I Know Someone Who Is Struggling

Mental illness is a scary topic. It’s a dark web of self-inflicted lies that traps away all hope of getting better – or, at least, that’s what it feels like. If you’ve never experienced the debilitating darkness of depression, or the mind numbing fear of anxiety, then it may be hard to understand how your friend or loved one may be feeling. Even more so, it would be hard to understand how these feelings could be leading your loved one to equally frightening behaviors, such as self-harm or suicidal ideation.

The important thing to remember is that your loved one is sick. They are not lazy or weak, and they cannot “get over” a mental illness any more than someone can “get over” cancer. Similarly, this sickness can affect anyone, regardless of personal circumstances. A student who is popular and beautiful, with loving parents, a big house, and a pool is just as likely to become sick as someone who has divorced or absent parents, is abused or neglected at home, has failed a few years in school, or does drugs. While certain experiences in life (such as neglect or drug abuse) can contribute to a mental illness such as depression or anxiety, it is important to understand that anyone can get sick with a mental illness. Looks certainly can be deceiving.

Perhaps your loved one knows that they are living with depression or anxiety. Perhaps they do not. By educating yourself on the signs and symptoms of depression, anxiety, and suicide, you can be a pivotal part in their recovery and even save a life.

SYMPTOMS OF DEPRESSION

Have you noticed 2 or more of these symptoms for at least 2 weeks or longer?

• Sad or melancholy mood most of the day, every day
• Lack of interest in activities he/she used to enjoy
• Lashing out at friends/family
• Suddenly gaining or losing weight without trying
• Tired or sluggish during the day, unable to stay awake
• Isolating self from friends, family, and peers
• Not doing well academically
• Getting into fights
• Talking or Writing about death, dying, or dark themes
• Looking disheveled, not caring about physical appearance
• Making risky decisions
• Not prepared for school, work, or other responsibilities

SYMPTOMS OF ANXIETY

Have you noticed 2 or more of these symptoms over the past 6 months?

• Surge of overwhelming panic or panic attacks
• Feeling of losing control or going crazy
• Heart palpitations, chest pain, muscle tension, headaches
• Feeling like you’re going to pass out
• Trouble breathing or choking sensations
• Plagued by irrational fears that won’t go away
• Waiting for something bad to happen
• Avoidance of everyday activities or situations because they cause anxiety

SYMPTOMS OF SUICIDAL IDEATION

If you notice any of these signs, contact help right away.

• Talking about wanting to die or killing oneself (even if in a joking manner)
• Looking for ways to kill oneself, such as researching online or buying a gun
• Talking about feeling hopeless or having no reason to live
• Talking about feeling trapped or in unbearable pain
• Talking about being a burden to others
• Use of drugs or alcohol
• Acting anxious or agitated, behaving recklessly
• Having a “death wish” – driving fast, running red lights, or other dangerous behavior
• Showing rage or talking about revenge
• Displaying extreme mood swings
• A sudden, seemingly overnight switch from being sad or anxious to being very calm
• Calling loved ones to say goodbye
• Putting affairs in order, writing or editing a will
• Giving away valued possessions

Key phrases to look out for:

• “You’ll miss me when I’m gone”
• “None of this is going to matter anyway”
• “You will regret treating me this way”
• “This is all so pointless”

If your friend or loved one has shown any signs of suicidal ideation, seek professional help immediately.

How Can I Help?

“The people who talk about it don’t do it.” Studies have found that more than 75% of all completed suicides did things in the few weeks or months prior to their deaths to indicate to others that they were in deep despair. Anyone expressing suicidal feelings needs immediate attention.

“Anyone who tries to kill himself has got to be crazy.” Perhaps 10% of all suicidal people are psychotic or have delusional beliefs about reality. Most suicidal people suffer from the recognized mental illness of depression; but many depressed people adequately manage their daily affairs. The absence of “craziness” does not mean the absence of suicide risk.

“Those problems weren’t enough to commit suicide over,” is often said by people who knew a completed suicide. You cannot assume that because you feel something is not worth being suicidal about that the person you are with feels the same way. It is not how bad the problem is, but how badly it’s hurting the person who has it.

“If a someone is going to kill himself, nothing can stop him.” The fact that a person is still alive is sufficient proof that part of them wants to remain alive. The suicidal person is ambivalent – part of them wants to live and part of them does not want death so much as they want an end to the pain. It is the part that wants to live that tells another person, “I feel suicidal.” If a suicidal person turns to you, it is likely that they believe that you are more caring, more informed about coping with misfortune, and more willing to protect their privacy than someone else might be. No matter how negative the manner and content of their talk, they are doing a positive thing and has a positive view of you.

Suicide prevention is not a last minute activity. All textbooks on depression say it should be reached as soon as possible. Unfortunately, suicidal people are afraid that trying to get help may bring them more pain: being told they are stupid, foolish, sinful, or manipulative; rejection; punishment; suspension from school or job; written records of their condition; or involuntary commitment. You need to do everything you can to reduce the pain, rather than increase or prolong it. Constructively involving yourself on the side of life as early as possible will reduce the risk of suicide.

Give the person every opportunity to unburden their troubles and ventilate their feelings. You don’t need to say much and there are no magic words. If you are concerned, your voice and manner will show it. Give them relief from being alone with their pain; let them know you are glad they turned to you. Practice patience, sympathy, acceptance. Avoid arguments and giving advice.

“Talking about it may give someone the idea.” People already have the idea; suicide is constantly appearing in the news media. If you ask a despairing person this question you are doing a good thing for them: you are showing them that you care, that you take them seriously, and that you are willing to let them share their pain with you. You are giving them further opportunity to discharge pent up and painful feelings. If the person is having thoughts of suicide, find out how far along their ideation has progressed.

If the means to harm themselves are present, try to get rid of them. Detoxify the home. Oftentimes suicidal individuals experience an acute emotional “spike” which is the danger zone of harming oneself. The decision to enact a plan could be quite impulsive, even if someone has been suicidal for a long time. Removing lethal means from an environment can help someone make it through that acute emotional spike where an impulsive decision could be made.

Persistence and patience may be needed to seek, engage and continue with as many options as possible. In any referral situation, let the person know you care and want to maintain contact.

It is the part of the person that is afraid of more pain that says “Don’t tell anyone.” It is the part that wants to stay alive that tells you about it. Respond to that part of the person and persistently seek out a mature and compassionate person with whom you can review the situation. (You can get outside help and still protect the person from pain causing breaches of privacy.) Do not try to go it alone. Get help for the person and for yourself. Distributing the anxieties and responsibilities of suicide prevention makes it easier and much more effective.

Most people have suicidal thoughts or feelings at some point in their lives; yet less than 2% of all deaths are suicides. Nearly all suicidal people suffer from conditions that will pass with time or with the assistance of a recovery program. There are hundreds of modest steps we can take to improve our response to the suicidal and to make it easier for them to seek help. Taking these modest steps can save many lives and reduce a great deal of human suffering.

DO:

• Take them seriously (even if they are joking – suicide is NOT a joking matter)
• Practice compassionate listening
• Pay attention to key phrases that may indicate suicidal ideation
• Ask direct questions – “Are you thinking of suicide?” “Do you have a suicide plan?” “Do you have the means to follow through with your plan?” “Do you have a time set?”
• Be prepared to call for additional help, such as parental figures or 911, if needed
• Let them do most of the talking
• Ask clarifying questions – “So, you feel like no one cares about you?” “You say you’re having problems at home?” “You feel that you are crumbling under pressure, is that correct?”
• Allow them to be emotional, even if it’s over something that doesn’t seem like a “big deal” to you.
• Encourage them to seek help from a professional
• Let them know that what they are feeling can be treated successfully
• Use “I” Statements – “I believe you would benefit from counseling”
• Continue to be part of their support system as they walk through recovery

DON’T:

• Promise to keep their feelings about hurting themselves or someone else a secret
• Tell them that it is “just a phase”
• Use clichés such as “everything happens for a reason”, “you can’t have a rainbow without a little rain”, “time heals all wounds”, etc.
• Try to be a counselor and “fix” their problems
• Give advice (your job is to listen)
• Do most of the talking
• Panic or become overly emotional yourself
• Expect logical answers. Remember: people living with a mental illness may be able to articulate that they feel bad, but they may not have any reasons why they feel bad.
• Use “You” statements – “you’re just looking for attention”, “you need to get over it”, “you’ll be fine”

ADDITIONAL RESOURCES:

• Get Help for Someone Else
• What to do When You Think Someone is Suicidal
• How to Help an Online Suicidal Person
• 10 Things to Say (and 10 Things Not to Say) to Someone With Depression
• 12 Tips for Friends and Family of Those with Anxiety
• 3 Ways to Help Someone Through a Panic Attack
• Beyond Blue: Supporting a Friend
• How to Help a Suicidal Person
• Co-occurring Disorders: Addictions and Mental Health

QUESTIONS TO ASK:

“Are you thinking about suicide?”
“Are you thinking about taking your life?”
“Are you thinking about killing yourself?”
– Asking the question will NOT plant the idea in their head. In fact, the most common response is relief that someone noticed they were in pain and cared enough to ask.

IF YES:
“Do you have a plan?”
“Have you thought about how you would do it?”
– Again, asking this question is NOT going to encourage the person to start considering it. If they DO have a plan, it shows that they have been thinking about suicide for quite some time.

IF YES:
“Do you have the means to follow through with that plan?”
“Do you have access to ____?”
– The risk of suicide is heightened drastically when the means are easily accessible. This is why removing lethal means from an environment is a big step in preventing suicide.

IF YES:
“Have you ever attempted suicide before?”
– People who have attempted suicide in the past and did not receive adequate treatment are more likely to make another attempt. Surviving an attempt does NOT “get it out of your system”.
– However, suicidal people who do receive appropriate treatment and recover will often never feel suicidal again.

THE MORE YESES, THE HIGHER LEVEL OF PLANNING, THE MORE DANGEROUS THE SITUATION.