What to do when someone is suicidal

The U.S. suicide rate is increasing in almost every state, according a report released by the Centers for Disease Control and Prevention. Suicide is listed as a leading cause of death in the report, and more than half the people who died by suicide did not have a known mental health condition. The CDC says "other problems contribute to suicide, such as those related to relationships; substance use; physical health; and job, money, legal or housing stress."

When someone says they are thinking about suicide or makes comments that sound as if he or she is considering suicide, it's upsetting. You may not be sure what to do to help. You might wonder if you should take talk of suicide seriously, or if your intervention might worsen the situation. Taking action is always the best choice. Here's what to do.

Start by asking questions

The first step is to find out whether the person is in danger of acting on suicidal feelings. Be sensitive, but ask direct questions, such as:

• How are you coping with what's been happening in your life?
• Do you ever feel like just giving up?
• Are you thinking about dying?
• Are you thinking about hurting yourself?
• Are you thinking about suicide?
• Have you ever thought about suicide before, or tried to harm yourself before?
• Have you thought about how or when you'd do it?
• Do you have access to weapons or things that can be used as weapons to harm yourself?

Asking about suicidal thoughts or feelings won't push someone into doing something self-destructive. Rather, offering an opportunity to talk about feelings may reduce the risk of acting on suicidal feelings.

Look for warning signs

You can't always tell when a loved one or friend is considering suicide. But here are some common signs:

• Talking about suicide, such as making statements like "I'm going to kill myself," "I wish I were dead" or "I wish I hadn't been born"
• Getting the means to take their own life, such as buying a gun or stockpiling pills
• Withdrawing from social contact and wanting to be left alone
• Having mood swings, such as being emotionally high one day and deeply discouraged the next day
• Being preoccupied with death, dying or violence
• Feeling trapped or hopeless about a situation
• Increasing use of alcohol or drugs
• Changing normal routine, including eating or sleeping patterns
• Doing risky or self-destructive things, such as using drugs or driving recklessly
• Giving away belongings or getting affairs in order when there is no other logical explanation for doing this
• Saying goodbye to people as if they won't be seen again
• Developing personality changes or being severely anxious or agitated, particularly when experiencing some of the warning signs listed above

For immediate help If someone has attempted suicide:

• Don't leave the person alone.
• Call 911 or your local emergency number right away. Or if you think you can do so safely, take the person to the nearest hospital emergency department yourself.
• Try to find out if he or she is under the influence of alcohol or drugs, or may have overdosed.
• Tell a family member or friend right away what's going on.

If a friend or loved one talks or behaves in a way that makes you believe he or she might attempt suicide, don't try to handle the situation alone:

Get help from a trained professional as quickly as possible.

The person may need to be hospitalized until the suicidal crisis has passed. Encourage the person to call a suicide hotline number.

In the U.S., call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to reach a trained counselor. Use that same number and press "1" to reach the Veterans Crisis Line.Teenagers: When someone you know is suicidal

If you're a teenager who's concerned that a friend or classmate may be considering suicide, take action: Ask the person directly about his or her feelings, even though it may be awkward. Listen to what the person has to say, and take it seriously. Just talking to someone who really cares can make a big difference.

If you've talked to the person and you're still concerned, share your concerns with a teacher, guidance counselor, someone at church, someone at a local youth center or another responsible adult.

It may be hard to tell whether a friend or classmate is suicidal, and you may be afraid of taking action and being wrong. If someone's behavior or talk makes you think he or she might be suicidal, the person may be struggling with some major issues—even if suicide is not a consideration at the moment. You can help the person get to the right resources.Offer support

If a friend or loved one is thinking about suicide, he or she needs professional help—even if suicide isn't an immediate danger. Here's what you can do:

Encourage the person to call a suicide hotline number.

In the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to reach a trained counselor. Encourage the person to seek treatment.

A suicidal or severely depressed person may not have the energy or motivation to find help. If the person doesn't want to consult a health care provider, suggest finding help from a support group, crisis center, faith community, teacher or other trusted person. You can offer support and advice, but remember that it's not your job to substitute for a mental health provider. Offer to help the person take steps to get assistance and support.

For example, you can research treatment options, make phone calls and review insurance benefit information, or even offer to go with the person to an appointment. Encourage the person to communicate with you.

Someone who's suicidal may be tempted to bottle up feelings because he or she feels ashamed, guilty or embarrassed. Be supportive and understanding, and express your opinions without placing blame. Listen attentively and avoid interrupting. Be respectful and acknowledge the person's feelings.

Don't try to talk the person out of his or her feelings or express shock. Remember, even though someone who's suicidal isn't thinking logically, the emotions are real. Not respecting how the person feels can shut down communication. Don't be patronizing or judgmental.

For example, don't tell someone, "Things could be worse" or "You have everything to live for." Instead, ask questions such as, "What's causing you to feel so bad?"; "What would make you feel better?"; or "How can I help?" Never promise to keep someone's suicidal feelings a secret.

Be understanding, but explain that you may not be able to keep such a promise if you think the person's life is in danger. At that point, you have to get help. Offer reassurance that things can get better.

When someone is suicidal, it seems as if nothing will make things better. Reassure the person that with appropriate treatment, he or she can develop other ways to cope and can feel better about life again. Encourage the person to avoid alcohol and drug use.

Using drugs or alcohol may seem to ease the painful feelings, but, ultimately it makes things worse. It can lead to reckless behavior or feeling more depressed. If the person can't quit on his or her own, offer to help find treatment. Remove potentially dangerous items from the person's home, if possible

If you can, make sure the person doesn't have items around that could be used for suicide, such as knives, razors, guns or drugs. If the person takes a medication that could be used for overdose, encourage him or her to have someone safeguard it and give it as prescribed.Take all signs of suicidal behavior seriouslyIf someone says he or she is thinking of suicide or behaves in a way that makes you think the person may be suicidal, don't play it down or ignore the situation. Many people who kill themselves have expressed the intention at some point. You may worry that you're overreacting, but the safety of your friend or loved one is most important. Don't worry about straining your relationship when someone's life is at stake.

You're not responsible for preventing someone from taking his or her own life, but your intervention may help the person see that other options are available to stay safe and get treatment.

©2018 Mayo Foundation for Medical Education and Research
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