I am open about my depression, friends and acquaintances are aware that I am often actively suicidal. And I mock stupidity like the meme below mercilessly with dark, dark humor.
A friend, Brian Smith, who lost his daughter and wrote a book called Grief to Growth, asked me how I would speak with a person who is suicidal. He is sincere, and deserved a thoughtful response devoid of sarcasm. This is my response.
DISCLAIMER: I am not a licensed therapist, counselor or psychologist. All depressed people are unique, as are their situations, so there is no boilerplate step-by-step guide. Adjust as needed – how you respond to a suicidal lover is different than a suicidal adolescent, than a suicidal friend or a suicidal acquaintance.
EXTRA SPECIAL DISCLAIMER: I no longer involve police unless there is literally no other choice. Police are not appropriate mental health responders, and that is not their fault. They signed up to arrest bad guys, not provide emergency health services. Our society has abdicated mental health services, and thus it is forced onto the police. Additionally, the para-militarized police of today are not the police of yesterday.
My experience speaking to suicidal people comes from being open about my suicidal thoughts on blogs, Daily Kos, Facebook, working as a tech in a psychiatric hospital, being part of a twelve-step program and just daily life.
Start by practicing active listening
This is difficult. You must hear what they are saying, despite how it may make you uncomfortable. Try not to rehearse your response as they speak. Try to focus on and remember what they are saying instead. When you do respond, begin by reflecting back to them what you heard them say so that
- The speaker can correct misunderstandings (“I feel so depressed, I want to die” is very different from “I can’t do this anymore. I just got my prescription and I might take them all” is different from “I’ve almost finished the last beer and the loaded pistol is in my lap” – and that last scenario is where I might call police).
- The speaker KNOWS you are actually listening. Depression is tough to listen to, and it is easy to tune out. They will know if you heard them. And if they feel heard, everything goes better.
Avoid judgement. Taking a 90-day supply of prescription drugs sounds stupid from where you are, but right now, the person you are talking to is incapable of seeing that viewpoint. Depression lies like a fog, concealing a way forward. Do not deflect; it is easy to try to switch to a more comfortable topic, and your own discomfort may want you to do so. This can lead to the speaker feeling discounted or ignored.
Express caring in an appropriate way
Let your relationship with them guide you. Someone you’ve known for years gets a different response than a social media acquaintance. Your emotions must guide you, and being awkward and worried can be taken wrongly as being distant or uncaring. This can be defused by being honest and vulnerable. Tell them you feel awkward, you are not sure what to say, and worry about saying the wrong thing, but you are still here for them. The idea is to disarm depression's defensive response. It’s okay to be awkward and imperfect.
An example is a young woman on FB who had shared somewhat light and sarcastic political/sexual banter with me on FB (I’m a smartass, and posted a risqué meme, and she responded in a lighthearted smartass manner). Later, in response to a post about my depression, she private messaged me about her depression. When I said “I care about you,” I added that based on our previous smart-ass exchanges, I wanted her to know this was not about flirting with her. This woman deserved a clear statement explicitly defining the non-sexual context of my response. It looked and felt awkward to say. But it defined the boundaries for our conversations about depression.
I use this example because it was uncomfortable for me. You have to extend yourself past your comfort zone in these conversations. At least, that is my experience of them. My sense is that if you are perfectly comfortable speaking to someone who is suicidal, you may not be the person for that conversation. It is about deep feeling and emotion.
Encourage any self care they already do.
Therapy, counseling, prescribed medication, meditation, exercise – all are good and should be encouraged. “You enjoy running? Do you have energy for that today? No? How about a walk?” That’s cool, positive and encouraging.
“Stop laying around in a dark room! Get out of bed in the sun! Get to the track and do a few laps!” said in a cheery tone– NOT FUCKING COOL. This would communicate that you really don't get at all how exhausting despair is.
Do not recommend a new form of self care like starting Yoga or something they are not already involved in. Depression is a thief; it steals energy, hope, confidence — all of which are needed for new ventures. Find out what they have done in the recent past.
I have found that if they have a pet they love, that is an outlet for this purpose. Depressed people often have an easier time caring for someone other than themselves. “How is (dog’s name)? Oh, he’s just sitting on the bed staring at you? Maybe he needs a short walk ... what if you took a few minutes to walk him?” Cats are different — brushing them is a good activity. Playing with a toy that they chase works also. Use the depressed person’s care for others to benefit them.
They may not have the energy or will to even do that. Knowing how hopeless they feel is important information.
Encourage socialization.
Depression isolates. Again, gently encouraging. Compassion. Not sunshiny pep talk. Ugh. Vomit.
My only exception for this is going out to a bar or alcohol filled party. Alcohol is a depressant. It interacts negatively with many medications. And it will seem to help initially, but it is likely to make things with the person’s emotional state and impulse control much, much worse.
Also, if the person has been drinking, it is much more difficult to get them emergency mental health help … they’re likely going to have to spend time in jail sobering up before seeing a counselor, because the mental health professional has no way of knowing if the suicidal talk is from the emotional state of the person or from the alcohol, and neither will you.
Goal: get them to professional help.
“You will make an appointment with your therapist, yes? Please just text ‘done’ when you’ve got one?” Make it a request, though, not a demand.
Most of the time, you are not professionally trained as counselor, and while listening as a friend short term can help short term, long term heavy duty listening to this kind of heavy stuff can cause you problems - a larger than appropriate sense of responsibility, a distraction from your own self care, guilt and shame over knowing that you are just a band-aid and not truly adequate help, habitual helplessness from realizing that this is bigger than what you can fix yourself ...
In my opinion, the endgame is to get them to some kind of mental health professional help. Counselor, Therapist, Psychologist, Social Worker – get them in the door with a listening mental health professional. Not all psychiatrists are trained in counseling/listening techniques - their training is usually as mental health mechanics/biochemists - but they are a viable second choice, and often know of good counselors that they work with regularly.
I do NOT consider pastors/ministers/priests/priestesses/rabbis/General Practitioner MDs/cosmetologists or bartenders to be mental health professionals UNLESS they also have certification as one of the above. BUT depending on the person, they may be the best possible avenue to bridge to a listening mental health professional (except the bartenders; strippers and drug dealers are also less than optimal choices at this specific moment).
So, to sum up:
• Listen and reflect back.
• Express care/love for them.
• Foster self-care if possible.
• Encourage social interaction and some kind of constructive activity.
• Direct them to professional help.
• Ask for confirmation they followed through.
Things you NEED to know going into this conversation:
Suicidal people sometimes kill themselves. It’s not about you. It never was. It is about the hell inside their head. It is also NOT your responsibility to fix this for them. DO what you can and let it go.
And if the person you are speaking with DOES harm themselves — don’t screw around - go get help for yourself. Even if it is just one or two sessions, it is a good self-check on how that affected you.
I once had my young daughter with me at the same time that a dear friend attempted suicide. I could not drive two hours to check on my friend because my child needed me. In that situation, I called the police. That was the best I could do at that time. Being me, I beat the hell out of myself for failing her by having her locked up for several days in the county psychiatric ward — not a pleasant place here in Texas. Now, I can look back and say: I cannot be everywhere at once. I acted as best I could based on the situation and information I had.
Finally, if you spot errors I have made or have suggestions to improve this post, please comment. I'm always learning.
I want to credit my awesome girlfriend, Mary Ann McCarty, with co-authoring this piece.