Suicide prevention: #Bethe1to ask how they're doing, to connect with them and listen.

Today marks the beginning of National Suicide Prevention Week 2019, and tomorrow, September 10, is World Suicide Prevention Day.

More than just observing a day or week like this, let’s use the opportunity to learn what we can actually do to make a real difference in the life of someone who suffers from suicidal thoughts. The National Suicide Prevention Lifeline has created the hashtag #BeThe1To to pull together people interested in learning what you can do to help.

Suicide Prevention: #Bethe1to Intervene

Approximately 1 million people die by suicide each year, according to the World Health Organization. That’s about 3000 people per day, or one death by suicide every 40 seconds. In the US, over 47 thousand people died by suicide in 2017. As such, suicide is the 10th leading cause of death in the US alone. But those are the ones who died.  1.4 million attempted suicide. 

When someone experiences suicidal thoughts, it doesn’t mean they’ll necessarily make an attempt to end their life. So if there were 1.4 million people who attempted to die, can you imagine how many suffer in silence from the torment of suicidal thoughts?

And here’s the thing…

You don’t really know whether a particular person who’s experiencing suicidal thoughts will try to stop living, even if you do know they’re having suicidal thoughts. 

And that’s why it’s so important to know what you can do, and learn how to get comfortable doing it.

Suicide Prevention: #Bethe1to Make the Effort

Suicide prevention: #bethe1to reach out and ask how she's doing.

So let’s talk today about how YOU can intervene and help protect people in your circle from making an irreversible decision. National organizations dedicated to suicide prevention, like Suicide Prevention Lifeline and the American Foundation for Suicide Research cannot ferret out everyone at risk. To reach all of those suffering requires your help, engagement, and willingness to reach out.

Most people do care about the number of people dying by suicide, but the majority of those who care, don’t really know what they can do to make a difference. And that’s why these organizations exist. 

#Bethe1to highlights what you CAN do. YOU CAN be the one to listen. To reach out. There’s an abundance of myths and misunderstandings surrounding suicide, and more importantly, suicidal thinking.  When someone is having suicidal thoughts, those thoughts often begin as an intrusion into their mind in most cases, rather than a decision. In most cases, the thoughts are a symptom of an underlying condition.

Think there’s nothing you can do? That’s a myth.

Just be genuine. Sincere. Caring.

The longer the thoughts go on, the more they can torment. And possibly influence the person experiencing them. So you can #Bethe1to interrupt the cycle, distract this friend or loved one from the influence of the thoughts, and counteract the thought’s impact.

So WHAT CAN YOU DO?

#Bethe1to  ASK

Suicide prevention: #bethe1to be there for him.

Start with developing a new habit, a new aspect to your interactions. Check on the people around you at work, at school, and at home. Ask questions. Inquire about their wellbeing. Show them that they matter to you. 

“Are you Okay?”  

Simply asking the people who are in your world if they’re okay can give you a more accurate idea about their wellbeing. Your question doesn’t need to be intrusive, but rather just a simple way of showing that you care about how they’re feeling, rather than just focusing on what they can do for you, your business, or your family. 

“How are you feeling these days..?”

The more you ask, the more comfortable you’ll get with asking the questions, and with the conversations that ensue. At the same time, it can set your friend at ease if you talk about your own mental health and experiences so he knows you can relate to his struggles. But avoid dominating the conversation by focusing on yourself. The goal is to get him talking.

“You know, you have seemed kind of quiet lately, and I don’t notice you hanging out with the people you usually do. I just wondered how everything’s going for you..?”

It’s true that much of the time, that person will say something like, “Sure, I’m great! How are you?” To which you can respond that you’re great, too, and smile and move on. But when someone is suicidal, they tend to isolate themselves… or may have been isolated from others. That aloneness leaves them without connections to others … and without feedback or support.

The more isolated a suicidal person is, and continues to be, the more likely they may be at risk of imminent death. 

So let them know you’re here… to listen. Resist the temptation to tell them why they shouldn’t hurt themselves…or how hurt people who love them would be.

That isn’t productive. Ask them reasons why they want to die, and accept what they say without judgment. Then ask them reasons they might want to live. Focus on their reasons for living or dying…not your own.

Studies show that by replacing their isolation with interaction, caring, support, and connections, you can help them move away from the risk of suicide and see value and purpose in their life again.

Once they tell you they’ve thought about how much easier it would be if they died, you know they’re having suicidal thoughts. And you can say that the fact that they’re having these thoughts is likely an indication that something’s going on with them…

#Bethe1to  Keep Them Safe

Suicide prevention: #Bethe1to ask questions and listen, and show them you take them seriously to keep them safe.

The next step is to keep them safe. If someone tells you they’ve been thinking about dying, or that their loved ones would be better off without them, they’ve admitted to you that they’re having suicidal thoughts.

Begin your response with reassurance that they’ve taken a good step by talking about it. People can be overwhelmed by feeling vulnerable after revealing something so intensely personal. They may withdraw from fear of judgment.

Your reassurance is invaluable at this point.

To keep them safe, ask more questions and stay connected. Ask them if they’ve ever tried to hurt themselves, to see how concrete these thoughts are to them.  Ask them if they’ve thought about how they might do it…?  If they have a plan and if they’ve taken any steps toward that plan. It’s also important to find out if they’ve considered the timing yet… when do they plan to do this?

While it may sound uncomfortable to talk about these details, this is where life-saving begins. Further, many people are reluctant to discuss these details because of the fear that they’re planting the idea of suicide in this person’s mind. And maybe they fear they’d feel responsible if the suffering person took action. But this is not the case. 

Suicide Prevention: #Bethe1to Reach Out and Reverse Their Isolation

Studies have shown that engaging this person in conversation and connecting with her about her plans, helps her air these thoughts…consider the realities and consequences. Most importantly, discussions like this promote connection, and dispel isolation. The very conversation itself establishes human connection and communicates the value of her life. Or of his life.

In addition, the information you gather through this discussion helps you evaluate whether you need to take action. The more details they have thought through, the greater the risk and more imminent the danger they’ll complete their plan.

Plus, if the method they plan to use is a method that’s likely to cause a final irreversible result, such as a firearm, and if they have access to that method readily available, then you may realize you need to do something to protect them.

Perhaps drive them to the hospital, or call for help, if necessary, to protect them.

Research has revealed that if you can put time and space between this person and his suicidal plan, he is likely to rethink the plan.

How often have you heard, “If they’re determined to die, you can take the weapon away from them and they’ll just find something else…”  

This is not actually true. In most cases, removing the method and keeping them safe for awhile gives them time to rethink their plan.  With support, they’re more likely to see value in their life and relationships and they tend to move away from the imminent threat.

#Bethe1to  Be There for Them

Suicide prevention: #Bethe1to listen, and care.

Do the best you can to be there physically, if at all possible. At the very least, be on the phone with them. Talk with them about others in their life they trust and would like to have nearby. It’s important that you not commit to be there with them if you know you won’t follow through. Remember, protecting them from isolation is life-saving. Keep them connected to you and to others who will help them remember the good in their lives. 

Someone with suicidal thoughts is likely isolated, and feels they don’t belong. Ask them about the people in their lives they like or trust and would like to have nearby.

#Bethe1to  Help Them Connect

Suicide prevention: #bethe1to listen, really listen, and show someone who feels isolated that you care.

At this point, help them reconnect with those they’d like to have nearby. Help them connect to other resources where they can build more connections with people who understand and will listen. Online organizations or local organizations in the community will give them more to plug into. And a place to reach out.

Ask them if they’ve considered a therapist, if they have insurance to help with that…what their feelings might be about it.

This can give them the safety net of a place and people to turn to if there is a future crisis like this one.

An excellent resource is to contact the Suicide Prevention Lifeline: 800-273-8255 for talking, more resources, and advice.

There is also a MY3 app they can put on their phone for safety, crisis, and other resources. Through the app they can make connections for support, too.

A study conducted by Gould et al. on the impact of Applied Suicide Intervention Skills Training (A.S.I.S.T.) used on the Suicide Prevention Lifeline showed that calling the Lifeline reduces the likelihood of death, and individuals were found to be less depressed, less overwhelmed, less suicidal, after talking with the trained counselors trained by Applied Suicide Intervention Skills Training.

In other words, persons who call this crisis hotline actually feel better after the call because of the degree of insightful and targeted training the volunteers have had.

#Bethe1to  Follow Up

Suicide prevention; #bethe1to make them feel they belong.

Once they’ve been released from the hospital or crisis center, give them a call, send text messages, drop them a post card – or all of the above – over time.

This helps to remind them they’re valuable, that their life is valuable, and that they do belong. Combined with psychiatric care and community mental health support, your effort to maintain connectedness can help protect them from falling back into the “suicidal thinking” frame of mind.

Supportive ongoing contact can help them move forward on a path toward restoration.

When you talk with them, listen. What they say is far more important than all the things you may want to say. You’ll learn about where they are in terms of life-threatening decisions. And, since they’ve been so isolated, being heard and feeling cared about are vital tools for restoring their desire to live.

And… don’t tell them “everything is going to be alright.” It can sound to them like you haven’t listened at all. Listen to how they’d like their life to be. Support their own view of the future. Their own reason to live. Not your own. 

And one more thing: talking over a meal can also raise their blood sugar, and improve their mood. Deeply depressed individuals sometimes don’t eat well. The simple experience of eating nutritious food can boost their outlook in small increments, while combining the food with friendship can have a significant effect on their hope… at least temporarily.

At Innovative Psychiatry we use innovative treatments to arrest suicidal thoughts:

IV Ketamine Treatment Can Stop Suicidal Thinking in an Afternoon

Suicide prevention: #bethe1to help them belong.

Once you’ve helped your friend or loved one put some time and distance between them and their method and plan, they can consider IV ketamine treatment for suicidal thoughts. IV ketamine has proven to be remarkably effective for removing suicidal thoughts in most cases.

That’s in addition to severe depression, bipolar depression, social anxiety, PTSD, addiction, panic disorder, and OCD. With a different mechanism used to relieve other symptoms, ketamine can erase those thoughts and images of death and suicide within just a few hours.

By doing this, it can erase the tormenting images and thoughts, so you can feel better, sooner. And at the same time, you can turn your focus to building a better outlook to maintain remission through all of the things that help keep you well.

IV ketamine treatment can lift the burden of suicidal thoughts and images, and can also transform your life with new initiative, motivation, fresh perspective…and hope. It can give you the energy to rebuild your relationships and your career.

You can be free of suicidal thoughts, despair, and that awful feeling that you don’t belong or fit in.

You can live a full and rewarding life, and IV ketamine treatment can help.

Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

To the restoration of your best self,

Lori Calabrese, M.D.

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