Your phone lights up: “Please call me ASAP.” You never get a text from your best friend during work unless it’s an emergency. You quickly call them back. “Things have been so hard lately. I’m not eating. I’m not sleeping. I don’t know what to do. I want to disappear.” You think your friend may be seriously thinking about suicide. You want to ask them directly, but you don’t want to make things awkward if you’re wrong. “Hang in there. It’ll get better,” you reply.
Jacqueline Sharp, Director of the Arkansas division of the American Foundation for Suicide Prevention (AFSP), has heard of interactions just like this from individuals who never saw the warning signs or knew that their loved ones were struggling with thoughts of suicide.
No matter how hard the conversation may be, asking the right questions and talking about suicide are critical steps to prevention.
AFSP was formed in 1987 by loss survivors and researchers who realized a lack of suicide prevention research and resources at that time. Educating the community on the latest research is now the core of AFSP.
“We are the largest provider of suicide prevention research globally,” Jacqueline says. Part of that research includes identifying recent trends and new discoveries around suicide and suicidal ideation. Over the last 36 years, research has revealed 10 pillars that Jacqueline says are vital to understanding suicide prevention.
10 Pillars of Suicide Prevention Education
- Suicidal ideations affect a person’s decision-making and behavioral control.
- Limiting people’s access to lethal means dramatically decreases suicide rates in communities.
- 90% of individuals who die by suicide have a preventable, treatable mental health condition.
- Depression, bipolar disorder, and substance use are strongly linked to suicidal thinking and disorder.
- Specific treatments used by mental health professionals, such as cognitive therapy and counseling, are proven to help people manage their suicidal ideation and behavior.
- Nobody takes their life for a single reason.
- Talking about suicide won’t put the idea in someone’s head.
- Certain medications used to treat depression and stabilize mood have been proven to help treat people with suicidal thoughts and behaviors.
- If someone can get through the intense and short moment of a suicidal crisis, chances are they will not die by suicide.
- Most people who survive a suicide attempt go on to engage in life.
Be Sensitive to the Struggle
“Suicidal ideations make it hard for people who are considering taking their life to find positive solutions,” Jacqueline says. They often resort to lethal means as a solution to their problems. It is essential that when a person begins resorting to lethal means, we intervene. “If someone has a plan and has been considering suicide, creating a safe environment and removing the lethal means from their plan decreases their likelihood to choose another means of suicide,” she adds.
Individuals do not often resort to suicide for a singular reason. Instead, Jacqueline says that many factors converge at a point of crisis, causing an individual to enter crisis mode and consider taking their own life. “There may be a conglomeration of outside factors and potential underlying mental health issues we haven’t diagnosed yet that are causing these feelings. Don’t be quick to say, ‘They died by suicide because of this single reason,’” Jacqueline explains.
“We often talk in the community about how when someone is considering suicide, their brain is in a crisis mode,” Jacqueline explains. “The most important thing to do is to give that person time to get out of their crisis point. Talk to them and give them time to process what they’re saying.”
What Can We Do?
Know the Numbers
Suicide remains one of the leading causes of death in the United States. According to the Centers for Disease Control and Prevention, between 2000–2021, suicide rates increased by about 36%, with an estimated 48,183 deaths from suicide recorded in 2021. That’s one death by suicide every 11 minutes. Suicide is the 3rd leading cause of death for individuals ages 10–19 and the second leading cause of death for ages 20–34.
The number of people who think about or attempt suicide is even higher: In 2021, 12.3 million Americans seriously thought about suicide, 3.5 million planned a suicide attempt, and 1.7 million attempted suicide.
These numbers reveal a continuing need for suicide prevention research and education. “When I found out how little suicide prevention and mental health are covered in the medical classroom, I was astounded,” Jacqueline says. In the last decade, medical students have learned more about topics surrounding depression and suicide, such as social determinants of health and adverse childhood experiences (ACEs). “I’ve also seen an uptick in suicide prevention education in emergency departments,” Jacqueline says.
Assess, Assess, and then Assess Some More
“I want to highlight how important it is that our medical professionals are doing assessments with individuals who show the warning signs of suicide,” Jacqueline says. “I know it’s hard. I know you’re overwhelmed, and you have a lot going on, but if someone is showing the warning signs and risk factors of suicide, they need an assessment.”
Part of that assessment should be asking the patient directly, “Are you thinking about killing yourself,” not “Are you thinking of harming yourself.” Harming oneself has many definitions and can lead to ambiguity. Asking directly about suicide confirms the need for help.
“Even just spending five seconds to ask a patient if they are okay is a good way to start the conversation,” Jacqueline adds. “Then you can ease into it: ‘As a doctor, I’ve seen some behavioral changes, such as increased alcohol consumption, lack of sleep, etc., that are warning signs consistent with individuals who contemplate suicide. Are you thinking of killing yourself?’”
Cultivate Open and Honest Conversations about Suicide
Suicide is still a sensitive and often stigmatized subject. Conversations surrounding suicide are, however, becoming more normalized. “One positive coming out of the pandemic is that people are more willing to talk about their mental health,” Jacqueline says. “People are having more open conversations about suicide. It’s still so stigmatized in our community, especially in more rural pockets of Arkansas.”
Talking about suicide will not put the idea into someone’s head. “Our research shows that talking about suicide with an individual who is struggling actually brings them relief.” By talking about suicide, the person struggling will realize that someone cares enough about them to allow them to be honest about how they feel. Opening the door for nonjudgmental conversation creates a safe space and makes it easier for a person to get the help they need.
People may feel uncomfortable asking an individual if they are considering suicide, but doing so is the first step to saving their life. “It’s a tough conversation, and it can feel awkward,” Jacqueline agrees. “I support someone who struggles, and I’ve had to ask a family member directly.” Despite the awkwardness, asking someone directly if they are thinking about suicide allows them to vocalize what they’re experiencing internally. Once you know they’re thinking about killing themselves, you can help them get the support they need.
AFSP often advocates for every school staff member who interacts with a child taking prevention training. “Students develop relationships with coaches, bus drivers, and resource officers. They may say something about their struggles to a trusted adult.”
The students themselves need prevention education as well. “What we’re finding more and more is that children likely talk to each other about their suicidal ideations before they talk to an adult, so we teach the students to know the warning signs and learn how to talk about suicide, too. We want to ensure that everyone, teacher or student, knows what to do.”
There is a right way and a wrong way to talk about suicide.
Jacqueline often discourages people from using the word “commit” suicide. “When you say or think about the word commit, the first thing that often comes to people’s minds is crime, Jacqueline explains. “But people who have died by suicide have done nothing wrong. They’re not criminals. They have reached a point of crisis and experienced real physical pain where they felt that their only option was to take their own life.”
When you have a conversation with someone who is strongly thinking about or has attempted suicide, openness and sensitivity are key. “We don’t want to come into the conversation with judgment or arguments,” Jaqueline says. “You are there to listen. Not to try and negotiate with them. Saying things like ‘You have so much to live for’ and ‘It gets better’ are not productive, even if your intentions are good.”
Instead, let the person talk about how they’re feeling. Ask them questions to get to know more about what they’re experiencing. Learn where they’re coming from. “You have to remember that someone who is in a suicidal crisis is experiencing pain,” Jacqueline explains. “If you’ve ever experienced severe pain, you know that you can’t think of anything else except that pain point. That’s why it doesn’t help to try and negotiate or debate with them.”
Have a Plan When Someone Answers "Yes"
Asking an individual if they are considering suicide is only the beginning of how you can help. Your obligation does not stop there. You must have a plan to support that individual and get them the help they need if they answer “yes.”
“It’s concerning, but statistics show that around 50% of people who have died by suicide visited their primary care provider one month prior to their death. So, that speaks to gaps in care,” Jacqueline says.
“As a provider, after you perform an assessment and the patient confirms they are considering suicide, it’s critical that you develop a plan with them to get help,” Jacqueline says. If you haven’t already, build relationships with your local behavioral health hospitals and leaders in your community so you can easily connect your patients to them.
Implement Postvention Strategies
If someone dies by suicide, it’s often glossed over and rarely talked about. Research shows that’s not the best response. Like dropping a pebble in a pond, suicide creates a ripple effect throughout the entire community. Suicide postvention (planning what to do or say after someone has died by suicide) is critical in caring for everyone affected.
After someone has died by suicide, take the time to help everyone affected process it. Once you’ve given it some time, implement training and talking points to ensure everyone knows the warning signs, how to ask someone directly if they are seriously thinking about suicide, and what to do when someone answers yes.
Use Your Resources
There are thousands of suicide prevention resources out there that benefit everyone affected by suicide. Here are four places you can start to gather your resources:
- AFSP Resources. AFSP has a wide variety of suicide prevention resources for you or someone you know.
- CDC Suicide Prevention Resources. The CDC provides facts, risk and protective factors, prevention strategies, and other suicide prevention resources that you may find very helpful.
- 988 Suicide & Crisis Lifeline. Learn more about the 988 Lifeline, which provides free and confidential support for people in distress, prevention and crisis resources for you and your loved ones, and best practices for professionals in the U.S.
- AFMC ACEs. Childhood trauma often leads to poor health outcomes and chronic diseases, including anxiety and depression, later in life. Learn more about ACEs and how to build resilience to overcome trauma.
Although mental health conditions have become less stigmatized since the pandemic, suicide still remains an epidemic. We are still having to implement suicide prevention strategies in our workplaces, schools, clinics, emergency departments, and everyday lives. Part of the reason we continue to stress suicide prevention techniques might be due to the fact that suicide as a topic is still so stigmatized and fragile due to the awkwardness and discomfort people feel when discussing suicide. Regardless of how it makes you feel, it’s important to remember that having an open dialogue about suicide assures your loved ones that you care deeply about their feelings and want them to feel safe and secure.