What to do if someone you know is suicidal
This was not a post I originally planned on writing. It is not directly about my weird life. This post is because of the conversation I had with Camel, when I realized that most people don’t actually know how to respond to someone when they are suicidal. Let me share my knowledge, with the caveat that this advice may not apply to everyone. This is general advice, not specific to any unique situations. I am a licensed therapist, so some of this advice comes from that training. Because I know that most people are not licensed therapists, a lot of the advice actually comes from a Question, Persuade, Refer suicide prevention program that I was trained in during undergraduate... which is something that anyone can be trained in, not just people in the mental health field.
So the first thing that you do when you think someone you know is suicidal, is you ask them, “Are you going to kill yourself?” Suicide is so stigmatized that people rarely talk about it, and it makes most people very uncomfortable to bring it up. But most people will experience suicidal ideations at some point in their lives. It’s something almost universal that no one wants to talk about. And people who are contemplating suicide tend to be relieved when someone asks them about it directly. People who are suicidal tend to be feeling very isolated, so when someone reaches out and cares enough to directly ask them about suicide, it can help them feel safe enough to open up to you.
The way you ask about it is important. Phrasing it as, “You wouldn’t do something stupid, would you?” tells the suicidal person that suicide is stupid, and that they can’t talk to you about it, because you don’t understand. While suicide may seem stupid to you, it isn’t to that person at that time. People who suicide don’t do it because they actually want to die or think it’s a great idea, they do it because they are in pain and can’t think of any other way to make the pain stop. You want this person to believe that you care about them, so remember to stop and think about how they are going to perceive your question before you ask it. Phrasing it as something stupid is because suicide makes YOU uncomfortable and because YOU can’t bear the thought of losing that person... it’s not about them. Make it about them, because that person is clearly in a lot of pain, and they need to know that you are there for them.
While we’re discussing language... the acceptable terminology is “died by suicide”. It is not as acceptable to say “committed suicide” because that implies that suicide is a crime, which it is not. I have heard other people say “completed” suicide, however this implies that it is a goal to achieve, and that people who do not complete it are failures. I believe that “attempted suicide” is still okay to say, or at least I have not heard any better alternatives. The goal is to be as neutral as possible with the language we use around suicide, because we don’t want people who are suicidal to misconstrue our thoughts on suicide based on the language we use. Suicide is there choice, we just want them to choose to live. My other favorite way of phrasing suicide is as a verb - “suicided”.
After you ask the question, they should either say yes or no. If they aren’t clear, or avoid the question, ask again. It should be a yes or a no, or they should explain more. Sometimes people will say that they are thinking about it, but they aren’t actually going to do anything. Sometimes people are not sure if they are going to do it. Usually those people are afraid that they are going to, worried they won’t be able to stop themselves, and want help.
Then comes the “persuade”. This can mean a few different things. You want to let the suicidal person know that you care about them, and then persuade them to get help. You can persuade them not to do anything to hurt or kill themselves, however that will likely not work long-term. Typically if it’s someone you’re close to, they may agree to not do anything to hurt or kill themselves, and sometimes they will also agree to get help. At a minimum the most important thing you can do here is make sure that the suicidal person knows that you love and care about them, and that your life would not be as fulfilled without them. Even if it’s someone you don’t know very well, you can still try to persuade them that they have something to offer and that the world would not be the same without them. They are unique and invaluable. This step shouldn’t come from a place of telling someone what to do or what you think is right, etc. It should come from a place of caring about them and believing that their life is valuable. You aren’t trying to convince them that suicide is wrong, you are trying to convince them that they are worthwhile. Worthlessness is one of the main symptoms of depression.
Then... refer. Help them figure out a plan of where they can go and who they can talk to. You can go on their insurance page and look up mental health services, or look up free clinics in the area. If they’re in school, they should have a school counseling center. They can call a national suicide hotline. I have an earlier post with the contacts for suicide prevention hotlines in tons of different countries. If they are on the brink of suicide and in need of significant intervention, they can go to an emergency room. Hopefully they will agree to go. You can ask, “When I leave here, are you going to kill yourself?” You can help them make a safety plan. Figure out how they are going to keep themselves safe - can they stay with anyone or have anyone stay with them? What are they going to do the next day, next week, to stay safe? What will they do if they feel like they can’t stop themselves from suiciding? As a last resort, if you are worried that they are going to suicide despite all these steps you’ve taken, you can have them involuntarily committed.
This is not something that should be done lightly. It is literally removing a person’s right to self. People generally do not like this. However, if the choice is between the person you care about being angry with you, or being dead, I’m guessing everyone would choose alive and angry. To file an IVC, you have to go to the local magistrate’s office. You let them know you want to file an IVC, and they will ask why. You give them the information you have. The magistrate will decide whether to agree to grant the IVC. You may have to swear you are telling the truth. I have filed an IVC on clients twice - once I had to swear and once I didn’t. You will have to sign the paperwork attesting that you are telling the truth. As I said, taking away someone’s right to self is a big deal, it is not just done on a whim. Then the police will be notified, and go find the suicidal person. I believe you have to file the IVC in the county where the person is currently located, because local police will have to track them down. Technically you can file an IVC (if the magistrate will grant it) if you aren’t entirely sure where the person is, but it’s only good for 24 hours before you have to renew it, if the person is still suicidal. If you are not able to go to the magistrate in the county where the person is located, you can still try calling the local police there and see if they will check on the person. If needed, they can transport the person to the hospital.
I hope none of you ever have to go through this process, but it’s something that I realized would be good to put out there. It’s knowledge everyone should probably have just in case. I am not going to put in all the statistics about suicide here, but just know that they are overwhelming. You can research it more if you want. It boils down to... way too many people die by suicide, way too often, and way too young. Let’s all do what we can to change that.