Suicide Prevention

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Reprinted from Marin Advocates for Children
Thanks to Robin Allen

Loss is the number one trigger to suicide. Clearly the children, parents and professional we work with every day experience extraordinary losses. Therefore I thought it might be helpful for me to write an article for our advocates. I encourage you, if you have not already to find out what your local suicide prevention number is and to identify others in the community who have received training in assessment so that you can pass that local information on to your volunteers.

Most people who consider suicide don't really want to die. They want to find a way to get out of the pain they are experiencing. Because this is true, at times we can be effective in intervening when we realize that someone is thinking of suicide. Thoughts of suicide are sometimes recurrent, but they are never chronic. The actual crisis is time-limited, so if someone is able to help a suicidal person through the crisis, they have then effectively bought some time which will allow other resources to be engaged to help the suicidal person deal with the feelings of hopelessness.

Warning Signs

• Statements about death or a desire to die: " I don't see any reason to go on."
  
  
• Preoccupation with themes of death: this is sometimes exhibited in art work, choice of music, poetry, etc.
  
  
• Drastic changes in behavior: this can be deep depression or agitation, but is often a change that appears as a change for the better. Often people who are profoundly depressed experience relief when they make the decision to take their lives. This is often misinterpreted as an improvement.
  
  
• Risk-taking behavior, such as increased use of drugs or alcohol: this is especially true with young people.
  
  
• Loss of interest in things that formerly had meaning: appearance, relationships, activities, etc.
  
  
• Withdrawal from friends and family, statements that exonerate a loved one of responsibility: "I want you to know if anything happens it is not your fault."
  
  

Predictors

• Prior suicide attempt. Many people feel that if a person has made a previous attempt "it is just her way of getting attention." It is, and if the person does not get the attention he/she needs he/she will often escalate his/her call for help. Every attempt must be taken seriously regardless of the severity. Often caregivers feel burned out by what seems like a manipulation. Therefore, we must never be alone with the responsibility for someone who is suicidal.
  
  
• Giving away prized possessions.
  
  
• Making final arrangements.
  
  
• A recent severe loss. It is important to evaluate this from the perspective of the person who is experiencing it. Although we might feel that separation from parents is the biggest loss a child could experience from the child's perspective, it might be humiliation in front of his/her peers.
  
  

What to do

• If you are concerned about suicide, ask . You cannot make someone commit suicide by asking the question. By asking the question you are saying, "I care enough about you to ask about the most scary feelings you may be having." It is a real gift when you are willing to be available to a person and truly hear what they are feeling. Use real words. "Are you thinking of killing yourself?" Not, " you're not thinking of doing anything to hurt yourself, are you?" People who are suicidal don't plan to hurt themselves: they want to stop hurting. Whenever you start a sentence with "you're not" you are saying "I don't want to hear." If you are unable to ask the question, stay with the person until you are sure you have gotten them to someone who can and will ask, e.g. their therapist or the suicide prevention hotline.
  
  
• Tell him/her you don't want them to die. Let them know you care and that together you will find help. Listen, really listen. By truly hearing what the person is feeling you will allow him/her to begin to relieve his/her anxiety and learn what has meaning to him/her. You will then be able to use this information to develop a contract *. Often, suicidal people are in a tunnel. They may be surrounded by people who care, but who have lost sight of them. Your expression of caring may be the first light they see at the end of the tunnel.
  
  
• Ask how they plan to do it and then assess how realistic and available their plan is. If they respond "today with my father's gun," the risk is very different from "if things don't get better by the time I leave home." How soon, how prepared. If a method is identified, be sure the person responsible for the environment has made the method unavailable. Most people have a specific idea about how they intend to do it. If the gun is removed, the suicidal person does not usually go and get a knife.
  
  
• Negotiate a contract .* A contract is an agreement that the person will not take action to harm him/herself without first abiding by the terms of the contract. The contract must be negotiated for it to have meaning. "I want you to promise you will not do anything to harm yourself without first calling your social worker." "Yeah, sure" is not good enough. The person must tell you who he/she has identified as a resource and what he/she is going to do if that resource is not available. The contract should include an agreement about time. "I want you to agree not to harm yourself until we get to a phone and call your therapist." You can then renegotiate the time. The purpose is to buy time. Remember the episode Is time-limited so if you buy time with a contract you can get through the crisis and have an opportunity to engage more resources. Most people don't want to die; they want to find a way to live. With a contract you are helping them manage the crisis. You can then find additional resources together.
  
  

Resources

• San Francisco Suicide Prevention 24-HOUR Hotline
  (415) 781-0500

  The hotline is available to use for consultation. It is also a good resource for a contract. I often have a person I am worried about call even if they are not in crisis at the moment and then report to me how it went. The hotline counselors will also make a call to someone you are worried about if you call the hotline with the information.

• The person's therapist

  Be sure the therapist knows the client is suicidal. Ask the suicidal person if he/she has talked to his/her therapist about his/her suicidal feelings. Often I have heard a client say " haven't told my therapist because I don't want to worry him/her". Be sure the therapist feels comfortable with talking about Suicide. Ask if he/she has a contract with their client. Remind the therapist that the hotline is available for consultation.

• The SFCASA Staff

  We are here to support you. Of course your CASA supervisor always wants to know if a person you are working with has considered, or is considering, suicide.
  

Never agree to keep suicide a secret! Never be alone with the responsibility for someone who is suicidal.