By Deborah Jeanne Sergeant
Why my loved one? Why my friend? What could have kept him from taking his own life?
Preventing death by suicide is not straightforward. But as with any health crisis that causes death, most people want to know afterwards what increased the risk for that individual. Warning signs are common and can point to many other scenarios, yet suicide is rare.
Physician Eric Caine, an international expert in suicide prevention and psychiatrist at University of Rochester Medical Center, offered a simple question: Is this person having a hard time?
“Most people won’t attempt and fewer will die by suicide,” Caine said. “Reaching out to people when they have a hard time doesn’t mean you have to be an expert. Here’s someone who has difficulty; their life is a mess. I’m really offering to be helpful. Ask questions about how they’re doing like, ‘How do you feel?’ and ‘Can I be helpful?’ or ‘Can I connect you or get an appointment for you or take you to the ER?’”
It’s also vital to keep in mind that the issue can present very differently in someone who’s a teen, young adult, middle-aged or older adult. Caine added that the genders present differently. Women tend to display emotions more forthrightly than men.
Regardless of gender, dig deeper when receiving a monosyllabic answer like “fine” to questions about how the person feels.
“At that moment, you need to say, ‘I’ve been worried about you.’ Or ‘It seems like things have been difficult for you’ and you need to show you want to listen to them. The major lesson many have learned is it’s important that you don’t preach ‘You can handle this’ or ‘Things will get better.’ Hear their thoughts,” he said.
Substance abuse can also indicate a person is struggling — and it varies across the lifespan. A young person may dabble in drugs while an older adult might rely upon alcohol. Also look for performance problems at work or school and a decline in self-care or taking care of their belongings. Caine said that these signal things aren’t going well.
Isolation, withdrawing socially and ceasing to participate in previously enjoyed activities can also present as risk factors, as can mental health issues, “whether it’s major depression, clinical depression or bipolar disorder, or someone with psychosis or history of schizophrenia, those are folks who collectively have higher rates,” Caine said. “That doesn’t mean all are immediately at risk. If you see someone’s function going down, that should be the thing that turns on the light. They may not share they’re feeling depressed, but if they’re functioning different than before, it’s time to pay attention.”
The person’s occupation can also matter. For example a self-employed person whose business is failing. Or a struggling farmer who fears losing the family’s way of life, land, home and profession.
Caine said that asking about whether people are considering suicide doesn’t “put the idea in their heads” but can show how much their friends and loved ones care. Those who aren’t considering suicide will simply say, “I’m not thinking of it.”
Caine also said that concerned loved ones should consider any available methods of death by suicide. Does the person have firearms?
“Have a very honest conversation about that,” Caine said. “We’re being intrusive talking about weapons. Part of that is ‘I’m here to listen, I’m present and it’s important for us to talk about that.’”
So much of suicide risk is tied to people feeling unheard and alone and as if they have no resources or help. They may view ending their own life as their only option to relieving their misery and so that they no longer burden others.
“We need to be letting people talk about what they’re experiencing and not pushing them away but letting them express it even if it’s hard to hear,” said Lynn Acquafondata, licensed mental health counselor and owner of Crossbridge Counseling and Crossbridge Wellness in Rochester.
Of course, family members and friends cannot be expected to provide mental health care like a professional. However, they can listen and also help direct the person to care such as connecting to emergency services or setting up a mental healthcare appointment.
Acquafondata said that anyone who has a plan for ending his life must have immediate mental healthcare such as at a psychiatric hospital or emergency room because “typically don’t just throw that out there.”
Despite knowing the risk factors, listening and trying to point people in the right direction, sometimes it’s not enough. The patient himself must be willing and able to receive help. No one should feel blame for the loss of a family member or friend to suicide.
“It’s not always possible to prevent someone who’s that deeply depressed,” Acquafondata said. Suicide is always coming from deep depression. Their life is not livable and they don’t see any other alternative.”
She points surviving family members to the “Serenity Prayer”: “Grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.”