with not wanting to hurt people they care about. Hearing this gives you a chance to reinforce the truth about how much they would be missed, about how much they matter.

If the answer is “Yes,” you need to ask if they have made a plan for how they might take their lives. If they don’t have a plan, that helps you know they may not be in immediate danger. But if they do have a plan–like the bottle of pills they held in their hands the night before, contemplating taking them, or the gun they have in their home, or some other specific action–you know the danger is serious and the risk of them taking their lives is high. You can also ask them if there is anything that might stop them from acting on their plan. If they are able to acknowledge that there are people they don’t want to hurt, you can reinforce this. If they are not able to acknowledge this, but instead are believing that others would be “better off without them,” they are at very high risk.

What you need to do if someone is thinking about suicide, but does not have a plan to act on these thoughts, is to make a plan with them to get help very soon and to stay in close touch with you. Thinking about suicide is an indication of significant depression and great suffering. If left untreated, a plan may be developed and carried out.

If someone you are talking to is thinking about suicide and has some plan formed or forming, you need to get immediate help, especially if they see no reason not to end it all. Getting them immediate help would include asking for the pills or the guns to be removed from their possession and letting a few other people close to them know that they are seriously thinking of suicide. It might also include taking them to the nearest emergency room where they can be evaluated and referred for further help and treatment. If they refuse to go, you will need to call a suicide hotline or 911 and stay with them.

What if our best attempts fail?

• Assigning blame or talking about suicide as if it is a moral failing (sin) is not helpful.
• Suicide has a way of spreading, so seek help for those in the community most impacted by a person’s suicide. Sometimes secrets have been shared, thoughts expressed about the possibility of suicide, and it is helpful if you are one of the secret holders to find someone who is capable of helping process your feelings.
• There is a temptation on the part of communities to simply want to move past the event. Instead, find ways to move through our grief. Avoiding grief, suffering, rushing to spiritualize an event, etc., are maladaptive coping strategies that actually foster feelings of hopelessness.

Summary

• Take it seriously.
• Talk about suicide in an open manner.
• Suicide is a cry for help, but unfortunately we have spoken of it in ways that discourage clear cries for help.
• Give folks hotline numbers and other resources AND use them yourself if you are a key person in the life of a suicidal person.
• Model healthy behavior and positive, effective problem-solving approaches. Our own inability to cope, frequent protestations that a problem is “out of our league”, is not helpful. As adults, it’s our job to show up for our life, figure out what we don’t know, learn how to cope well, etc.
• Use film, music, television to call attention to effective ways to deal with stress and depression. Most importantly, let your life be the model of living the abundant life.
• Provide group support groups are extremely effective!

Resources

Hotlines:

• National Hopeline Network: 1-800-442-HOPE or 1-800-SUICIDE
• National Suicide Prevention Lifeline: 800-273-TALK
• For veterans: 1-877-VET-2-VET (1-877-838-2838)
• The Samaritans Helpline (local chapters, mostly in the NE): 212-532-2400

Other Resources:

• Suicide Prevention Resource Center
• Check out alt.support.depression (peer support)
• Check out resources under Mental health, or family health, through your local city or county services as well.
• After the death of a child, encourage parents to look for a local chapter of Compassionate Friends