As an EAP (Employee Assistance Professional) Counselor, one of the most difficult situations is calls from people whose loved one is suicidal. In this article “family” is construed as people who are involved and concerned.
Dealing with a loved one who is suicidal is one of the greatest challenges a person can face. One could divide the scenarios into four categories: A) those who are significantly depressed and one fears that they may be suicidal; B) people who talk about committing suicide or wanting to be dead; C) those who have just attempted suicide; and D) those who have recently made an attempt and are now in the recovery phase.
For scenario A, in which one fears that a person may be suicidal, there is fair consensus about what one should do: talk to the person. People often think of suicide as an option when they are feeling overwhelmed and helpless. There is no evidence that talking to a person about what they are feeling, including inquiring as to the presence of suicidal thinking, will cause suicidal thinking. The risk of triggering such a thought is much, much less than the risk of not addressing the concern. One can approach the discussion by observing with the person that they seem to be feeling very badly. Regardless of what the person answers, because sometimes people are reluctant to share such feelings, one can follow up with a question such as ‘do things seem so bad that you think you’d be better off dead?’ The fact that someone reaches out to them may alleviate some of those feelings. Depending upon circumstances, simply acknowledging how difficult a situation is can validate their understanding and ease their distress. Alternatively, people typically feel suicidal when they see no options; discussion with another person may open new ways of thinking about things. One might suggest that the person seek professional help (if the person is not in treatment) or, if they are in treatment, contacting their current therapist for an earlier session. A person who acknowledges and articulates clear, current, suicidal intent should be referred for evaluation by a mental health professional.
In the scenario B in which a person is open about their suicidal thinking, the approach picks up with engaging the person. Because of the scariness for most people about suicide, in some circumstances the talk of suicide is off-putting. It is best to think of talk of suicide as a cry for help, even if the conversations don’t feel that way. As noted above, people who contemplate suicide often feel that there are no meaningful alternatives. Their thinking is constrained; they see few or no options. To the extent that the suicidal thinking is linked to what appears to be an overwhelming problem, then a more structured approach to problem-solving may be helpful. “Overwhelming problems” often can be divided into pieces, many of which may be subject to some solutions. There may be no one singular solution to the problem, thus the sense of being overwhelmed. One could help by analyzing the problem, dividing it into components, prioritizing the component parts and contemplating solutions to the parts may reduce the intensity of the suicidal thinking. While nothing that is said may alleviate his or her distress, often the demonstrated concern is helpful in itself – the person is not alone, “someone else sees possibilities even if I [the patient] don’t.” Other times, the suicidal thinking may emerge from serious depression, unrelated to life events. In this circumstance, treatment of the depression per se ought to mitigate the suicidal thinking. Here, involvement in professional treatment is critical, as depressions may last for months or more if untreated. None of the treatments for depression work immediately, so a person with serious depression and suicidal ideation needs to have a good alliance with their treatment professional(s).
Scenario C, where a person has just made an attempt, is even more complicated and stressful. Most people don’t know what to do to help someone who has attempted suicide. In some cases, the suicide attempt may have been the first you knew that things had gotten so bad. A person who has made a suicide attempt should be evaluated by a mental health professional. The urgency for seeking such an evaluation is typically gauged by the severity of the intention, dangerousness of the attempt, and ability to make another attempt. If the attempt was potentially very dangerous or if there are significant medical consequences, then the person needs to go to an emergency room for immediate attention.
For those in scenario D where you have a loved one in recovery from a suicide attempt, many questions can run through your head. If I leave her alone for just a few minutes – will she try again? Do I need to commit him to keep him safe? Is she giving me signals that I do not understand? Was it my fault he tried to kill himself? A suicide attempt is never the start or the end of an emotional struggle. This goes for the person who makes the attempt, as well as those who love them. It’s a frustrating, unpleasant, disheartening and helpless experience to watch someone you care about fall into a depression; to see someone hurting that way. Do not allow their suicide to overshadow the rest of their person. Engagement in usual family and other social activities is helpful, although the person may be self-conscious. Acceptance of people as they are includes accepting the suicide attempt. It should not be a taboo topic and it should not be the only topic.
The Effect on Loved Ones and Hints to Help Understanding
The frustration and sense of helplessness in helping a loved one dealing with suicidal thoughts or actions is normal; it does not make you a bad parent, spouse, partner, sibling, child, or friend. It would be wonderful if one were able to give concrete answers to all questions about risk, but unfortunately, those answers do not exist. The only thing one can do to help your loved one is encourage them to start/continue counseling so they are getting the kind of professional help they need and listen if they clearly ask for more help. Many suicidal people are capable of recognizing when they are more at risk for hurting themselves and will let you know. Then it is time to get them immediately to professional help, whether they can see their own therapist or go to an emergency room for an evaluation. It may be time for them to be admitted to a hospital. Let your loved one know that it is okay for them to tell you this; you will help them get the assistance they need.
But another aspect of suicidal behavior is a fundamental sense of hopelessness. Hopelessness is an emotion that does not motivate a person to reach out – for there is no hope. There are some more subtle signals that you can look out for that might suggest higher risk of dangerous behaviors: loss of interest in things/activities that used to give them pleasure, if someone who has regularly been very depressed suddenly becomes happier/calmer, if your loved one starts to give away things that are important to him/her, and talk about things being better “if I weren’t here” or “I don’t want to live anymore.” If your loved one displays any of these warning signs – ask them straight out – “are you thinking about or planning to end your life?” Yes, it’s a very scary question to ask – and it could save their life. If he or she says yes, then it is time to take him or her to the nearest emergency room. If they refuse to go to the emergency room, suggest that they call the National Suicide Prevention line at 1-800-273-TALK (8255). Professional counselors can talk to them and assist them in getting professional assistance.
A related question that often comes up is the issue of confidentiality. Mental health professionals are obliged to follow rules of confidentiality that are incorporated into federal and state regulations. Many people misunderstand these rules. These rules significantly limit what the professionals may tell someone, especially without authorization. These rules do not apply to people who are not professionals and are concerned about someone. These rules do not prohibit a friend or family member from informing a therapist or doctor about their patient’s condition. The kind of information that is most useful to the professionals are factual observations of the behaviors of the individual that may not be known by the professional, such as the person not showering, not eating, lying in bed all day, talking of despair, giving things away. The mental health professional is permitted to listen to whatever one says; the rules only limit what the professional may say! You should be aware, though, that the professional is likely to reveal to the patient what was said and by whom. This disclosure occurs because the professional needs to be forthright with the patient and may be bringing in information to the conversation with the patient that the professional would otherwise not be privy to. This informing of the patient is not to betray the person who provides the information but only to make the conversation sensible. As a result of this likely revelation, if you are going to call someone’s therapist or doctor, it is best to let the patient know it, so they are not surprised and understand the context in which the information was shared.
Self-Care and Resources
The caring for and worrying about a loved one who has attempted suicide is exhausting. It is certainly stressful. Sometimes that stress can even turn to resentment towards your loved one. Again, these feelings are normal and this may be a sign that you need to also make sure that your own needs are being met. You might find it helpful to get some counseling for yourself to help you cope with the stress and worry you are always feeling. It can be extremely helpful to discuss your thoughts and feelings with an impartial 3rd party who is knowledgeable about suicide, warning signs, and the stress that family members of depressed people deal with. You might find that a few sessions is all you need to refresh yourself; you do not have to feel that you are committing yourself to a weekly appointment indefinitely. The following are some ideas of where to get some emotional relief from the stress.
- Check to see if your employer (or your spouse’s or parent’s) offers an EAP (Employee Assistance Program) benefit. Through many companies you can get a few counseling sessions with a qualified clinician completely free of cost. It might be just the amount of counseling you need to feel emotional refreshed. If you do not have that available, call your insurance provider to find out about your mental health benefits and to get referrals to clinicians in your area. If you do not have insurance right now, go to nmha.org/go/find_therapy to see if one of those resources can assist you in finding care in your area.
- If individual counseling does not sound like it would be a good fit for you – maybe you would find a support group more helpful. Support groups can be run by professionals or simply another person who has had the same experience you are having right now. You can find one by: searching for your local Mental Health America affiliate at nmha.org/farcry/go/searchMHA and then calling to locate the kind of group you need; or you can also call the National Alliance on Mental Illness at (800) 950-NAMI (6264) and they can refer you to your local chapter who can assist in finding an appropriate group. Active duty military, national guard and reservists as well as their dependents, can also contact Military One Source at (800) 342-9647 or www.militaryonesource.com. Alternatively, there are many online support groups you can find by doing a Google search. The National Suicide Prevention Hotline website has a special page (www.lifeline-gallery.org) designated for personal stories by those who have attempted suicide as well as those who love them.
It is important not to allow your concern for your loved one consume you; you need to show yourself as much care and concern you give them. Maybe if they see you reaching out to help yourself – they will be more inclined to do it themselves. You both deserve to feel better. Suicidal thinking and acts typically occur within crisis situations, and crises can be resolved. A hopeful attitude is often realistic as well as therapeutic.