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Prevention

Are people who injure themselves more at risk for suicide?

Many people who are not familiar with self-injury, such as cutting, automatically assume that anyone who does this must hate him or herself so much that they are probably on the verge of committing suicide or certainly headed in that direction. This is particularly true when someone is cutting or slicing through skin tissue. However, more often than not, this behavior falls under the heading of “non-suicidal self-injury.” As hard as it may be to understand, people who do things like cut or burn themselves are usually doing it to feel better. Many who cut or hurt themselves in other ways find that it helps them to regulate intense negative emotions or overcome feelings of numbness. Still others resort to it as a way of punishing themselves for thoughts or behavior that they deem unacceptable or as a means of distracting themselves from an unpleasant reality. And while it is not uncommon for people who cut to feel a rush of energy or a high after they hurt themselves, most tend to experience a sense of shame afterward, which only reinforces their depression.  Nonetheless, even though they are not necessarily trying to end their life, studies show that people who have been injuring themselves over a long period of time have a higher risk for suicidal thoughts, gestures, and attempts. For this reason alone, it is important to ask whether the person is having suicidal thoughts.

 

If the person resists help

While a suicidal individual is likely to feel relieved that someone realized how desperate they were feeling, the person may be terrified that he or she will be “taken away and locked up.”  Should that be the case, there is a chance that he or she may get angry and reject your efforts, especially when you try to get outside help. If this happens, try saying “I’d rather have you upset (or angry) with me than have you think I’d just walk away from you without trying to get some help.” Keep stressing that what is important is getting relief from what is causing the person to feel so depressed. If the person maintains that suicide is the only solution, you may need to work with the person’s “reasoning” by pointing out that choosing not to kill oneself right now doesn’t mean he or she is relinquishing that option forever.

 

Providing Emotional Support

 

Things Not to Do:

Don’t dismiss suicidal threats or attempts, past or present, as just an attempt to get attention.  Whether the person is being manipulative is irrelevant. If the person has made such threats in the past or has actually tried to kill him or herself, it’s easy not to take new ones seriously.  If you do this, you will probably be reacting to your own anxiety because you don’t know what to do to be helpful. You may assume that your friend or family member is just being manipulative, but research shows that anyone making such threats or who has acted on them in the past is at a higher risk to do so again.

Don’t try to cheer the person up. Your desire to help someone feel better may be well intentioned, but it may leave a person thinking that you can’t possibly understand how bad he or she is feeling. Empty reassurances like “you’ve got everything going for you ” or “ everything will look better after you get some rest” is likely to reinforce that belief.

Don’t use vague language.  Instead of resorting to phrases like “feeling bad” and “hurting yourself,” use more descriptive language like “have you thought about killing yourself.....” This will reassure the individual that you understand how desperate he or she is feeling and that you understand what is at stake. Using direct language will not put the idea of suicide in someone’s mind and make it more likely that he or she will try to commit suicide.  He or she has already had the idea and openly talking about it is one of the most useful things you can do.

Don’t analyze the person’s motives.  Someone who is profoundly depressed will not be comforted by a psychological explanation of why he or he is feeling hopeless. Saying things like “you just feel bad because......” or “you’re just feeling sorry for yourself” or “you’re just angry because….” may be of no help and at worst, may be taken as insulting and leave the person feeling hurt and/or angry.

Don’t argue with his or her feelings. When someone is feeling bad, you need to trust that they’re feeling as bad as they say and not respond with “You really don’t feel that way.....”  You also don’t want to say ”I know how you feel” because in all likelihood, you don’t.

Don’t be judgmental. “Suicide! Are you crazy? How could you be that selfish! How could you do that to your family?” These are examples of things that would not be helpful to say.

Don’t tell the person what to do about his or her problem. Even though you may think that you have some ideas that would be helpful to the person, he or she may be feeling too overwhelmed to be able to do what you’re suggesting. Prematurely giving advice may also convey that the person’s problems can be easily “fixed” and contribute to feeling misunderstood.

Don’t leave the person alone. When a person’s life is at stake, you have the right - and the responsibility - to contact a qualified professional who can decide what action needs to be taken. Tell the person “I’m very concerned about you. I am going to call______to help us.” Then, try to contact resources in the area such as a suicide prevention program, poison control center, the local ER, or the police department. Stay with the person until help arrives.  Don’t give in to emotional pleas that you not contact anyone - even if your friend or family member becomes furious with you for breaking a confidence. There will be time to rebuild trust between the two of you later on; remember, a lost life cannot be restored.

 

What to do instead:

Ask about suicidal thoughts. You need to have the courage to be direct and try something like “sometimes when people feel really badly, they think about hurting themselves. Have you been considering it?” Don’t succumb to the myth that people who commit suicide don’t talk about it. The fact is that a high percentage of suicides are preceded by warnings. Again, don’t be afraid that you’ll be putting the idea of suicide in the person’s mind or that you’ll offend him or her by asking this question. If you talk openly and frankly about suicidal thoughts, the person is less likely to feel embarrassed and more likely to be open about what they are going through.

Be assertive and ask how close the person may be to acting on these thoughts. Ask if they have already done something to hurt him or herself. For example, “how many pills did you take?” If the person has not taken any suicidal action, ask if he or she has a plan and the means to complete it. As uncomfortable as you may be in pressing the person to answer these questions, you need to do it anyway so that you can get an idea of how serious the person may be about committing suicide.

Slow things down by speaking calmly and providing encouragement. Explain that while suicide may feel like it’s the only option, this doesn’t mean that it is. Emphasize that suicide is not the answer and that with help, the person can discover other ways of dealing with his or her problems. Show that you take the person’s feelings seriously by letting him or her talk about what is on his or her mind. Let the person know that it matters to you that he or she is suffering and that you want to help. One way to convey this would be to say “I can see that you’re hurting a lot. I want you to feel better.”

Challenge the belief that no one will care if he or she dies or that everyone will be better off if he or she is no longer in their life. Point out that family and friends are likely to be tormented by the thought that they could and should have done something to prevent this tragedy. 

Encourage the person to tell you what may be causing the problems. A first step toward finding alternative solutions is to identify the problem(s). Try to get the person to talk about the events that have left them feeling so hopeless. Reassure the person that they don’t have to solve all of their problems right away and that this isn’t the best time to be figuring out exactly what to do about everything, anyway. Usually, just making a connection between what’s happening in one’s life and feeling badly can lead to a belief that there are options out there and encourage a belief that all is not lost.

Discuss a plan for the person to stay safe. Talk about what the person will do if the suicidal thoughts worsen. Find out who they trust and if he or she would be willing to contact that individual. It’s important to not take anything for granted. Stay with the person until a safety plan have been worked out and you feel reasonably certain that the crisis has passed.  Explore arrangements for your friend or family member to get professional help and offer to accompany the person to the first appointment.

Stay involved. Periodically check in with the person to see how he or she is doing. Don’t be surprised if after the crisis has passed, the person you helped is very self-conscious around you. But staying involved will also let your friend or family member know that you haven’t been scared off by anything that happened and that you still care about him or her.

 

Taking care of yourself

It’s pretty scary to feel like you’ve got someone’s life in your hands. Your first thought might be “how did I ever get into this situation? Your next thought might be “I don’t want to be responsible for this person’s life.” Perhaps, you worry that the person will end up having to go into the hospital and then deal with family, friends, and authorities when he or she never intended to actually commit suicide. However, no matter what your reservations or fears may be, you will feel much better if you’ve taken decisive action. So, don’t talk yourself out of taking action by worrying that you may be complicating his or her life if you take what the person is saying, seriously. It’s far better to err on the side of caution because if you don’t do something and the person makes an attempt on his or her life, you’re likely to subject yourself to endless second-guessing, not to mention a lot of guilt.

Since these situations can be traumatic for you as well as the person at risk , don‘t feel self-conscious about the need to talk to someone, whether it be a friend, family member, or counselor about how the situation has affected you. 

 

When is a suicidal risk for real?

There are times when a person feels so overwhelmed by their problems that it seems like things are never going to get better.  When hopelessness sets in, thoughts of suicide are likely to cross one’s mind. At first, he or she may be frightened by them. But if things don’t start to improve, killing oneself may seem like the only way out of the intolerable pain the person is experiencing. So, when a friend or family member says to you “If I disappeared, no one would miss me” or  “I don’t want to live like this anymore,” you have to assume that the person is actively contemplating suicide. Here are some signs that can help you determine how serious your friend or family member is about suicide:

  • Depressed mood – the person seems distant and preoccupied and just wants to be left alone. In fact, it’s difficult for him or her to get out of bed in the morning.  Responsibilities that were once taken seriously no longer seem important to the person, and he or she has little inclination to do the things that used to provide purpose and pleasure. Your friend or family member’s school and/or work performance has slipped, and being able to concentrate on anything seems like an impossible task. In short, the person seems distracted, discouraged, and sad.
  • Self-loathing attitude – beliefs such as “I can’t do anything right” and “I’m always letting everyone down” dominate the person’s thinking. People who are this self-critical think that they’ll be a complete failure if they don’t do things perfectly.
  • Feelings of hopelessness – the person feels as though his or her life is in shambles and is at a loss as to how to fix it. The despair that he or she is experiencing may be accompanied by frequent crying spells, and no amount of support and love from family or friends appears to make a difference. At this point, he or she may be feeling like it is time to “give up.”
  • Worrisome comments – you experience a panicky feeling when the person says things like “I don’t want to be here any more” or “I might as well end it” or “I can’t handle one more disappointment.”  And you get even more anxious when your friend or family member talks about being a burden to others……and that people will be better off after he or she is gone.
  • Planning to commit suicide. The person mentions the circumstances that would lead him or her to do it, including a specific plan as to how he or she would do it; and actually has access to the means to accomplish this goal. For instance, the person says that flunking out of school or getting a divorce would be the last straw and you know that he or she possesses a gun or a large number of pills. In addition, any signs of preparing for death such as looking up suicide strategies online, giving away personal possessions and/or expressing wishes for how things should be handled when he or she is no longer around are signs that one is putting affairs in order before dying. And you need to be even more alarmed if you know that the person has made previous suicide attempts. 
  • Excessive drinking/drug use – relying on alcohol and/or other substances to feel better is another sign that your friend or family member is caught in a downward spiral. This behavior will be even more cause for concern if the person is indulging in it alone and doing so during both the daytime and evening.
  • Marked personality changes –the more the person doesn’t seem like his or her usual self, the more reason there is to take the situation seriously. For example, someone who was once the quiet, cautious type is now acting in a loud, attention-seeking manner. He or she may be engaging in risk taking behavior such as driving too fast, attempting dangerous stunts, or randomly hooking up with strangers. Or the opposite may be true: a highly sociable, outgoing person is no longer interested in hanging out and doing things with others, preferring to spend all their time in their room or apartment.

Each one of these signs, alone, is not a predictor of imminent suicide. But the more of them you notice in someone you’re worried about, the greater the risk that the person might try to kill him or herself. Moreover, a major disappointment or an unrelenting string of troubling developments in the person’s life may be viewed as the last straw and contribute to his or her despondency and hopelessness. Examples might be serious illness, a romantic break-up or divorce, a perceived failure at work or school, a financial crisis, a falling out with a best friend, etc.

A less obvious sign that an individual may be at a breaking point is a sudden lift in spirits. This may be an indication that your friend or family member has already secretly decided to commit suicide and feels relieved because the problem will “soon be ended.” You, too, may feel relieved that this person is in a much better mood, but it can be very deceiving.

The worst thing is to ignore any of these warning signs and to not trust your judgment. Analyze the situation and also use your instincts to guide your assessment. Consider that the more nervous you are feeling about the situation, the more likely it is that you need to take some action.

 

Why suicidal thoughts should always be taken seriously

People who seriously contemplate suicide usually don’t want to die. What they want is some relief from the unrelenting psychological and emotional pain they’re experiencing. They realize that committing suicide would devastate people who care about them.  For some, ending one’s life would be a violation of their religious or personal beliefs. When they give themselves some time to think about how bad things seem to be, most people realize that there are other ways to deal with how overwhelmed they’re feeling.  The problem is that when a person is profoundly depressed, he or she may not be able to think clearly enough to get things in perspective. And in those situations, there is no sure way of predicting whether a person will actually try to kill him or herself. Understanding how someone can feel that desperate and knowing what to do in the situation can help you be a calming influence and lessen the chances of that person hurting him or herself.