Talking About Suicide: Moving from Reactive to Responsive

Trigger warning: This post talks about suicide. If you or someone you know is experiencing suicidal thoughts or a crisis, please reach out immediately to the Suicide & Crisis Lifeline at 988 or text HOME to the Crisis Text Line at 741741. These services are free and confidential.

‍
Talking about suicide is activating. It elicits strong responses - ranging from panic, avoidance, helplessness, sometimes even anger. Unhelpful narratives around suicide include it being “selfish,” it being a “sin,” or seeing chronic suicidality as “attention seeking.” Not often is it acknowledged for what it truly is - a nuanced reaction to a complex set of circumstances, often influenced by factors involving trauma, marginalization, systemic oppression, and stigma. When we subscribe to reductive narratives, we do harm to our loved ones and to our communities.

In the years I have spent working with clients experiencing suicidal thoughts, the one commonality that is present for nearly everyone is a profound sense of isolation. Many times, my clients have waited months, sometimes even years, to fully open up about their relationship with suicidality. I have held space for folks as they shared the pain of being othered by their loved ones, their thoughts deemed too dangerous to be heard - leaving them further isolated and alone. Worse, I have listened to the stories of those who made the brave and vulnerable choice to share their suicidal thoughts with someone, only to be met with immediate panic and sometimes subjected to traumatic experiences with police encounters and hospitalization. 

We are quick to tout words of encouragement about how folks should “talk to somebody,” but how many of us (providers included) have been guided on how to actually sit with the pain and the worry that hearing someone’s experience can evoke? Providers can be hyperfixated on liability - being made to feel so concerned about protecting their license that they are not able to tolerate the perceived risk of working with a suicidal client. And it comes as no surprise, then, that clients are reluctant to open up about what might actually be going on for them. If you are a provider that has been taught that safety plans, crisis lines, and hospitalization should be your top considerations when working with a client expressing suicidal thoughts, I gently challenge you to consider how this might be impacting the quality of care you provide. I invite you to consider the possibility of expanding your practice to include a more compassionate, regulated, and anti-racist approach to this work. 

While the rest of this blog will focus on how anyone can support a person who expresses suicidal thoughts, helping professionals might find it useful too.
‍

Being a Support 

When we see suicidal thoughts as pathological and immediately urgent, we run the risk of being reactionary rather than responsive. Of course there are situations where someone might be in imminent danger, and at that point calling 911 might be the only option. These situations, though, are not nearly as common as we might think they are. If our first response to someone that shares suicidal thoughts is to advise calling 911, we have missed an important opportunity to connect and understand so that we can offer support that might actually make a difference; and we run the risk of putting certain people (particularly BIPOC people) at a greater risk of harm. 

Similarly, if we are too quick to respond to someone’s disclosure of suicidal thoughts with statements like, “you should really talk to a professional,” we have effectively communicated that their feelings are too big and scary for us to sit with. 

Now, I want to be clear in saying that there is nothing wrong with being activated by someone sharing suicidal thoughts with us. This activation comes from a place of concern. It is challenging to know that someone we care deeply about is suffering, whether it is a client or a loved one. It is okay to feel panicked. What actually matters, is what you do with your panic. 

When I am training new therapists I love using the analogy of being like a duck - calm on the surface, but paddling like hell underneath.

‍

Responsive Versus Reactive 

I want to share some tips with you on how you can be responsive, rather than reactive, when someone shares thoughts of suicide with you: 

Step One: Check in with your body! Is your heart racing? Palms sweating? Do you feel like running out of the room? Take a moment to center yourself. A deep belly breath can help, or trying to orient yourself to the space you are in - feel your feet planted firmly on the ground, sit up nice and tall. 
‍

Next: Consider saying something like, “I’m so glad you told me.” And then listen. Offer curiosity. You might say something like, “Can you tell me more about what’s been going on.” Offer validation. This can sound like, “That makes a lot of sense,” or, “I can tell that you are really in a lot of pain.” Maybe ask some clarifying questions like, “How long have you been feeling this way?” See if you can identify the need the person is expressing and focus on that. Do they just want to be heard? Are they asking for help, and if so what kind? 

Things to resist doing: Try to avoid phrases like: “You have so much to live for,” or, “Think of your family.” These responses, while well intended, can often have the opposite effect by further shaming the person for their feelings. 

Next: Inquire if you are the first person they’ve shared their thoughts with. Maybe they have already been talking to a therapist or another trusted resource. Try not to make assumptions. 

Ask them what they might need to feel supported. If they don’t know, that’s okay! If they are already connected with a therapist you might ask about when their next appointment is. Maybe they tend to their mental health through another spiritual practice like yoga, body work, or working with a community healer. Therapy, while helpful, is not the only vehicle for healing. Focus on ensuring supports, whatever those might look like, are present.

If they aren’t connected with supportive resources, you can ask them if they would be open to connecting with someone. Oftentimes the hardest part is taking the first step. You might offer to help them make calls to their insurance, doctor, or a mental health provider when they are ready. You might also consider calling a suicide hotline together, and sitting with the person as they talk with the hotline worker.

If you are too activated to be helpful that’s okay. You might say something like, “I want to be able to provide you with support, let me just take a moment to… calm my body… grab some water… get some air… etc.,” or, “I think (insert supportive person here) might really be able to help, would it be okay if we called them?” 

A support person can also reach out to a crisis hotline or text line for help! If you feel overwhelmed or unsure of what to do, you might consider this option as a way of connecting immediately with a trained professional.

Following Up

It can be difficult to know when or how to follow up with a loved one after they disclose suicidal thoughts. When in doubt, ask your loved one what they would prefer. You might say something like “would it be okay if I checked in with you tomorrow?” or “would you rather I call or text you to check in?” 

Revisiting the conversation might feel uncomfortable, but rest assured that asking people about suicidal thoughts does not make them more likely to act on them- in fact opening up about the thoughts can be a significant protective factor and is often what opens the door to accessing further support. 

‍

When There is an Immediate Threat 

If someone is expressing suicidal thoughts and there is an immediate threat to their safety - for instance if they have shared that they have a plan, intent to act on their plan, and means to carry it out -  first, you should determine if they are willing and able to go to the hospital themselves. If it is safe, you or a loved one can offer to take them and wait with them. If they are not willing or able to go to the hospital, then calling 911 would be the next step. Some things that you can do to mitigate risk when calling 911 include: requesting a crisis or mental health trained officer, providing a thorough description of the situation, including whether or not the person is currently a threat (for example, if they do not have any weapons on them say that), you might also request that the police/EMS do not come with lights/sirens or use a specific entrance that is less public. 

‍

Closing Thoughts

Finally, it is important that you take care of yourself after you have been supporting someone else. Know your limits and honor them, you cannot and should not do it all. 

Make some time to connect with your own support people, nourish your body, and make space to cultivate joy.

‍

‍

‍