Suicidal ideation support group?
October 15, 2013 11:31 AM   Subscribe

Do you think starting a suicidal ideation support group (in the flesh, not chat groups or hotline numbers) would be helpful or detrimental?

Suicidal ideation has a lot of stigma attached to it. I've struggled with it my whole life pretty much, and the shame I feel for having those thoughts just strengthens them and makes me feel more depressed and hopeless. I've also personally been trying to get sober (booze is my drug of choice) and have been going to AA meetings everyday recently. I'm still skeptical of it all, especially the rhetoric involved (as an agnostic), but just meeting in a room with people who have experienced some of what you have experienced and talking openly and anonymously is helpful in itself. Does such a thing exist anywhere for suicidal thoughts? I've searched, and I've only found support groups for people who have lost someone from suicide.

I've known many people who have made plans and even attempts, but were unable to be honest with their family/friends/therapist/whatever because of the stigma. I know something like this might come with a huge liability, but to put it into perspective, chronic alcoholics are basically killing themselves without much fear of being forcibly hospitalized. Suicide hotlines and whatnot I'm sure can be helpful for some, but I think sitting down with other people who have thought the same thoughts you have and being open and honest about it might be helpful. Am I totally off base here? Everyone has their own reasons for thinking about killing themselves, just like everybody has their own reasons for drinking, or shooting up, or whatever.

If you do think this would be a helpful thing, I am welcome to any advice about how it should be set up, or any other ideas about how it could be helpful rather than potentially detrimental.
posted by mingo_clambake to Human Relations (12 answers total) 5 users marked this as a favorite
Best answer: I believe this is the type of thing best discussed with a therapist, one on one, and not in a group setting. I have not been suicidal but I do suffer from pretty bad depression. I find speaking with other depressives about the disease causes me to get kind of stuck in it, I focus and think about it too much, I remember the horrible way I felt during a bad episode, I relive the triggers and causes (if there was one) of the bad episodes, I get sad for all the time I lost being stuck in my depressive state, and it usually kicks my mood. The discussion with other depressives often isn't about solutions or ways to get out of a depressive state, but instead be more focused on how our depression manifests for us each personally, and that is where the toxicity comes in. Considering that I have that happen to me just with my depression, I have to believe that a similar thing could happen when discussing suicide. I would be worried that speaking with other suicidal people would run the risk of putting (or keeping) people in a really unhealthy mindset.

Speaking with a therapist, however, changes the discussion from co-miserating and reliving bad moments to a discussion about solutions, how to get out of that depressive feedback look, ways of thinking about things to try to get better. It is a healing and solution finding discussion. I know that sometimes hearing how other people have come through a similar situation can be helpful, but I think the risks are too high. I would never want to risk having those thoughts put back into focus, I would never want to risk dwelling and focusing on such a negative bad time in my life.

Just my opinion.
posted by PuppetMcSockerson at 11:43 AM on October 15, 2013 [4 favorites]

Every group therapy session I have ever attended included at the introduction the fact that discussion of suicidal ideation was expressely not permitted and anyone bringing up the topic would be ejected from the meeting.

Suicide appears to require a person to feel three things concurrently (however brief the overlap may be)
  • "thwarted belongingness"
  • As if they are a burden
  • Not afraid to die
Two of these things may bring a desire for suicide. But the three together appear to be fatal.

One of the things that happens with suicidal ideation is that the method the person is thinking of is too scary/potentially painful/ or might cause loved ones to have to find the body or deal with a mess at the scene. This creates or intensifies a fear of dying. Which prevents suicide.

Now, in a group setting to discuss ideation, another member might mention a method that strikes someone else as nowhere near as scary as the others that have come to mind previously. This dissolution of fear could be the tipping point toward an attempt.

I also understand the concerns raised with wanting connection to other people who have ideations, but what happens if that connection is broken or not well forged? Then the sense of not belonging may grow. Which is dangerous. And what if the client is the person with lots of questions, or with special needs like claustrophobia or flashbacks? Then they feel like a burden on the rest of the group.

I cannot see a way to safely have such a group.
posted by bilabial at 12:17 PM on October 15, 2013 [12 favorites]

Best answer: I'm with kanata 100%, word for word.

I would really love to attend a group like this, because meeting with people at various stages of progress can be very inspiring and encouraging. A lot of times, suicidal ideation works to enhance feelings of terrifying isolation, and it often convinces you that no one who has felt this low has ever lived to see the other side. It can be very refreshing (and even quite scary) to see and interact with people who are earnestly and actively trucking through the mud in spite of it all. Hearing people talk about how they have been able to adapt their lives around suicidal ideation makes long-term survival seem more possible and tangible, less abstract or wishful. So much focus is given to simply eliminating those thoughts outright, and little to no effort is spent touching on the possibility that it is not necessarily possible to do so for everyone -- it certainly hasn't been for me. It definitely does get a little funny sometimes and it would be brilliant to be able to talk about stuff like that.

Unfortunately, as has been touched upon, the liability issues would likely be labyrinthine and may make the continued existence of such a group into tenuous and touchy at best. Would there be liability release forms? What would you do if you lost a group member to suicide, or if someone wanted to pointedly discuss methods based on their effective lethality? What if someone said they were going to do it that night, right after the meeting? Would you contact authorities to have them locked up or let it slide? And if they succeeded, would their family or friends approach group leadership with open arms, thanking you for your consistency and support during their darkest hours, or pointed fingers, demanding to know what you had done or discussed or why you hadn't taken a more active role in ensuring their survival?

As someone who has been in the same boat for decades, my overarching fear would be that word would somehow get out and group members could or would be involuntarily institutionalized even though the overwhelming majority of them would just be looking for kindness and support. It is absolutely lost on the majority of people, including many who work in mental health-related professions, that suicidal ideation does not always equate to suicidal intent. And contrary to popular perception, it is not especially difficult to remand someone into custody for a 72-hour psych hold. A lot of people believe that suicidal ideation is, in and of itself, evidence of grave disability. Having a group openly discussing information that easily meets most states' 5150 standards would be putting everyone into an inherently vulnerable position. It would mean each member would have to rely entirely on the generosity of strangers to not call the cops/shrinks and have them forcibly detained. That's super scary, to put it mildly.

The closest thing I can imagine to a suicidal ideation support group would be something like The Icarus Project, so it might be worthwhile to touch base with some of those folks and see how they have handled the liability aspects of creating a group that is likely to include people struggling or working with those thoughts.

Thanks for wanting to accomplish something like this. I agree that it would be immensely valuable.
posted by divined by radio at 12:19 PM on October 15, 2013 [2 favorites]

as someone who has known a lot of people who have committed suicide i'd say this is not a good idea, especially for a layperson, to start. the thing about suicide is that it has a strange habit of happening in clusters or spreading from one person to another who are in proximity. this has been documented by the american medical association and also happened in my hometown. if you start a group and someone kills himself then it may also embolden others to do the same. the people left in the group would be traumatized and more likely to do the same themselves. being exposed to the suicide of others increases the chances of one doing it himself. trust me on that one as i know from losing so many friends. after many years of no one killing himself i just found out a little over a week ago that another friend's spouse has done so. it is a really devastating thing to experience losing multiple people to suicide and you don't want to experience this.

i totally understand that you want to have a place to share and find support and i've felt these feelings myself, but i just don't think this is a good way of finding help. you probably already know that alcohol is a depressant, so i think if you keep working on your sobriety you are definitely on the right road. i tried numerous therapists and meds for years for help with depression, including suicidal thoughts, and neither helped. what did was going to adult children of alcoholics even though i'm not even from an alcoholic family. it was the only thing that worked for me. honestly, it's pretty much a miracle that i'm alive and didn't end up like my friends. my advice to you: keep going back. just take your agnostic doubts with you and you'll figure all that out in time. it's a process so be gentle with yourself.
posted by wildflower at 2:17 PM on October 15, 2013

Response by poster: bilabial,

Suicidality is not foreign to me. If I were to start any type of group like that there would be ground rules-- That is part of why I am asking here, for ideas; Things like: 1. thought does not equal belief 2. no talk of specific plans 3. a sponsorship-like set up where you could call someone you trust without having to listen to 10+ minutes of options while listening to muzak, only to speak to another stranger who doesn't know your story, like it is with call-lines.
I think what I envision it being like would negate your first concern "thwarted belongingness" -- In fact that's exactly why I thought such a group would be helpful.
I do really believe it would be helpful for many people, but of course a major concern would be the legality/ethics of it, hence this AskMefi... I really would like to have a conversation about the plausibility of something like this.
I recently just talked to a friend that has been through AA and NA and she mentioned how she bought well more than enough heroin to overdose, with that intention, years ago. Did that make me go out and do the same, even though I was struggling with these self-destructive thoughts myself? No. It made me empathize with her and in turn enabled me to empathize with myself, and accept why I have had these feelings for so long--- which a lot of abused, abandoned, neglected people have a hard time with. I think it's pretty fair to say that people in those types of situations put themselves last, much of the time... And sometimes you need to empathize with someone you see to be more or less in the same boat to be able to accept that and have compassion for yourself.
posted by mingo_clambake at 2:39 PM on October 15, 2013

It sounds like a bad idea to me.

While I understand the intent, in practice I think it would unfortunately lead to some people hearing of "better" ways, or ways that they hadn't thought of, to suicide.

One-on-one meetings with a professional, as mentioned above, sound much better/healthier/safer as they would not seem to have have any possibility of turning into "story/method/fantasy pitch sessions".
posted by blueberry at 3:51 PM on October 15, 2013 [1 favorite]

Best answer: I think it could be helpful, as long as clear boundaries were set (as you have outlined.) I know that there is an idea that if you talk about a method of suicide you might be "putting it into someone's head" but if someone is truly intent on ending their life they will find a way no matter what. No one is responsible for another person making that choice. I would also argue that a support group would mitigate against the sense of not belonging, which is one of the risk factors mentioned above.

I'm not sure if this is entirely analogous, but I worked on a children's counselling helpline for a while. The kids used message boards to support each other. The thing that really struck me, in relation to SI and also eating disorders among others, was that rather than encouraging each other or "sharing tips" as such, they were all absolutely wonderful at telling each other the things they needed to hear for themselves. They helped each other find ways to cope with the issues, and find better ways forward. My gut feeling is that rather than people saying to each other "this is a better way to kill yourself", they might say to each other "I know how you feel, but don't do it".

Good luck in staying well and congratulations on dealing with your alcohol issues. That takes guts.
posted by billiebee at 4:07 PM on October 15, 2013

For logistics, your best bet is to become a trained therapist and do clinical research of suicidal ideation. Design a reliable instrument and collect data about what thousands of people who have experienced/ are experiencing SI want. Look at what the people who want this kind of group have in common.

Then, recruit for groups. Randomly assign people into the ideation discussion group, and the control group. Measure outcomes at 6 month, one year, five years out. Control for other treatments received in the interim. Control for everything.

Maintain IRB approval throughout the process.
posted by bilabial at 4:35 PM on October 15, 2013 [2 favorites]

while i think your heart is in the right place i still think this is an idea that could cause more problems than help. in my previous comment i was talking about people actually committing suicide and how that is known to increase the likelihood of others in proximity to them doing so. having a group of people who are struggling with SI (suicidal ideation) you will invariably have someone in the group go ahead and kill herself. sadly, it is just very likely to happen. have you also considered that the family of someone in your group who kills herself may sue you and your group? you can have members sign liability waivers, but you can't waive liability for what their family members do. because this idea seems to go against what mental health professionals think is therapeutic i can sure imagine a jury finding with a family whose loved one committed suicide after being in a group where they talked about the SI. i know that you are really wanting to help others and de-stigmatize this issue but there are other factors to consider here--namely the effects of suicide on others who are struggling.

I recently just talked to a friend that has been through AA and NA and she mentioned how she bought well more than enough heroin to overdose, with that intention, years ago. Did that make me go out and do the same, even though I was struggling with these self-destructive thoughts myself? No. It made me empathize with her and in turn enabled me to empathize with myself

your response here is about people talking about suicide and i don't honestly know how much that affects others, but your logic here is really flawed for a number of reasons. first, your friend is talking about something that happened years ago in her past rather than in real time. second, she has been through AA & NA so has obviously experienced some recovery, possibly significant recovery. she is telling you an experience from her past from the place of being in a healthier state. so, it is not at all surprising that it didn't prompt you to go out and do the same. say this did happen in real time and it was someone who didn't have years of recovery. maybe you would be fine even under those circumstances which would be great. that in no way means you can generalize that to how others struggling with SI would react. one person may be fine and another may go out and do the same thing. you can in no way come to the conclusion that because you didn't go out and do the same from someone telling you about an experience from their past after years of recovery that others would all react in the same way in real time to someone they know talking about their suicidal plans. it just doesn't work that way at all.

as others have suggested i think your best bet is to find a therapist that is okay with you talking about SI. some therapists do not have a problem with this. i know you want to help others and there are many other ways to do so. you could volunteer at a suicide hotline. also, there are recovery groups that are designed for those who are spiritual skeptics. here is a group called life ring that i think used to be SOS.
posted by wildflower at 5:57 PM on October 15, 2013 [1 favorite]

I think that a support group for people with suicidal ideation could work really well IF, and only if, it was led by a therapist.

I've been in a couple different eating disorder groups over the years, which have the potential for all sorts of bad outcomes - normalizing disordered behavior, teaching new techniques (such as how to purge more easily), a weird competition element (who can be the thinnest / sickest), and liability for potentially very dangerous behavior.

All of those can be, and are, problems in unmoderated groups. All of those are minimized/avoided if the group is led by a (good!) therapist, who in addition to moderating/ being present for the group also screens the members in advance. In the good eating disorder groups I've been in, the therapist has only let in people who she thinks are in the right place mentally to benefit from the group. And, people have been kicked out if they were harming the group dynamic.
posted by puppetshow at 6:03 PM on October 15, 2013 [1 favorite]

Isn't suicidal ideation most of the time a co-morbid symptom with a range of conditions? You would be essentially bringing in a very diverse group of people for one risky symptom, and it would be less useful to have someone who has ideation because of severe depression talking to someone who has it from borderline personality because the symptom is coming from entirely different origins.

I understand wanting to connect with people about this, but you would need to identify people like you and kanata who deal with this as a long-term issue that doesn't spiral into a crisis, and somehow prevent or block access to people for whom discussing this without a trained therapist can trigger a suicide attempt.

I would suggest starting a very heavily moderated blog with discussions on this where you look for people who have this as an ongoing non-crisis issue and gather together research and other commentary, while making it very clear that you will not discuss methods and will ban anyone encouraging suicide attempts and have a clear protocol for people who are in crisis, such as contacting their support, emergency services etc. You would have to very very much moderate this, even online.

Bilabial has the best longterm plan if you wanted to do this safely in reality. Otherwise, this is more likely to harm than help.
posted by viggorlijah at 8:21 PM on October 15, 2013 [1 favorite]

I think a therapist led group would be a good idea. I think if it's led and populated solely by lay individuals would be detrimental.
posted by RainyJay at 1:31 PM on October 18, 2013

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