The 2014 suicide of Conrad Henri Roy III — coming after he allegedly received disturbing text messages from a friend, 18-year-old Michelle Carter, urging him to act — offers a sobering example of how not to respond to someone who is suicidal.
This week, mental health professionals are marking National Suicide Prevention Week, offering advice on how to respond to someone who may be on the verge of killing himself or herself.
“You can make a difference, especially if you can get somebody to talk about it,” said Elsa Ronningstam, a psychoanalyst, McLean Hospital psychologist, and board member of the American Foundation for Suicide Prevention. “Many completed suicides, people don’t talk about it — they just go and do it.”
Anyone who takes the time to listen — calmly, sympathetically — can save a life, said Dr. Christine Moutier, the foundation’s chief medical officer.
“A suicidal crisis — the actual moment, that period of possibility — is on the order of five minutes to 30 minutes,” Moutier said. “If you engage them in conversation, there’s a very good chance you’re getting them through that period.”
First, recognize the signs of suicidal thinking, which can include: behavioral changes that are out of character, such as showing up late or having angry outbursts; increased use of alcohol or drugs; loss of appetite; sleeping too much or too little; withdrawing from family or friends; reckless or aggressive behavior; giving away possessions; and visiting or calling people to say goodbye.
“Some people just feel a very specific sense of calmness, as if they had come to terms with something,” Ronningstam said. The signs “can be very very subtle. You may need to know someone quite well.”
Approach the person in private, Ronningstam and Moutier advised. “Say in a very caring, supportive way, ‘I’m bringing this up because I care about you. I’ve noticed something that caught my attention,’ ” Moutier said.
Instead of asking, “Are you OK?” — likely to get a terse “yes” in response — Moutier recommended open-ended questions, such as asking about what’s going on in the person’s life, and whether there are new stresses or worries.
Listen for references to feeling hopeless, trapped, or overwhelmed; suffering unbearable pain; or having no reason to live. If the person expresses such feelings, Moutier said, “Then, you should ask them quite directly, ‘Does that mean you’re actually thinking about ending your life?’ ” If the person denies it, but you’re still worried, let him or her know you’re available to help. Encourage the person to seek professional help.
“Offer some hope that life can change even if it feels dark today,” Ronningstam said.
If the person admits to suicidal thinking, make sure he or she is safe. Ask whether there is a method in mind. Separate the person from anything lethal — guns, knives, medications. Urge him or her to contact a mental health therapist or primary care physician.
If the person seems in imminent danger, take him or her to the emergency room or call 911. Help can also be found by calling the National Suicide Prevention Lifeline: 800-273-8255 or visiting the American Foundation for Suicide Prevention website: www.afsp.org.
Specialists recommend against:
Reacting with shock or judgments.
Minimizing the person’s pain.
Engaging in arguments about the value of life.
Suggesting ways to fix problems.
Assuming you can solve the problem without professional help.
“Suicide almost always takes place in the context of a mental illness,” usually depression, said Dr. Mark J. Goldblatt, a psychiatrist and past president of the foundation’s New England chapter. “Someone who is clear-thinking can steer them in the right direction, help them get to a doctor or nurse or clergy person. . . .
“Never give up. You can do a lot. You can hang in there. You can show them support.”