.png)
What do we do when a loved one tells us they don't want to be alive anymore? What can we do when we want to protect someone that is hurting themselves?
There's no quick-fix, but below you'll find some tips for helping someone you care for survive through incredibly difficult times.
Suicide is a scary word. Terrifying. Even the most seasoned of mental health professionals feel a knot in their guts when they hear a client confess that they're not sure they want to be alive. And yet, suicide is the 12th leading cause of death for adults in the US and the second leading cause of death for young people aged 15-24. There were 1.2 MILLION suicide attempts in 2020 alone.
With statistics like that, we can't really afford to close our eyes and pretend that there's no monster hiding in the closet. The monster is real and it's out for blood.
One of the biggest problems in helping people through suicide and self-harm is how much we DON'T talk about it. Not just in a professional context. We don't talk to our friends about it, we don't talk to our family about it, we don't talk to our partners about it. While there are a lot of reasons for that, most of these reasons are based in misunderstandings or faulty assumptions about the issue.
We worry that by asking about suicide or self-harm, we might "give someone the idea" or "push them over the edge". We worry that asking about their innermost struggles would feel too intrusive and might push them further away. We worry, and we worry, and we worry, but worry alone doesn't keep our loved ones safe. So what can we do?
Self-Harm, Ideation, & Suicidal Action: Understanding Important Differences
First, let's talk about the difference between self-harm, suicidal ideation, and suicidal action. These three things are not the same.
Self-Harm is exactly what it sounds like: intentional self-injurious behavior. One of the biggest misunderstandings about self-harm is the intent or goal behind the behavior. With self-injurious behavior like cutting, biting, punching, etc the intent is rarely to kill one's self. On the contrary, self-harm is most frequently an attempt to cope with something that feels like it might kill us.
Like any coping behavior, the goal is to survive an emotion that feels unsurvivable. Self-harm behaviors release a flood of endogenous opioids (pain-killers). The sudden flood of new chemicals into the brain and the strong sensory component involved in most self-harm behaviors result in a quick and intense shift in emotion. This flood of "relief" chemicals in the brain also helps explain why those who struggle with self-harm have a difficult time stopping the behavior despite the level of danger and the intense shame that follows. As far as maladaptive coping strategies go it's a powerful emotion regulation tool, but like any other maladaptive coping strategy (substance abuse, sex, food, etc) the strategy becomes less effective over time and progressively more dangerous with each use.
The take-away? Self-harm is rarely about suicide or "attention-seeking". It is often an attempt to control emotions that feel completely out of control. The intense shame and guilt that follow this behavior often result in intense secret keeping and covering up of self-harm behavior (which is about as opposite of "attention-seeking" as one could get).
Suicidal "Ideation" is a clinical term meant to convey that someone may be thinking about suicide, but have not yet taken action towards hurting themselves. There is a WIDE variance in intensity captured by this umbrella term. Suicidal ideation may convey that one occasionally has brief, very general suicidal thoughts such as "I wish I wasn't here anymore" or "Everyone would be better of without me". Suicidal ideation might also convey that one has a very specific plan in mind for how they may take their lives. Because of this wide categorization, clinicians will often spend time with clients meticulously trying to decipher where exactly a clients falls along this continuum.
Suicidal thoughts are relatively common, particularly among those that struggle with mood disorders (depression, bipolar disorder) or PTSD. However, suicidal thoughts don't always translate into suicidal action. Just because someone has a general or even specific thought of suicide does not necessarily mean that they will act on the thoughts.
The take-away? Suicidal ideation is important to identify and discuss with a trained professional. Generally speaking, the more general and non-specific the thought, the lower the risk. Just because someone struggles with suicidal ideation does not mean that they are in immediate danger of hurting themselves. They do, however, need support and to be connected to resources and professional help. This does not mean you have to rush to call 911 unless action is imminent, however contacting a suicide hotline or other resource may be helpful. Slow down and listen. Compassion is a great first step to getting someone the help they need.
Suicidal Action is another self-explanatory term. Those with intent towards suicidal action ("I have a plan and I'm going to do it") need immediate emergency intervention. As mentioned above, it can often be difficult to distinguish between non-suicidal self-injury and a suicide attempt. Leave this to the trained professionals. If a friend or loved one has a plan and intent to hurt themselves, they need help now. Suicidal action may be generally planned out ahead of time, but the intent to act on a plan is often an act of impulsivity (I.e. the straw finally broke the camel's back).
Some warning signs that someone has moved from "ideation" to "action" are listed below:
Sudden isolation from friends and family
Visiting, calling, or texting loved ones to say goodbye
Giving away prized possessions
Sudden relief or dramatic improvement in mood following a long period of depression or hopelessness
Talking about wanting to die and/or researching methods of dying
The take-away? Suicidal action is extremely serious. If you're with someone or hear of someone planning to hurt themselves, call 911 or mobile crisis immediately.
Not Sure What To Do? Act.
Knowledge is power, but action saves lives. Remember that you're not a trained professional. It's not your job to be able to swiftly and accurately to tease out the subtle clues and identify exactly what a loved one is struggling with. If you're worried about someone, it's always best to take action now and ask for forgiveness later.
Not sure what to do? Here's our "Do"s and "Don't"s for helping a loved one struggling with self-harm or suicide:
Tip #1 - Don't Be Afraid To Ask. Instead, Be Direct
One of the BIGGEST fears I hear around supporting a loved one through self-harm or suicide is this: "If I ask them about suicide, it might put the idea in their head or push them over the edge". This couldn't be further from the truth.
Asking someone if they're thinking about killing themselves will never put the idea in their head. If you've noticed a troubling pattern of behavior that makes you feel the need to ask, chances are the person you're worrying about has been struggling for at least a little while already. Asking someone directly about suicide can feel like a relief to those that are struggling. They've likely already been struggling with feelings of hopelessness, isolation, and feeling like a "burden" to those around them. Asking them about suicide or self-harm can be the first step in letting someone know that they are cared for, not alone, and not invisible.
When you ask a loved one about suicide or self-harm, be direct. Don't beat around the bush. "You seem like you've been down. You wouldn't do anything crazy, would you?" Is not going to cut it. "Suicide" is not a bad word. Use it to ask exactly what you mean: "I've noticed you've been really depressed lately and I'm worried about you. Are you thinking about hurting yourself or having thoughts of suicide?"
I've never met anyone who regretted asking a loved one about their depression and suicidal thoughts. I have met those who regretted remaining silent.
Tip #2 - Don't Keep Secrets. Instead, Tell Only Those That Need To Know
We've all lived through a situation where a friend turns to us and asks "Can you keep a secret?". Who wouldn't feel pressured to say "of course"? When it comes to safety though, we may want to rethink this policy.
Teens and young adults get stuck here most often, but adults are not immune. A friend may confide in you or your child that they're struggling and try to swear you to secrecy because "no one understands and if other people find out it will only make it worse". Sometimes, it's true that a loved one might not have anyone else in their life that understands or may be in a situation where they get some backlash for needing to be hospitalized for suicidal behavior or severe depression. But these concerns are secondary to keeping them alive.
When we keep secrets around suicide, we're only hurting and isolating our loved one further. It often prolongs the situation driving the overwhelming emotions in the first place (abuse, bullying, neglect, isolation, etc). Don't get me wrong, we don't need to put our loved one's innermost struggles into a tweet for the world to see. We do need to tell those people who need to know, and ONLY those who need to know: a parent, a romantic partner, a sibling, or (if all else fails or there's imminent intent) an emergency services provider.
We can't emphasize this enough: if someone you know is on the verge of or has a plan to act on thoughts of self-harm, call 911, 988, or mobile crisis immediately.
Here's a phrase to practice when someone asks you to keep a secret:
"I can keep anything a secret, as long as it doesn't risk yours or anyone else's safety" – You After Reading This Blog
Tip #3 - Don't Turn a Blind Eye. Instead, Reduce Access to Means
This tip is mostly suited for parents of struggling kids/teens or romantic partners, but it's a critically important tip none-the-less. As we mentioned above, it can be all too tempting not to ask direct questions about suicide even though we know our loved ones might be struggling. We also might be tempted to trust our loved ones to reach out and let us know if they need help or want us to take a more active role in their safety/healing.
But sometimes, we can't afford to wait.
Suicidal action is often an act of impulse. Even if someone has been wrestling with suicidal thoughts for months, most often people put these plans into action in moments of desperation, emotional overwhelm, immediately following a new stressor (losing a job, a breakup, etc), or while under the influence. This means that every single obstacle we can put between an actively sucidal loved one and something they can use to hurt themselves with buys us critical seconds.
The longer it takes someone that is actively suicidal to find something they can use to hurt themselves, the more likely they are to rethink their intent. Emotions do not last forever, even really big ones. By buying our loved one critical time to defuse, it's more likely that the overwhelming sense of hopelessness will begin to fill a little less intense and that just might be enough to keep them alive and get them help.
What does this entail? If your loved one has disclosed a plan to you, make sure the items they have planned on using are accounted for, under lock and key, or (preferably) out of the house entirely. This could be guns, knives, razor blades, pills, rope, or even their vehicle. To be clear, this is not a permanent solution. The kitchen knives don't have to stay locked up forever, just for the next few months while you're loved one is getting treatment.
It's important to walk a fine line and not make your loved one feel like a child or like they can't be trusted. Don't try to be sneaky or covert about their shaving razor suddenly vanishing. Be direct, honest, and KIND about what you're doing and exactly why you're doing it. It's all about buying time.
As we said at the top, this is most likely to apply primarily to parents or partners. Friends don't always have easy access to a friend's home. But it doesn't hurt to ask, especially if your friend is really struggling. A simple "Why don't I hold onto that for you while you get some help" can go a long way. Don't hesitate to make this recommendation to someone who needs to know that your friend is struggling (a parent, a partner, a roommate, etc).
Tip #4 - Don't Try To Change Their Mind. Instead, Listen & Validate
It can come as quite a shock when you find out that someone you love is struggling with suicide or self-harm. Our first instinct is sometimes one of disbelief. Our second instinct may be to point out what seems obvious to us: that they have "so much to live for", that self-harm "is just making your problems worse", or to tell them that suicide is "selfish".
Even though we're sure you have many fantastic and wonderful reasons why your loved one shouldn't hurt themselves, it's likely that most of these arguments will fall on deaf ears. Those who struggle with suicidal ideation and self-harm often struggle with another co-occurring disorder: depression. One of the most common side-effects of depression are "automatic negative thoughts". Often those who are wrestling with these difficulties feel strongly that they're a "detriment to those around me" and/or "that everyone would be better off without me". People often spend months or years with these thoughts bouncing around their head before they decide to take action on hurting themselves.
On top of this, our brain's emotional center is older and stronger than the pre-frontal part of our brain, which is the rational, logical, "brake system" of our brain. When a person is overwhelmed by emotion and in a state of crisis, this pre-frontal area is significantly impaired because of how much energy the emotion center of the brain is utilizing. The engine is running full throttle, but the brakes are cut! Appeals to logic, however sound, are really unlikely to work when someone is in crisis, no matter how much you care about them or they care about you.
So what can we do? Lean into their emotions via genuine connection and validation. People in the midst of struggling with self-harm and suicide often report feeling isolated, alone, and the deep sense of shame that accompanies these urges often prompts them to hide how they're really feeling from those they love for fear of being judged. When a loved one discloses self-harm or suicidal ideation to you (NOT IMMINENT SUICIDAL INTENT) we should be listening and offering support as our very first step to helping them.
Validation does not mean that you agree with their self-deprecating thoughts. It does not mean that you support their choice to hurt themselves. Validation is conveying through words and actions that you hear how they feel, that you're actively trying to understand, and that you recognize how much pain that they are in. Reflect their feelings back to them, summarize their points, and try to read between the lines. Validation can help us feel connected to those we care about and when we're connected, we can "co-regulate" our emotions with more ease. This may help deescalate current emotional intensity and your loved one may then be open to additional resources and support around their struggles from trained professionals.
Tip #5 - Don't Try To Fix It. Instead, Remember: You're Not Their Therapist
Our last tip may be our most important tip. Remember: you're not their therapist! I know it sounds obvious, but hear us out.
Offering support to our loved ones through a really difficult time is an amazing gift to give someone. If you have the capacity to use any of the tips above, offering a listening ear is already doing more than should be expected of you. However, when it comes to supporting those we care about we have to draw the line somewhere for two important reasons.
First, you're (likely) not a trained professional. Suicide and self-harm are really tricky things to deal with. Making any misstep can quite literally mean life or death. Someone who is actively hurting themselves or planning on hurting themselves needs more help than you can provide by yourself. It requires direct medical and mental health intervention via therapy and sometimes medication or hospitalization. The best thing you can do for your loved one is get them linked to those that can directly help.
Second, you have a responsibility to take care of yourself as well. Even with all the patience and compassion in the world, supporting a loved one through mental health struggles can be incredibly draining. There is only so much support you can provide before your own well-being and mental health will begin to suffer too. It's very important to have clear and consistent boundaries, how much and what kind of support you can offer loved ones that are struggling. The road to healing is a long one. Remember, you're running a marathon, not a sprint and we can't pour from an empty cup. You won't be able to help your loved one when they need it most if you've completely burnt yourself out by over-extending yourself.
So, when a friend comes to you and tells you that they're struggling, listen. Validate. Offer support. Ask questions. Tell them how much you care about them. And then say this: "Let's get you some resources".
"Let's Get You Some Resources"
What kind of resources does one need to deal with suicide or self-harm? There are several great resources everyone should have on hand.
Resources for Suicidal Action
If you or someone that you love is struggling with active suicidal ideation or you/they don't feel like they can keep themselves safe, reach out to emergency services immediately. Here are some options for our area (Middle Tennessee):
Call 911
If you or someone you love is in active physical danger, don't wait. Don't hesitate. Call emergency services NOW.
Call or Text 988
988 is a suicide crisis line. It's a wonderful resource for those that need additional support but are not yet in imminent physical danger.
Call Mobile crisis at 615-726-0125
Mobile crisis is a group of trained professionals who will show up to evaluate and assess for safety when someone may be in active danger of hurting themselves.
Resources for Suicidal Ideation
The best resources for passive suicidal ideation are often a combination of medication and psychotherapy. Many therapists, like our therapists at Mind The Gap, specialize in treating suicide and self-harm. We highly recommend going to a website like PsychologyToday.com which is a therapist and medication provider search engine.
You can filter your search results by all kinds of options, one of which is "suicide". Take a look through the providers that specialize in working with this, read through their profiles, and reach out to a few that seem like they might be a good fit for you.
Resources of Self-Harm
Self-Harm also benefits from a combination of medication and psychotherapy. However, we can get a little more specific here. With self-harm, there is a particular form of therapy that address self-harm and it's underlying causes directly: Dialectical Behavior Therapy (DBT). You can look for therapist that specializes in DBT via PsychologyToday.com filters, but you might also benefit from a DBT skills group, like the one we offer here.
DBT skills groups are more like "classes" that introduce critical coping skills for crisis behavior and overwhelming emotions. Group, individual therapy, and medication often offer one hell of a 1-2-3 approach to getting great results a lot more quickly that one of these things alone.