March 1, 2019
What if They Say ‘Yes’ to Suicide Question?
When someone discloses thoughts of suicide, it can be scary, but it can also be a gift. Here are four things to say that could save the person's life.
What if you ask someone if they are thinking about suicide, and they say, “yes”? What do you say? Here are four responses that can make a difference.
- Express gratitude
The first words out of your mouth: “Thank you.”
“Thank you for trusting me.”
“Thank you for your courage to be vulnerable with me.”
“Thank you for valuing our relationship.”
Often, when people express daunting thoughts about suicide, they expect to be judged. They anticipate that others will react in negative ways such as fear, anger, minimizing or shaming. When they hear a genuine expression of gratitude, often they are put at ease. This honoring response creates a safe space to move into next steps. Starting here is starting from a place of dignity and respect.
- Reassure with partnership
Second words to share: “I am here for you.”
“I will stay with you as we figure this out together.”
“I am on your team. You are not alone.”
“I will persist with you until we have a viable plan to get you the support you deserve.”
“I’ve got your back.”
“It’s my honor to be here for you. I know you’d do the same for me.”
“I don’t know exactly what you are going through, but maybe I have had some similar experiences. My heart is with you. Let’s figure this out together.”
Because rejection and discrimination are real outcomes for people living with mental health conditions and suicidal thoughts, reassurance can be very grounding. Too often after disclosure, people who are suicidal experience the “hot potato effect.” Well-meaning people (and this includes many therapists) get scared, so they bounce people to someone else, who then does the same. Each time the person in despair is passed along to someone new to “help,” they must start over, telling their painful story, recounting symptoms and so on. All the time, no one is actually helping them solve problems and recover. The hot potato effect is demoralizing and often feeds into a narrative of “I am worthless and unlovable” or “no one can help me.” Bouncing people around worsens the suicidal crisis rather than helps resolve it.
Working in partnership lets people know they have an advocate, someone who is in their corner. Another way to express this part is the idea of reciprocity. “I am helping you just as you would help me.” This statement lets the person know he or she is not a burden, but that this is just what friends and family do for one another out of love.
Finally, this step emphasizes the importance of an empathic connection. You must reach inside your own memories of experiences and tap into something you have gone through that may give you insight into the other person’s current emotional state. By doing this, you will be more likely to respond as you would want to be treated.
See also: Suicide and the Perspective of Truth
- Offer hope
Hope is the antidote to suicide. The most effective way to offer hope is through action.
“If you were less miserable, you would probably be less suicidal, yes? I have some ideas to help you alleviate your suffering.”
“I know some resources that might help.”
“Let’s call the National Suicide Prevention Lifeline (or let’s text the Crisis Textline) together, so they can help us make a plan to keep you safe for now.”
“This is important. Let’s talk through some ways to help you cope. I know of an app (My3App.org) that can guide us.”
With compassion and collaboration, you can help the person consider options for developing a personal plan for healing. Offering hope is NOT about championing change (e.g., “You better see a doctor!”) or proposing reasons for living (e.g., “But you have so much to live for!”). Offering hope is about helping a person craft his or her own plan for safety and wellness by providing possibilities to help the person figure out what is best for him or her.
Building in choice and empowerment is key in this step. Offer options at every turn (e.g., “We can take a walk and talk about this or go to the coffee shop.”). Have the person identify coping strategies and wellness tactics and write them out in his or her own handwriting. Say, “You are the expert in your own resilience. Let’s write down what has worked for you in the past.”
Let the person know that you would like to be considered part of the safety net, and for you to be effective in that role, you would like help, too. Say, “If it’s okay with you, I’d like to go with you to your first appointment, so I can also get coaching on how best to support you.”
Other resources to engage in this step might include your local mental health center, employee assistance programs or HelpPro.com’s suicide prevention therapist finder resource.
Suggest that you call or meet with these resources together, at least as a first step.
While you don’t want to inject your own ideas for the person’s reasons for living, you may listen to and reflect back the reasons for living you hear the person say. For example, you can say something like, “On one hand, I hear you say you feel so overwhelmed, you don’t know if you can go on. On the other hand, I am hopeful when I hear you say things like you want to be a good role model for your kids. The way you say that it sounds like a part of you is fighting against this despair.”
Another way to offer hope is to hold it for them. You can say something like, “What you are telling me is that you feel hopeless. I, however, see positive things in you and your future. I know you can’t feel this, but I can. I will hold on to your hope until you can feel it again.”
See also: New Approach to Mental Health
- Follow up
Before ending the conversation, make a plan to reconnect.
“I will send you a note tomorrow to see if things are moving along.”
“Let’s schedule a coffee for next week, so you can update me on whether or not the plan is working for you.”
“I will call you by Friday to see how that therapy appointment worked out. Sometimes, things don’t seem like the best fit on the first pass, so, if that is the case, we can try again.”
“You matter to me, so I’m going to let you know when I am thinking of you.”
“I am feeling good about the steps you are taking to get back on track. I will reach out from time to time, and I’d love to hear about your success and any challenges you are experiencing.”
It turns out following up is one of the most effective ways to prevent suicide. Sometimes these communications can be “checking in” to see if the person has hit a roadblock. Other times “non-demand caring contacts” are all that is needed.
What are non-demand caring contacts? Just what they sound like. No asks. No telling what to do. Just “I’m thinking of you” messages. They could come in the form of pictures, “what I appreciate about you” thoughts or even funny cat videos.
By following up, you are letting the person know he or she is not a hot potato, but that you are there standing shoulder to shoulder, walking with the person out of the darkness together.
When someone discloses thoughts of suicide, treat it as a gift. The person has invited you in to a vulnerable part of their world, and you are a guest in this space. While it can be very scary to hear that your loved one is in such a desperately painful situation, your presence can make a huge difference in their recovery. So, when the person says “yes” to the suicide question, take a deep breath and follow these steps. You might just be the one to help the person save his or her life.