By Elizabeth Neri, MPH, LMSW
This June the CDC released a report outlining an increase in suicide rates in the US. Also in June, two celebrities, Kate Spade and Anthony Bourdain, took their lives. As I watched my Facebook feed fill up with posts encouraging those who are struggling to reach out and call suicide hotlines, I thought about how difficult it is to have conversations about suicide. People often avoid asking a struggling friend or family member if they are having thoughts about suicide. Why? Asking about suicide can be downright frightening. What if I say the wrong thing? What if the person asks for help and I don’t know what to do?
Whenever I am giving workshops in the community about mental health, no matter the topic I was asked to lecture on, I try to sneak in a slide about how to talk about suicide. In offering some “best practice” tips on how to talk about suicide, I hope to destigmatize mental health and give people the courage to have a potentially lifesaving conversation with a struggling friend or family member. Given the recent outpouring of support for those who might be struggling with suicidal thoughts, I wanted to share some tips on how to talk about suicide:
1. Ask direct, yes or no questions about suicide.
When asking a person if they are contemplating suicide, it is important to ask a yes or no question. An example of a good question would be, “have you ever thought about committing suicide?” Asking a direct, yes or no question leaves little room for ambiguity. Sometimes we unintentionally ask questions that might lead an individual to give a response that they think might please us – for example, “You haven’t ever thought about killing yourself, have you?” Questions that assume a person’s answer or are too vague might lead your loved one to tell you what they think you want to hear, rather than what they are really feeling.
2. Use the word “suicide.”
When asking a person if they have thought about committing suicide, it is good practice to use the word “suicide” or “kill yourself.” Again, this leaves little room for interpretation and lets the person who is struggling know that you aren’t afraid of the word and can handle tough topics like suicide.
3. Maintain a matter-of-fact tone.
While talking about suicide may make you uncomfortable, it is important to try to have a neutral tone and body language. If you seem overly distressed by your loved one’s suicidal thoughts, they will most likely stop talking about them with you. Your loved one might assume that they are making you uncomfortable or that these thoughts should be buried and stuffed down. They may also be more resistant to reaching out to someone in the future if they feel judged by your tone. Therefore, take a deep breath and try to appear as attentive, calm, concerned and engaging as possible.
4. Listen and accept feelings.
When someone tells us they are struggling, we often try to “fix” them by offering suggestions or reasons that they shouldn’t feel the way they are feeling. This often feels dismissing to the other person. If your loved one says that they have been thinking about suicide, listening to them is one of the best things you can do. I often teach clients I work with to listen with the intention of understanding rather than responding. This means that while you are listening you are not trying to give your opinion, fix, or change how the person is feeling. Instead, you are reflecting how they are feeling. Some examples of useful phrases that convey listening are:
“That sounds very difficult.”
“It seems like you have been having a lot of painful feelings.”
“Tell me more.” “How has that been for you?” In addition, you can say very little and give that person space to talk without interruption.
5. Don’t be sworn to secrecy.
If your loved one is contemplating suicide, they may not want you to tell others. Making a promise that you won’t tell other people is both dangerous for your loved one and can hurt your relationship in the long-term because you may need to break that promise. It is better to let them know that you will get them the support they need and will only tell those that need to know to keep them safe. In addition, trying to handle a situation with a person who is struggling with suicidal thoughts can feel overwhelming. Try to involve and get support from other people your loved one trusts. Ask your loved one who else can be part of their support team.
6. Take action.
Suicide is an emergency. Since you are not a mental health professional, you will probably need to help your loved one get to a professional that is trained to handle this sort of emergency. Calling a crisis number with a loved one is a good place to start. The National Suicide Prevention Lifeline (1-800-273-8255) or, if you are in Georgia, the Georgia Crisis and Access Line (1-800-715-4225) are excellent resources. If deemed necessary, the Georgia Crisis and Access Line will go out to your loved one’s home and do a safety check. Similarly, you can also call 911 and the police department will come to your loved one’s house to do a safety check.