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Experts say that asking someone directly “Are you thinking of killing yourself?” can be effective at identifying someone at risk for #suicide, offering the opportunity to steer them to professional help

By Julie Mack | special to MLive

When Paulo realized a troubled friend was at risk of #suicide, he knew what to do.

A few years before, Paulo had participated in a #suicideprevention program at Kalamazoo Central #HighSchool. He learned the red flags. He also learned the importance of asking someone if they were having #suicidalthoughts.

“He was freaking out,” said, Paulo, whose last name is being withheld to protect his friend’s privacy. “I was really worried about his well-being.”

Paulo, now 20, called his mother, whose work includes #suicideprevention, to review how he should intervene. “She told me what I already knew from the training, which was just keeping him calm, talking to him, asking him if he was thinking of #suicide,” Paulo said.

Paulo ended up helping his friend go to a hospital and notifying the friend’s #parents.

That #highschool training “helped me stay mentally OK through the whole process and helped me help my friend,” Paulo said in a video for Gryphon Place, a Kalamazoo #suicideprevention program.

More than 15,000 Michiganders died by #suicide over the past decade, include 345 in Kalamazoo County. While rates are highest among middle-age and older men, suicides account for more than 20% of deaths among ages 15 to 24.

Studies indicate 90% of people who die by #suicide have an underlying — and potentially treatable — #mentalhealthcondition.

Regardless of age, experts say that asking someone directly, “Are you thinking of killing yourself?” can be effective at identifying someone at risk for #suicide, offering the opportunity to steer them to professional help.

In fact, “people can kind of give you that invitation to ask if they’re feeling suicidal,” said Susan Davis, a #counselor with Children & Family Services in Kalamazoo. “They want somebody to ask. There’s a big myth out there that if you ask somebody if they’re thinking about #suicide, you’re giving them the idea, and that’s not true. They either already have it and or they don’t and they’ll tell you.”

Maricela Alcala, the Gryphon Place executive director, agreed. Asking the question “shows the person that you’re concerned, that you care, that you want to help,” she said. “And you’re also showing that you’re not afraid to talk about #suicide,” which makes it more comfortable for them to share their thoughts.

People contemplating #suicide often feel isolated and alone, and having a conversation about their despair may lessen those feelings, said Larry Beer, a longtime Kalamazoo clinical #psychologist.

“Lack of connection is one of the reasons why people come to #suicide,” Beer said. “For instance, it’s a high risk after a severe breakup -- somebody really feels that hurt and pain and just can’t imagine being able to reconnect again. So when they feel connection with somebody, it can make less likely they actually act on” #suicidalthoughts.

To be sure, asking someone about suicide is a difficult conversation for people who aren’t trained #therapists.

“It’s hard to get comfortable asking that question about #suicide. I get it,” Davis said. “I don’t have a hard time at work with it. But in my personal life, when I’ve had to ask that question, I’ve tripped over my words. It’s hard to ask.”

But she also said she’s seen the benefits many times. “It’s amazing to see how kind of relieved that a #parent feels when they’ve asked their #child that question, even when they get the ‘yes’ answer,” Davis said. “As least they know what’s going on, and they can reach out and get help.”

But what are the red flags that indicate such a conversation is needed? How do you initiate that talk and what needs to be conveyed? And, perhaps most importantly, what action needs to be taken if the individual acknowledges #suicidalthoughts?

https://mlive.carto.com/u/levinscott/builder/c3897441-c7c0-4c68-98c2-09d0d6501151/embed

The above map shows #suicide deaths by county for 2010-20, based on data from the federal #CentersforDiseaseControl. The map is shaded by the #suicide rate per 100,000 residents. You can click on a county to see the numbers. Can’t see the map? Click here.

Warning signs

The #NationalInstituteofMentalHealth lists a number of warning signs that someone may be at immediate risk of #suicide. Among the red flags:

• Talking about wanting to die or wanting to kill themselves or talking about death often.

• Talking about feeling empty or hopeless or having no reason to live.

• Feeling unbearable emotional or physical pain.

• Talking about being a burden to others.

• Talking about feeling great guilt or shame

• Withdrawing from family and friends.

• Saying goodbye to friends and family and/or putting affairs in order, such as making a will and giving away important possessions.

• Taking risks that could lead to death, such as driving extremely fast.

Other serious warning signs: Extreme mood swings; using #drugs or #alcohol more frequently; looking for ways to kill themselves, such as searching for lethal methods online, stockpiling pills, or buying a gun.

“If someone’s been depressed for awhile and then all of a sudden starts feeling really good, that’s kind of a scary time because maybe they’ve come to the decision they do want to commit #suicide,” Beer said.

In that situation, those around the person may well see the change in mood as a positive sign. “They think, ‘OK, I don’t have to worry anymore,’ " Beer said. “But it can be a sign of concern.”

Specific life events -- the death of a loved one, the breakup of a relationship, the loss of a job, financial problems -- can be so overwhelming for some that they see suicide as the only solution. Likewise, people with serious clinical #depression may see no other resolution.

“Sometimes when people are really depressed, they can’t imagine feeling good ever again,” Beer said. “People want to commit #suicide because they don’t want the pain anymore.”

While #women are more likely to attempt #suicide, #men have a much higher rate of dying because they are more likely to use a gun. White men comprise 69% of Michigan #suicide deaths -- 10,425 of 15,062 deaths in the past decade, a rate four times that of white women and twice that of other #men, as shown by the chart below.

However, adjusted for population size, the group with highest rate of #suicide in Michigan are Native #American #men.

Having the conversation

Asking someone about #suicide is a conversation that should be had in person versus over the phone, experts say. That’s especially true if the #suicide threat seems immediate: You don’t want to risk the individual cutting the conversation short by hanging up.

It’s also important to be direct but empathetic versus judgmental during the talk, experts say, and to stay calm.

“When someone is agitated and very anxious or angry, we’re not really thinking clearly,” Marcela Alcala said. “We’re not really using our cerebral cortex and reality is different at that point. We’ve all had experiences where we were angry -- and then when we’re calm, we realized, wow, that wasn’t quite as big of a deal as it felt like when we were agitated. So first thing is to have someone calm so you can have a rational conversation.”

Tell the person that you want to check in with them and ask how they’re feeling. Ask directly: “Are you having thoughts of #suicide?” or “Are you thinking about killing yourself?” Avoid framing the question in a judgmental way such as: “You’re not thinking of doing anything stupid, are you?”

Listen to their response and let them talk about why they’re thinking of #suicide. Ask if they have a #suicide plan. Once again, don’t be judgmental or argumentative. But tell the person that you and others really don’t want them to die.

Michelle Serlin, who heads Choices for Change, a Kalamazoo counseling agency, said that when she has a client with #suicidalthoughts, she might say, “I really hope you don’t do that because I would be really sad if I never got to see you again. Don’t you care about my feelings?”

“They usually start laughing and it kind of pushes them out of a it a bit,” she said. “Then I’ll say, “Now let’s talk about what’s bothering you.’ ”

If someone acknowledges #suicidalthoughts, the next step is helping them to connect with a #mentalhealthprofessional.

If the #suicide threat seems immediate, that may involve taking the person to an emergency room for a #mentalhealth evaluation or calling 911 if the person refuses to seek medical treatment.

Other options: Calling the individual’s primary #healthcareprovider or calling Gryphon Place or another #suicideprevention agency or hotline. “A person can call us and say, ‘I’m calling for another person’ and hand over the phone,” Alcala said.

Gryphon Place also can be a resource in advance of such a conversation, by coaching the person initiating the talk on what to say and what steps of action might be necessary.

Gryphon Place can definitely help guide someone “through the process of supporting another person with #suicidalthoughts,” Alcala said. The agency serves the Kalamazoo region, and operates a 24-hour hotline at 269-381-HELP.

In fact, Gryphon Place offers several types of #suicideprevention trainings specifically designed to help people identify friends and family members who might be at risk of #suicide and how to talk to them about it.

One of those trainings, The Gatekeepers program, helped Paulo recognize the need to reach out to his troubled friend. That curriculum is designed for middle and high schoolers, and is in place in Kalamazoo, Portage, Mattawan, Gull Lake, Otsego, Mendon, Constantine, White Pigeon and Union City #school districts plus Hackett Catholic Prep.

Another program offered by Gryphon Place, safeTALK, is a similar half-day training for #adults.

Both programs are designed to provide participants with information about #suicide, #depression, and resources available for at-risk individuals; how to identify people who might be at risk of #suicide, and when and how to intervene.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleOrder your copy of James Donaldson's latest book,#CelebratingYourGiftofLife:From The Verge of Suicide to a Life of Purpose and Joy

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Maricela Alcala, chief executive officer of Gryphon Place, poses for a portrait in Kalamazoo County, Michigan on Monday April 11, 2022. Gryphon Place is agency that provides crisis and counseling services, they also provided a 24/7 helpline.

Not a silver bullet

To be sure, an intervention session with a suicidal loved one may not save their life.

Serlin knows that all too well. Her brother Joel died by #suicide at age 32 in 1998.

Joel was smart and handsome, but he also suffered from severe #mentalillness.

“He was diagnosed with schizoid type 1,” Serlin said. “My brother said to me once, ‘I want you to understand how I feel. So I want you to take your worst, worst, most miserable day. That’s my best day.’ I’ll never forget that comment.”

Serlin said she and other family members had numerous conversations with her brother over the years about his #suicidalthoughts. “I always thought we would catch it if something bad happened,” she said. But then her brother went through a very painful breakup with a longtime girlfriend, and took his own life.

“Sometimes people reach a tipping point,” Maricela Alcala said. So even when friends or family members offer support, #suicide “can still happen and it’s nobody’s fault.”

Another big issue is access to #mentalhealthservices, even when the person is willing to seek help. While hospital emergency departments are required to see people in a #mentalhealthcrisis regardless of ability to pay, finding affordable outpatient therapy can be challenging.

The #pandemic has increased the demand for #counselors -- and decreased the supply, as some #therapists have experienced burnout and left the profession.

“There’s just not enough #mentalhealth #counselors out there,” Beer said.

One option is working through a primary-care provider to find a #therapist. Another option for people who can afford it: Online #therapists available through an app such as Talkspace.

“It gives you access to people who are trained, who can provide the help,” Beer said.

What the research says

Based on anecdotal experience, experts say that asking people directly about #suicidalthoughts can be an effective intervention.

The actual research on the topic is encouraging, but limited.

Studies found asking people about #suicidalthoughts does not increase #suicideideation, according to a 2014 meta-analysis published in Psychological Medicine. That analysis concludes “acknowledging and talking about #suicide may in fact reduce, rather than increase #suicidalideation, and may lead to improvements in #mentalhealth in treatment-seeking populations.”

Likewise, studies that look that at programs such as Gatekeepers and safeTALK found they can raise awareness and reduce #stigma about #depression and #suicide, and reduce the reluctance to intervene when someone is at risk of #suicide, according to a 2015 meta-analysis in Rand Health Quarterly.

Still, that 2015 review of the literature noted that the question of whether such interventions actually reduce #suicide “remains unexamined,” saying there are no studies that have linked such interventions to a lowering of #suicide rates.

Maricela Alcala said part of the problem is that #suicide numbers historically have been unreliable and subject to undercounting, based on the reluctance of some to state that someone died of #suicide. Plus, some suicides -- especially those involving car crashes or drug overdoses -- get recorded as accidental deaths because intent is unclear.

In fact, Alcala said, it’s possible the rise in suicides in the past 15 years actually reflects better reporting vs. a true increase. “With all the educational awareness that communities are doing, people are more likely to call a #suicide death for up what it is and that’s why there are more numbers,” she said. “That’s my personal opinion, that we’re able to count better.”

Still, in a 2021 paper on #suicideprevention research priorities, the federal #CentersforDiseaseControlandPrevention acknowledged that research has yielded lots of information about risk factors for #suicide, but “less is known about protective factors.”

“There is also little known about potential synergies between combinations of various risk and/or protective factors that could amplify risk or protective effects,” the paper said.

But based on his own experience, Paulo has no doubt that intervening with his friend made a difference.

If he hadn’t known to intervene, Paulo said, “I think the situation could have escalated and gotten a lot worse. I might have blown off the situation, and been like, ‘This happens to everybody. He’ll be fine.’ "

Instead, Paulo said, “we got him the help that he needed.”

#Suicideprevention resources:

Gryphon Place operates a 24-hour crisis hotline at 269-381-HELP (4357).

The #NationalSuicidePreventionHotline is available at 1-800-273-8255.

Crisis Text Line is a texting service for emotional crisis support. To speak with a trained listener, text HELLO to 741741. It is free, available 24/7, and confidential.

The #VeteranCrisisHotline is 1-800-273-8255, press 1.
https://standingabovethecrowd.com/2022/10/jamesdonaldson-on-mentalhealth-saying-these-words-could-help-someone-who-is-contemplating-suicide/