I often go for a walk over the Newburgh-Beacon Bridge on Route I-84. Perhaps some readers have traveled this stretch over the Hudson River in New York State. Along the walkway there are signs reminding travelers that help is available for those who are feeling hopeless and might be considering jumping from the bridge. The good news is that there are signs that offer alternatives to suicide. The bad news is that we have experienced an increase in suicide over the past twenty years.
Most years since 2000, about 32,000 suicides occurred in the US, but more recently the numbers have swelled to around 48,000. Other facts about suicide are that white males account for 7 of every 10 suicides. Firearms are used in almost 50% of all suicides. Most suicide victims are in their midlife, and veterans are twice as likely to die by suicide than nonveterans. Another important fact is that suicide strikes both men and women, all races, and across all ages, even children as young as eight and nine.
Signs that may signal that a person is thinking about suicide include feelings of sadness, guilt, or emptiness, hopelessness, or being a burden to others. Behaviors may include irritability, talking about wanting to die, giving away cherished possessions and withdrawal from friends, changes in eating and sleeping patterns, or increased use of alcohol and/or drugs.
Perhaps this topic hits close to home for some readers if they have lost a family member or a friend to suicide. Some readers may have experienced a suicide attempt. It is estimated that for every suicide, an average of 135 people are affected by that one death. These sobering facts can leave us feeling helpless, but there are ways to take action. One of many suicide prevention programs is QPR (Question, Persuade, Refer). It trains non-medical people to manage and encourage a person to take three steps to get some assistance when suicide is a concern.
If you know someone you think may be considering suicide, it is okay, actually really helpful, to ask the question, “Are you thinking of hurting yourself?” or, “Are you thinking about killing yourself?” Such a pointed question makes us feel uneasy because it seems too intrusive and too personal, but sometimes it just needs to be asked. We may also be concerned that the person being asked would not answer truthfully or that the topic is too “touchy-feely” to even ask them about it. There is also the concern that raising this question might contribute to a depressed person considering suicide, and they just might act on it.
All these possibilities could discourage us from asking this question. However, the research tells us that asking about suicide does not set things on a downward spiral. It is possible that the person may express surprise or annoyance when asked. A possible answer to them could be, “I asked because you seem sad, hopeless, not yourself, and I certainly would want you to ask me that same question if I appeared to be feeling or acting that way.” More often, what results when the question is asked, is that the person may be relieved that someone has noticed and has raised the issue.
Sometimes, by asking the tough questions, you become the first person caring enough to have noticed this person’s cries for help. Keep in mind, it is very important that this type of conversation is engaged in privately. If the person acknowledges that suicide is on their mind, this can be frightening. Now what? What is the best way to proceed? In this brief column, we have already covered the first of the three stages – Question the person about suicidal thoughts or intent. The second stage, Persuade, involves respectfully raising concerns about why suicide is a bad idea. Some examples would be asking about the impact their suicide would have on their immediate family members, friends, their co-workers, neighbors, and even their pets. Sometimes the person in danger has not considered this. Other times they may respond that they feel isolated and have no one who would care. Assure them that you do!
Another approach would be to point out that most suicidal people pass through a period of days, maybe up to two weeks, where they are in a serious danger of hurting themselves, but this is usually a temporary period. The advice “never make an important decision when you are in a bad state of mind” applies here. The person who is in danger may protest that they have felt like ending their life for longer than two weeks. So, another talking point to persuade them is that suicide usually is the result of depression, and depression is one of the most treatable health conditions.
There is great success with today’s medicines for depression that can get many people back to a more positive frame of mind. It is usually even more effective if the person is willing to also engage in counseling, especially Cognitive Behavioral Therapy. Many health insurance policies provide coverage for this kind of counseling or psychotherapy. Some community mental health centers charge fees based on a person’s income. The goal is not to debate the person, but to offer alternatives to suicide, which can be described as a very permanent solution to a temporary problem. Listen attentively and respectfully and provide support for this person who may be struggling with how to problem solve because they are depressed.
The third and last step is to Refer – help connect the suicidal person with a professional who can assist them. The best referral is to accompany the suicidal person to a mental health provider or if the person is in imminent danger, take them to a hospital emergency room. It is best to sit with them in the waiting room until they are actually admitted. Another good referral is when the suicidal person agrees to see a professional and you know that they have actually kept their appointment. A third type of referral is getting the person to agree to accept help, even if it is in the future.
If you or someone you know is struggling with mental distress or suicidal concerns, anyone can call and speak to a volunteer without charge at the National Suicide Prevention Hotline. Just dial “988” (services are available in English and Spanish, 24/7). You can call, text or chat. Calling 911 is another source for help. If you would like more training or information about the QPR program, call the QPR Institute at (888) 726-7926 or visit their website (www.qprinstitute.com). Sometimes a suicidal person just needs to know someone cares and, maybe, someone to help them think more clearly. Each of us can initiate conversations that can offer alternatives and save lives.
~ Dr. Terence P. Hannigan is a licensed psychologist in New York and New Jersey. Trained as a Counseling Psychologist, his focus is working with healthy people who want to use psychological principles to improve the quality of their lives. He is a semi-retired psychotherapist who works with both couples and individuals. His personal interests include cycling, travel, and gardening.