Closing Out National Suicide Awareness Month with a Q&A

September is National Suicide Awareness Month and there has been a lot of information on social media about suicide. Below are two of the most common questions I’ve been asked. I am not a mental health professional (yet!), but I can offer my thoughts from my own experiences and from what I have learned from my clinicians and friends in recovery.

I’ve always thought that people with depression just choose to stay depressed. Why can’t people just choose to be happy and not contemplate suicide?

For a long time, I had always thought that my depression, which led to thoughts of suicide, was a character flaw. I felt “less than” because I couldn’t get myself to be as happy as those around me. While in treatment, I learned a lot of the science behind how depression works, and it felt like a weight lifted off my shoulders. I learned that it wasn’t a reflection of who I am or of my character.

Because I ask my doctors and clinicians a lot of questions, they have educated me on the medical side of severe depression. I’ve learned that the brain is an organ that can become ill, just like any other organ. When a lung gets sick, trouble breathing is an obvious symptom. When a brain is ill, it cannot recognize its own symptoms, and the brain thinks the symptoms are reality. It would be silly to expect the lung to know how to make itself better. Likewise, it is silly to expect an ill brain to know how to recognize it’s symptoms and know how to treat them. In my case, my brain needed medical intervention, which includes medication and skills that help me cope while my brain is healing.

For me, depression and thoughts of suicide were not a choice. I have never encountered someone who has enjoyed being in that state. I surely did not.

A loved one just told me that they want to die. What do I do now?

One of the first things I learned in treatment was the importance of curiosity and non-judgmental questions. When questions are asked with authentic curiosity, it creates an environment where sharing can happen openly and honestly. It shows that the person asking is listening and places a high value on what is being shared and who is sharing it. An example of questions that communicate curiosity are:

• When did you start feeling like this/has something specific triggered you?
• What can I do to support you?
• Can you tell me more?
• What would help feel like to you?

Secondly, it is important to validate the person’s feelings and thoughts, even if you see holes in their thinking. Validation is “recognition and acceptance that one has feelings and thoughts that are true and real to them, regardless of logic.” (Hall). Don’t misunderstand what I am saying- I am not saying to validate the suicidal thoughts. I have been taught that feelings and actions are separate, and you can validate someone’s feelings while discouraging any suicidal action. Below are some examples of validating phrases:

• “That sounds really hard and I’m so sorry you’re feeling this way.”
•  “I hear what you are saying and I can only imagine the pain you are experiencing.”
• “I can understand why the circumstances you described make you feel this way.”

In addition to the above questions, below is a sentence pattern that one of my therapists used often:

• “I can only imagine how difficult this feels because……[list three things you heard the person say].”

This can easily be followed up with encouragement and helpful ideas. An example of using this sentence is:

 “It makes sense that you feel so hopeless because you have felt this way for a long time, you’ve tried to get better on your own, and you don’t believe that it is possible to get better.” This can be followed up with “but I have a friend that went through something similar, got appropriate help, and is doing great now.”

Skipping this step of validation and going straight into your opinion and solutions could feel like a lecture and may add frustration, guilt, and shame. Validation communicates acceptance and normalcy. Once the person feels heard and validated, below is an example of an action plan that you can help implement to ensure safety.

1. Ask the person “What can you do to keep yourself safe?” and “What can I do to help you stay safe?” Some examples may be keeping meds from being available for overdose (don’t take them off of their prescription meds PLEASE!) or removing sharp objects and weapons.
2. If the person is already seeing a therapist, ask if they or you can contact the therapist and explain what is going on. The therapist will likely want to see this person as soon as possible and will provide additional guidance on next steps.
3. If the person is not seeing a therapist, help them find other options of support, such as calling or texting the 988 suicide hotline or getting in touch with family members that can help determine options for treatment. It is important to note that there are many options for levels of treatment ranging from simply seeing a therapist multiple times a week, to outpatient programs that still allow a person to work/attend school, to inpatient programs (and many more in between).
4. If the person is in immediate danger to themselves or others, please take them to an emergency room or call 911 as soon as possible.

Again, I am not a mental health expert, and I am still learning. These are just some things I have learned along the way in my recovery journey.

For more information, head to the resources page.

References:

Hall, K.D, Cook, M.H. (2012). The Power of Validation: Arming your Child Against Bullying, Peer   Pressure, Addiction, Self-Harm and Out of Control Emotions. New Harbinger Publications, Oakland, CA.