Author: Carrie Overbey, LCPC, Chief Clinical Officer – Chicago
Suicide is complex and evokes emotions in so many of us. In this blog, Chief Clinical Officer Carrie Overbey, LCPC, explores why it is difficult to talk about this topic and why we must continue to destigmatize these conversations—and help save lives.
It is Hard to Talk about Suicide — This is Why
I remember being at a training course with over 100 clinicians. The facilitator separated us into small breakout groups and asked that we each use the word suicide in a sentence. I did not want to be the first to speak. I was shocked at how long we all sat there in silence. Finally, someone reluctantly spoke, but most others remained silent.
I was surprised at how difficult it was for a group of therapists to talk about suicide. When we processed the assignment afterward, nearly everyone shared a story of how they had been personally or professionally impacted by suicide. This should not be surprising. Fifty-four percent of Americans have been impacted by suicide in some way. So then, why is it so hard to talk about it or even say the word? Even for clinicians?
Suicide is complex. There is no single cause. It evokes intense and challenging thoughts and feelings in us, and across all the roles we may play in our lives: as clinicians, parents, family members, friends, and individual people. However, talking about suicide is key to increasing awareness and understanding as well as prevention and treatment efforts. Fear and discomfort may be two of the reasons that we avoid thinking and talking about suicide—but they are not the only ones. Many of us do not know how to talk about suicide. Given the seriousness of the subject matter, we are afraid to get it wrong. Before diving into a discussion about suicide, it is important to understand a few key terms.
Key Terms to Know When Discussing Suicide
The Center for Disease Control and Prevention defines suicide as death caused by injuring oneself with the intent to die. As professionals and for those who are personally affected, we learn that suicide is an action taken by a person to end their life because they may be experiencing perceived insurmountable life challenges which may seem to have no resolution along with unendurable emotional pain from which there appears to be no respite in the moment. It is one last, absolute, and an irreversible act of a person seeking help and relief. Suicide typically comes from a place of despair, hopelessness, and worthlessness.
Passive and Active Suicidality
When exploring the topic of suicide, the words “passive” and “active” are used to describe the level or intensity of the suicidality and allow us to better assess risk and determine the next steps. Passive suicidal ideation describes when a person has thoughts of suicide and dying but does not have a plan or intent. Active suicidal ideation is when there are thoughts of suicide with a plan with intent to act on the plan.
Self-Harm or Self-Injurious Behavior
Self-Harm or Self-Injurious Behavior refers to deliberately injuring or trying to injure oneself without suicidal intent.
When to Ask about Suicidal Ideation
It can be hard to know when to have a conversation with a friend or loved one about suicide. How you approach the conversation will depend upon several factors including context, relationship to the person with whom you are talking, developmental age, and more.
Research shows that conversations about suicide do not cause people to attempt suicide. In fact, the opposite is true. Directly asking and creating a supportive space for someone to share about how they are feeling, including suicidal thoughts, goes a long way toward prevention and improvement of symptoms. It directly facilitates effective conversations and leads to action steps.
Do NOT wait for a crisis to occur before broaching the topic. If you are concerned that a friend or loved one is depressed or possibly thinking about suicide but are not sure, check in with them. Ask them how they are doing and let them know that they have your support unconditionally. Continue to check in with them from time to time rather than waiting for them to come to you. There may be some warning signs that someone is not ok. This may include changes in mood, an increase in depression, loss of interest in things they used to find enjoyable, increased rage, or irritability. You may notice changes in behavior such as isolation from family and friends, saying goodbyes, and acting recklessly.
How to Discuss Suicidal Ideation
Create time and space to talk. Be an active listener and ask open-ended questions. Stay present, calm, and supportive. You are not there to drive the conversation nor to achieve a specific agenda. Staying calm and responding with compassion sends the message that you can handle whatever it is that they are feeling and sharing and encourages vulnerability and openness.
It is okay and crucial to ask directly about suicidal thoughts and behaviors. This underscores that it is helpful and acceptable to talk about overwhelming emotions, and the experience can be therapeutic in and of itself. It empowers your friend or loved one to share and to seek and accept support and resources.
Do not promise to keep their thoughts of suicide a secret. The goal is to validate. Do not be afraid to ask clearly and directly. Examples that you can ask include: Are you thinking about suicide? How often have you had these thoughts, or how frequently during your day do you have these thoughts? What is your plan? Do you have access to this plan? What happened that caused you to have thoughts of suicide?
Clinicians, when you need to delve deeper and gather more information, ask about the intensity of the ideation, including frequency, duration, and reasons for wanting to die AND wanting to live. For example: How often have you had these thoughts? When was the last time you had these thoughts? What is your reason for thinking about dying? It can also be helpful to identify protective factors- reasons for living by asking: Is there anything or anyone that stopped you from acting on these thoughts or from wanting to die?
What to Do with the Answers Received
Take care of yourself & know your limits
It is important to check in with yourself. Be aware of how you are feeling during and after the conversation. One of the most important things you can do is to remember to take diligent care of yourself. Focus on the things that bring you joy, help you relax, and stay healthy. We are not able to take care of others until we take care of ourselves. Another critical point to remember is to manage our own emotional reactions. If we panic and are not able to respond calmly and compassionately, then we are not able to get the person the help they need.
Tell someone/get personal and/or professional help.
Clinicians seek and use clinical supervision and case collaboration for support in managing their own reactions and increasing knowledge of what to do when working with someone who is talking about suicide. If it is a family member or a loved one, be sure to seek support from a trusted individual. There are many free hotlines and helplines available. The 988 Crisis hotline is available 24 hours a day, seven days a week.
What is the Role of an Ally for Suicide Awareness Prevention
If you are a clinician, try to know and understand your own emotions and reactions.
Are you comfortable talking about it? Can you ask directly?
Managing our emotions and thoughts will help you care for at-risk individuals. You can seek supervision and consultation as needed. Once you can manage your own emotions, be sure you have the tools and resources to care for these individuals. There are many short-term interventions such as assessments, collaborative safety planning, and lethal means counseling to keep clients safe. Once the crisis is over, utilize longer-term interventions such as Cognitive Behavior Therapy for Suicide Prevention, Dialectical Behavior Therapy, and Collaborative Assessment and Management of Suicidality.
If you are not a clinical professional, your role is not to assess. Your role is to create space, be a friend/family member, listen, offer support, get them to be open to professional help, remove access to means if applicable and possible, and either connect them with that help or find someone who can. Be supportive. Let them know you care and that you are there for them.
What’s Next? Where to Get Help and Additional Resources
Just because someone is thinking about suicide does not mean they are at risk of death. Ask and listen. People dealing with suicide are listening- and want to live. When a person who is thinking about suicide encounters caring partners and professional support, they will follow their lead. And as with all best practices in life, to keep their commitment to keep making safe choices, they need reinforcement, continuous support, and follow through from all of us.
Asking people who are at risk if they are suicidal does not increase suicidal thoughts nor behaviors. Acknowledging and talking about suicide can in turn reduce suicidal ideation.
Children, youth, and adults alike need an opportunity to voice their fears, concerns, and feelings. People who are considering suicide are looking for that one person to ask the right question, to listen to them compassionately, and provide reassurance and hope. That one person on any given day may be you or me.