Most people do not know how to respond to suicidal conversation or topics, other than with fear or jumping to solutions. Although that makes sense to the person trying to help, that does little to help with the person who is struggling. Desperation from a seeming or literal lack of alternative options will not easily be swayed by oversimplifications of the problem. And problems that lead to desperate thoughts and actions are usually complex and will take time to resolve. Individuals struggling with suicide who obtain treatment versus individuals struggling with thoughts of suicide who refuse treatment, have a much better survival rate. The risk of completed suicide more than doubles over the first four years for those who refuse treatment (Motto, 1976).
There are many types of counseling which can help with suicidal thoughts or imminent risk of suicide. One very effective and research based approach is called Dialectical Behavior Therapy (DBT). DBT was developed as a protocol-driven, therapeutic process for individuals struggling with suicidal thoughts, self-injury, out of control emotions, impulsive and risky behaviors, and chaotic interpersonal relationships. Many clients seeking DBT have already been diagnosed with Borderline Personality Disorder, Bi-Polar Disorder, Post-Traumatic Stress Disorder (PTSD), or Treatment-Resistant Anxiety or Depression, all of which have a higher level of suicidal risk. The focus of this type of therapy is to create a focused, structured approach to helping clients learn skills to deal with the distress they feel in a more effective way, allowing them to take control of their experience and create a life that is worth living.
If you have a friend or loved-one for whom you are concerned, there are many things you can do. First off, listen and be there. The gift of your presence, without judgment or suggestions, is very therapeutic. Most people do not speak about how they feel, as their shame is already heightened. Well-meaning people often give clichés, oversimplified solutions, or straight negation in response to a spoken thought of suicide. As options seem bleak as it is, and as rejection is already feared, the suicidal individual is less likely to share their distress if any of those responses seems likely. That said, it is important to listen as long as you can. Offer support in helping them find options and choices that fit with their own goals. Go with them if they would like to seek help. Offer to stay with them if they are alone. Offer to have them stay with you.
Most importantly, ask. Ask questions of concern, not guilt. Show that you have noticed a difference. Share your concern, not your disapproval. Avoid explaining their life to them. Involve other people, whether it is family members, administrators, significant others, or other people whom you feel would be safe and would contribute to the solution. Keep the conversation alive. Stay active. Hiding information that you know adds to the shame of the situation for the person struggling. Be willing to flex as they need or request, while firmly holding your caring approach. Get support for yourself.
Above all, we can’t get through most situations alone, and better yet, we don’t have to. There are professionals available to help when the answers aren’t obvious or seem completely blocked. Many of us have had training to get through barriers, see other options, or know how to get to resources available. Please reach out. Please don’t struggle alone. We are here.