Most people who attempt suicide are not likely to die…at least not the first time. But they are likely to try again. The biggest risk comes within the first three months of a suicide attempt, but risk remains elevated throughout their depression recovery, which can be years long.
It’s common for people close to someone who attempted suicide to say that they didn’t see it coming. Loved ones tend to put blinders on, says Heidi Bryan, a member of the National Suicide Prevention Lifeline Consumer Survivor Committee. But once a suicide attempt has occurred, what you do and don’t do, and what you say and don’t say, matter—a lot—she says.
Bryan speaks from the heart and from experience. She has battled depression most of her life. Not only is she a suicide-attempt survivor, she also lost her brother to suicide in 1995.
A suicide attempt is traumatic for everyone involved, the depressed person and everyone who loves him or her. But you don’t have to stand by and feel helpless, says Bryan.
Know that some people will be resistant to your intervening and that there’s only so much you’ll be able to do to persuade them to get help or cooperate, said Bryan. But it also has been her experience that when you show empathy—recognize the severe emotional pain that he is in, know that he didn’t really want to die but wanted to end his pain—and approach him with compassion, the majority of suicide-attempt survivors will be cooperative. When feeling understood and having a sense of collaboration, they also have ownership of their life and aren’t just being told what they need to do. This goes a very long way for someone who just attempted suicide.
First, make your home safer. Remove all guns. Just locking them up isn’t enough. If you don’t want to permanently get rid of them, see whether a friend or family member who lives elsewhere can safeguard them for you. At the very least, store ammunition separately from any gun, and keep both under lock and key. Only you should know where the key is kept.
Some people attempt to overdose with drugs. That’s why you don’t want to the attempt survivor to be in charge of his/her medications. Hide or lock up over-the-counter medicines, too, especially Tylenol, Bryan says.
Though people often think of Tylenol as safe, teens tend to use it to try to commit suicide, and overdosing with it can cause severe liver damage. It’s in a lot of households and often overlooked as being potentially dangerous.
Do the same with liquor, pesticides and other poisons, razors, knives and rope. It can be difficult for you to live this way, but think of it as a small sacrifice to make sure that your home is a safe zone, Bryan says.
If the suicide-attempt survivor doesn’t live with you, to make his environment safe, go with him to his home and remove as many access to means—items that could be used to attempt suicide—as possible.
If someone was hospitalized after a suicide attempt, it’s recommended that he not go home to an empty house for the first few weeks. Have him stay with you or stay (or have someone stay) with him temporarily. If being with him around-the-clock isn’t possible, maybe during the day is doable, supplemented with one or two check-in calls in the evening until his suicidality subsides. See if you can form a safety network of friends and relatives to support the person during the initial period of crisis.
Try to keep your emotions in check. It’s understandable if the suicide attempt left you angry or upset. But lashing out with statements such as, “What were you thinking?” or “How could you do this to me?” aren’t helpful and could be very harmful, Bryan says, causing your loved one to withdraw rather than share what made him want to end his life.
Say thoughtful and kind things. How would you treat someone who had just had a heart attack? Reach out to your loved one with the same type of concern, Bryan says. Help him focus on reasons for living and making life more positive and meaningful. Unsure of how to take the first step? Bryan suggests saying this your loved one: “You may not feel loved, but you have to know that you are. Trust me to know that I’m right about this. So let’s work together to get you feeling better. And always remember, you are not alone. I am here for you.”
Educate yourself. Learn the warning signs of suicidal thoughts so that you can tell whether you need to step in before your loved one tries again. Sleeping too much or too little and losing interest in favorite pastimes are well-known signs of depression, but talking about being a burden to others or saying that life has no purpose are the kind of statements that often lead to suicide. For more signs, go to SuicidePreventionLifeline.org.
It can be painful and frightening for you to acknowledge that your loved one could be on the verge of another suicide attempt, but don’t ignore any signs. Face them head-on. Try this: Sit down with your loved one, and through loving conversation, identify three to five negative emotions that he’s wrestling with. These might include, for example, anger, feeling overwhelmed or trapped. Determine a scale he can use to describe their severity—for instance, one is mild and five is bubbling over. Then have a daily check-in—ask whether the levels of these emotions are rising, and if they’re nearing the top of the scale, agree that it’s time for intervention, such as more intensive mental health therapy.
Walk the line between concern and smothering. Yes, you want to keep a watchful eye on your loved one and be in a position to take action to prevent another suicide attempt if needed, but you don’t want to be constantly hovering—that will make him feel trapped and aggravate the situation, Bryan says. You and your loved one need to determine how much space feels right. It may take some trial and error, but don’t give up.
While the majority of suicide-attempt survivors, when approached with empathy, compassion, and collaboration, will respond positively to working together, that’s not the case for everyone. If your efforts are met with a response such as, “Leave me alone,” there isn’t much you can do but leave him alone for a period of time. You might express concern about doing that and then wait for an opportunity to talk with him, Bryan said. He will need to process what happened. You can only do your best—the rest is up to the attempt survivor.
Fill out a “safety plan” together. This is a written plan that details a series of progressive steps he can take to address suicidal thoughts. First, list his specific warning signs that suicidal thoughts are starting to grow, such as the emotions listed above. Experiencing these are the signal to take action.
The next section of the plan lists at least three self-soothing steps that he can do himself to distract his mind from these thoughts. These can be as simple as meditating, journaling, cleaning out a drawer, holding ice cubes in his hand and letting them melt, or petting a dog. There should also be a list of external resources—a change in scenery, so to speak—such as going for a walk, to a movie or to a coffee shop to distract himself and stop the thoughts if the initial distractions don’t work. You might also suggest that he try an app with a mood journal, distraction techniques and other resources, says Bryan, who recommends the free app MoodTools-Depression Aid for iOS devices.
The safety plan next lists at least three people he can call to talk to about his feelings—family or close friends—when self-soothing doesn’t work.
It must include numbers for a crisis center such as the Suicide Prevention Lifeline at 1-800-273-TALK (8255), for a text such as Crisis Text Line at 741741 (patients can text with a trained crisis counselors), and for his doctor to contact for help.
The plan should also detail at least one thing that’s important to him and makes life worth living so that he can look at this on his safety plan and be reminded of it when life looks bleak, Bryan added.
Deal with your feelings, too. It may not be an easy conversation to have, but you and other family members should openly discuss what happened and everyone’s feelings about it. You might all benefit from therapy, not just the person who attempted suicide, because you all need support, says Bryan. Make sure that the professional you choose is a good fit for everyone, is knowledgeable about specific treatments and practices that can help prevent suicide attempts and has an approach to care that feels like a good fit for you and your loved one.
And the online booklet, A Journey Toward Health and Hope from the Substance Abuse and Mental Health Services Administration.