When the Netflix series “13 Reasons Why” was released more than a year ago, it sparked significant controversy from the public, as well as mental health professionals. In case you missed it, the show tells the graphic story of a fictional high school girl who dies by suicide and leaves behind a box of audio tapes she recorded to explain the 13 reasons why she ended her life. There was a buzz among my colleagues at the office, as well as from my patients, family and friends. Would the show help raise public awareness about a serious issue? Or would it glamorize the victim and the act of suicide, posing a risk to already vulnerable teens?
The buzz died down as it usually does; replaced by other stories and busy lives. However, when the second season was released last month, I thought it might be a good time to discuss warning signs of suicide and what to do if someone you know is showing those signs.
Before I even started writing, we learned that Kate Spade and then Anthony Bourdain ended their lives and publicity abounded. For me, their deaths are not any sadder than those of less famous individuals, but maybe some good can come from their notoriety as it increases the conversation about suicide. I want to help take that conversation in a helpful direction by suggesting tools for people to use when they have concerns about people in their lives.
Look For Warning Signs:
While nothing tells you that a person is definitely going to kill him or herself, you may see concerning changes in behavior or personality that indicate that someone is at risk and needs help.
Here is a list of what to consider:
- Talking about suicide
- Researching ways to do it
- Making statements about feeling helpless, hopeless or worthless
- Deepening depression
- Severe anxiety or agitation
- Preoccupation with death
- Withdrawing from family and friends
- Out of character behavior, apparent change in personality
- Extreme mood swings
- Increased use of drugs or alcohol
- Risky or self-destructive behavior
- Giving away possessions
- Visiting or calling people, as if saying goodbye
Consider Risk Factors:
In addition to these warning signs, there are identified risk factors. While these are not proof of an impending act of self-harm, they should raise the level of concern:
- Access to lethal means, including guns and drugs
- Serious physical health issues, including pain
- Exposure to someone else’s suicide or to sensationalized accounts of a suicide
- Previous suicide attempts
- Family history of suicide
- Prolonged stress or a recent stressful life event
- History of childhood abuse, neglect or trauma
- Reluctance to seek help because of stigma
What You Can Do To Help:
We do not yet know as much about the protective factors which can shield individuals from suicidal thoughts and behavior. From what we do know so far, access to high-quality mental health services, connections to family and community, good problem-solving skills and certain cultural and religious beliefs that discourage suicide and provide support, can be protective.
Knowing this information, what can you actually do to help someone you think may be suicidal? People are often worried about bringing up the subject of suicide to someone who appears to be suffering. It is actually helpful to ask direct questions as long as you do it in a sensitive manner. There is no evidence that such conversation pushes someone to hurt themselves. You can start with a more general question about how they are coping with an apparent stressor, such as the end of a relationship or the loss of a job. Then you can ask,” Are you thinking about hurting yourself?” If they say yes, then you can follow up with more specific questions about how or when. If you are worried they might do something to hurt themselves, you should offer the following support:
- Urge the person to get professional help. If they do not have the energy or motivation to do it themselves, you can help them by finding a provider, scheduling the appointment, and/or taking them to the appointment
- Encourage the person to call a hotline number, such as the National Suicide Prevention Lifeline at 800 273-TALK (800 273-8255)
- Promote communication by being a good listener
- Be respectful and acknowledge their feelings without being patronizing or judgmental. For example, you might say, “It sounds like you’ve been feeling really sad,” rather than “Things could be worse.”
- Do not promise to keep it a secret because if the person is in danger, you need to try to get help
- Remove dangerous items, such as weapons, if possible
- If you think the person is in immediate danger, do not leave them alone. Call 911 or take them to the nearest emergency room
The most important thing to remember is that if you are concerned someone may be suicidal, do not ignore it. While ultimately you are not responsible for preventing a person from taking his or her own life, you may be able to help by being supportive and assisting them in seeking professional treatment.
The following sources were used in preparing this blog: mayoclinic.org, afsp.org, and cdc.gov/violenceprevention/suicide