Talking about suicide is a tough conversation. Learn how to overcome fear and discomfort to offer help to someone in need.

Your Health, Men's Health, Women's Health | 2 years ago

How to Talk with Someone Who May Be Considering Suicide

Talking about suicide is a tough conversation. Learn how to overcome fear and discomfort to offer help to someone in need. 

According to the CDC, more than twice as many adults (11%) reported suicidal ideation (serious consideration of suicide) in June of this year compared to 2018 (4%). This uptick can be clearly correlated with the peak of the COVID-19 pandemic for several across the nation. It’s no wonder – isolation because of social distancing and stay-at-home orders has increased uncertainty, fear, depression, anxiety and substance use.

“Are you considering suicide?” may be the toughest question you’ll ever ask – while standing six feet apart or over the phone – but it could save a life.

Rates of suicide in the U.S. were already on the rise prior to the pandemic. We need to realize that thoughts of suicide may impact those who are around us each day, according to James Rachal, MD, chairman of the Department of Psychiatry and psychiatrist at Atrium Health.

“There’s a perception that people who are depressed, anxious, or having suicidal thoughts are ‘those people,’ that they’re not our friends or family or colleagues,” Dr. Rachal says. “Even I never conceived that someone close to me would die by suicide … We need to acknowledge that these people with suicidal thoughts walk amongst us every day.”

Someone close to Dr. Rachal did die by suicide, shattering the boundary between his professional work and his personal life. Since then, he says that he’s become more vigilant to look for signs of suicide risk, even with loved ones and colleagues, and more willing to engage in conversations about suicide. “We all need to learn to have these conversations together,” he says.

Kevin Champion, chaplain and Mental Health First Aid instructor at Atrium Health, teaches people how to talk about suicide in an empathetic, direct and helpful manner. Here, Champion also provides guidance on how to initiate a conversation about suicide.

Worried About Suicide Risk in a Loved One? Speak Up.

We can find many reasons to avoid talking about suicide. Some people fear that asking someone about suicide will put the idea in their minds. It won’t, Champion assures. Others fear that it may seem rude or intrusive. Champion encourages anyone concerned about a loved one to begin gently.

“Initiate the conversation by starting with, ‘I’m concerned about you. Can you tell me what’s going on? You’ve become very quiet, very isolated,’” Champion says. “Bring up how the changes in their behavior make you concerned about their well being.”

That person may not be willing to talk just then, but expressing genuine concern in a kind manner may open the door to later communication. If the person expresses thoughts or behaviors that do indicate that they may be considering suicide, Champion urges direct communication.

“Ask them, ‘Are you thinking of killing yourself?’” Champion says. “Don’t hem and haw. You want to be direct.”

Champion urges people not to ask, “You’re not thinking of killing yourself, are you?” If you do, you’re signaling that you’re not capable of hearing a Yes. He also urges people not to ask, “Are you thinking of hurting yourself?” In addition, don’t use tactics of guilt – such as, “Think of your family” or “What would your kids do?” – as the person in crisis may believe that others would be better without them. Speak with directness and compassion.

What to Do If Someone One Tells You They’re Considering Suicide

React in a calm and reassuring manner. You’ll likely be an emotional mess on the inside, Champion says, but you’ll want to show the person that you’re calm, reassuring and willing to help. If you’re not sure what to say, consider saying, “I don’t know what to do, but we can find help together.”

If the person needs immediate assistance, call 911. You can ask your loved one if they’ve thought about when or how they have considered suicide. This information could be helpful when you talk with the dispatcher. If they’re considering using a weapon, such as a gun, ask where it is.

If immediate assistance isn’t needed, call a help line. Many resources are available to assist your loved one and yourself. Atrium Health’s Behavioral Health Help Line is available around the clock to those considering suicide and those who want to help them at 704-444-2400. If texting is preferred, text “connect” to the national Crisis Text Line at 741741 and a crisis counselor will usually respond within five minutes.

Remember: Words and Attitudes Matter Everyday

Too often, people use words like “crazy” or “psycho”, unaware that that these words contribute to the stigma of mental health. Others may equate people with a mental health diagnosis (“She is depressed”) in ways they never would with other health diagnoses (“She is cancer”). Consider using phrasing like, “She is struggling with depression” or “She is dealing with depression.” People are people, and they’re more than their diagnoses.

This consideration about word choice should extend to suicide, too. Instead of saying that someone “committed” suicide ­– a word associated with a crime or sin – it’s more appropriate to say that they attempted or died by suicide, according to Champion.

“That whole thing about, ‘Sticks and stones may break my bones, but words may never hurt me’? That’s a lie,” Champion says. “You don’t know who around you has been impacted by suicide, either by an attempt on their own part or by someone they love. It’s important to use language that isn’t stigmatizing. Be sensitive. People are much more likely to talk with you if they know you’re not judging them.”

Misconceptions perpetuate stigma surrounding mental illness. One misconception is that mental illness is a result of weakness or moral failure, which is not true.

“Some people see suicide as a character flaw. It’s not,” says Dr. Rachal. “People who die by suicide don’t want to die, they just want their pain to end.”

Another misconception is that people with mental illness are likely to be violent. This, also, isn’t true: Only 3 to 5 percent of violent crimes in the U.S. are connected to people who live with mental illness. People with mental illness are far more likely to become the victim of a crime or to harm themselves.

“Because of stigma and discrimination, people are not seeking treatment as readily as they might,” says Kevin Champion. “It greatly increases the possibility that someone struggling with mental illness will attempt or complete suicide.” 

Atrium Health’s Virtual Suicide Prevention Community Event on October 15 will empower and teach you how to become a suicide prevention advocate in your community. The event is free and open to the public. Learn more and RSVP here.

Mental Health First Aid is an evidence-based eight-hour course that teaches attendees how to recognize and respond to signs/symptoms of suicide, mental illness and substance use disorders. Learn more about Atrium Health’s Mental Health First Aid program and register for a class online.