Suicide is a tragic and largely preventable cause of death. Sadly, it is still a leading cause of death in Australia across many age groups, impacting people from all walks of life. Despite this, it can be helpful to keep in mind that most people who have suicidal thoughts and behaviours do not want to die. They are usually experiencing significant despair and want their pain to end. This means that people with suicidal thoughts and behaviours will often respond positively to offers of support.
The way we do and don’t talk about suicide can have a direct impact on those around us. It used to be thought by many that talking about suicide could ‘put ideas into a person’s head’ and so even words of support were often avoided. This avoidance is not helpful. The real and perceived stigma around suicide can be the reason that many people don’t get the help they need. They need to understand that they are not alone. They may need assistance to process their thoughts and actions, come up with a plan for safety, and to get help. At the same time, talking about suicide needs to be done in a careful and considered way.
- Normalise conversations about mental health, feelings, worries and help-seeking.
- Take all conversations or discussion about suicide seriously.
- Use correct terminology and empathetic, respectful language when talking about suicide.
- Avoid language that is stigmatising, sensational or blaming when talking about suicide.
- Always act if you think there might be a risk that someone is thinking about suicide.
If you are concerned about someone or suspect they may be at risk of suicide, then it’s time to take action.
1) Prepare yourself
- Get yourself physically and emotionally ready. Remember that being calm and empathetic, is more important than knowing ‘all the right things to say.’
- Be mindful that there may be difference in culture, beliefs, age and gender. Try to be open to their preferences for communicating and respect differences.
- If you feel unable to ask the person about suicide, then find someone else who can.
2) Make the approach
- Act promptly. Even a mild suspicion can be an indication and is worth acting on.
- Express your concern using conversational language. It can be helpful to point out some of the behaviours or changes you’ve noticed.
- Use calm, non-judgemental language and convey that you’re willing to help.
- If the person is not receptive to talking with you, respect their boundaries, but offer to find someone else who they can talk to.
3) Ask the question
- This is often the hardest part but remember how important it is and that it can save a life.
- Ask the person directly if they are thinking about suicide. This demonstrates your willingness to have the conversation. Often people will not express their suicidality unless asked directly. Ways to ask can be simple:
- “Are you having thoughts about suicide?”
- “Are you thinking about killing yourself?”
- Try not to use leading or judgemental language as it can shut down the truthful response e.g. don’t say “You’re not thinking about suicide are you?” or “You wouldn’t do something stupid would you?”
- Don’t be embarrassed, worried about offending them, or reluctant because you think you will ‘put ideas in their head’. Asking a person if they are suicidal will not increase their risk of acting on suicidal thoughts, but it can be the first step in getting help.
- Be as relaxed, calm and patient as you can, and ready to listen to their response even though it can be confronting.
4) Continue the conversation
Be supportive and understanding and listen with undivided attention.
- Open body language and a gentle voice can help.
- Don’t interrupt or change the subject.
- Don’t feel you need to rush to offering solutions – it’s more important to explore the person’s feelings and for them to feel heard.
- Encourage the person to share their thoughts, feelings, and details about their problems and suicidal thoughts.
- Let the person explain their reasons for thinking about suicide, and don’t dismiss these as trivial or invalid.
- Allow them to openly express their emotions (they may cry, yell, swear, etc)
- Acknowledge the courage the person is displaying by sharing with you.
5) Words of support
- Use supportive, empathetic and genuine language.
- Keep the conversation going – ask open ended questions.
- Use active listening without rushing or cutting the person off.
- Be calm and patient with the conversation.
- Focus on the person and their feelings and experiences.
- Summarise or repeat what the person is saying to clarify and understand.
- Respect the person’s boundaries and preferences for how to talk about it.
- Use the word suicide, and correct language such as ‘die by suicide.’
- Dismiss or trivialise the person’s concerns or feelings.
- Argue over whether suicide is right or wrong.
- Doubt whether the person is really suicidal or imply you don’t believe them.
- Jump to solutions, ‘easy fixes’ or minimise the problem.
- Interrupt with opinions, feelings or stories of your own.
- Use guilt, threats or shame e.g. talk about ruining lives or religious implications.
- Lose interest, get frustrated or decide that it’s too hard to continue.
- Test or incite the person e.g. ‘call their bluff’ or tell them to ‘go ahead’.
- Be dismissive, glib or over-simplify e.g. ‘cheer up’, ‘you’ll be fine.’
- Use inflammatory, judging or stigmatising language e.g. ‘commit suicide’, which implies wrong-doing, or refer to past suicide attempts as ‘failures’ or ‘successes.’
6) Assess immediate risk level
The following imminent risk indicators can be assessed through conversation – ask for specifics.
- Does the person have a plan for suicide (where, when and by what means)?
- Has the person taken any steps or preparations to start ending their life?
- Has the person previously attempted suicide?
- Is the person immediately influenced by drugs and/or alcohol?
- Is the person hearing voices or seeming detached from reality?
If the answer is ‘yes’ to any of the above, then the person may be at heightened immediate risk of completing suicide. People at the highest risk of suicide in the immediate or future are those who have a plan. It should be noted however that those without a plan, can still be at risk and intervention is key.
7) Keep the person safe
- A person who is suicidal should not be left alone. Stay with them or connect them with someone to keep them safe.
- Reassure the person that there are options, supports and ways to keep safe.
- Develop a safety plan together with the person – involve them in the steps.
- Focus on practical things that can be done, not what shouldn’t be done.
- Be clear and assign steps – who will do what and when?
- Identify a length of time that this plan can take place in e.g. over the next hours or days. Hitting these milestones can be a sense of achievement.
- Provide the person with options for support including contact numbers for crisis lines, emergency contacts or a GP.
- Link the person with supports or positive resources that have helped them in the past.
- Connect the person with any helpful family, friends, or other people that can follow the safety plan – everyone needs to be on the same, supportive page.
- If the person refuses to follow a safety plan or you feel you are not getting anywhere then you can ask their permission to contact a medical professional, counsellor or crisis line on their behalf.
8) When to escalate or refer
There are times when keeping someone safe will be difficult or not possible. This is not your fault. You may need to seek assistance from emergency services such as police or ambulance, or from medical and mental health professionals in the following circumstances:
- If the person is actively hurting themselves or is behaving in a way that endangers you or others.
- If the person has an immediate suicide plan, the means to follow through with that plan, and does not respond to steps to keep safe.
- If the person is a child or adolescent (a more active and direct approach may be required, and other mental health supports should be brought in).
- If the person is experiencing psychosis or is physically or mentally incapable of keeping safe.
- If the person has a weapon (call the police and ensure they know that the person has suicidal intent).
9) Self-care and safety
Providing care and support to a suicidal person is hard work, and can be physically, mentally and emotionally confronting and exhausting. Keeping yourself safe and well is of the utmost importance.
- If your physical safety is at any point at risk, take steps to keep yourself safe.
- Be prepared for the person to express all sorts of words, actions and emotions that can be confronting.
- Try not to take their words or behaviours towards you personally – remembering that the person is not in a good place.
- Remember that while you can follow all the steps provided the person’s behaviours and outcomes are not a reflection on you.
- Practise self-care: rest, eat well, get plenty of fluids, and do things that bring you a sense of wellbeing and happiness.
- You are not alone – help is also available to you– talking with others such as friends, family or mental health professionals can help.