1. TAKE IT SERIOUSLY
* a. Myth: "The people who talk about it don't do it."
Studies have found that more than 75% of all completed suicides did
things in the few weeks or months prior to their deaths to indicate to
others that they were in deep despair. Anyone expressing suicidal
feelings needs immediate attention.
* b. Myth: "Anyone who tries to kill himself has got to be crazy."
Perhaps 10% of all suicidal people are psychotic or have delusional
beliefs about reality. Most suicidal people suffer from the recognized
mental illness of depression; but many depressed people adequately
manage their daily affairs. The absence of "craziness" does not mean
the absence of suicide risk.
* c. "Those problems weren't enough to commit suicide over," is often
said by people who knew a completed suicide. You cannot assume that
because you feel something is not worth being suicidal about, that the
person you are with feels the same way. It is not how bad the problem
is, but how badly it's hurting the person who has it.
2. REMEMBER: SUICIDAL BEHAVIOR IS A CRY FOR HELP
Myth: "If a someone is going to kill himself, nothing can stop him."
The fact that a person is still alive is sufficient proof that part of him
wants to remain alive. The suicidal person is ambivalent - part of him
wants to live and part of him wants not so much death as he wants the pain
to end. It is the part that wants to live that tells another "I feel
suicidal." If a suicidal person turns to you it is likely that he believes
that you are more caring, more informed about coping with misfortune, and
more willing to protect his confidentiality. No matter how negative the
manner and content of his talk, he is doing a positive thing and has a
positive view of you.
3. BE WILLING TO GIVE AND GET HELP SOONER RATHER THAN LATER
Suicide prevention is not a last minute activity. All textbooks on
depression say it should be reached as soon as possible. Unfortunately,
suicidal people are afraid that trying to get help may bring them more
pain: being told they are stupid, foolish, sinful, or manipulative;
rejection; punishment; suspension from school or job; written records of
their condition; or involuntary commitment. You need to do everything you
can to reduce pain, rather than increase or prolong it. Constructively
involving yourself on the side of life as early as possible will reduce the
risk of suicide.
4. LISTEN
Give the person every opportunity to unburden his troubles and ventilate
his feelings. You don't need to say much and there are no magic words. If
you are concerned, your voice and manner will show it. Give him relief from
being alone with his pain; let him know you are glad he turned to you.
Patience, sympathy, acceptance. Avoid arguments and advice giving.
5. ASK: "ARE YOU HAVING THOUGHTS OF SUICIDE?"
Myth: "Talking about it may give someone the idea."
People already have the idea; suicide is constantly in the news media. If
you ask a despairing person this question you are doing a good thing for
them: you are showing him that you care about him, that you take him
seriously, and that you are willing to let him share his pain with you. You
are giving him further opportunity to discharge pent up and painful
feelings. If the person is having thoughts of suicide, find out how far
along his ideation has progressed.
6. IF THE PERSON IS ACUTELY SUICIDAL, DO NOT LEAVE HIM ALONE
If the means are present, try to get rid of them. Detoxify the home.
7. URGE PROFESSIONAL HELP
Persistence and patience may be needed to seek, engage and continue with as
many options as possible. In any referral situation, let the person know
you care and want to maintain contact.
8. NO SECRETS
It is the part of the person that is afraid of more pain that says "Don't
tell anyone." It is the part that wants to stay alive that tells you about
it. Respond to that part of the person and persistently seek out a mature
and compassionate person with whom you can review the situation. (You can
get outside help and still protect the person from pain causing breaches of
privacy.) Do not try to go it alone. Get help for the person and for
yourself. Distributing the anxieties and responsibilities of suicide
prevention makes it easier and much more effective.
9. FROM CRISIS TO RECOVERY
Most people have suicidal thoughts or feelings at some point in their
lives; yet less than 2% of all deaths are suicides. Nearly all suicidal
people suffer from conditions that will pass with time or with the
assistance of a recovery program. There are hundreds of modest steps we can
take to improve our response to the suicidal and to make it easier for them
to seek help. Taking these modest steps can save many lives and reduce a
great deal of human suffering.
WARNING SIGNS
A. Conditions associated with increased risk of suicide
* 1. Death or terminal illness of relative or friend.
* 2. Divorce, separation, broken relationship, stress on family.
* 3. Loss of health (real or imaginary).
* 4. Loss of job, home, money, status, self-esteem, personal security.
* 5. Alcohol or drug abuse.
* 6. Depression. In the young depression may be masked by hyperactivity
or acting out behavior. In the elderly it may be incorrectly
attributed to the natural effects of aging. Depression that seems to
quickly disappear for no apparent reason is cause for concern. The
early stages of recovery from depression can be a high risk period.
Recent studies have associated anxiety disorders with increased risk
for attempted suicide.
B. Emotional and behavioral changes associated with suicide
* 1. Overwhelming Pain: pain that threatens to exceed the person's pain
coping capacities. Suicidal feelings are often the result of
longstanding problems that have been exacerbated by recent
precipitating events. The precipitating factors may be new pain or the
loss of pain coping resources.
* 2. Hopelessness: the feeling that the pain will continue or get worse;
things will never get better.
* 3. Powerlessness: the feeling that one's resources for reducing pain
are exhausted.
* 4. Feelings of worthlessness, shame, guilt, self-hatred, "no one
cares". Fears of losing control, harming self or others.
* 5. Personality becomes sad, withdrawn, tired, apathetic, anxious,
irritable, or prone to angry outbursts.
* 6. Declining performance in school, work, or other activities.
(Occasionally the reverse: someone who volunteers for extra duties
because they need to fill up their time.)
* 7. Social isolation; or association with a group that has different
moral standards than those of the family.
* 8. Declining interest in sex, friends, or activities previously
enjoyed.
* 9. Neglect of personal welfare, deteriorating physical appearance.
* 10. Alterations in either direction in sleeping or eating habits.
* 11. (Particularly in the elderly) Self-starvation, dietary
mismanagement, disobeying medical instructions.
* 12. Difficult times: holidays, anniversaries, and the first week after
discharge from a hospital; just before and after diagnosis of a major
illness; just before and during disciplinary proceedings. Undocumented
status adds to the stress of a crisis.
C. Suicidal Behavior
* 1. Previous suicide attempts, "mini-attempts".
* 2. Explicit statements of suicidal ideation or feelings.
* 3. Development of suicidal plan, acquiring the means, "rehearsal"
behavior, setting a time for the attempt.
* 4. Self-inflicted injuries, such as cuts, burns, or head banging.
* 5. Reckless behavior. (Besides suicide, other leading causes of death
among young people in New York City are homicide, accidents, drug
overdose, and AIDS.) Unexplained accidents among children and the
elderly.
* 6. Making out a will or giving away favorite possessions.
* 7. Inappropriately saying goodbye.
* 8. Verbal behavior that is ambiguous or indirect: "I'm going away on a
real long trip.", "You won't have to worry about me anymore.", "I want
to go to sleep and never wake up.", "I'm so depressed, I just can't go
on.", "Does God punish suicides?", "Voices are telling me to do bad
things.", requests for euthanasia information, inappropriate joking,
stories or essays on morbid themes.
A WARNING ABOUT WARNING SIGNS
The majority of the population at any one time does not have many of the
warning signs and has a lower suicide risk rate. But a lower rate in a
larger population is still a lot of people - and many completed suicides
had only a few of the conditions listed above. In a one person to another
person situation, all indications of suicidality need to be taken
seriously.
Crisis Intervention Hotlines that accept calls from the suicidal, or anyone
who wishes to discuss a problem, are (in New York City) The Samaritans at
212-673-3000 and Helpline at 212-532-2400.
This material was prepared by Suicide Prevention Resources, a non-profit
public education organization that is dedicated to three goals: reduce the
degree and duration of suffering of despairing individuals, prevent
attempted and completed suicides, and reduce the hardship and stigma
suffered by relatives and friends of suicide victims. Suicide Prevention
Resources (Box 7693, FDR Station, NY NY 10150-1914) gives talks and
workshops in New York City. Permission is granted to reproduce copies of
this material for use within your organization or facility.
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