Suicide is the most preventable form of death (QPR Institute) and is an epidemic crisis in this country, especially among younger and older people. With just a little bit of information and a lot of caring, anyone can help another person experiencing a suicidal crisis. You do not have to know the exact right thing to say or do. You also do not need to worry about doing or saying the wrong thing. Almost any indication of caring without judgment will likely be experienced as helpful to someone in crisis. The intention of writing this blog is to present factual information, dispel myths about suicide, teach others to recognize the risk of suicide, highlight some considerations in talking with a suicidal individual, reduce the stigma of talking about suicide, and reassure readers that anyone and everyone can prevent suicide.
Almost 45,000 people die by suicide every year which amounts to 123 deaths per day and 1 death every 12 minutes (Drapeau & McIntosh, 2017).
White/Caucasian males, Native American males, and Black/African American males are highest risk ethnicity/gender groups (Drapeau & McIntosh, 2017).
10th leading cause of death in U.S.A. for all age groups and 2nd leading cause of death for young people (15-24 year olds) (Drapeau & McIntosh, 2017).
3.4 male deaths for every female death and 3 female attempts for every male attempt (Drapeau & McIntosh, 2017). This means that females attempt suicide much more often than males, but with less lethal means (e.g., poisoning or intentional overdose). Men are much more likely to use firearms which is very lethal.
25 attempts per death on average (Drapeau & McIntosh, 2017). There are several opportunities to intervene and get appropriate help for someone who has survived a suicide attempt.
Firearms overwhelmingly top method for suicide deaths followed by hanging/suffocation (2nd) and poisoning (3rd; most common method for females) (Drapeau & McIntosh, 2017).
Suicide costs the US $51 billion annually (American Foundation for Suicide Prevention, 2017a).
90% of people who die by suicide have a mental disorder at the time (American Foundation for Suicide Prevention, 2017b).
Oklahoma is 7th in the nation for highest suicide rate per capita in 2016 behind Alaska (1), Montana (2), Wyoming (3), New Mexico (4), Nevada (5), and Colorado (6) (Drapeau & McIntosh, 2017).
Lowest rates of suicide are found in the mid-Atlantic and New England areas (Drapeau & McIntosh, 2017).
Suicide to homicide rate in Oklahoma is 3:1 (B. Woods-Littlejohn, personal communication, May 25, 2017).
Suicide is 2nd leading cause of death for the following age groups: 10-14, 15-24, and 25-34 (B. Woods-Littlejohn, personal communication, May 25, 2017).
Firearms is most common method for men (64% of suicides) and women (49%) in Oklahoma (B. Woods-Littlejohn, personal communication, May 25, 2017).
368 official suicides in Oklahoma between 2011 and 2015 among 18-24 year olds with mean age of 21 and 82% males (B. Woods-Littlejohn, personal communication, May 25, 2017).
Myths about Suicide
1. Myth: Suicide is unstoppable.
Truth: Almost any sign of caring can help prevent suicidal action. And, suicide is the most preventable form of death (QPR Institute).
2. Myth: Bringing up the idea of suicide might ‘plant the idea’ in someone’s mind and I will become responsible if they attempt or complete suicide.
Truth: Talking about suicide decreases the risk because a person considering suicide often feels like no one is comfortable or safe enough to discuss suicide with. Also, others are not likely to be considered responsible for suicidal actions except in the most extreme cases (e.g., encouraging suicide).
3. Myth: Only experts can prevent suicide.
Truth: Non-experts do more to prevent suicide with signs of caring, recommending professional help, intervening with someone who is considering suicide, and offering hope. Sometimes, a person helps prevent a suicide without ever knowing that the other person was ever considering suicide.
4. Myth: Suicidal people are secretive about their plans. Suicides happen without warning.
Truth: Most people consider suicide for weeks, months, even years prior to action and tell people about these thoughts along the way. There are usually many attempts to get help prior to a suicide death. However, most people who attempt and complete suicide do not leave suicide notes, only about 25% of cases.
5. Myth: Suicidal people want to die or, at least, stop living.
Truth: A person considering suicide is searching for an escape from their emotional pain and have trouble considering any other options. Many suicidal individuals are ambivalent about death with reasons both for and against living.
6. Myth: Those who talk about suicide do not take action and should not be taken seriously, especially if they have threatened suicide multiple times.
Truth: Any indication of suicide, especially a direct verbal statement about suicide, should be taken seriously regardless of one’s history. Not taking suicidal threats seriously can lead to a fatal outcome.
7. Myth: Suicide is an act of cowardice.
Truth: Overcoming one’s natural inclination towards living and facing the physical pain of a suicidal act is one of the most challenging things to do. Typically a person makes several attempts before a death by suicide occurs as they build up a tolerance to pain and familiarity with the method. This allows opportunities to intervene and get the person the hope and help needed to prevent further suicidal action.
8. Myth: Suicide has only one cause.
Truth: Suicide is complex and has multiple causes that influence each other in unique ways. There is no ‘one’ reason why people attempt or die by suicide.
9. Myth: People become more suicidal in the winter, especially during the holidays.
Truth: Suicide is more common in late spring and less common during the holidays. April and May have the highest rates of suicide; November and December have the lowest rates of suicide.
Warning Signs and Risk Factors
Many people wonder how to recognize that someone else might be distressed to the point of thinking about suicide. Sometimes, this type of information seeking does not occur until a suicide death occurs. When I present on this topic I like to remind audiences that you are only responsible for the actions you take based on the information you have at the time. So, I encourage readers of this blog to not hold themselves responsible for not knowing this information with past incidents of attempting to help someone through a suicidal crisis.
Warning signs are more immediate indications that a person is considering taking suicidal action whereas risk factors increase overall chances of suicidal action based on statistics (e.g., being male). Most of these should be taken into account within the context of what you know of a person. However, any direct or indirect verbal indications of suicidal thoughts can be taken seriously regardless of other information. Generally the more warning signs and risk factors that are present or if the more intense/severe warning signs are occurring the more you should be concerned about someone.
· Verbal statements (either direct or indirect) that indicate thoughts of death or suicide:
o “I plan to kill myself.”
o “Sometimes I wonder what it would be like if I was no longer here.”
o “I can’t stand the pain any longer.”
o “What if I did not wake up tomorrow?”
· Behavioral clues:
o Past suicide attempts, gestures, or plans
o Researching suicide methods
o Alcohol or other substance use/abuse
o Giving away possessions or putting personal affairs in order (e.g., a twenty-something writing a will)
o Saying ‘goodbyes’ to close others
o Stockpiling medications or acquiring means of suicide (e.g., a firearm)
o Poor hygiene or grooming
o Increasing intensity of physically risky activities (e.g., sports, skydiving, etc.)
o Low motivation to do things previously enjoyed
o Drastic changes in religious activity (either greatly increased or greatly decreased interest and participation)
o Poor sleep habits
· Emotional indications:
o Feeling hopeless or in despair
o Sudden anger or irritability (especially when the person did not previously have problems in this area)
o Extreme mood swings
o Frequent crying and sadness
· Health factors:
o Diagnosis of a depressive disorder, a bipolar disorder, an eating disorder, or a trauma disorder
o Diagnosis of a serious, chronic, or fatal medical condition
o Constant physical pain or fatigue
o Alcohol or other substance use disorder
· Social signs:
o Social isolation/withdrawal
o Being bullied or abused
o Disconnection from previous relationships (e.g., death of a loved one, divorce/separation, job loss)
o Restrictions due to hospitalizations, incarceration, deportation, etc.
o Feeling like a burden to others (e.g., financially or with regards to social support/assistance)
· Situational circumstances:
o Being fired or laid off from work
o An unwanted move (e.g., moving to a nursing home or assisted living facility)
o Death of a loved one, especially if death was by suicide
o Greatly reduced financial income or loss of financial security
o Fear of punishment
· Being male
· Being White/Caucasian, Native American, or African American
· Owning a firearm
· Living in a rural area, especially the Western part of the country
· Lacking access to quality health care
· Physicians and other health care providers
How to Intervene
Once you have identified someone as potentially suicidal based on their context, warning signs, risk factors, and other information you have about them, it is time to consider how to discuss your concerns with them. It is helpful to talk with someone in private to help them feel more comfortable and safe in opening up. Also, give them your full attention and do not set time limits for the discussion. If you are asking someone about suicide, there is likely no other issue that is more urgent or more important at that time. Express your observations and concerns in the most objective manner possible. For example, you might say something like, “I have noticed that you have missed a lot of work and that you seem disconnected from others since your divorce. I have been concerned about you because I care about you.” Then, as calmly as you can and without any judgment ask the person if they are thinking about suicide. You do not need to know any exactly right words or have any kind of planned response to their answer. Most likely, they will begin doing most of the talking and then your job is to listen patiently and express hope by connecting them with resources. If the person is hesitant to answer, be persistent and ask again. Remember that most suicidal people are worried that no one will understand and that no one is willing to discuss suicide. If you can be the exception to that belief it will bring a lot of relief to the distressed person. Someone considering suicide is often more open than expected. Tell them that you are ready to help and that there are reasons to be hopeful for improvement. Some options for connecting the person with resources regardless of whether they are considering suicide or not:
· Helping them make a counseling appointment either by phone or in-person
· Researching treatment providers online to find the best fit
· Calling or texting one of the crisis hotlines together-see below
· Providing contact information about treatment options
· Calling 911 or taking the person to an emergency room
It is common to be uncomfortable with the topic of suicide, especially when you consider asking someone a very personal question like whether or not they are considering killing themselves. If you are concerned enough about someone to have suicide be a consideration and you are unable to ask the individual, find someone else that can. Preferably this would be someone who has a good relationship with the potentially suicidal person. As with most things, asking about suicide gets more familiar with experience and practice.
Another consideration for a suicidal individual is to remove any items they have considered using for a suicide attempt. This might be relocating a firearm to another location or placing a gun lock. Removing potentially harmful medication, especially large quantities of medication can help. Taking away or hiding car keys is an option. Staying with the individual or arranging others to be with them so that they are not alone is something to consider. Most people will not think about changing one suicide method to another in most situations, so focus on putting as many barriers between them and the method(s) they have considered. Have them commit to not taking suicidal action and to give treatment an honest try.
Ask them how you can continue supporting them and, then, follow up with them. Check in with them the next day. Ask them how about their first therapy appointment. Offer to help in ways that you feel comfortable about and avoid getting over-involved. Also, consider getting others involved in ongoing support for the individual. Trust them when considering whom to invite. If they say that their parents will likely react negatively and that it is better to involve others, believe them. Any offers of assistance and caring are likely to be received positively from someone distressed whether they are considering suicide or not. Remember that you do not need to be an expert or know the exactly right thing to say or do. Being your genuine, caring, and non-judgmental self is the best thing you can do for someone distressed.
Coping and Support
There are many things that can help a person considering suicide. These apply to other distressed individuals whether they are suicidal or not. Use the ones that apply to your situation:
· Hope and positive thinking
· Anger management
· Remaining active
· Staying connected with others
· Plans for the future
· Social support (including talking about suicidal thoughts and talking about other things)
· Avoiding alcohol or other harmful substances
· Counseling treatment
· Medication management of symptoms
· Support groups
· Reasons against suicide
If you or someone you know is having thoughts of suicide, help is available and hope is real. Use the following resources to connect with someone immediately:
· Suicide Prevention Lifeline: (800) 273-TALK (8255)
· Crisis Text Line: 741741
· Teenline (Crisis hotline for teenagers): (800) TLC-TEEN (852-8336)
· Trevor Lifeline (Crisis hotline for LGBTQ youth): (866) 488-7386
· National Alcohol and Drug Abuse hotline: (877) 437-8422
· Call 911 or go to the nearest hospital emergency room
For less urgent situations, the following resources have a lot of helpful information about suicide prevention, training options, treatment options, statistics, and more:
· American Association of Suicidology (www.suicidology.org)
· American Foundation for Suicide Prevention (afsp.org)
· ASIST (Applied Suicide Intervention Skills Training) (www.livingworks.net)
· National Eating Disorder Association (800-931-2237)
· National Institute of Mental Health (www.nimh.nih.gov)
· Oklahoma Suicide Prevention Council/Oklahoma Department of Mental Health and Substance Abuse Services (www.odmhsas.org)
· Psychology Today (www.psychologytoday.com)
· QPR (Question, Persuade, Refer) Institute (qprinstitute.com)
If you have questions or concerns about someone who is distressed and possibly considering suicide, give me a call at 405-614-2846 for a consultation. Keep in mind that this phone number is not for emergency situations-see above resource information for other options for urgent suicidal crises.
American Foundation for Suicide Prevention (2017a). Suicide statistics. Washington, DC: American Foundation for Suicide Prevention dated August 31, 2017, downloaded from https://afsp.org/about-suicide/suicide-statistics.
American Foundation for Suicide Prevention (2017b). Treatment. Washington, DC: American Foundation for Suicide Prevention dated August 31, 2017, downloaded from https://afsp.org/about-suicide/preventing-suicide.
Drapeau, C. W., & McIntosh, J. L. (for the American Association of Suicidology). (2017). U.S.A. suicide 2016: Official final data. Washington, DC: American Association of Suicidology, dated December 24, 2017, downloaded from www.suicidology.org.
Joiner, T. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
Joiner, T. (2010). Myths about suicide. Cambridge, MA: Harvard University Press.
Quinnett, P. G. (2000). Counseling suicidal people: A therapy of hope. Spokane, WA: The QPR Institute Inc.
Quinnett, P. G. (2008). Suicide: The forever decision. New York, NY: The Crossroad Publishing Company.