Life Health & Wellbeing

Thursday 19 July 2018

How you can help a suicidal person

Mind matters...

Brendan Kelly
Brendan Kelly

Brendan Kelly

What should you do if someone tells you they are suicidal? The first piece of advice is the most obvious one: you need to take this seriously and take the time to listen. Doing this is more important than whatever you were doing just before the person told you how they're feeling (no matter what that was). You need to settle down and take some time with this.

Remain calm and collected. If you think someone might be suicidal but you are not certain, asking them directly does not increase risk, once you ask with care and in a supportive context. Asking does not "put the idea into their head". For example, if a person says they are feeling very depressed and hopeless about the future, you can ask: "Are there times when you feel so low that you feel you can't carry on? That you want to end your life?"

Contrary to what many people think, asking in this direct fashion does not increase risk. Nor does asking the person to tell you more about how they're feeling, if they are hesitant or unclear. Most people are hugely relieved to talk about their distressing thoughts with someone who has the capacity to listen and not be overwhelmed. Someone who will actively listen, really hear what they say, and demonstrate that they care.

Language matters greatly. Mostly listen. When you speak, avoid platitudes. For example, do not say: "Don't worry; everything is OK". Clearly, everything is not OK. Saying that everything is OK confirms the person's worst fear: that you're not really hearing them. As they see it, everything is most certainly not OK.

It is generally not helpful to tell people that "things could be worse". You don't know if that is true, and, even if it is, the person probably thinks things cannot possibly get any worse. That's why they feel the way they feel. It might not be true, but it is how they feel right now. And you are not there to argue with them. For now, you are there just to be there and to listen.

Take your time. Ignore your phone. Do not feel the need to speak every time there is a silence. The most important thing that you're doing is simply being there.

After a while, make one or two very pragmatic, very short-term suggestions, such as: "Let's go for a walk while you tell me more about this". At the outset, avoid making more long-term suggestions such as: "Maybe you should quit your job" or "Why not leave your husband?" These are issues for another day.

Be generally hopeful but remember that simplistic solutions to long-term problems can seem trite and unrealistic. Just focus on today. Do not panic or let yourself get overwhelmed. Do not blame the person. Remain calm, pragmatic and hopeful as you speak and make a plan of action.

When making a plan, there is good advice on the website spunout.ie about what to do when someone is feeling suicidal. In the first instance, if the person has already taken steps to end their own life, it's important to call 999 immediately to get them medical attention, or take them straight to an emergency department in a hospital.

If they have not already taken steps to end their life but remain suicidal, it is useful to stay with the person and remove means of self-harm from their immediate vicinity (e.g. tablets). It is also useful to assist the person in accessing one of the support services available, depending on the situation.

The Samaritans (samaritans.org) provide a listening service to anyone who contacts them, many of whom are contemplating suicide (tel: 116 123; email jo@samaritans.org). Pieta House (pieta.ie) also offers support for anyone who is suicidal (tel: 1800 247 247). Other key sources of support include GPs and community mental health teams.

In the more acute situation, most large and regional hospitals have psychiatry services operating 24 hours a day, seven days a week, 365 days a year.

Where the local inpatient unit is located within a general hospital, emergency and out-of-hours psychiatry assessments generally occur in the emergency department of the hospital. This is often a difficult setting but staff try to make it as therapeutic as possible. For inpatient units that are not located in general hospitals (e.g. stand-alone psychiatric hospitals), emergency assessments sometimes occur in the hospital itself or in a neighbouring general hospital.

It is important at all times to remain calm and supportive, and really listen to what is being said. You will never know what you prevented simply by listening and being there.

* Brendan Kelly is Professor of Psychiatry at Trinity College Dublin and author of Mental Health in Ireland: The Complete Guide for Patients, Families, Health Care Professionals and Everyone Who Wants to Be Well

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