According to the latest data from the Centers for Disease Control and Prevention, the number of suicide deaths in the U.S. is climbing.1
We need to reverse this trend. Each of us can make a difference. We can reach out for help ourselves or help others reach out for help. Reaching out for help is the key.
Dr. Eli Robbins studied 134 suicide deaths during a one-year period (1956-1957) in the City of St. Louis and in St. Louis County2. He found that 69% (93 people) communicated their intent to kill themselves an average of three times, which means that only about a third of the suicidal people he studied did not ask for help. Those that reach out give us a chance to help.
But we may be wondering what to do if given a chance. For ourselves and for those who give us the chance to help, you can take a variety of steps to help preserve life, your own or someone else’s. Here are a handful of action steps. If you are thinking about suicide, click here for 5 steps you can take. To help someone else who is thinking about suicide, see the 3 steps below.
The signs of suicide
You might be wondering how to know if someone else is suicidal. Listen for talk about death. Is this person getting ready to die by buying a gun or putting their affairs in order? Watch for changes in their behavior like changes in their sleep (more or less sleep) or an increase in risky behaviors like using more alcohol. Listen for any talk about “being a burden” or feeling trapped and hopeless. Is this person withdrawing from others?
Knowing the signs is only the first step. The only way to really know if a person is withdrawing because they are thinking about suicide (or because they are busy at work) is to ask them. We may worry that asking if someone has thoughts of suicide plants the idea in their head. There is good evidence that this is not the case3. Most suicidal people are relieved when you bring up the topic for them. Thoughts of suicide are intensely distressing because they are scary and unexpected and suicidal people may not know how to start the conversation they so desperately want to have. Ask directly, “Do you have thoughts of suicide?” or “Are you thinking about killing yourself?” What action steps can you take if they say “yes”?
Step 1: Stay with the person until they connect to help
If a person has thoughts of suicide, stay with them until they get connected to help. One option is to contact the National Suicide Prevention Lifeline (1-800-273-TALK  together. The Lifeline will connect this person to a network of crisis centers throughout the U.S.. Alternatively, this person can go to their nearest emergency room for an evaluation.
Move to Step 2 only after a person is connected to professional help. Step 1 is crucial. Once the person is connected to help, there is more you can do.
Step 2: Write them caring letters
Jerome Motto4 studied 3,006 patients who were discharged following a psychiatric hospitalization. He followed three groups: those who got treatment after discharge, those who refused treatment who did not receive letters or calls, and those who refused treatment who received non-demanding letters or phone calls on a set schedule. The call or letter expressed interest in how the person was doing and was signed by the person in charge of the patient’s care. A letter might say, “Dear [first name], It has been some time since you were here at the hospital and we hope things are going well for you. If you wish to drop us a note, we would be glad to hear from you.”
A self-addressed unstamped envelope was enclosed, and if the person wrote back, their letter was answered. The group that got calls or letters had the lowest suicide rate over two years. You can easily do the same thing for a suicidal person by writing them caring letters.
Step 3: Help them develop a safety plan
A safety plan, or crisis response plan, is a short, easy-to-read plan for a suicidal person to follow when they experience suicidal thoughts. It includes a list of calming activities (like playing with a pet) and supportive contacts5. It will include emergency numbers like the National Suicide Prevention Lifeline or local mental health crisis numbers. A safety plan is like a life jacket. It gives a suicidal person something else to do besides think about suicide. The goal of a safety plan is to interrupt the chain of events leading to suicidal behavior. One of the messages of a safety plan is that a person can be successful in fighting the thoughts of suicide.
Susan Rose Blauner survived many suicide attempts and she writes, “I’ve experienced the ‘I want to die’ moment thousands of times over the last eighteen years, which means suicidal thoughts have passed just as many times.”6 A safety plan assists with the passing of suicidal thoughts.
1 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005) [cited 2019 December 31]. Available from URL: www.cdc.gov/injury/wisqars
2 Robins, E. (1981) The Final Months: a Study of the Lives of 134 Persons who Committed Suicide. New York: Oxford University Press.
3 Eynan, R., Bergmans, Y., Antony, J., Cutliffe, J.R., Harder, H.G., Ambreen, M…. & Links, P.S. (2014). The effects of suicide ideation assessments on urges to self-harm and suicide. Crisis, 35(2): 123-131.
4 Motto, J. A. (1976). Suicide prevention for high-risk persons who refuse treatment. Suicide: A Quarterly Journal Of Life-Threatening Behavior, 6(4), 223-230.
5 Wenzel, A., Brown, G.K., & Beck, A.T. (2009). Cognitive Therapy for Suicidal Patients: Scientific and Clinical Applications. Washington, D.C: American Psychological Association pp. 144-145.
6 Blauner, S.R. (2002.) How I stayed Alive when my Brain was Trying to Kill me: One Person’s Guide to Suicide Prevention. New York: William Morrow p. 149.