It can be overwhelming when a loved-one is thinking of suicide.
There are lots simple and helpful things you can do to help, and you truly can be a great support. The bad news is that this is one of those times when you really don’t have control. Your love can not save someone who is truly intent on dying. It is important to have hope and to try to help. The vast majority of people who think about suicide never attempt it, and even of those who attempt, 2 out of 3 report that they didn’t truly want to die.
The first step sounds pretty simple, but it may also be the scariest step:
Just Ask: “I’m really worried about you. Have you been thinking about hurting yourself? Are you considering suicide?”
Our culture has long viewed suicide (and all mental health) as shameful, and it can be really difficult to speak our shame aloud. We put a lot of pressure on each other to say “I’m fine” to smile and and not be a burden on others, so yeah it is hard to “just ask”. But it’s also important because shame feeds on secrecy and silence. And when a loved one is suicidal, shame can kill.
If they aren’t feeling suicidal they can just say no, and then your mind can be at ease. If you ask with kindness and non-judgement it will not “give them the idea” or “push them toward” acting on it. In fact many people feel a huge sense of relief to say it aloud, to be able to talk about the dark thoughts they’d been sitting alone with.
Try to go into the conversation with the intention of just listening, understanding, believing, just “being with”, rather than “fixing”. Many people who are struggling with mental health already feel like they’ve failed to ‘fix’ themselves... so advice, or pushing, no matter how kind, is often misguided. (I will talk about an exception to “not pushing” below.) Usually what they need more than anything is to feel loved and valued. Seen and heard. Exactly as they are.
If they say that they have been having thoughts, the next step is to get some idea of what that looks like to them. One tool that works well is a simple rating system of 1-10. If 1 is no thoughts of dying then 10 is "I’d do it now if I could." If they say 7, the next step is to ask them what a 7 looks/feels like. It is also good to ask if they’ve felt worse in the past, if they have ever been up to a 9 or a 10? When and how often? Ask what those numbers feel like.
Important things to clarify:
Have they moved from passive or occasional thoughts toward making plans? Have they thought about ways they might go through with it? How elaborate or detailed are those plans?
Have they moved from planning toward preparing? Have they written a note? Have they taken the gun out of the cabinet? Have they gathered pills?
Do they have a history of being impulsive or triggered? Do they notice that they can go from a 2 to an 8 very quickly? Or is it more of a long, slow build?
Each of these questions will help you to determine a plan of action for moving forward. If your loved one is having a few passive thoughts of “wishing I wouldn’t wake up” then some self care and keeping an eye on it may be all they want to do. If they have have made plans, are reporting high numbers or experiencing frequent spikes, then you should encourage them to get professional help right away.
If the numbers are moderately high but they don’t seem to be in immediate danger, you can create a SAFETY PLAN. A safety plan can include:
Coping mechanisms they’ve used successfully in the past or would like to try -- activities or work they could do to redirect their attention.
Steps *they* want to take to improve their mental health- therapy, exercise, self-care, sleep hygiene. If they want help implementing these changes, then list sources of support.
Safe people they could call when they feel that they are not okay: trusted friends, family, clergy, therapists could all be on the list. It is important that they choose these people, because they know who feels safe to them.
Places that feel safe or uplifting for a change of pace and scenery.
Make the environment safer: remove pills, guns, ropes or other items they may have thought about using.
Have access to hotlines. There are suicide hotlines, hotlines forLGBT+ folks, and for domestic violence. Many places have a variety of local hotlines, and some localities provide mobile mental health emergency services.
Include a reminder that if none of those things work, they can and should call 911 or go to their nearest emergency room.
Finally, the safety plan should include things that that they want to live for -- things that feel worth living for.
If the numbers are very high (7-10), or if many of the warning signs are present, they may not be in a mental place where they feel capable or hopeful enough to reach out for help. If you fear that your loved one is in serious danger, then now is the exception to the “no pushing” guidelines above.
It is always important to include your loved one in your decision making process, to give them information and options. It will be better for their mental health if you leave as many details to them as they feel capable of making. If they are in immediate danger and do not want to call 911 or check themselves into a facility, you can explain to them that you think it would be best if they were to make the call or check themselves in, but that since they are a threat to themselves you will do it if they do not. Keep them informed so your decision does not come as a surprise to them. Keeping information from someone can add a sense of betrayal to the loss of control. In many states you may actually be legally required to report someone who is a danger to themselves or others.
Throughout this process always remember your own boundaries, mental health, safety, and self-care. Dealing with a loved-one with severe mental-health struggles is wearing. It’s easy to fall into feeling trapped or martyred, and then our help will start to feel grudging and resentful, which isn’t the kind of help we want to give, and it isn’t the type of help our loved one really needs. Maintaining good boundaries, putting on our oxygen mask first, assures that we are doing the very best we can for everyone.