My friend doesn't want to live anymore. What should I do?

Q: My friend told me she doesn’t want to live anymore. The world will be better off without her. What should I do?

A: Well the first thing I can tell you is that your friend is reaching out to you by telling you that she wants to kill herself. It may not seem like it, but that’s a good thing. Now someone knows.

Most suicides do not happen fast. Although, there may not be direct statements about death, there are usually plenty of warning signs and invitations by the person to hear their distress and subtle cries for help. Your friend has just reached out to you. Believe me, a concerned and caring person can make all the difference here!

In our teen years there are a lot of pressures, changes and transformations taking place in our bodies, minds and environments. We enter puberty, high school, experiment with new things and new experiences, there is a growing awareness of sexuality and relationships, and developing into an adult which are all bunched together in one big mixed bag of things we have to make sense of. It can be a lot for anyone to handle and can sometimes overwhelm us.

Suicide, or even the word suicide, can be a scary thing for anyone. Yet one of the greatest myths is that talking about suicide to someone at risk will make them kill themselves. It’s simply not true. It is actually the other way around. By bringing the subject of suicide out in the open, it’s like taking the weight of the world off their shoulders. It’s creates a kind of freedom for them like “I feel so much better now that someone knows, I don’t feel so alone anymore.” Most people who attempt suicide try to communicate with someone first but may not find an ear willing to listen. They may not directly address suicide either so it is important to take any signs of suicide seriously and not be afraid to talk about it openly. Although it may feel uncomfortable, the best thing you can do if you suspect someone is thinking about suicide is to ask them directly. “Are you thinking about killing yourself?” Don’t be vague or general; be very specific when you ask them.  Most people thinking about suicide are of two minds; they want to die but they also want to live. If they really wanted to kill themselves they would just do it, but most people don’t. They give signs and warnings, behavioural changes, become withdrawn, you may see character changes. The idea of suicide usually happens in the middle of turbulent feelings and events and sometimes we get so overwhelmed with things we just can’t see any way out. No one wants to be suicidal and most people who consider suicide don’t act on it. Talking to them and helping them clarify their thoughts may be all that’s needed to get them past this dangerous time.

I am going to briefly explain 3 basic steps to helping someone at risk of suicide.

Please remember that every person and every situation is different so this is only a guide.

Connect ....... Understand ....... Assist

1) Connect – Exploring invitations

You may not be certain that a person is thinking about suicide but there may be “invitations” from the person who is reaching out in subtle ways or behaviours. This is the time to explore what they are experiencing and try to connect with the person, being open, accepting and supportive. Below is a list of possible invitations that may point towards hopelessness, helplessness, despair and desperation which can lead to thoughts of suicide.

Key things to watch for are Situations and events that have feelings of loss connected to them and a change in behaviours and actions

Stressful events like the loss of loved one, trouble with the law, recent suicide or violence, sexuality, abuse.

Physical changes like lack of interest, lack of energy, disturbed sleep, loss of sex drive, weight/appetite change, and health complaints.

Behaviours and actions involving crying, emotional outbursts, relationship troubles, school grades, drug or alcohol abuse, being reckless or impulsive, loss of interest in things, withdrawal or giving away possessions.

Thoughts of escape, guilt, being alone, talk and/or planning for suicide, putting affairs in order, having no future, “can’t take it anymore”, “feel like dying”, “wish I were dead”, “no one can help me now”, everyone is better off without me”, I can’t do anything right”, “I’m  such a loser but my problems will be over soon”

Feeling –desperate, angry, sad, ashamed, worthless, lonely, disconnected, hopeless,, worthless.

If you suspect the person is may be considering suicide,

Ask them directly!

“Are you thinking about killing yourself?”

2) Understand - Review the Risks

Reasons: You need to listen and understand their story and why they want to kill themselves. They want to be heard, so please listen. Persons who are at risk of suicide are almost always ambivalent and unsure about killing themselves. Talking is almost always helpful. Listen to the reasons for dying as well as living. Stay with the negative parts as long as they want and let them tell you their story. Be persistent though and reinforce and build on any positives they talk about- stay with them if they stay in the negative and let them talk about what’s bothering them.

Remember                                           C. P. R.

Current plan-(are they prepared for suicide?-disable the suicide plan- (put away the gun) how will they do it, how prepared are they, are the means to kill themselves available, how soon will they do it?

Pain (are they desperate? - ease pain) - pain and despair that feels unbearable

Resources (are they alone?-link them to resources) - children, friends, neighbours, spouse, relatives, job, hobbies, spirituality, clergy, a will to live, distress centers, health workers, hospital, suicide hot lines.

Other items that put a person at higher risk of suicide: 

Having previously attempted suicide- those who have tried before are more likely to try again because it makes it more acceptable and increases the risk 
History of Mental health- drug or alcohol treatment, depression schizophrenia etc.

Stay in sync with the person, don’t try to move to quickly into positives if they resist, stay with them where they want to talk but keep building on the positives. They are talking because they don’t really want to kill themselves.

3) Assist- Contracting a Safe plan

Make a contact with the person and a commitment from them to remain safe for an agreed specified time period. It can be 1 hr, 1 day or, 1 week, but it must be realistic. Ensure details of the commitments made are specific and clearly understood. Be sure they can repeat the plan to you and remember it or they may not be able to follow it. Confirm there is some form of emergency support for them if the safe plan fails for some reason. Encourage them to write down telephone numbers etc. and make their environment suicide safe.  For example remove guns, pills, knives that they might use to kill themselves.

Give them your commitment to them to follow up and to keep them safe and supported.

               

Summary

***Explore invitations to help---ask about thoughts of suicide- don’t be afraid to talk about it----listen-to the reasons for dying and living—review the risk factors--contract-a safe plan for them—follow-up-on the commitments to the safe plan*** 

You have reached out to help them but you cannot control their actions. Remember that no matter what happens the person at risk is responsible for their own actions. Think of us as lifeguards who stay on the lookout and help people in danger. However, if the swimmer is caught in a strong current it’s not always possible to pull them to safety. Please understand, if a person chooses to end their life, it is not your fault.