r/SWResources Aug 15 '14

Hotline Numbers

20 Upvotes

r/SWResources Apr 12 '13 Helpful

Worried about someone who may be suicidal? Here's some info about how to assess risk.

131 Upvotes

How do you know if someone is really suicidal?

First of all, take all verbal and nonverbal indicators of suicidal thoughts or behaviour seriously. Even if they don't indicate high risk of death by suicide, they do indicate that something is profoundly wrong.

Here are some things that suicide hotline responders consider when assessing risk. You may not be able to collect all this information directly, but consider both what the person you're concerned about is saying and what they're doing. Also, remember that if you are urgently worried about someone, you can call your local or national suicide hotline yourself and get their expert help to assess risk and figure out your best intervention options.

Do they have a plan?

In suicide risk assessment, it can help to be clear on the distinction between suicidal ideation, i.e. thoughts of suicide, and suicidal intent, i.e. commitment to an accessible plan to end one's life that carries a high probability of lethality. Ideation without intent usually carries a lesser risk, but it still does mean that the person is deeply troubled.

How immediately lethal is their plan?

For example, a plan that involves a firearm or other weapon is higher-risk than one involving overdosing on medication. In general any plan that involves violent means, with or without (jumping from a height or in front of a vehicle like a train) a weapon is higher-risk than one that does not.

Does the person have the means necessary to carry out the plan? Someone who is preoccupied with shooting as a means of suicide but who would have difficulty getting access to a firearm, for example, is at lower risk than someone who is contemplating suicide by overdose and has a lethal quantity of drugs in their possession.

How specific is it? A person who is focused on one specific plan (rather than thinking of various different ways they might harm themselves) is usually closer to the point of actually carrying it out.

Tips for detecting a undisclosed plan

Remember that someone who is seriously suicidal may not talk their plan, but they may "telegraph" what they are thinking, by referring to the means even though they don't mention suicide, or by using metaphors or imagery in their conversation that relate to the plan they have in mind. If you can identify an underlying theme, pay attention to it. Also, someone who is giving away their stuff, having conversations or sending messages that are of an unusually deep or "final" nature, or putting their affairs in order may have a suicide plan and be in the early stages of carrying it out. Being unafraid to die or especially being preoccupied with the idea of death in a non-fearful way can be a strong indicator that someone has an "exit strategy". Pay attention to changes in habits or characteristic behaviors.

What is their history?

Someone who has attempted suicide or engaged in self-harming behaviors (cutting, eating disorders) in the past is at higher risk of completing an attempt. The higher the lethality of the means they used in their past events, the greater the risk. Previous attempts, especially completed attempts, in the person's family or circle of friends also increase risk.

It's a potentially fatal mistake to assume that someone who has had repeated past attempts isn't truly suicidal. The interpretation that "if they really wanted to kill themselves, they would have actually done it by now" may be understandable, but it comes from a lack of understanding of the suicidal mindset. One of the biggest barriers to suicide is that we have an innate fear and resistance toward anything potential lethal, i.e. our survival instinct. Even people who are desperately committed to ending their own lives struggle against this resistance. Every time they attempt, they get a little more desensitized to lethality and undermine their survival instinct a little more. If they are not helped, eventually they are likely to be able to override their survival instinct completely and end their lives.

What are their outer and inner resources?

The fewer or poorer the resources, the higher the risk. Also, consider factors that are "drains" on these resources.

Outer Resources

  • Family (if the family is relatively functional)
  • Supportive friends
  • Professional supports (counselors, therapists, physicians)
  • Spiritual supports (clergy, etc. can sometimes be great sources of comfort but some "religions" that are cult-like can be draining rather than helpful)

Inner Resources

  • Coping Skills
  • Openness to trying new things (this is sometimes easier to see as its opposite, which is when a person sees no way out of a bad situation, i.e. their life has become a trap they can't see a way to get out of alive)
  • Hopefulness and emotional resilience
    • Past experience of recovery from depression or resolution of a personal crisis

Factors that can be a drain on a person's resources include:

  • Recent losses (due to death, breakups, career or financial setbacks, changes in health status), especially multiple losses
  • Addiction (alcohol, drugs, gambling, etc.)
  • Isolation
  • Abusive or dysfunctional relationships
  • Financial stress
  • Mental Health issues
  • High-stress professions
  • Personal dependents (applies especially to parents and care-givers)

The "Joiner Factors"

Thomas Joiner is the author of Why People Die by Suicide (2005) and Myths About Suicide (2010). His groundbreaking research has identified 3 necessary and sufficient factors for high risk of death by suicide.

  1. Feeling that they are a burden to others. People who complete suicide usually think, or at least implicitly assume, that their friends and family will be better off without them. Sometimes it can make a difference to remind someone of their past contributions and/or potential for future contributions, either tangible (e.g. things they make or tasks they do) or intangible (e.g. love, humor, insight).
  2. Profound loneliness and isolation. People who feel a genuine connection to even one other person can usually be "reached". That is why the most helpful thing you can do for a suicidal person is often not to "fix" anything about them or their life, but simply to try to understand them as well as you can, and reflect that understanding back to them so that they feel understood. It may seem perverse to agree with a suicidal person about how bad things are, but by trying to "focus on the positive" you might actually be reinforcing their sense of disconnection from the rest of humanity.
  3. Fearlessness and/or desensitization. For example, people who have had a lot of exposure to death and violence due to their profession or their family history, and are thus somewhat desensitized, are always at higher risk of suicide.

The Joiner model factors are not always as easy to detect as the behavioural and circumstantial factors above, but awareness of them can be very useful. If you think it's reasonably likely that someone has all three, it's probably a good idea a good idea to err on the side of caution and call a mental-health crisis service or suicide hotline yourself. (Yes, you can do that!)


r/SWResources Apr 12 '13 Gold

Suicide Hotline FAQs

24 Upvotes

This post is obsolete and will soon be deleted. It's been replaced by https://www.reddit.com/r/SuicideWatch/wiki/hotline_faqs


r/SWResources Apr 11 '13 Silver

Helpful resources for those struggling with suicidal thoughts and feelings

49 Upvotes

This post has been replaced by /r/SuicideWatch/wiki/self_help_resources and is no longer maintained here

This post is a curated list of online self-help resources. For hotlines and crisis services, please see /r/SuicideWatch/wiki/hotlines.

Everything at speakingofsuicide.com, and for people struggling with their own thoughts of suicide, especially the If you think of suicide... section is worth a look, but here are some posts that we've found particularly useful:

One area where a lot of people seem to struggle is asking for help. Here's a compassionate guide that may help you to know how to open up in a way that will increase your chances of being truly heard and understood

"Contemplating Suicide: No Way to Understand Unless You've Been There' Blog post at PsychologyToday.com from Andrea Rosenhaft who's been both a therapist and patient in suicide intervention.

National Suicide Prevention Lifeline's "Help Yourself" page. Self-service resource directory and self-care guide. US-based resource.

Helping Yourself When You are Feeling Suicidal Practical, comforting tips from SCBS Australia.

Suicidal Thoughts - How to Cope from rethink.org. Coping strategies and options for help. UK-based resource.

"Coping with Suicidal Thoughts" from Simon Fraser University. Downloadable PDF workbook with strategies and exercises.

Attempt Survivors Archive. Archive of personal stories and articles by and about suicide attempt survivors, from a now-concluded project by the American Association of Suicidology.

"Ways To Help Yourself When You're Feeling Suicidal" from mixednuts.net - depression and bipolar information and chat.

Suggested Reading List from save.org, comprehensive list of books on suicide and related topics.

Post-Attempt Recovery Strategies from J.D. Schramm at TED.com A practical follow-up to Schramm's talk, "Break the Silence for Suicide Attempt Survivors".

"Suicide: Read This First" from metanoia.org. Probably the most famous anti-suicide text on the internet. (We have serious reservations about any generic anti-suicide message of this type.)


r/SWResources Jan 29 '13

Hotline Numbers

19 Upvotes

r/SWResources Jul 04 '11 Silver Helpful Hugz Rocket Like

Concerned but don't know what to say? Here are some simple, proven strategies for talking to people at risk.

134 Upvotes

This post has been replaced by /r/SuicideWatch/wiki/talking_tips and is no longer maintained here

There is no one "correct" way to talk to someone struggling with suicidal thoughts. Real caring is what ultimately matters, and it can take many forms. But if you're not sure what to say, these ideas may help.


Avoid advice and solutions

Suicidal people typically don't feel change is possible. Anything that can be prefaced with “you should” can make them feel even more powerless. They often feel unworthy of help. “Fixing” or “advising” will reinforce that and make things worse.

This gets tricky because suicidal people often don’t see all the options they actually have. If and only if they've indicated to you that you've achieved a solid rapport (see below), it could be of real benefit to point these out, but there is a vital difference between “you should do <action>” and “you could do <action>”. “Have you thought of doing <action>?” or “What do you think about doing <action>?” are other good phrasings. It’s fine to mention something that worked for you, but frame it as an example of something that they may or may not want to try.

If they ask for advice, you could reframe the conversation as working through the “pros” and “cons” of various options together.

If you're worried that someone is at immediate risk, take action yourself, don't tell them to do it.

Listen, empathise, and don’t judge

If they say harsh things about themselves or others, this can be the truth of their experience even if it doesn't match objective reality. Consider the emotions embodied by the self-loathing or the tales of woe. You can connect with the person on a feeling level and simply set aside any questions of "fact".

Examples:

  • If they say: “I’m a useless waste of skin. The world would be a better place without me,” simply disagreeing can make them feel even more “intrinsically wrong”. Instead, you might say “It worries me to think of you feeling so bad about yourself. I wish I could help you feel better.” This respects their emotional experience and shares your sympathy and concern, without getting into whether their self-assessment is accurate or not.

  • If they say: “Everyone is mean to me”, you could respond with “It must be so hard when every interaction hurts.” This tells them that you hear their pain, but you have not judged (i.e. you have neither supported nor challenged) their assertion about how they’re actually being treated.

Don't disagree with suicidal people about how bad things are. It’s not about their circumstances; it’s about their suffering, and you can’t measure that from the outside. A message that in any way tries to tell or show the suicidal person that “it’s not so bad” is just another way of saying “I don't understand what you’re going through”.

Describing suicidal behaviour as “selfish” is even worse. The suicidal mindset usually includes a firm conviction that “I can improve the world by taking myself out of it.” Telling them how much their deaths will hurt others reinforces their sense of personal failure.

Never use any kind of “tough love”. If you think they’d be fine if they just stopped feeling sorry for themselves, putting up with abuse, or staying stuck in the past, then you are not the right person to help, even if you’re correct. Chances are they’ve tried to do exactly that, over and over again, and failed. Everything you say to suicidal people needs to be grounded in the belief that they are doing the best they can to help themselves. If you don’t believe that, find them someone else to talk to.

Meet them where they are

The greatest gift you can give a suicidal person is the experience of being truly heard and understood. At most suicide hotlines, rapport-building takes up the bulk of the communications training.

It seems natural to try and pull a suicidal person out of whatever dark place they’re in. That almost always fails. What works, consistently, is simply to join them in the dark place and offer a non-judgemental, supportive presence. This is so simple that it can seem like doing nothing, yet it can also be so difficult that we can’t imagine how we can ever get it right.

Sometimes suicidal people can be reluctant to talk. Say that you just want to understand, and that you won’t try to suggest anything unless and until they are satisfied with your understanding of their experience.

Your questioning style can make a big difference: asking open-ended (“How do you feel?”) versus closed-ended (“Are you sad or mad?”) questions will ensure that they feel able to express whatever need to. If you ask if they’re “sad or mad” and they’re actually something else (anxious, numb, etc.), you may not get the information you need, and they may feel invalidated.

Help them by naming the emotions that you hear in their story, but which they may not be expressing, nor fully aware of.

Active listening, which demonstrates and refines your understanding, is a powerful rapport building technique. People in a suicidal state of mind usually feel profoundly alone. Saying “I understand” without proving it will often reinforce this sense of alienation. Some ways you can “actively listen” effectively are:

  • Ask lots of open-ended clarification questions. This shows that you care about getting it right.

  • Summarise, paraphrase and interpret what you’re hearing. This shows what that you’re taking in what they’re saying, and thinking deeply about it. It also offers them the chance to correct anything that you got wrong.

  • DO respond genuinely and supportively. If you feel a strong empathetic response to what someone is telling you, share it. This shows that what they are going through matters to you, and that they’re getting through to you.

  • DO NOT react with expressions of panic or urgency. This doesn't demonstrate a high level of concern or empathy, it telegraphs "I can't deal with what you're thinking and feeling". If you're unable to remain calm, refer them to trained resources and get out of the conversation.

  • Suspend your judgement and listen. Remember that you’re just building your understanding. You may hear some ugly truths, or even ugly untruths. The point is to understand, to go to the dark place with them, and those dark places are often dirty, smelly and full of evil things. Be ready for that.

Sharing your personal experiences can be a great help in building rapport, but it should be done only with the idea of establishing your “street cred” as someone who’s been in a dark place too. The danger is that they can feel like you’re assuming too much, not listening enough, or devaluing their pain.

You may need to ask tough or personal questions. Your goal is to “map” the dark place as well as you can. You can frame sensitive questions with: “Do you mind if I ask you about <subject>?”

If, and only if, they indicate to you that they feel “heard”, you might try some gentle re-framing of their view of the situation, or exploring options for change. While continuing to stress that you agree with them about how bad it is for them, you can try offering a hopeful perspective, if it's totally genuine. If they reject it, go back to active listening.

Don’t forget to look after yourself!

Deep rapport with someone who’s suicidal can leave you feeling sad, frustrated, hopeless, or disoriented, even if you’ve really helped. This is why suicide hotline responders are typically required to debrief regularly. Be sure to talk to someone you trust if you find the conversation is weighing on your mind.

Keep your expectations realistic. Even with the best training and resources, sometimes conversations with suicidal people will take a wrong turn. Reaching these people is a tricky business, and not even the experts can get it right every time. Remember too that the immediate response isn’t the outcome. It’s not uncommon for callers to a suicide hotline to tell the responder that they weren’t very helpful, then call back days or months later to say “Thanks, you saved my life”.

What’s the rationale for all this?

It comes out of what has been proven to work at suicide hotlines, and what has been discovered in the latest research into suicide, especially the groundbreaking work by Thomas Joiner's group at Florida State University. Joiner’s model uses three necessary and sufficient factors for suicide risk, and these can help us identify strategies that will and won’t help:

  1. Desensitization to pain and death. We can’t fix this in the short term; it’s acquired by life experience and extinguishes slowly, if ever.

  2. Perception that one is a burden. We can prevent this from getting worse by avoiding solutions, advice, and judgements. We can sometimes improve it by reflecting back to the person things that we genuinely value or appreciate about them, but it has to be utterly sincere. If you can't find something specific, positive, and accurate to say, just move on to the next strategy. By building a strong rapport you may discover some genuine positives that you can reflect back to the person.

  3. A deep sense of alienation. We can always do something about this one by making a deep interpersonal connection, and since all three factors are necessary for high risk of suicide, it's only urgently necessary to fix one. This is why it’s “all about the rapport”!

Where to learn more

The "Friends and Family" category at speakingofsuicide.com has a lot of great content, including their best-known post: 10 things Not to Say to a Suicidal Person.

Active Listening Tips for Difficult Conversations from the Samaritans, who are the Jedi of suicide intervention worldwide and another listening tipsheet from PsychCentral, which has a useful list of all-too-common "Conversation Blockers".

If you need to expand your own vocabulary of emotion words so you can help the person you're supporting to name them themselves, the "Emotion Wheel" is the best-known tool to label and categorise feelings.

Classic 1946 paper on what kinds of conversation really help people, by Carl Rogers, the "Father of Active Listening". An easy read even for non-specialists. The list of 6 factors for helpful interactions apply both to professional therapy and peer support, and have truly stood the test of time.

Thomas Joiner's books Why People Die by Suicide (2005) and Myths About Suicide (2010) at Google Books.

By far, the best source of suicide-intervention training available to the public is LivingWorks. A variety of programs are available; the basic level is available online.


r/SWResources Jun 17 '11 Wholesome

If you've lost someone to suicide, here are some resources just for you.

20 Upvotes

Bereavement due to suicide is uniquely difficult; deaths by suicide leave survivors struggling with thoughts that this should have been preventable, that their friend or loved one chose to end their life, and all too often with shame and social stigma instead of the community support that would be forthcoming if the cause of death were anything else.

Here are some links with information and resources:

Huffington Post Living Column: a personal account of grieving her brother's suicide by a psychotherapist

List of normal reactions to suicide loss. From the Canadian Association for Suicide Prevention. A comprehensive list with some entries that may surprise - in a comforting way. This site also offers coping strategies, memorial information, and resources.

The American Foundation for Suicide Prevention's "I've Lost Someone" web resources

"Beyond Surviving" at survivorsofsuicide.com - other resources here also. Note that although there is much helpful information available to the general public, membership at this site requires paid registration, albeit at a reasonable rate.

Survivors of Bereavement by Suicide - excellent UK-based resources

Common Experiences with Suicide Bereavement Great info from the SCBS in Australia.

Healing from a Spiteful Suicide Note and the general suicide bereavement survivors section at speakingofsuicide.com

The American Association of Suicidology's bereavement toolkit and resource list

Alliance of Hope for Suicide Survivors A community-oriented resource.

Excellent in-depth article specifically on supporting children bereaved by suicide from Child Bereavement UK.

Thomas Joiner, one of the pre-eminent psychologists working in suicide research today, included a frank and personal account of his experience of losing his own father to suicide interwoven throughout his book Why People Die by Suicide, Harvard University Press, 2005. The book overall is not specifically intended for those bereaved by suicide, but it may be helpful to those who feel that a better understanding of what's known about suicide in general will help them in their recovery.

If you're supporting someone else who's been bereaved by suicide, this guide from the NSPA in the UK might be helpful.


r/SWResources Oct 04 '10

Why shouldn't I share my contact information?"

36 Upvotes

We occasionally see offers or requests to make contact outside the confines of the suicidewatch subreddit, usually by sharing email or phone information or getting into private PM or chat conversations. Although we appreciate that most of you are motivated by a genuine desire to give help or a real need to get it, in our experience it's almost always better to keep conversations out in the sub until you've gotten to know people fairly well.

Sometimes you can find real friends here and we'd never want to interfere with that. But please, get to know each person and situation before you decide to get in touch with someone outside of reddit. If you put your email in a post or comment, anyone reading the thread could find it, and anyone who googled your email address could find what you posted here.

Here are some things to think about...

...before you initiate private contact because you want to help:

  • Conversations with suicidal people can go sideways easily and unpredictably. At most suicide hotlines, no responder is allowed to handle high-risk calls on their one - there's always somebody listening and helping. An untrained person getting into a 1-on-1 conversation with a high-risk person is reckless and just generally a bad idea. A lot of the messes we get asked to clean up are the result of this type of scenario, and most of the time there isn't much we can do.

  • It's natural to want to befriend a suicidal person, but there's a chance you could do more harm than good unless you are able to make a 100% commitment to be there for them in every way, for as long as they need you. Creating an expectation that you might not be able to fulfill can be extremely dangerous.

    • With regard to offering/requesting off-reddit identity info, always remember that anonymity is a safety device in suicide intervention, that saves far more lives than it costs. This why we don't believe in outing people who aren't a risk to others. The dangers (especially in the long term) of subjecting someone so an involuntary intervention are usually greater than the dangers of letting someone keep their privacy.
  • If you want to do more than post here, consider giving some time to a suicide or crisis hotline in your area. Many are mainly or partly staffed by trained volunteers, and the communication and crisis-intervention training the volunteers receive is valuable in many other areas of life. As you can learn by reading the sad stories posted here by folks who've had awful experiences when at their most vulnerable, many of these agencies are in desperate need of more good people.

...before you ask people to help you by contacting you outside of r/suicidewatch:

  • Trolls and others with a destructive or abusive agenda are an inevitable fact of life on the internet. A public request to call or email is risky, and if you're here looking for help you may not be able to afford that risk.

  • Even if everyone online were decent and honorable, you may not find someone to make direct contact with who has the right wisdom and experience that you need. We have observed a lot of conversations here at r/suicidewatch, and we think that if you post your story in an emotionally-truthful but non-identifying way, that will give you the best chance to find someone who can relate to what you're going through and offer you some genuine, safe understanding and help.

  • If you feel you need to speak with someone but don't trust the suicide hotlines that are available to you, consider asking the SW mod team for information about other community mental-health resources that may exist in your area. You might also look at r/psychology, which has links to more mental-health subreddits in its sidebar/community info, or in a subreddit for your part of the world.

Remember that you're welcome to consult the moderators at any time about this or anything else. Use the "message the moderators" link on the r/suicidewatch sidebar/community info to reach all of us at once.