Mental Health First Aid: How to Help Someone Feeling Suicidal

By Wasim Rashid Kakroo

THE act of taking one’s own life is referred to as suicide. It is a situation in which someone plots or acts on self-destructive ideas and sentiments, frequently when under intense stress. According to the World Health Organization (WHO), over one million individuals die by suicide eacH year.

It’s tough for individuals who aren’t suffering from suicidal depression and despair to grasp what causes so many people to commit suicide. A suicidal individual, on the other hand, usually has exhausted all the means of making sense of his or her life and is in so much anguish that he/she sees no other way out.

Suicide is a desperate attempt to end pain that has grown unbearable. Suicidal people are blinded by feelings of self-loathing, hopelessness, and loneliness, and they see no other way out but death. Despite their wish to end their suffering, most suicidal persons are extremely torn about taking their own lives. They wish there was an alternative to suicide, but they can’t find one.

Suicide can be avoided. The majority of suicidal persons do not wish to die. They just do not want to be in agony. Talking openly about suicide thoughts and feelings can save a life. So, a common man should not underestimate his/her ability to assist a suicidal individual, or perhaps to save a life.

How can I know if someone is suicidal?

It is critical to understand the warning signs and reasons for suicide, as well as the risk factors why someone would consider suicide.

Signs a person may be suicidal are:

• Threatening to injure or kill oneself
• searching for methods to kill themselves: looking for drugs, weapons, or other means
• Talking or writing about death, dying, or suicide
• Hopelessness
• Rage, fury, seeking vengeance
• Acting carelessly or participating in dangerous behaviours seemingly without thinking
• Feeling imprisoned, as if there is no way out
• Increasing alcohol and drug usage
• Withdrawing from friends, family, or society
• Anxiety, restlessness, inability to sleep or sleeping all the time
• Dramatic mood swings
• No reason for living, no sense of purpose in life

Reasons why a person might have thoughts about suicide:

The most common reasons given for attempted suicide are:

1. A desire to escape or alleviate uncontrollable feelings and thoughts. The individual seeks escape from terrible emotional anguish, believes their position is hopeless, believes they are worthless, and believes that other people would be better off without them.
2. A desire to speak with or influence another person The individual want to express their feelings to others, influence how others treat them, or obtain assistance.

Factors linked to a higher risk of suicide:

People are more likely to commit suicide if they have:

• A mental illness such as severe depression, anxiety, borderline personality disorder, substance abuse disorder etc.
• Poor physical health and disabilities
• Have attempted suicide or harmed themselves in the past
• Have had bad things happen recently, particularly with relationships or their health
• Have had adverse childhood experiences such as experienced childhood emotional neglect, abandonment and/or has been physically, emotionally or sexually abused as a child

How can a common individual save a person who is suicidal?

If you are concerned that the individual may be suicidal, you should contact them and discuss your worries.

Getting ready to approach the individual:

Be conscious of your personal views around suicide and the influence they have on your capacity to help others (e.g. beliefs that suicide is wrong or that it is a rational option). If the individual comes from a different cultural or religious background than yours, bear in mind that they may have different views and attitudes regarding suicide than you do.

It is more vital to have a genuine desire to assist than to have the same age, gender, or cultural background as the person. If you don’t feel comfortable asking the individual about suicide thoughts, find someone who can.

Developing the strategy

If you suspect someone is contemplating suicide, act quickly. Even if you simply have a passing hunch that the individual is suicidal, you should contact them.

Tell the individual you care and want to assist them.

Tell them about your fears about them, outlining the behaviours that have caused you to consider suicide. Understand, though, that the person may not wish to speak to you. In this case, you should offer to assist them in finding someone else with whom they can talk. Also, if you are unable to connect with the individual, assist them in finding someone else to chat to.

Inquiring about suicidal ideations

Suicidal ideation can strike anyone at any time. If you suspect someone is suicidal, you should approach that individual immediately. Unless they tell you, the only way to find out whether they are considering suicide is to ask.

For example, you may inquire:

• “Are you contemplating suicide?”

or • “Are you thinking of taking your own life?”

While it is more essential to address the question directly than to be concerned with the exact phrase, you should not inquire about suicide in a leading or judgemental manner (e.g.,‘You’re not thinking of doing something dumb, are you?’).

People are sometimes hesitant to ask openly about suicide because they fear they may implant  the concept in the person’s mind. This is not correct. Similarly, if a person is suicidal, inquiring about suicidal ideas will not enhance the likelihood that they would act on them. Instead, asking the person about suicide thoughts will provide them the opportunity to talk about their problems and demonstrate that they are not alone.

Although it is natural to feel worry or astonishment when someone shares suicidal intentions, it is critical to avoid voicing negative responses. Make every effort to look cool, confident, and compassionate in the face of the suicide crisis, since this may have a reassuring effect for the suicidal individual.

How should I talk with someone who is suicidal?

It is more essential to care than to say “all the correct things.” Be cooperative and empathetic of the suicidal individual, and pay close attention to them. Suicidal thoughts are frequently a cry for aid as well as a desperate attempt to escape issues and distressing feelings.

Inquire about the suicidal person’s thoughts and feelings. Assure them that you are interested in hearing what they have to say. Allow them to express their thoughts and feelings, as well as their reasons for wanting to die, and acknowledge them. Tell the suicidal individual that it is appropriate to talk about things that are hurtful, even if it is difficult. Allow them to express their emotions (for example, allow them to cry, express anger, or scream). Suicidal people may feel relieved to be allowed to do so. Remember to praise the suicidal person for expressing their thoughts with you and acknowledge their courage that was required to do so.

How can I assess how critical the situation is?

Take all suicidal ideas seriously and take action. Do not disregard the person’s ideas as an attempt for “attention seeking.” Based on the detection of suicide warning signals, determine the urgency of taking action.

Inquire with the suicidal individual about problems affecting their immediate safety such as:

• Whether they have a suicide plot.
• How they mean to commit suicide, i.e., direct inquiries regarding how and where they want to commit suicide.
• Whether they have chosen when to carry out their strategy.
• Whether they have previously made measures to get the means to end their life.
• Whether they have used drugs or alcohol. Intoxication can enhance the likelihood of a person acting on their suicidal urges.
• Whether they had previously attempted or planned suicide.

If the suicidal individual claims to be hearing voices, inquire as to what the voices are saying. This is significant if the voices are related to their present suicidal thoughts.

It is also beneficial to learn about the person’s accessible supports:

• Whether they have expressed their feelings to anybody.
• Any changes in their work, social life, or family life.
• Whether they have had therapy for mental health issues or are currently taking medication.

Be aware that people who have a detailed suicide plan, the means to carry out the plan, a time set for executing it, and the will to do it are those who are most likely to act on their suicidal ideas in the near future. However, the absence of a suicide plan is insufficient to assure safety.

How can I ensure the individual’s safety?

Once you’ve determined that a suicide risk exists, you must take action to keep the person safe. Suicidal individuals should not be left alone. Even if you are hesitant, intervene immediately if you believe the individual is in immediate danger of acting on suicide intentions. Rather than acting alone to prevent suicide, work jointly with the suicidal individual to secure their safety.

Remind the suicidal individual that suicidal ideas do not have to be followed through on. Assure the suicidal individual that there are other options for dealing with issues or coping than suicide.

When speaking with a suicidal individual, focus on the things that will keep them safe for the time being rather than the things that will put them in danger. Create a safety plan with the suicidal individual to help keep them safe. Involve the suicidal individual as much as possible in decision-making regarding a safety plan. However, do not presume that a safety plan will suffice to keep the suicidal person safe.

Although you can give assistance, you are not accountable for someone else’s actions or behaviours, and you have no influence over what they do.

What is the role of mental health professionals?

Encourage the individual to seek appropriate professional assistance as soon as feasible. Learn about the resources and services available to someone who is thinking about suicide, including local services that can help individuals who are suicidal, such as district mental health programme units (DMHP units) available at various general district hospitals, state psychiatric diseases hospital, mental health clinics, mobile outreach crisis teams, suicide prevention helplines, and local emergency services. Give this information to the suicidal individual and talk about your choices for getting assistance with them. If they don’t want to talk to someone in person, encourage them to call a suicide hotline. Don’t presume that the individual will get well on their own or that they will seek treatment on their own. People who are suicidal often do not seek treatment for a variety of reasons, including stigma, humiliation, and the idea that their situation is hopeless and that nothing they or somebody else do can help.

If the suicidal person is hesitant to seek assistance, continue to encourage them to see a mental health professional and to call a suicide prevention hotline for advice on how to assist them. If the suicidal individual rejects professional treatment, contact a mental health centre or a crisis hotline for assistance.

A more direct approach may be required if the suicidal individual is a teenager. If a teenager is hesitant to seek help, make certain that someone close to them is aware of the problem (i.e. a close friend or family member). If the adolescent refuses professional treatment, seek support from a mental health expert as well.

If at all feasible, the health practitioner called to assist should be someone the suicidal person knows and trusts. If the individual has a detailed suicide plan, or if they have the tools to carry out their suicide plan, contact a mental health centre or a crisis hotline and ask for advice on the situation.

Contact the police if the suicidal individual has a weapon to commit suicide. When contacting the authorities, make it clear that the person is suicidal in order for them to respond appropriately. Make certain that you are not putting yourself in risk when providing help to the suicidal individual.

Be prepared for the suicidal individual to show anger and feel deceived if you try to prevent their suicide or assist them in seeking professional treatment. Try not to take the suicidal person’s harsh acts or words personally.

What if the individual asks me to promise not to inform anybody else?

You must never agree to keep a suicide plan or danger of suicide hidden. If the individual does not want you to inform anybody about their suicidal thoughts, do not agree but explain why (for example, “I care about you too much to keep a secret like this. You need help, and I am here to assist you in obtaining it”). Respect the individual and include them in decisions regarding who else knows about the suicidal crisis.

Keep in mind that having the individual upset at you for disclosing their suicidal thoughts without their consent in order to get treatment is preferable than losing the person to suicide.

What should I do if the individual has taken action based on suicide thoughts?

If the suicidal individual has already injured themselves, provide first aid and contact suicide helpline for an ambulance. Remember that, despite our best efforts, we may not be able to prevent suicide.

The individual I’m attempting to assist has hurt themselves, yet they say they are not suicidal. What am I supposed to do?

Other than suicide, some individuals hurt themselves using sharp objects such as blade. This might be to alleviate extreme pain, stop feeling numb, or for other causes. This might be upsetting to witness. Such cases call for professional assistance for non-suicidal self-injury that individuals do when they are under huge stress such as due to depression or borderline personality disorder.

Take good care of yourself: 

After assisting someone who is suicidal, ensure that you take proper self-care measures. It is exhausting to provide support and help to a suicidal individual, therefore it is critical to take care of yourself especially emotional care and seek professional assistance if you are not able to handle your stress post the event.

The author is a mental health professional at Institute of Mental Health and Neurosciences Kashmir (IMHANS-K) and can be reached at [email protected]

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