Is someone you care about just down, or is it more serious? Jefferson mental health experts share warning signs of suicide that shouldn’t be missed, and how to reach out with a listening ear.
Content Warning: Information presented in this article may be triggering to some people. If you are experiencing suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255, or the Crisis Text Line at 741-741, for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
September is National Suicide Prevention Month, and this year it may be more important than ever to spread the message. While countries across the globe brace for a “second wave” of the COVID-19 pandemic, it may have come earlier in the form of a mental health crisis. In a survey conducted by the CDC last month, a staggering 41% of respondents reported experiencing at least one negative mental health condition, including symptoms of anxiety or depression, or increased substance use to cope with stress related to the pandemic. Even more alarmingly, of the 11% of respondents who reported having “seriously considered suicide,” the percentage was disproportionately higher in 18-24 year olds (25.5%), Black (15.1%) and Hispanic people (18.6%), and essential workers (21.7%). Indeed this reflects a complex confluence of stressors, as communities reel from widespread protests against racial injustices and collectively grieve for the hundreds of thousands of lives lost to the novel coronavirus. All the while, healthcare and frontline workers have been tirelessly working under extremely stressful conditions that led one emergency medicine doctor to take her own life, after treating dozens of patients at the height of the pandemic in New York. National Physician Suicide Awareness Day, which is marked every year on September 17th, will share her story and try to prevent others like it. Last week, the Department of Graduate Medical Education at Jefferson hosted a showing and panel discussion of Do No Harm, a documentary that explores physician suicide and burnout.
Confronting suicidal thoughts of your own or of a loved one is frightening. But there are things we can do – signs to look out for and small actions to take – that can be life-saving. We talked to mental health experts at Jefferson for helpful tips and tools.
Don’t Ignore These Warning Signs of Suicidal Thoughts or Behavior
“Many of us are feeling blue or down right now,” says Matthew Wintersteen, PhD, Associate Professor of Psychiatry and Human Behavior, whose research focuses on suicide prevention. “But if someone is much more depressed or anxious than usual, don’t just chalk it up to the pandemic.”
“In general, there are three areas to look for warning signs, both overt and subtle,” says Meghan O’Meara, LPC, director of Jefferson University – East Falls Counseling Services. “Talk, behavior, and situation.”
Talk: Keep an ear out for words or phrases that express hopelessness, feeling trapped, alone, or not wanting to live.
“Not everyone who experiences suicidal thoughts will verbalize them,” says Dr. Wintersteen, “but if you hear someone say something like ‘I don’t want to be here’ or ‘I have no reason to live,’ even in passing, that is a red flag.”
Behavior: Actions are just as important as words, so it’s important to notice if your loved one is acting differently or out of character.
“It may be subtle things like they’re sleeping and eating a lot more or a lot less, they’re avoiding social interaction much more than usual,” says O’Meara. “Other things to watch out for – are they suddenly giving away their possessions, are they increasing their use of alcohol and/or drugs, are they searching for means of doing harm to themselves, and even more importantly, have they engaged in self-harm?”
Situation: While depression and other mental health disorders like anxiety and bipolar disorder are major risk factors for suicide, the CDC reported in 2018 that more than half of people who died by suicide did not have a known mental health condition.
“There is no one single cause for a person having suicidal thoughts or ideation, but certain situations can precipitate or exacerbate them,” says O’Meara. “A recent break-up, job insecurity or poor job satisfaction, getting expelled from school, a medical diagnosis, a loss of a family member or friend, especially a death by suicide.”
How to Approach Someone Who May be Suicidal and What to Say
“It’s really scary to know that someone you care about may be suicidal,” says Dr. Wintersteen, “and that fear may paralyze us into not saying or doing anything, and hoping that the person will get better on their own. But that can be catastrophic.”
“Many of us think we need particular expertise or skills to reach out in those situations, but we aren’t aware that there’s a lot we can do with the skills we already have.”
Dr. Wintersteen walks us through a few steps of reaching out, listening, and encouraging a person to get professional help.
Step 1: Ask them – “Are you OK?”
If you are worried about someone you care about, you have to start a conversation.
“This is the hardest step, because it is less scary or easier to think that someone is just having a bad day vs. they’re feeling suicidal,” explains Dr. Wintersteen. “But if you’re worried about someone, the first and foremost thing you need to do is approach them and ask – are you OK?”
Step 2: Expect the Answer – “I’m fine”
“Suicidal people do not want to be a burden on others,” says Dr. Wintersteen, “and as a result, they tell people they’re fine. So we need to be prepared that they may not open up immediately, even to the people they’re closest to.”
Step 3: Be Specific
“Once we recognize that initial resistance, we need to be specific about why we’re concerned,” says Dr. Wintersteen. “Point to concrete examples – you haven’t been interacting with other people as much, you seem distracted, you made that comment the other day about not wanting to live.”
It’s important not to shame or pass judgement, but provide context for your concern. “By being specific about their words or actions, it shows that you’ve been paying attention, and that you care. This can make the person feel more encouraged to open up about what they’re feeling.”
Step 4: Listen, and Reflect
Hopefully once we get to a point where the person says, “Actually, I haven’t been doing well,” the next step is to listen.
It’s easier said than done. When someone is in a crisis, there’s a tendency to go into problem-solving mode and offer advice or suggestions, or to reassure and say “Everything is going to be OK.” That’s something you want to try to avoid.
It is critical not only to listen, but to also engage in what Dr. Wintersteen describes as reflective listening. “So I would say ‘It sounds like you’re feeling x,y,z…’ and then it’s important to add ‘Do I have that right?’” he explains. “And they might say, ‘Well I’m feeling x and y, but not z…’ And then you would affirm that by saying ‘OK, so you’re feeling x and y, but not z. Tell me more.’ This lets the person know that we’ve heard what they intended to communicate to us.”
He explains that this type of reflective listening opens up the conversation and makes the person feel more connected.
Step 5: Let Them Know They are Not Alone
Suicidal individuals often struggle in silence. By affording them time and space to open up to us, they no longer harbor the burden of carrying these feelings on their own. “We need to let people know that we are with them and we support them on their path to recovery,” says Dr. Wintersteen.
Step 6: Reinforce that Treatment is Effective
Suicide is preventable, and suicidal thoughts can be managed effectively with therapy and/or medication. Adopting healthy habits like regular exercise, sleep, and avoiding alcohol and substance use, can improve overall mental health.
“It’s important to let individuals who are feeling suicidal know there are effective treatments out there that can help them feel better,” says Dr. Wintersteen. “There are those who have tried therapy and felt like it didn’t work. But it’s important to encourage them to persevere, and find a therapist who is a good fit for them and who is able to help them create meaning in their life. Remind them that their life is worth it.”
Step 7: Guide Them to Get Professional Help
It can be intimidating to try therapy for the first time, or discouraging to wade through the healthcare system to find another therapist. These can become barriers to people reaching out for services. To help broach the conversation, Dr. Wintersteen suggests saying, “Now that we’ve talked about your experience, how do you feel after sharing? I wonder if it would be helpful if you and I work together to get you connected to someone who can do this with you more frequently, and are trained to give you the right kind of tools.”
Dr. Wintersteen warns that it is important not to take on the job of a therapist. “We want to be supportive, but there’s a real risk in trying to help someone else manage such a serious crisis without bringing in professional help.”
Stay Connected, Stay Alert
Public health officials predict that the toll on mental health will only intensify as college campuses reopen, as job insecurity and economic fallout increase, and with the compounding threat of the flu and the coronavirus looming. New research from the Well Being Trust estimates there could be as many at 75,000 deaths stemming from substance misuse or suicide because of the pandemic.
“It’s important to take that extra step during the pandemic to connect with someone you’re worried about, and to create spaces for social interaction,” says Dr. Wintersteen. “Get a sense for who else they’re engaging with and try to organize small virtual game or movie nights, or Zoom calls, with a group of people they feel safe with.”
On campus, Jefferson continues to do outreach with their students to engage them in activities and resources around well-being. Specialized trainings known as Question-Persuade-Refer Suicide Prevention Training and Mental Health First Aid are offered at both East Falls and Center City campuses.
“We are being proactive with educating faculty and staff on how to identify students in distress and providing them with the resources to refer them to the Student Counseling Center,” says O’Meara.
“We believe that suicide prevention is everyone’s business.”
- National Suicide Prevention Lifeline; 1-800-273-8255 (TALK); suicidepreventionlifeline.org
- Prevent Suicide PA
- NAMI (National Alliance of Mental Illness) Helpline 800-950-NAMI. Or in a crisis, text “NAMI” to 741-741. NAMI.org/Covid19
- National Behavioral Health Treatment Services Locator
- Substance Abuse and Mental Health Services Administration. SAMHSA National Helpline: 1-800-662-HELP (4357) Treatment referral and information, 24/7.