Best ways to handle someone who is suicidal?

September 20, 2016 6:01 AM

What are considered the best ways to handle someone (stranger or friend) who is about to commit suicide?

Note: this is not a personal scenario and no one I know is suicidal. This is more of a "what should one do, in this case?".

Is there a general "best practices" guide for how to talk to / behave around someone about to jump off of a building, or otherwise has an imminent plan + method on killing themselves?

I imagine that police officers receive some training on this. What would they learn? Do they call in someone special? Is there time for that?

If you were to see someone about to jump off a bridge, for example, what is the best possible thing to do as a bystander? Call to them? Start a conversation? Should you call the police yourself?

If you or someone you know was suicidal, what sort of things were not helpful to hear? What could someone have said to you to make a difference? Is there anything someone would do inadvertently that would make things worse?

Once again, this is not a situation I am in right now, but I would appreciate any and all insights.

Thanks!

posted by amicamentis to Human Relations (19 answers total)

Some resources on the MeFi wiki.
posted by EndsOfInvention at 6:07 AM on September 20, 2016

First, I have no training so this is just from my own personal perspective from being suicidal a lot.

If you or someone you know was suicidal, what sort of things were not helpful to hear? What could someone have said to you to make a difference? Is there anything someone would do inadvertently that would make things worse?


Not helpful: everything's going to be okay, you have so much to live for, don't be selfish, it's really not that bad, [anything about God], you're being dramatic

Helpful: What's going on? What happened today? I love/care about you and you can tell me anything. [Listen. LISTEN LISTEN LISTEN to them, no matter how irrational they seem, no matter how much you disagree. Just shut up and listen. If they stop talking, make physical contact if appropriate and sit in silence. Provide tissues.]

Inadvertently unhelpful: challenging what they say, e.g. "I'm worthless" "No you're not"
posted by AFABulous at 7:08 AM on September 20, 2016

And - maybe this is obvious but I don't know - the reason you LISTEN is because suicidal people feel that 1) no one cares and 2) everyone hates/judges them/thinks they are a burden. You are directly challenging these beliefs without even saying anything.
posted by AFABulous at 7:10 AM on September 20, 2016

In my experience as a sometimes-suicidal person, almost any reaching-out is better than silence. There have been times when getting a text from an acquaintance about something totally mundane and irrelevant has been enough to remind me that there's people worth talking to and things worth doing and I might as well live.

I guess that might not apply if the suicidal person is a total stranger. But realistically, unless you lead a very unusual life, you are much more likely to hear that a friend is suicidal than you are to encounter a stranger with a gun to their head.
posted by nebulawindphone at 7:52 AM on September 20, 2016

If someone threatened suicide around me and I thought it was a credible threat (someone clearly not just being hyperbolic or sarcastic), I would call 911 first. Then I'd engage with them in as supportive and sympathetic a manner for as long as it took for emergency services to intervene.
posted by smirkette at 7:54 AM on September 20, 2016

I attempted suicide in college, and for about a year prior was deeply depressed. During that time, many of my friends noticed that something was wrong and tried to talk to me about it. One of the things that depression can do is create a trap where improvement feels impossible. I did not want to talk about what was happening to me, because I did not believe my situation could improve. So I basically pushed my friends away -- they tried to talk to me, I said I didn't want to. They tried to invite me to stuff, I wouldn't come. I would go to a party, grab a huge drink, and leave. I think many of my friends must have perceived this as me simply not wanting to be friends with them anymore. I was a jerk to many of them. For those that might have recognized what was going on, it must have seemed as though nothing they tried was helping. Being close to someone who is going through this sort of thing must be very difficult, and it's important to consider your own boundaries and to recognize that you cannot fix their problems.

During my terrible year, I think the best thing that anyone could have done was to be persistent and to try to convince me to get professional help. I am not sure it could have worked. But I do think a few things are important for a depressed/suicidal person to know:

1. There are people who care about you and who will not go away, no matter how low you sink or how terrible of a person you think you are. Depression tells you that you are worthless and that the world would be better off without you. That hanging out with friends or family is just going to bring them down so its better to be isolated and alone. It takes lots of reminders to start understanding that you are not isolated, and so having some persistent people around who keep hammering the message "we care about you, no matter what, and we aren't going away" can be very helpful.

2. There is a way for things to get better. Depression tells you that things are terrible, have always been terrible, and will always be terrible. Lows are so intense that any bit of relief or happiness seems pale in comparison and is sure to be quickly replaced by new and terrible psychic pain. Trying to make things better is demoralizing, because it never works, and that's just another confirmation that you are a terrible person who will always feel terrible. This has got to be one of the hardest things for outsiders to understand and to do anything about. Those persistent people who aren't going away would do well to also share a second message-- you can get better, and there are people who can help you. Finding a therapist or psychiatrist can be a difficult process even when not depressed, and having support in that process can really make it easier. Support can be actual help (look up options and make initial calls to see which docs are taking new patients) or process help (how many calls are you going to make today? what shall we do to celebrate after you've made them? etc).


Last thing -- if it's an acute situation, where you think that suicide is imminent, then calling professionals for help is a great idea. That does not always mean 911. In Boston, for example, there is the Boston Emergency Services Team, which is specifically trained to deal with mental health issues. Might be good to be aware of services in your area and program your phone with some numbers. After calling for help, don't leave the person alone if you can -- either by physically remaining present or through persistent texting/phone calls. Make short term deals -- it's easier to hang on for 5 more minutes or 1 more hour than to resolve against the suicide attempt altogether.

I think it is very hard to help a depressed person. I would not advise trying to do it alone, as a tag team approach means no one person needs to feel all of the burden. Thanks for asking the question and doing what you can to be prepared.
posted by cubby at 8:01 AM on September 20, 2016

Is there a gun in the house?

Remove gun from house.
posted by feral_goldfish at 8:44 AM on September 20, 2016

I'm a suicide hotline volunteer. I'll be nthing some things others have said, but here's a quick summary of what we do:

-Ask outright if the person is thinking about suicide. You won't incite them or give them ideas by saying so. If they say yes, ask if they have a plan. If they have a plan, see if you can talk about how to deescalate that plan: immediate, practical ways to be safe (like removing gun or pills from house, or making sure they are not alone).

-But we don't just baldly ask that series of questions. Mostly, we listen listen listen. We try to observe an 80/20 rule: talk 20% of the time at most. In general, we try to drop the main suicide question as soon as possible, just to get a sense of triage, but after that we focus on hearing the caller out, letting them really talk things through, reflective listening (mirroring back what the person says, to demonstrate that we understand or give the caller the chance to correct our understanding). Safety plan talk comes later.

-Focus on safety for today/tonight, not safety forever. One day at a time. If they're suicidal again tomorrow, we'll talk again tomorrow.

-Try to remember your boundaries; don't slip into feeling ultimately responsible for what another person does or feels. You'll be more empathetic if you do.

-Ask about mental healthcare. Listen to what they have to say about what they've done and whether it's worked. Push for more of what's worked, even if it was only a little.

-Whether we call the police depends a lot on the situation. If we've had a good conversation and made a safety plan and the person has promised to stick with it (and especially if that plan includes a way for them not to be alone tonight), we generally won't call. If we can't secure a promise of safety or doubt that safety is really possible, we call local police non-emergency for a welfare check. We do our very best to involve the caller in this decision, since many people are uncomfortable (at best) with a visit from the police, but we'll call without their knowledge if we absolutely have to.

-You can always give out our number, 1-800-273-8255, or call us for advice on how to talk to a suicidal friend. We do this all the time. You will probably be sent to a call center that's close to you geographically, so ideally we'll also know resources in your area (although I still have to look stuff up all the time -- it's part of the job).

-The suicide prevention protocol we use is called ASIST and there are weekend trainings for it all the time, open to the general public, not just new hotline volunteers. It's spendy, but you may be able to get your work or organization to pay for it. I really encourage anyone who's interested in mental health first aid to check it out. There's lots of roleplaying to get you comfortable.



I really appreciate the input here from people who have been at risk of suicide. Part of the reason I do this is because I've been suicidal too, but it's been a while since I was in that kind of deep-pulp psychological pain and I find that it's very easy to slip into "it'll be OK!" talk now that my main contact with suicidal ideation is from the caretaker's side.

I really encourage anyone talking to a potentially suicidal person, though, not to worry about saying the wrong thing. If you say something tactless or silly once in a while (and we all do it, even experienced hotline supervisors), it doesn't matter compared to the really key stuff: asking, listening listening listening, and making a safety plan. We deescalate 95% of our calls just by listening, and if a person is willing to confide in you, remember that they are asking for help and that's the most important step towards safety.
posted by thesmallmachine at 9:27 AM on September 20, 2016

Mental health first aid has some training on this, and it's a training we provide to employees and student staff at our university. We provide information on the Suicide hotline, and mention that it can be helpful for allies in the moment, because it's a variation of phone-a-pro. My response would be to listen and validate what they are feeling, as there is often a feeling of profound disconnection, or that depression is convincing them that disconnection is a best option and our moment, if we are up for it, is to be that non-judgmental sounding board that deeply hears them until the pros are on board. If you are not up for it, 911 has trained responders. They talked a very drunk & depressed ex-law down from a 80-foot height, in Baltimore, and the 72-hour hold introduced him to detox & recovery.
posted by childofTethys at 10:08 AM on September 20, 2016

Years ago when I took an introduction to pastoral counseling class, our professor told us that if someone ever threatens suicide in front of us, we should call 911 right away. If they were serious, we might have just saved their life. If they were being hyperbolic, they just learned not to speak casually about suicide. That always stuck with me.
posted by Pater Aletheias at 10:57 AM on September 20, 2016

This is if it's someone you know: I just wrapped up a Mental Health First Aid class and was taught it's critical to ask, "Do you have a plan?" because if they actually do have a plan, then we are talking FAR more serious than saying you feel suicidal.

If they have a plan, you want to listen. Tell them that YOU care about them and want them to feel better. Ask them if you can help with their getting help. It's okay to remind people that they haven't always felt this way; they have felt better. No matter who it is, unless you're a trained professional, you should NOT try to take this on by yourself.

What you want to do is to help them get the help they need. Often, that means immediate hospitalization (so you do call 911) or taking them immediately to their psychiatrist/clinician/ER for an assessment. Beyond that, you can be supportive but trying to solve this is not on you.

If a person doesn't have a plan, continue being supportive and help them figure out how they're going to get through the next few hours. Will they see a psychiatrist the next day, etc.

And to responding to a person you don't know who is about to do something suicidal, call 911. Don't think twice. While you're waiting, engage them in conversation. Let them know that someone sees them and someone cares that they stay safe, then let the professionals do their jobs.

*Also, smile at strangers. There are loads of stories of people who have contemplated suicide and said if only ONE person smiled at them, they wouldn't do it. And one person did smile at them and they lived to share that.
posted by yes I said yes I will Yes at 11:29 AM on September 20, 2016

If you call 911, there is a non-zero chance that the person you're trying to help will be shot dead by police. That's a risk I wouldn't be willing to take just to teach somebody not to speak hyperbolically.

If somebody is talking about suicide in your presence, please follow the suggestions of the people in this thread who are trained and have recent experience with assisting people in crisis. If the person you're concerned about isn't yet doing something actively harmful, there are almost certainly better resources than calling 911.
posted by Lexica at 11:48 AM on September 20, 2016

It's extremely contextual but if the person is transgender, neuroatypical (e.g. autistic), a person of color, or doesn't speak fluent English, then I would only call 911 as the absolute last resort. I agree with Lexica that the person is in danger from the police themselves. A trans woman called me once to say she was suicidal and she was planning to take some pills. I called the suicide hotline (who never picked up, btw) and then just went to her house. I took away the pills, checked the place for guns, and listened to her for a long time. If I'd called police it's likely she would have fought them and ended up in a men's jail, which would put her at incredible risk.

Watch the documentary The Bridge. Suicide is usually an impulsive act and most of the people who survive attempted jumps from the Golden Gate Bridge do not attempt again. If you can put any barrier between someone and an immediate attempt, most people won't just go find a different method. The two people close to me who killed themselves did so because there were 1. guns and 2. alcohol present. Take one or both away and I am certain they would still be here. There's a reason I personally do not own a gun.
posted by AFABulous at 12:03 PM on September 20, 2016

From a personal standpoint, the only thing that stops me is my best friend saying "you can't do that to me, you can't do that to my kids."

She knows that in my heart I believe that suicide doesn't remove pain from the world, it just packages the pain up and parcels it out to everyone who loves you. She plays on that. Genuinely, I mean. She believes it too and she's just reminding me.

From a professional standpoint, all the advice above is really, really good. A plan and a means are huge steps past ideation.
posted by The Noble Goofy Elk at 2:56 PM on September 20, 2016

AFABulous, I'm so sorry that the Lifeline let your friend down. Thank you for being there when we weren't. I'm sure you know about the good work the Trans Lifeline does, but for others in the thread who might not, they're at 877-565-8860 (and they're a warmline, too).

I do nth the people pointing out that for members of many populations, the police are a danger in themselves, and they should be a last resort. I've worked with a lot of very admirable cops and dispatchers, but you don't know who you'll get.
posted by thesmallmachine at 7:02 PM on September 20, 2016

To add another voice to the 911-as-a-last-resort crowd, keep in mind that "suicide by cop" is a real way that people use to commit suicide. Be absolutely sure sending the police won't just escalate things.
posted by Aleyn at 9:30 PM on September 20, 2016

What helps with my depressive family members is reminding them of whatever godsawful stupid thing we saw on Youtube in the last week, and pointing out, hey, you're not as bad as That Dude, are you? And no, she does not think she is as bad as That Dude.

So, if he deserves to live - and he certainly thinks he does - you deserve to be alive. If you think neither he nor you deserves to be alive, you at least deserve to *think* you deserve to be alive. Do not let your evil brainweasels cheat you out of something That Dude gets for free.

If you want to use this technique and you don't watch much Youtube, go find some. I'm sure mefites could come up with plenty of inspirational, "look, really, you are not as bad as This Dude" videos. (I will posit that there could be some "not as bad as This Chick" videos, but really, the worst jackassery on youtube is very, very dude-focused. Not talking about horrible racism or other vile content - I mean the "dude is too stupid to live and it is a travesty that the laws of probability have not removed him from the potential gene pool; he did WHAT with a stapler??" variety.)

For myself and occasionally other friends, I point out that, if I'm considering suicide, I might as well consider other extreme no-way-back solutions. I've never tried stowing away on a cruise ship nor given myself a home tattoo using dry ice as an anesthetic nor dyed all my skin bright blue with fabric dye, but hey, if I'm planning on Quitting Everything Forever, I might as well try something exotic and crazy first.

So far, that's been enough to derail the suicidal thoughts. I'm hoping that if it ever isn't, I will be too distracted at playing with dry ice in a bowl of water to remember why I supposedly acquired it.

... doing something small and fun helps. Doing something small and fun that adults (or teens) are told is Too Young For Them helps. Fidget toys. Drawing hand turkeys. Whatever. The point is to find something simple and mildly enjoyable that doesn't have stress or guilt, something that there is no "wrong way" to do. Remind them that they have the right to enjoy their life.
posted by ErisLordFreedom at 11:09 PM on September 20, 2016

(not an answer to the question, but it doesn't seem like quite the thing for MetaTalk, mods feel free to delete if it's inappropriate)

Thank you to all of you who have answered in this thread. This is a situation that's come up a few times, and it's terrible to not know what one should do, feeling like a misstep will have terrible consequences.

I don't have any advice to add, however, if you do find that you are helping someone who is suicidal access help, expect that you will need some self care afterwards. If you have driven somewhere to help, consider whether you are really ready to drive before you leave. Find someone who is further from the situation and can keep things confidential to talk it over with, and expect to be dealing with some difficult emotions. If the person you helped is a friend, it's probably good to do this before next time you see them. Don't expect your friend to be grateful to you for wanting to help, they might even feel like you did something wrong in seeking help for them -- but know that you did a good thing anyhow.
posted by yohko at 7:31 PM on September 22, 2016

As an amateur and pro, I'd say "understand" then "escalate" is a good solution. Basically you want to separate "cry from help" from "risk of death" and providing serious consequences for behaviors is a good way to do this.

Unfortunately, in some countries (USA) escalating to the "I'm going to call 911" level can be very adverse, so it's not clear what to do. Many communities have non-police numbers to call ("community psychiatric emergency" etc.) lines which are less likely to end up with your loved-one dead.
posted by soylent00FF00 at 7:40 PM on September 22, 2016