If you or someone you know is at risk of harming themselves or others: Please call 9-1-1, the Access & Crisis Line at 888-724-7240, or call/text the California Coalition for Youth Crisis Line at 800-843-5200. Both crisis lines are available 24 hours / 7 days a week.
Whether you are a mental health professional or simply concerned about the wellbeing of someone you care about, there are supportive and nonjudgmental ways that you can begin talking about suicide with the people in your life. In this article, we hope to provide guidance on ways to become more comfortable discussing suicide and other mental health concerns. Contrary to popular belief asking about suicidal thoughts does not put the idea in someone’s head, in fact, research strongly suggests otherwise. The best way to know if someone is thinking about suicide is to ask them. You can look for warning signs for suicide based on the language and behavior of an individual. However, it’s not always apparent that someone is at risk.
Below we've outlined 5 ways you can reduce the stigma and open a conversation around suicide.
- Reduce Shame – Suicidal Ideation can often be a taboo or shameful topic, so the best way to get an honest answer is to reduce feelings of shame or guilt when asking your family member, friend, or therapy client. One way to do this is to normalize the potential for suicidal thoughts. Normalizing suicidal thoughts may feel odd to those who have never experienced similar thoughts before, but it is key to creating a supportive environment. For example, saying, “I’ve heard from a lot of people who have gone through the same pain you, that they have had thoughts of killing themselves, have you thought about that?” or “with all the stress you have been under, have you ever had thoughts of killing yourself?”. Questions like this will help you quickly assess where this person falls on the spectrum of thoughts about suicide. You may hear something like “I actually have” or “Oh my goodness, I would never do that,” which can help you determine the level of risk.
- Use Clear Language - It can feel uncomfortable to even use the word suicide, but it is important and necessary to use clear and direct language. Research from Shawn Christopher Shea, M.D. at the Training Institute for Suicide Assessment says we should ask explicitly whether the person has thoughts about killing themselves or ending their life; other phrases can be unclear and ambiguous.
- Don’t Panic – Suicidal thoughts in someone you care about are scary. Whether you are a family, friend, or professional, the best thing you can do is to continue listening. This only applies in instances where there is no immediate threat to their safety. If you find yourself in a situation with someone who admits to thoughts of killing themselves continue to interact calmly and seek to learn more. Instead of cutting them off and immediately calling for help, let them continue sharing their story staying with them at all times. As you remain with them, listen to asses when was the last time they had those thoughts and what keeps them from doing it now. It is also important to talk about how you will know they will keep themselves safe and what the plan is moving forward to ensure their safety.
- Get Professional Help and Continue to Keep a Close Eye - Always seek support from professionals if someone has thoughts of killing themselves and increase your supervision. You can never be too cautious. The San Diego County Crisis and Access Line is available 24/7 for referrals to mental health support or in the event you need a crisis team to come out immediately 1-888-724-7240.
- Let Individuals Stay Connected – Despite how frustrating screen time might be for you as a caregiver, we have to face the reality that this may be one of the only sources of support for people (especially teens). Don’t be too quick to remove this from their day. We encourage you to work with a therapist to explore possible replacement behaviors and ways to manage the fine line between how screen time may be hindering progress or supporting progress.
Tips for Mental Health Professionals
Any door must be the right door - According to the Zero Suicide Framework, a critical component to an individual seeking and benefiting from treatment for Suicidal Ideation is the experience of a competent and caring workforce. Interactions with staff are a crucial part of any patient experience. This is doubly true for many suicidal individuals who have had experiences with health care providers or interventions where their needs were not met, their suicidality not reduced, and worse, where they were stigmatized or traumatized. For many people at risk, this is their first encounter with the behavioral health care system. Any door must be the right door – through which the staff, both clinical and non-clinical, engage people at risk by encouraging them to believe treatment can work, that the team cares about them, instilling a commitment to come back to the next appointment. Understanding that ambivalence—the desire to find a solution to the intense pain versus the innate human desire to live—is essential for any clinician working with a patient at risk of suicide.
At the YMCA of San Diego County’s Youth and Family Services Branch, we train all of our staff to be Compassionate, Aware, Accepting, Validating, and empowering the people we work with. We call this the CAAVE Approach. The CAAVE Approach creates a trusting and inclusive setting for a relationally based human service workforce – so that even those most challenging to engage might show up one more time. We understand the healing power that connections have on the clients we serve.
Seek continued growth and knowledge - Use standardized risk assessment tools to determine the course of treatment and next steps. Screen people and every visit, even if you feel you are a “non-clinical” staff. All staff should be comfortable asking about suicide directly without judgment.
- Text GO to 741741 to reach a trained crisis counselor or call 1-800-273-8255
- For local resources, contact 1-888-724-7240
The YMCA Youth and Family Services in San Diego offers individual, couples, and family therapy on a sliding scale based on annual household income. For more information visit www.ymcasd.org/mentalhealth.