About Suicide

How do I support someone with suicidal thoughts?

A person can be thinking about suicide without being suicidal. Thinking about suicide is often referred to by professionals as suicidal ideation. There are different levels of severity with a spectrum that goes from thinking about it – to considering it – to planning it. Increasing protective factors such as strong relationships and sense of purpose and decreasing risk factors such as access to lethal means like drugs, alcohol and firearms are very important for someone engaging in suicidal thoughts. Seeking professional help and creating a safety plan are also recommended. A safety plan template can be found in this guide.

What is QPR Training?

QPR is a suicide prevention training and serves the same purpose as ‘CPR’ does in a medical emergency, but for a mental health emergency when someone may be contemplating suicide. This is a basic suicide prevention training that can benefit anyone who may be in a position to recognize that someone else may be in crisis.

QPR stands for: Question, Persuade, Refer.

Question a person about suicide

Persuade someone to get help and,

Refer someone to the appropriate resource

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How do you tell a person you think they need help?

It’s best to be very specific with people. Instead of just saying “I’m worried about you,” say “I’ve seen this, this, and this, that you’ve been doing/saying and that makes me worry about you.” Some people don’t realize things have gotten as bad as they have until you point it out. Try to find out why they don’t want help so you can make them feel better about asking for help. Sometimes they just need a little moral support so offer to go with them to the counselor’s office so they don’t feel like they’re in this alone.

We have a child or family member that struggles with mental illness. Where do we find support?

Like a family member living with any other chronic health issue, mental health issues require additional support and the entire family system will be impacted. Peer support groups such as the support groups you will find at NAMI or trainings such as the training offered by PPSPP, Perfectly Imperfect: Support Rooted in Love, can help provide the family system with some tools to be more effective at supporting one another and an overall increased understanding of the needs of the loved one who is living with mental health challenges.

How can you tell if it's suicidal thoughts or just bad attitude?

The simple answer is you can’t tell unless you ask and even then, your friend may not tell you the truth because they might not be ready to talk about it. Some people are by nature pessimistic — they always see the bad side of everything — and this does not in itself make them more likely to become suicidal. If this “bad attitude” is a change from how your friend was before, if it has lasted more than a few weeks or if it is accompanied by other warning signs it’s better to be safe than sorry.

How many suicides are prevented?

That’s a good question, but a tough one to answer because scientifically, it’s hard to prove that something would have happened, but didn’t because of something you did. Researchers who study suicide deaths believe that 80-90% of all suicides might be prevented if people who are feeling suicidal get help. In the United States, that would mean saving 24,000-27,000 lives every year.

What if you know someone who has attempted suicide and got help but you are seeing the warning signs again?

It takes time to overcome suicidal feelings especially once you have crossed the line between being committed to life and being willing to die. Getting help is a critical first step, but it is just the first step of what can be a long and sometimes frustrating journey. It can take 6 months to a year to really climb out of a suicidal depression. Many people get impatient when their life isn’t better over night and they give up on counseling or stop taking their medication before they’re really healthy again. If you see the warning signs, act on them and get help for your friend. Remember, a previous suicide attempt is a big red flag that should make you take all subsequent warning signs very seriously.

How often do suicidal people harm others before taking their life?

Murder-suicide grabs a lot of headlines but it is actually pretty rare. It tends to happen when someone becomes suicidal and for whatever reason blames someone else for why they are feeling so bad. The most common scenario is in domestic violence cases, where one partner either blames the other for how they are feeling or is so angry that they feel it would be unfair for that person to live while they are planning to die. The depression warning signs are the same, but you will usually also see aggression, agitation and hostility expressed toward the other person. If you or someone you know is being threatened take it seriously and get help.

What about self-mutilation?

Hurting yourself is a sign that there is something wrong, although it is not always a sign that someone is suicidal. If self-mutilation is accompanied by other warning signs, it certainly could be a suicidal gesture. Often, though, it is more a product of anxiety or obsessive-compulsive disorder. Does this person still need help? Yes, and you can get help for them the same way you would for a suicidal friend.

Can the death of a loved one cause depression or make the depressed person even more depressed?

Any loss can make a depressed person more depressed. It can be the “trigger episode” or straw that breaks the camel’s back, particularly if the person who died was someone you felt you could turn to if you needed help and now you feel there is no one who can help you. Can grief cause the illness of depression? Yes, it’s called “situational depression” which is often an emotional, not a biological, illness and is treated by talking to a counselor or joining a grief support group. Situational depression can sometimes alter the brain chemistry by temporarily depleting the level of neuro-transmitters in your brain. In this case, medication is sometimes prescribed on a short-term basis along with counseling.

Why do people do it?

That’s the big question, isn’t it? And when you love someone, believe me, there will never be a good enough answer because there will never be a good enough reason to lose them. People who become lethally suicidal are hurting very badly and they are desperate to find a way out. It’s a horrible, lonely place to be — you feel shut off from everyone even when there are lots of people around. You become so hopeless that death seems like the only possible way out. If we can break through that, if we can help them find another way out of the pain, we can help them want to live.

What happens when you call a hotline?

Trained interventionist will do two things. First, they will try to reassure you that reaching out was the right thing to do, that you are not alone in how you feel and that they will do their best to help you find a way out of this. Second, they will work with you to decide how best to help you overcome your depression and suicidal feelings. For most, it will mean developing a plan to see a counselor once or twice a week to help find a way to resolve the situations that are contributing to the depression. For some, it may mean checking into the hospital for a few days in order to be safe and have a chance to focus on getting better.

What biological factors increase risk for suicide?

Researchers believe that both depression and suicide can be linked to decreased serotonin in the brain. Scientists have learned that serotonin receptors in the brain increase activity in persons with major depression, which explains why medications that desensitize receptors have been found effective in treating depression. Currently, studies are underway to examine to what extent medications can reduce suicidal behavior.

Can the risk of suicide be inherited?

There is growing evidence that familial and genetic factors contribute to the risk for suicidal behavior. Major psychiatric illnesses, including bipolar disorder, major depression, schizophrenia, alcoholism and substance abuse, and certain personality disorders, which run in families, increase the risk for suicidal behavior. This does not mean that suicidal behavior is inevitable for individuals with this family history; it simply means that such persons may be more vulnerable and should take steps to reduce their risk, such as getting treatment at the first sign of mental illness.

Do suicides occur more frequently around the holidays?

Nationally, suicides are not more frequent during the holidays. Suicide rates tend to be highest in April and the summer months of June and July.

Who is at highest risk for suicide in the U.S.?

Older adults experience the highest rates for suicide, which increase significantly with age. White men 85 years and older have a suicide rate that is six times that of the overall national rate. Males use more lethal methods (i.e., firearms) and are less likely to talk about their plans. Older adults are less likely to survive attempts because they are less likely to recuperate. Teen girls ages 15-19 years have the highest rates.

Are gay and lesbian youth at high risk for suicide?

Regarding completed suicide, there are no national statistics for suicide rates among gay, lesbian, bisexual or transgender (GLBT) persons. Sexual orientation is not a question on death certificates. Sexual orientation is a characteristic that people can, and often do, choose to hide. This is a problem when considering GLBT youth, who may be less certain of their sexual orientation and less open. GLBT youth also face additional stigma and trials because of their sexuality. State and national studies indicate that high school students who report to be homosexually or bisexually active have higher rates of suicidal thoughts and attempts in the past year compared to heterosexual youth.

What is the most frequent method of suicide?

Sixty percent of all people who complete suicide do so with a firearm, accounting for more than 18,000 deaths each year in the U.S. Firearms are now the most frequent method of suicide for men and women of all ages, including boys and girls ages 10-14 years.

What can be done to reduce the stigma of suicidal thoughts or depression?

Attitudes about suicide will begin to change as people begin to recognize that suicidal behavior is a symptom of a medical illness, not a sign of weakness or a character.

Apart from encouraging a suicidal person to go for counseling, what else can we do?

Going with someone to a counselor often helps. If the suicidal person is not listening to you, it is important to talk to someone else who might influence him or her. Saving a life is more important than keeping their thoughts a secret. People often get uncomfortable when someone discloses suicidal thoughts.