Trigger warning: frank discussion of suicide.
The first time someone told me he was planning to kill himself, I was a sophomore in high school.
I had met Freddy (name changed), who lived in Florida, one time through a mutual friend. We had kept in touch through AOL Instant Messenger and occasional phone calls. Freddy, like me, was in 10th grade, and was a very troubled young man. As we kept in touch, he opened up to me and told me about the disconnect he felt from his parents, about his struggle to find a niche to fit in socially, about the hopelessness he felt all the time.
The call came at about 5 PM California time on a school night: “I just wanted to let you know, because you’ve been so nice to me, that tonight before I go to sleep, I’m going to tie a plastic bag over my head, and I just wanted to say goodbye.”
As a teenager, I was not equipped to respond calmly to this information. I spluttered, “wait, what? No, don’t… you can’t… why would you do that? Don’t do that! Have you told your parents?”
I could practically hear him roll his eyes. “Yeah, but they don’t care. I don’t think they believe me.”
I don’t remember the rest of the conversation, but I do remember getting off the phone about five minutes later and feeling completely and utterly helpless. I paced around my bedroom. I wrestled with dozens of questions that were pouring through my brain:
- Would it be a betrayal if I didn’t keep his secret?
- Would he end his life if I didn’t tell anyone?
- Where the heck were his parents?
- Can you even die from tying a plastic bag over your head?
- If you can’t, will he try something else later?
- How do I help him?
- What can I do?
Finally, I cracked through my own adolescent stubbornness and decided I was out of my depth. I turned to my mother. She stood with me while I looked up the phone number for a suicide hotline, called them, and gave them the information I had about Freddy.
“We’ll send out an ambulance,” said the person taking the call.
“Wait, what? No, don’t… I mean… he’ll be so angry!”
And he was. After he was released from the hospital, I reached out to him, and he said he didn’t want to talk to me anymore. His parents were also angry, though almost 20 years later, I now understand that this wasn’t about not caring… it was the thing they had to feel to protect themselves from their own pain and fear.
But ultimately, everyone was safe.
I spoke to Freddy a few years ago… Facebook suggested that he was a “people I may know” and we exchanged a few messages. He still struggles with depression sometimes. He still has a difficult time socially fitting in. His life isn’t perfect, and he’s not without his struggles. But when we spoke, he was very clear that as an adult, he does not want to die, and he expressed gratitude that I prevented him from killing himself as a teenager.
How to Help a Suicidal Person Get Help
I read a great article a few days ago about 10 things not to say to someone who is suicidal. This is a great list, and if someone you love has told you they’re thinking about killing themselves, I think it’s well worth a read. But it leaves a dangling question, which is “that’s what not to do… what should I do?”
1. Offer love, support, and unconditional positive regard.
“Unconditional positive regard” is a term coined by Carl Rogers, and it means that even if I don’t agree with every decision you make, I still like and respect you as a person. This is vital to effectively supporting someone, especially someone who feels suicidal. It means that you are there for them, even if they say things that make you uncomfortable, even if they make a suicide attempt.
Most people who have suicidal thoughts and feelings feel a deep sense of shame about it, and that shame is reinforced by not having a supportive, loving person to confide in. The message to give to your loved one is, “I love you, I care about you, and no matter what happens, I’m here for you.” There’s not one perfect cure for the kind of depression that leads someone to contemplate suicide, but feeling connected to and supported by loved ones is a vital ingredient in healing.
2. Take them seriously.
Many people think that suicide threats are a “cry for help.” Even if this is true, when someone cries for help, it tends to mean that they genuinely need help.
It’s not really your role to assess or evaluate whether someone is actually planning to follow through on their thoughts about killing themselves. Even licensed therapists who have specifically educated themselves about working with suicidal clients sometimes cannot accurately evaluate how serious a client is about following through on their suicidal ideation.
If you are not a therapist and have not received training in this area, you’re even less equipped to evaluate how likely someone is to follow through on their suicidal thoughts. It’s always better to err on the side of caution. Even if a person is having flickering thoughts of suicide with no intent to follow through, they will feel more validated if you believe them, and this helps reinforce a positive connection. (See #1.)
3. Practice empathy.
There’s a great quote from David Foster Wallace that describes the experience of a suicidal person. To paraphrase, he urges the reader to consider a person who jumps from a high rise building that is on fire – it’s not that the person wants to leap to their death, but rather they feel it would be less painful to jump than to be burned alive. A person who decides to take their own life is not crazy or selfish; rather, they feel in that moment that the prospect of death is less painful than the alternative.
If you have never felt suicidal, this may be abstract and hard to relate to. But this metaphor can help you respond in an empathic and understanding way. Letting your loved one know that you understand that they are in a great deal of pain, even if it’s not a kind of pain you’ve ever experienced yourself, can help them feel validated. This will let them know that they’re not crazy or stupid and, more importantly, that they’re not alone.
4. Reinforce that you’re there for the person, and then ask who else is part of their support system.
You can’t be on call all the time. In times of crisis, someone’s therapist may ask you to do a “24 hour watch” with that person to mitigate their danger to themself. But otherwise you probably have things that will prevent you from being there in a moment of crisis, such as work, social obligations, and spending time with your family. If your loved one is having severe suicidal thoughts, you shouldn’t be their only line of defense.
As you’re supporting your loved one, it’s also helpful to say, “have you talked to so-and-so about this? What have they said?” It tells you what’s already been tried ineffectively, or maybe what was helpful. If they haven’t talked to another person yet, it also enables you to say, “I want to be here for you, but I’m kind of at a loss for what would be helpful. Maybe so-and-so has some better thoughts?”
5. Help your loved one find a great therapist.
Ideally, this should be someone who has worked with a number of suicidal clients.
If your loved one has never been in therapy before, this might feel like a radical step. But someone who is having serious thoughts about suicide is in need of professional support that you are probably not equipped to offer. It also means that there’s someone else on Team Keep-This-Person-Safe, so you don’t have to do it all by yourself anymore.
It might take a little while to find a good fit, and your loved one may need to try a few different therapists before finding someone who they feel can help them. It’s not just a matter of finding the therapist with the best reputation; it’s much more important to find a therapist who is a great fit for your loved one.
6. If needed, hold their “means” for them.
If someone has a suicide plan, this often involves some type of external implement. A person may be hoarding pills, or might have a straight-edge razor blade stowed away, or may have a gun in their home. A decision to act on suicidal feelings can be impulsive, and if a person has to go to the store to buy something, the urge may pass.
For this reason, your loved one’s therapist may ask them to have someone hold their “means.” If they have an object in their home that they feel they might use to die by suicide, a fairly straightforward thing that you can do is be willing to hold onto that object until the risk has substantially decreased.
This does not mean that you should take their belongings by force. If they’re unwilling to give up their means voluntarily, it may mean the threat is more serious and they may need to be hospitalized.
7. Call 911 if you need to.
If someone you love has told you that they have a specific, time-sensitive plan to kill themself, call 911. Push through your guilt, push past your concerns that they will be angry, and call 911. This may be hard to talk yourself into.
Freddy was the first of five suicidal people for whom I’ve had to call an ambulance. Some of these people have been clients, and some have been people in my personal life. It has not gotten easier. I have never felt like a hero. Every time, I’ve felt like I was betraying the trust of someone who had confided in me by taking away their right to make autonomous decisions. Almost every time, the person I had hospitalized was very angry at me. Every time, it took a long time to have enough perspective to feel like I did a good thing.
But in hindsight, I’m glad I called 911 all five times. Whether they’re living full, happy lives or still struggling with depression, my decision to call 911 means they have a chance to try.
8. Practice Self-Care
I would be remiss if I didn’t add this to the list. It can be very hard to be a caregiver for a loved one who is suicidal. Be supportive and keep your loved one safe, but also set healthy boundaries and develop a self-care practice that will help you to be your best. Ultimately, you can’t pour from an empty cup.
If the loved one you’re supporting is someone very close to you, or is leaning on you a great deal, consider seeking your own therapy. The needs of caregivers are often overlooked, and you need to make sure that you’re taking care of yourself.