National Suicide Prevention Week: How to help people at risk

Publisher’s note: If you or someone you know is struggling with suicidal thoughts or mental health issues, call the National Suicide Prevention Lifeline on 988 (or 800-273-8255) to connect with a trained counselor or visit the nspl site.


Suicide is a leading cause of death among children and adults, but it’s not easy to spot the risk factors and warning signs.

It’s National Suicide Prevention Week September 4-10, part of Suicide Prevention Awareness Month. Nearly 46,000 people in the United States committed suicide in 2020, which equates to one death every 11 minutes, according to the US Centers for Disease Control and Prevention.

Worldwide, almost 800,000 people die by suicide each year, and in 2020, there were 1.2 million attempts worldwide.

Researchers haven’t yet determined how best to predict who is at risk of attempting suicide, and whether or when vulnerable people will, said Justin Baker, clinical director of the Suicide and Trauma Reduction Initiative for Veterans at Veterans State University. from Ohio Wexner Medical. Center.

“That is extremely, extremely difficult,” he said. “You can look back in time, when someone made an attempt or died, and say, ‘Oh, look at all these things that were going on in their life.’ The difficulty is that many people deal with or experience those kinds of stressors as well, but they never get to (attempt suicide).”

Also, there isn’t always a long period of time when someone is considering suicide and showing signs, and there may be as little as 5 to 15 minutes between when someone decides to attempt suicide and does so, Baker added.

“What we collectively understand is that emotional dysregulation and cognitive error occur,” Baker said. “They can’t fix the situation, or they can’t think of how to get over the situation, so suicide becomes a viable option as a way to deal with the pain they’re in. short, short window.”

But there are some situations where a person who is suicidal and planning for a longer period of time will show behavioral changes, Baker added.

“If you notice that kind of thing, obviously it’s someone who is very close to being in imminent danger, someone who is very close to making the decision to end their life,” he said. “But I would say most people don’t get that kind of warning.”

If you think you or someone you know is at risk, the 24/7 National Suicide Prevention Lifeline’s trained counselors may be able to help you resolve any signs you’re experiencing or seeing. To increase its accessibility, all states began implementing the 988 as the new lifeline on July 16. The current number is 1-800-273-8255 (TALK) and will always be available for people in emotional distress or suicidal crisis, according to the Substance Abuse and Mental Health Services Administration.

Here are some of the most common behavioral, verbal, and emotional signs and risk factors to watch out for, according to experts.

Some people may seem business as usual in the weeks or days leading up to a suicide attempt, while others may show behavioral changes that don’t match what you know about them, said Michael Roeske, a clinical psychologist and senior director of the Center for Newport Healthcare for Research and Innovation.

Those may include practicing or preparing for suicide, which might appear to exhibit unusual behavior with firearms, pills or other potentially lethal items, according to SAMHSA.

Other potential behavioral red flags include giving away prized belongings, sleeping too much or too little, withdrawing or withdrawing, showing anger or a desire for revenge, and acting anxious or agitated, according to Roeske, Baker and SAMHSA. Getting very drunk one night or reckless driving could also be signs to watch out for, Roeske said.

Such behavior could be them “testing themselves to see if they can really do it,” Baker said. “A lot of times, people need to work towards that real intent because it’s a biological thing that you have to go against, your very survival.”

Talk of wanting to die, whether by suicide or otherwise, is another warning sign that should always be taken seriously, Roeske said. Such comments are sometimes just expressions of discomfort, pain, boredom or a desire for closeness rather than a reflection of wanting to die, but that doesn’t mean the person making them isn’t controlled, he added.

Some people may say that they feel they have no reason to live. “If someone is struggling to find a reason to live, that’s a much higher risk person than someone who can even identify a (reason),” Baker said.

Others talk about feeling like a burden to those close to them, Roeske said, or like they don’t belong anywhere or to anyone. Such comments may include “You don’t need me for this anymore” or “I feel like it would be better if I wasn’t here.” Teens who are contemplating suicide may not want their guardians to use their money for college, she added.

Psychological factors, distressing situations or genetics can increase the likelihood that someone will consider, attempt or die by suicide, according to SAMHSA. These risk factors cannot cause or predict a suicide attempt, but knowing about them is important, according to SAMHSA:

  • Despair. “They don’t have a sense that the future will get better, or they just feel really unable to imagine not feeling the pain that they do,” Roeske said.
  • Extreme mood swings. This includes if someone who is usually very stressed or depressed suddenly appears calm or cheerful, according to Roeske and Johns Hopkins Medicine. This person could have decided to attempt suicide without telling anyone, and is relieved about it. Also indicative of this is joy after a depressive episode.
  • Obsession with death or lethal means. Some people have artistic or musical interests that are more somber than others, but if their commitment to those things exceeds what is normal for them, that would be concerning, Roeske said.
  • Experiences of abuse, neglect, or other trauma
  • substance abuse problems
  • Mental disorders such as schizophrenia, depression or anxiety, and personality disorders, especially in combination with lack of treatment
  • Serious physical illnesses, including chronic pain. “Especially if it’s a little recalcitrant and very difficult to treat, people can become very desperate,” Roeske said. “It’s really just, ‘I don’t want to feel this anymore and I can’t find another way. I feel trapped.'”
  • Family or personal history of suicide. “The greatest predictor of completed suicide is previous suicide attempts; the reason is that you will see an escalation in lethality, or the means by which someone does it,” Roeske said.
  • Job or financial loss
  • Loss or relationship problems
  • Loss of interest in activities or school
  • Prolonged stress from other causes, such as harassment or bullying.
  • Easy access to potentially fatal media
  • Exposure to suicide or to graphic or sensational accounts of suicide. “On the one hand, we don’t want people to shy away from the topic of suicide. We want people to reach out and even use the word with others and have discussions about it,” Roeske said. But if a description or account gratuitously idealizes or justifies the sense of relief that could be gained from suicide, that is problematic.
  • Insufficient social support or feeling of isolation.

If any of these signs resonate with you, seek professional help and talk to someone you can trust and feel supported by, Baker said. Psychotherapy and certain psychiatric medications, such as antidepressants, can help, Roeske said.

If a loved one is showing signs that they might be at risk for suicide, “it’s really not your job to be able to predict the future,” Baker said. But you can be understanding and intentional about asking them what’s going on, Roeske and Baker said.

“You’re not going to make someone suicidal by asking them directly about suicide,” Baker said. “The worst thing they are going to say is ‘no’ and not be offended. If they are, still ask them. I’d rather someone offend me than die.”

When controlling someone, use what experts call a person-centered narrative approach, Baker recommended. That might seem like an open-ended question: “Hey, I’ve noticed that life has gotten overwhelming these last few days. Do you want to tell me?

As the person responds, you can, to some extent, listen, express appreciation for sharing their story, and offer help in working it out together, without offering advice on how to handle it, Baker said. But if your loved one seems more at risk or in the process of attempting suicide, “you no longer have the time or luxury to get their opinion,” she added. Get medical attention or call 911.

When Roeske started working as a clinician, he had a young patient who was a highly skilled equestrian, attended a prestigious school and had a lot of family resources, he said, but she had been chronically suicidal for 10 to 15 years. since she was a teenager.

“Every time she would go to her mom and say that, her mom would say things like, ‘Oh, you’re so beautiful. Look how you are with horses,’” Roeske said. “And she (the patient) she said, ‘What I felt was that mom was afraid of what she was saying and she needed to distance herself from it.’

She said therapists would do the same thing, you know, “create a positive gratitude list or correct their cognitive distortions.” Finally, there was a psychiatrist who looked at her and said, ‘I think I’m going to kill myself.’ And the psychiatrist said, ‘I think you could too.’ And he said it was the first time anyone was willing to be there with her.”

When talking to someone who is suicidal, you may want to tell them all the wonderful reasons why they should stay alive, Roeske said, but that can actually make you feel more alone.

If you’re concerned about someone living in your home, mitigate opportunities for suicide attempts by restricting access or removing potentially lethal items like firearms or pills, Roeske said. Just hiding a gun isn’t a sufficient precaution, experts say.

Unfortunately, “we can’t better predict who will die by suicide than who will be in a car accident,” Baker said. “This doesn’t help ease the grief or pain of those who have lost loved ones to suicide, but hopefully it helps remove some of the blame and responsibility.”

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