"I am not okay."
? "You may feel
reluctant to ask a teen if they've been thinking about
Parent's Guide to Teen Depression
For more information:
Suicide is the 8th leading cause of death in Oregon, and the second leading cause of death for 10 to 24 year olds. Still, suicide remains a taboo topic, is highly stigmatized and is surrounded by myth and mystery.
Myth: Asking someone Are you thinking about suicide? or Are you thinking about killing yourself? will put that idea into someone's head.
Studies show that asking
if they are suicidal does not increase suicides or suicidal
thoughts. In fact, studies suggest the opposite: findings
suggest acknowledging and talking about suicide "may in fact
reduce rather than increase" suicidal ideation.
Ask the Question
Ask directly about suicide. Ask the question in such a way that is natural and flows over the course of the conversation. Ask the question in a way that gives you a "yes" or "no" answer. Don't wait to ask the question when the person is halfway out the door. Asking directly and using the word "suicide" establishes that you and the at-risk person are talking about the same thing, and lets them know you are not afraid to talk about it. Ask: "Are you thinking about killing yourself?" or "Are you thinking about ending your life?"
How NOT to Ask the Question "You're not thinking about killing yourself, are you?"
Do not ask the question as though you
are looking for a "no" answer. Asking the question in this
manner tells the person that although you assume they are
suicidal, you want and will accept a denial.
Start a conversation. Directly and gently ask the question, Are you thinking about suicide? or Are you thinking about killing yourself? This step can be particularly difficult for many people. Sometimes people worry if they ask if someone is feeling suicidal that they might put the idea in their head. Worry not. There is no research that supports this idea. Asking the question will not increase the risk of someone completing suicide. If anything the person will be grateful you expressed what they have been thinking about. Google "Know When to Get Help Suicide rarely happens without warning." Oregon Department of Education
not be afraid to talk about suicide. Some cultures or
families treat suicide as a taboo and avoid talking about
it.. You may also be afraid that if you talk to
someone about suicide, you will prompt them to act on their
suicidal thoughts. These factors or others may lead you to
hesitate to speak openly about suicide. However, you should
fight this instinct because the opposite is actually true;
speaking openly about suicide often prompts someone in
crisis to think about and reconsider their choices.
Preventing Suicide: A Global Perspective by the World
Health Organization (2014)
issue of suicide among young people, by inviting youth to
take the lead. We recognize the need for student involvement
and ideas in shaping the campaign against suicide. By
engaging young adults and providing the facts, the NCPYS
seeks to help those most at risk..."
we bravely have open and honest conversations about mental
illness and suicide, we potentially make life-saving
connections. Without those conversations, we only have
loneliness, silence and unanswered questions. We might
consider overcoming our reluctance to speak of suicide to
break apart the taboo that encloses it. Until we start
talking, healing cannot happen.
Suicide rarely happens without warning. Dont be afraid to talk about suicide. You might save a life by talking about it. Never agree to keep suicidal thoughts or plans a secret; most important thing you can do is get help with the person. Google "Know When to Get Help Suicide rarely happens without warning." Oregon Department of Education
about suicidal thoughts or feelings won't push someone into
doing something self-destructive. In fact, offering an
opportunity to talk about feelings may reduce the risk of
acting on suicidal feelings.
you suspect that your teen might be thinking about suicide,
talk to him or her immediately. Don't be afraid to use the
word "suicide." Talking about suicide won't plant ideas in
your teen's head. Ask your teen to talk about his or her
feelings and listen. Don't dismiss his or her problems.
Instead, reassure your teen of your love. Remind your teen
that he or she can work through whatever is going on
and that you're willing to help.
may be concerned about your son or daughter, a student, or
another youth. It is important to know "Are you thinking
about killing yourself?" Talking about suicide does not
cause suicide. If you have difficulty asking the youth about
his or her thoughts, enlist another adult to help you. Or
call the National Suicide Prevention Lifeline at
1-800-273-TALK (8255) or text "SOS" to the National Crisis
Text Line 741741.
Risk Assessment "Have you been having thoughts about killing
yourself either now or in the past? Do you ever feel that
life isnt worth living? Have you ever wished you could
just go to sleep and not wake up? Have you ever tried to
hurt yourself, wishing you would die? Have you ever tried to
shy away from the subject: Just talking about suicide isn't
going to lead anybody to kill themselves. "We know that is
just not the case," Karim said. "You will not put that idea
into somebodys head by talking about suicide." Said
Oshel: "Just because you ask the question doesn't mean
youve planted a seed in their head. It is far worse to
ignore it than to openly address it."
people (both teens and adults) are reluctant to ask teens if
they have been thinking about suicide or hurting themselves.
That's because they're afraid that, by asking, they may
plant the idea of suicide. This is not true. It is always a
good thing to ask.
is difficult to talk about, there's no denying that. If you
think someone close to you is having suicidal thoughts, you
might feel reluctant to bring the subject of suicide up in
case it gives them the idea to do it. This is not so. In
fact, most people say talking directly about their
experiences can be a huge relief, and helps them to discover
other ways of getting through the pain they feel. Don't let
this person carry their feelings around in silence -
instead, give them a chance to release them.
interrelated factors contribute to suicide among AI/AN
people. Risk factors include mental health disorders,
substance abuse, intergenerational trauma, and
community-wide issues. Be an active part of your loved
ones support systems and check in with them often. If
a they show any warning
for suicide, be direct. Tell them its OK to talk about
suicidal feelings. Practice active
and let them talk without
be afraid to ask whether the person is considering suicide
and whether they have a particular plan in mind. These
questions will not push the person toward suicide if they
werent considering it.
suicide attempts go unrecognized, but if you are aware of a
previous attempt, pay attention to warning signs. If your
friend is expressing some thoughts about suicide, it's okay
to ask, "have you ever had these thoughts before?" and if
so, "have you ever done anything about them?"
items close to you that you could use to harm yourself can
create a dangerous situation. Its important to remove
items that you may use impulsively. What items do you have
nearby that you could use to harm yourself? How can you
safely remove them for the time being?
is important to be straight forward," Foster said. "We say,
'Are you thinking about hurting yourself? Are you thinking
about killing yourself?' ... Most of the time, asking them
is going to be a relief for them. They don't have to say it.
They didn't have to bring it up. You have opened the door
for them to come to you because they know that you are
paying attention and they know you care about them enough to
know that those at risk for suicide do not necessarily want
to die, but do want help in reducing the pain they are
experiencing so that they can go on to lead productive,
fulfilling lives. There is a lot of ambivalence surrounding
the decision to take ones own life, and by recognizing
this, and discussing it, we can help the suicidal person
start to recognize alternative options for managing their
suffering. Often suicidal people are experiencing
intolerable emotional pain, which they believe to be
unrelenting. They often feel hopeless and trapped. By
helping them to recognize and explore alternatives to dying,
you are planting the seeds of hope that things can
Whats the Harm in Asking
About Suicidal Ideation?
What to Do When
You Think Someone is Suicidal
One of the biggest and most destructive myths is that if you discuss suicide, youre planting the idea in someones head, said Scott Poland, Ed.D, the prevention division director at the American Association of Suicidology and associate professor at Nova Southeastern University. Clinical psychologist and suicide expert William Schmitz, Psy.D., likens it to talking to someone whos recently been diagnosed with cancer. By mentioning cancer, youre not forcing the topic front and center. If someone is diagnosed with cancer, its on their mind. Bringing it up shows support and concern. Similarly, by talking about suicide, you show the person that you truly care about them. In fact, lack of connection is a key reason why people have suicidal thoughts; isolation contributes to and escalates their pain.
In general, its important to take any suicide thought or attempt seriously. But what does that mean and then where do you go from there? Because we talk so little about suicide, theres little awareness about how to help. Dr. Poland emphasizes that people dont have to suddenly step into a therapists shoes and counsel the person. But there are important ways you can help. Drs. Schmitz and Poland discuss the best ways below.
Take suicide seriously, and dont minimize it.
When talking to a person you think might be suicidal, its critical not to dismiss what theyre saying. While this makes sense, we might minimize a persons pain without even realizing it. Poland even sees this when training professionals on suicide prevention.
For instance, in a training example, if the person says, My life is so terrible right now, its usually met with reactions like Oh, its not that bad or I know youd never hurt yourself. Even when the person mentions being overwhelmed, well-trained professionals dismiss the comments. For instance, they say: Things were awful for me last semester, too, and I got through it. Let me help you with your studying. Although help is being offered, this reaction still minimizes and discounts the persons feelings and experiences. And both slam the door on communication.
Know the warning signs.
According to both experts, these are some of the warning signs to pay attention to: dramatic changes in behavior or weight; drinking more than usual; mood changes; anxiety; making hopeless statements about death and dying; and isolating or withdrawing, such as dropping out of activities. Ultimately, though, trust your gut that something is not quite right, Poland said.
The American Association of Suicidology also features an in-depth list of warnings signs. Its designed to help professionals detect risk for suicide, but it may give you more information.
Approach the person.
If you notice one or several red flags, dont hesitate to talk to the person. Again, the worst thing you can do is to ignore whats happening. Poland suggested starting the conversation by saying something like: Id like to talk to you a minute, Im really worried, you seem like youre a little down. Could we talk about that? Im here to help.
Also, during the conversation, consider your physical cues. You may be asking the person to share their feelings with you but your demeanor may indicate that you dont really care, youre rushing or youre not open or fearful about hearing them.
Importantly, never agree to secrecy, Poland said. For instance, you can say, I really care about you, Im here to help, and I cannot promise to keep this a secret, he said.
Some resources suggest asking the person if they have thoughts of hurting themselves. According to Schmitz, such questions are rarely beneficial. Thats because When people walk around the topic of suicide [such as the question of hurting oneself], it can send the unintended message that it is not OK to discuss suicide.
Also, he added that for a lot of suicidal individuals, they have no desire to hurt themselves, they are striving to cease pain and want relief/death, and will often decide on the least painful method of suicide in their ideations.
Ask the person directly if theyre considering suicide, Schmitz said: You know, John/Jane, a lot of people with (insert warning sign[s]), can have thoughts of suicide or of killing themselves, are you having any thoughts of suicide?
Too often we either dont listen well or we say something that cuts off the conversation, Poland said. But listening is one of the best ways you can help, both experts emphasized. Give the person the opportunity to tell you how theyre feeling and what theyre going through.
As Schmitz said, We can have so much fear in talking about suicide [and] were so scared about saying the wrong thing, that we say nothing. Speak from the heart. Anything thats said genuinely and directly, he said, ultimately cant be damaging.
Schmitz recalled working with a high-risk suicidal patient whose thoughts included killing himself with a gun. During one of their sessions, when talking about treatment, Schmitz unwittingly said to the patient, we just havent found a magic bullet for this yet. Doc, Im not sure thats the best analogy, the patient responded, and they were able to laugh at the situation because of the connection they had.
Its not about the right four words or two sentences, its about the connection, Schmitz emphasized. There are no magic words. Whats important is conveying empathy, concern and a willingness to help.
Help them eliminate access.
If the person discloses to you how theyre considering committing suicide, eliminate access to those means, Schmitz said. For instance, if theyve had thoughts of using a gun and there are guns in the house, either get the guns out or get the person away from the home, he said.
Even if the person says in passing that theyre thinking about overdosing, its invaluable to see what kinds of medications are in the house and to talk about getting rid of them, he said. He added that you can tell the person, I really care about you and I dont want you to do something impulsive that youll regret. This shows them that you genuinely care.
The next critical message after connection and empathy is that [suicidal thoughts are] treatable and there is help, Schmitz said. Numerous studies have shown that treatment can reduce the severity, duration and frequency of suicidal thoughts. Let the person know that theyre not alone, that others have experienced suicidal thoughts and go on to lead fulfilling lives after seeking treatment.
Help them get help.
When talking to the person, the key is to get them treatment right away. As Poland said, this isnt something we want to wait on, even if its checking back with them later that day or the next day. Avoid assuming that things will be better the next day.
At their university, Poland encourages faculty members to walk students to the counseling center or call a provider together immediately after their talk. Together, the two of you also can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), which is free, confidential and available 24/7. (Heres more information.)
Call 911 in case of an emergency.
In addition to calling 911, stay with the person until emergency services arrive, Poland said. Its vital not to leave a suicidal person alone. You can show support and compassion by saying things like Im going to be there for you, Im going to visit you or Who can I call for you, he added.
Unfortunately, suicide is largely
misunderstood in our society. But there are many things you
can do to help, including: paying attention to the warning
signs, approaching the person, being direct and empathetic,
truly listening and helping them find help right away.
Encourage Someone To See A Therapist
Here are some steps you can take to tell your loved one about the benefits of seeking therapy.
Misconception about mental health and therapy has intensified stigma in society. Your loved one may be aware that they need help, but may be afraid to seek it if they think you will judge or treat them differently. Therefore, it is essential to use non-stigmatizing language when talking with them about their mental health. Assure them that you will support them through the therapy process.
Demi Lovato is one of the most vocal celebrities about her mental health issues. She mentioned on multiple occasions how important it was for her to have people around that really care about her wellbeing. She credits her support group for being able to go through everyday life. Demi asks for advice from her loved ones and asks them to let her know when they feel somethings off: "So whether it's with my management team or with my friends, every choice that I make, I run by people. And that's what's really helped mevocalizing what you need."
Be Sensitive To Timing And Place
Talking to someone about mental health requires emotional sensitivity as well as physical sensitivity. The where and how the topic is presented may determine how a person reacts to your suggestions. Your loved one may not be as bold as Kesha when she shared her condition and struggles with the world while receiving an award.
Dont start this delicate conversation in front of other people or where others can hear as this may cause discomfort. And avoid grouping up in an intervention-style conversation as people do on TV shows. Allow the person struggling to decide whether they want others to know. This way, they feel respected and in control of their own treatment.
Also: Avoid talking to someone when they are in a bad mood, tired, have tight deadlines at work or if theyre doing something important. They may dismiss you or disregard the weight of the topic. Approach the person when theyre in a good mood, relaxed and undistracted. Try as much as possible to keep the conversation private, friendly and relaxed.
Prepare For Resistance
Not all people who hear about therapy will be willing to try it out. You need to be prepared to make your case if your loved one resists your suggestion. Here are some ideas that you can use to highlight the importance of therapy:
Offer To Help
You can try to embolden someone to go to therapy, but unless you are willing to offer meaningful support, its not going to encourage them. Some people do not know where to start when seeking help. Guide them in finding a suitable therapist in the area, depending on their preferences. You can contact offices on their behalf or research various professionals, their credibility and reviews.
Some people are scared of seeing a therapist alone or signing up for group therapy. Offer to go with them until theyre comfortable. You can sit in the waiting room during their first few sessions. Make sure to assure them that you wont ask prying questions about the counseling unless they want to share.
Seeking therapy is one of the best
steps that a person with a mental health condition can take.
However, its an effort that requires great strength
and courage. Share your suggestions as openly as possible
and leave them to make the decision that best suits their
needs. Above all things, assure them of your continued love
and support throughout the process.
A Cry For Life
Many also face the stigma our culturesand often our churchesassign to a death by suicide. For instance, I think its a terrible shame when families insist that the service not even mention the word suicide. Once, a mother whose son died by suicide reasoned that she feared his life would forever be reduced to that single act. She feared that all other aspects of his life, like the work he did and the friendships he enjoyed, would be forgotten. If he had died of cancer, or in a car accident, that wouldnt be all people talked about, she argued.
Inspired by this mothers fear of how her sons memory might be reduced and skewed, I began to characterize suicide in my funerals and memorial services as not a desire for death, but a cry for lifemore life, better life.
So often, our culture concludes that suicide is a rejection of life, a willful refusal to live any longer, but I believe suicide is a statement that life can and should be so much more than pain or despair. If a suicidal person only sees a future with days on end of pain, then that vision looks nothing like the sort of life we all long to enjoy.
I remember in my own times of depression and thoughts of suicide, I often thought, If this is all there is, if loneliness and meaninglessness and failure are going to be the sum of my experience, then forget it. This is not life. I am breathing, going through the motions, but I am not truly living. I desperately wanted to live, but I couldnt find a way to do so. Yet without realizing it, saying that I no longer wanted to live actually became a way to live.
Having the courage to say how I was feeling and what I was experiencingnot pretending, but being honest even when what I was saying was difficultwas how I took my first steps away from a life that seemed no life at all towards a real life worth living. Its a strange paradox: The more willing we are to be vulnerable and less-than-perfect, to ask for support when can no longer support ourselves, the stronger we become and the richer our lives become. Connections with others make the difference.
Opening The Conversation
When we bravely have open and honest conversations about mental illness and suicide, we potentially make life-saving connectionslike what happened to me. Without those conversations, we only have loneliness, silence and unanswered questions.
When I speak to those who attend the services of a person who died by suicide, I often discover that its not their first experience of grieving such a death. They reference family members, friends, colleagues or neighbors who died by suicide, and how the present death brought back those earlier losses. They talk about how they continue to struggle with their memories and questions.
The shadow of suicide is long. Those who just experienced a suicide loss need comfort, and a religious service might provide it. However, that cannot happen if the manner of death is never mentioned. So, as we approach International Survivors of Suicide Loss Day, we might consider overcoming our reluctance to speak of suicide, to break apart the taboo that encloses it. Until we start talking, healing cannot happen.
And as we speak more openly and honestly, we open the possibility that the cry for life suicide represents might be heard in time.
International Survivors of Suicide Loss Day is Nov. 18
The American Foundation for Suicide
Prevention will be hosting gatherings in local communities
for those affected by suicide to come together and share
stories of healing.
When To Push And When To Show Extra Compassion - Nov.
Beyond my relationship with Andrew, I am also a mental health practitioner. Whether Im caring for someone with schizophrenia or depression, I often walk the narrow, unforgiving line of when to push and when to administer a large helping of mercy. Though challenging people to improve their quality of life is risky, if we don't, those who are struggling may continue to struggle.
People have asked me so many times when and how to encourage, or push, someone struggling with a mental illness. Here is what has worked for me:
Practice Compassion And Mercy First
An act of mercy starts with an open mind and a sensitive, understanding voice while communicating. I constantly challenge myself to see the bigger picture and put aside my own frustrations, so I dont come across as judgmental or abrasive. As this type of personality can prevent an empathetic viewpoint. If I am open about my own problems around my husband, he might be more willing to talk about his own struggles.
To push someone successfully, knowing when symptoms are flaring is helpful. Phone calls, text messaging or other forms of digital communication can make it difficult to assess symptoms. Body language and word choice, comparatively, offer a wealth of information. For example, anxiety can cause a persons body to twitch and tighten.
Show Love During Confrontation
Unfortunately, caregivers often have to challenge struggling individuals during difficult times. Waiting for peaceful moments or willing ears is not always an option. That's where the art of confrontation and mercy merge into one cohesive act of love. However, yelling or speaking from a platform of self-assumed intelligence, pride, anger or bitterness typically results in a negative outcome. People tend to respond well to a loving presentation of information that reinforces equality.
Build Relationships That Foster Equality
Healthy relationships start with the understanding that mental health conditions have labels, but those labels dont represent the person. Treat your loved one as a person who is equal to you, not as a lesser person because they have mental illness. If their relationship with you isnt built on mutual respect and admiration, it will be very difficult for them to grow or be challenged by you.
With all this said, keep in mind that no one has absolute control over another human beings actions. Caregivers must let go at times to remain healthy themselves . Holding on to bitterness or regret can cause a caregiver emotional turmoil.
Expect to make mistakes as you grow
into your role as caretaker. Though I have often felt guilty
for making his life harder with my pushing, Andrew often
tells me he may have been lost to a permanent state of
delusion without our relationship. I know that my presence
in his life has challenged him to be the best he knows how
to be. Never give up on the person you love, and try to
remember the immense challenges that a person with a mental
health condition faces each day.
accounts of self-stigma experienced by young people with
attention-deficit/hyperactivity disorder (ADHD) or
and discrimination from mental health service providers
Health Awareness and Stigma
Dr. Nordal is a licensed psychologist experienced in treating adults, children and adolescents and has clinical expertise in the treatment of stress-related disorders. As executive director for the APAs Practice Directorate, Dr. Nordal manages a variety of activities involving legislative advocacy, legal initiatives, efforts to shape the evolving health care market, and a nationwide public education campaign, including the Mind/Body Health Campaign, to enhance the value of psychology. Dr. Nordal is a recipient of the APAs Karl F. Heiser Presidential Award for advocacy on behalf of Psychology. She was an APA/AAAS Congressional Science Fellow (1990-91) and served as a legislative assistant in the U.S. House of Representatives and with the House Select Committee on Hunger. Her clinical interests included: learning, behavioral and emotional disorders in children and adolescents; neuropsychological assessment; brain injury in children and adults; and civil forensic psychology.
Do you think there is still a stigma associated with mental illness?
Awareness of mental health issues has definitely improved in recent decades. When I entered practice more than 30 years ago, individuals in my semi-rural community would often travel 40-50 miles to get treatment because they did not want anyone to know that they were seeing a therapist. Many people were concerned about what others may think if they were open about their mental health. In many ways, we have taken great strides since then as more people talk about mental health publicly and as we see more positive depictions of mental health in popular culture. Yet, for many, stigma remains. A 2008 APA survey found that more than half of Americans saw stigma--and concerns about what other people might think--as barriers that could prevent them from seeking mental health treatment. And while an estimated 50 million Americans experience a mental health disorder in any year, only one in four will receive treatment.
It is important to remember the impact that stigma can have. Because of stigma, people who need treatment may fail to seek it and they may face discrimination and problems at work or school or even encounter harassment or violence. Furthermore, untreated mental health disorders cost businesses millions of dollars in lost productivity, absenteeism and health care costs.
Why does the public often have a different view of mental illness than physical illness?
Traditionally, the medical model has separated mental and physical health. But this fails to take account of the strong links between the mind and body. Research shows that physical health is directly connected to emotional health, and millions of Americans know that suffering from a mental health disorder can be as frightening and debilitating as any major physical health disorder. Poor mental health has implications for physical health for example, research has shown that people with depression are at greater risk for developing heart disease, and conversely, that people with heart disease are more likely to suffer from depression than others.
Integrated health care care that treats both the mind and body is the key to breaking down stigma and providing the best care. Many psychologists already work in primary care settings with physicians and other health care professionals, often serving as members of multidisciplinary treatment teams and taking the lead when a patient has a primary mental health or substance abuse diagnosis.
What can be done to combat stigma and stereotypes about mental illness?
Congress took a huge step in tackling stigma when the Wellstone-Domenici Mental Health Parity and Addiction Equity Act was passed last year. This new law means that insurance policies can no longer discriminate against those with mental health or substance use disorders. Weve long known that mental health disorders can be as serious as those impacting physical health. The new parity law recognizes this by mandating that coverage must be the same for mental health as for physical health including co-payments, deductibles and in-patient treatment limits.
Events like Mental Health Month also
serve to raise awareness and decrease stigma. Mental health
disorders impact everyone by talking about mental
health we can dispel stereotypes and raise awareness.
relationship between stigma sentiments and self-identity of
individuals with schizophrenia
Launches New Journal: Stigma and Health
To be published on a quarterly basis, Stigma and Health (ISSN 2376-6972) serves as a venue for articles examining research representing stigma in its various guises (e.g., public stigma, self-stigma, label avoidance and structural stigma) as it impacts people living with mental and physical illness.
Stigma and Health publishes peer-reviewed, original research articles that may include tests of hypotheses about the form and impact of stigma, examination of strategies to decrease stigma's effects and survey research capturing stigma in populations. Stigma and Health especially welcomes research studies on methods meant to erase the stigma of mental and physical illnesses. Theoretical reviews and pioneering reports on innovations are also welcome. The journal publishes regular articles as well as brief reports.
As stated in the journals inaugural editorial, the true value of the research published in the journal lies in helping to replace stigma with affirming attitudes and behaviors that recognize the worth of personhood not diminished by illness or wellness and that acknowledge communal responsibilities for opportunities and accommodations that help people realize their goals.
More information about the journal as well as guidelines regarding submissions can be found on the journals homepage. Prospective contributors and subscribers are encouraged to visit the site.
The inaugural editor of Stigma and Health is Patrick W. Corrigan, PsyD, distinguished professor of psychology at the Illinois Institute of Technology. Previously, he was professor of psychiatry at the University of Chicago, where he directed the Center for Psychiatric Rehabilitation. His research examines psychiatric disability and the impact of stigma on recovery and rehabilitation. Currently, he is principal investigator of the National Consortium on Stigma and Empowerment (NCSE). Funded by the National Institute of Mental Health, NCSE is a collaboration of investigators from more than a dozen research institutions. He is also principal investigator of current grants from the National Institute on Minority Health and Health Disparities and the Patient-Centered Outcomes Research Institute, and he is conducting stigma research with support from the Department of Defense, the Veterans Administration and the Canadian Institutes of Health Research. Corrigan has authored or edited more than a dozen books, has published more than 300 peer-reviewed articles and is editor emeritus of the American Journal of Psychiatric Rehabilitation.
Articles published in Stigma and Health will also be available through PsycARTICLES®, the most used full-text database in psychology and one of the most popular databases in all scholarly disciplines and fields. PsycARTICLES is available to a global audience of nearly 3,700 institutions and 80 million potential users.
The American Psychological
Association, in Washington, D.C., is the largest scientific
and professional organization representing psychology in the
United States. APA's membership includes more than 122,500
researchers, educators, clinicians, consultants and
students. Through its divisions in 54 subfields of
psychology and affiliations with 60 state, territorial and
Canadian provincial associations, APA works to advance the
creation, communication and application of psychological
knowledge to benefit society and improve people's lives.
How Asking the question Are you thinking about suicide? communicates that youre open to speaking about suicide in a non-judgmental and supportive way. Asking in this direct, unbiased manner, can open the door for effective dialogue about their emotional pain and can allow everyone involved to see what next steps need to be taken. Other questions you can ask include, How do you hurt? and How can I help? Do not ever promise to keep their thoughts of suicide a secret.
The flip side of the Ask step is to Listen. Make sure you take their answers seriously and not to ignore them, especially if they indicate they are experiencing thoughts of suicide. Listening to their reasons for being in such emotional pain, as well as listening for any potential reasons they want to continue to stay alive, are both incredibly important when they are telling you whats going on. Help them focus on their reasons for living and avoid trying to impose your reasons for them to stay alive.
Why Studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts. In fact, studies suggest the opposite: findings suggest acknowledging and talking about suicide? may in fact reduce rather than increase? suicidal ideation.
Keep Them Safe
How First of all, its good for everyone to be on the same page. After the Ask step, and youve determined suicide is indeed being talked about, its important to find out a few things to establish immediate safety. Have they already done anything to try to kill themselves before talking with you? Does the person experiencing thoughts of suicide know how they would kill themselves? Do they have a specific, detailed plan? Whats the timing for their plan? What sort of access to do they have to their planned method?
Why Knowing the answers to each of these questions can tell us a lot about the imminence and severity of danger the person is in. For instance, the more steps and pieces of a plan that are in place, the higher their severity of risk and their capability to enact their plan might be. Or if they have immediate access to a firearm and are very serious about attempting suicide, then extra steps (like calling the authorities or driving them to an emergency department) might be necessary. The Lifeline can always act as a resource during these moments as well if you arent entirely sure what to do next.
The Harvard T.H. Chan School of Public Health notes that reducing a suicidal persons access to highly lethal means (or chosen method for a suicide attempt) is an important part of suicide prevention. A number of studies have indicated that when lethal means are made less available or less deadly, suicide rates by that method decline, and frequently suicide rates overall decline. Research also shows that method substitution or choosing an alternate method when the original method is restricted, frequently does not happen. The myth If someone really wants to kill themselves, theyll find a way to do it often does not hold true if appropriate safety measures are put into place. The Keep Them Safe step is really about showing support for someone during the times when they have thoughts of suicide by putting time and distance between the person and their chosen method, especially methods that have shown higher lethality (like firearms and medications).
How This could mean being physically present for someone, speaking with them on the phone when you can, or any other way that shows support for the person at risk. An important aspect of this step is to make sure you follow through with the ways in which you say youll be able to support the person do not commit to anything you are not willing or able to accomplish. If you are unable to be physically present with someone with thoughts of suicide, talk with them to develop some ideas for others who might be able to help as well (again, only others who are willing, able, and appropriate to be there). Listening is again very important during this step find out what and who they believe will be the most effective sources of help.
Why Being there for someone with thoughts of suicide is life-saving. Increasing someones connectedness to others and limiting their isolation (both in the short and long-term) has shown to be a protective factor against suicide. Thomas Joiners Interpersonal-Psychological Theory of Suicide highlights connectedness as one of its main components specifically, a low sense of belonging. When someone experiences this state, paired with perceived burdonsomeness (arguably tied to connectedness through isolating behaviors and lack of a sense of purpose) and acquired capability (a lowered fear of death and habituated experiences of violence), their risk can become severely elevated.
In the Three-Step Theory (or more commonly known as the Ideation-to-Action Framework), David Klonsky and Alexis May also theorize that connectedness is a key protective factor, not only against suicide as a whole, but in terms of the escalation of thoughts of suicide to action. Their research has also shown connectedness acts as a buffer against hopelessness and psychological pain.
By being there, we have a chance to alleviate or eliminate some of these significant factors.
Help Them Connect
How Helping someone with thoughts of suicide connect with ongoing supports (like the Lifeline, call 800-273-8255 or text "SOS" to 741741.) can help them establish a safety net for those moments they find themselves in a crisis. Additional components of a safety net might be connecting them with supports and resources in their communities. Explore some of these possible supports with them are they currently seeing a mental health professional? Have they in the past? Is this an option for them currently? Are there other mental health resources in the community that can effectively help?
One way to start helping them find ways to connect is to work with them to develop a safety plan. This can include ways for them identify if they start to experience significant, severe thoughts of suicide along with what to do in those crisis moments. A safety plan can also include a list of individuals to contact when a crisis occurs. The My3 app is a safety planning and crisis intervention app that can help develop these supports and is stored conveniently on your smartphone for quick access.
Why Impact of Applied Suicide Intervention Skills Training on the National Suicide Prevention Lifeline found that individuals that called the National Suicide Prevention Lifeline were significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful by the end of calls handled by Applied Suicide Intervention Skills Training-trained counselors. These improvements were linked to ASIST-related counselor interventions, including listening without judgment, exploring reasons for living and creating a network of support.
How After your initial contact with a person experiencing thoughts of suicide, and after youve connected them with the immediate support systems they need, make sure to follow-up with them to see how theyre doing. Leave a message, send a text, or give them a call. The follow-up step is a great time to check in with them to see if there is more you are capable of helping with or if there are things youve said you would do and havent yet had the chance to get done for the person.
Why This type of contact can continue to increase their feelings of connectedness and share your ongoing support. There is evidence that even a simple form of reaching out, like sending a caring postcard, can potentially reduce their risk for suicide.
Studies have shown a reduction in the number of deaths by suicide when following up was involved with high risk populations after they were discharge from acute care services. Studies have also shown that brief, low cost intervention and supportive, ongoing contact may be an important part of suicide prevention. Please visit our Follow-Up Matters page for more.
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It's ok to say, "I'm not ok.'
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