What do I do if someone sounds suicidal?
By Andrea Pratt, LCSM, MSW
→ Related resource: Recommendations for Biblical Counselors
Thoughts of suicide can be a jarring thing to talk about. Yet, it is more of a common human experience than we may realize—National Institutes of Health ranks it as the 10th leading cause of death in the United States.
In my own experience as a mental health professional, suicide is something I assess with patients almost daily. Among the patients who disclose feeling suicidal at one time or another, I have noticed a common theme; it’s a feeling that comes alongside depression, the stinging, gutted feeling of hopelessness that one can’t shake. It’s a hopelessness that leads the individual into a holding pattern where they feel there is no relief and nowhere to turn.
In my own practice, discussing suicide with patients has led me to wrestle with this dark and weighty topic. How does someone get to the point of wanting to kill themselves?
Maybe you’ve experienced this feeling yourself. Maybe you know someone who has attempted or even committed suicide. You know there is no short answer, or quick fix here. While I haven’t found the magic thing to do or say to “cure” patients from thoughts of suicide, I have found some relief in the Bible, like when Job wishes he was never born (Job 3:3). I’ve found some connection to the topic when Rebecca cries out in pain, “Why go on living?” (Gen. 27:46), or a little more understanding as Moses exclaims, “This burden is too heavy…if this is how you are going to treat me just go ahead and kill me.”(Num. 11:15) The honest cries of hopelessness continue with Jonah, Elijah, and Jeremiah.
Their hopelessness gives me courage to consider my own hopelessness, that I am weak, a sinner in need of a savior with limitations in a broken world. Through that lens I sit with patients soberly in their raw honesty as they share about their own thoughts of suicide.
As you may be aware, many of our own church members walk in bouts of depression and anxiety, most likely with varying thoughts of suicide. As their community group leader, you may be the best person in the best possible position to recognize warning signs of suicide.
First, we must be willing to recognize our own reluctance, fear, denial, shock, and anger towards the idea that someone would consider suicide or harming themselves. Suicide is complex and difficult to understand. Today’s conversation is less about the how and why, and more about identifying warning signs and linking a person in crisis to immediate help through a strategy called QPR.
Research shows the majority of people who attempt suicide give some type of verbal warning of their intent to kill themselves.
This may look like someone saying:
- I wish I were dead.
- I’m so tired of it all.
- What’s the point of going on?
- My family would be better off without me.
- Soon you won’t have to worry about me any longer.
If you are concerned about someone, your best bet is to ask them clearly and directly about it. Below I share the suicide prevention method from QPR Institute, created by Paul Quinnett, PhD, to provide a guide on how to ask about suicide and what to do if someone acknowledges it.
QPR focuses on these 3 life-saving actions:
- Question the person about suicide
- Persuade the person to get help
- Refer the person to the appropriate resource
The most important step is asking the question. Though it might seem counterintuitive, asking about suicide does not increase the risk of it.
Here are some examples; choose a phrase that sounds most like you:
- Have you been unhappy lately? So unhappy that you wished you were dead?
- As your community group leader, I am concerned about you. Are you thinking about suicide?
- You look pretty withdrawn. Are you thinking about killing yourself?
- Do you have thoughts, feelings or plans to kill yourself?
This step looks to move the person’s mindset towards finding help. First, listen and acknowledge the person’s pain, since listening is crucial to this entire process. Then, persuade them to get help from a professional.
Here are some options for initiating this step in the conversation:
- Will you go with me to the emergency department or call 911?
- Will you call the crisis line with me?
- Will you promise to contact your counselor?
- I want you to live. Will you please stay alive until we can get you some help?
What if they refuse to get help?
If a person refuses help and you think they are a danger to themselves, contact crisis services for immediate assistance. Services vary by county in North Carolina. A mental health professional will respond to your call and provide you with support.
The final step is assisting the person with receiving professional help. Here are some things to think through in this step:
- The best referral is when you go with the suicidal individual to an emergency room, crisis center, or meeting with a mental health professional.
- In the immediate context, this can look like making a phone call together to the crisis center, suicide hotline, or to schedule an appointment with their counselor.
- And finally, even if you don’t get to immediately accompany them to professional help, this step includes getting the individual to agree to accept help, even if it’s in the future.
Whether or not they are interested in contacting a professional, getting others involved is important. This can look like asking, “Who else would you like to know that you’re feeling this bad?” Working with the person to identify a friend or family member and then calling or meeting with that person to share what is going on will increase the patient’s proverbial safety net. Not everyone will want to involve their whole community group, but your group can provide an excellent support network if they are willing. Keep in mind, when they let your group in on their suicidal thinking it might elicit default problem solving responses from your group members (ex. “well just stop thinking about it”), so you’ll need to lead your group in listening to the person, acknowledging their pain, and persuading them to seek professional help (or asking how that help is going, if they’ve already sought it).
Who else needs to know?
As a community group leader, you’ll want to keep your coach aware as you assist this person in seeking help (note: groups are organized slightly differently across our multiple locations, so for those leaders who don’t have a CG coach, substitute whomever you report to). Obviously, confidentiality is an important aspect to this conversation, so the best way to do this is to let the person know by including it in the referral step above with, “Is it okay with you if I also let my community group coach know?” Feel free to explain what a coach is, that your coach is there to support you and your group, and that your coach will join you in praying for them. Also, the coach wouldn’t reach out to the person, or have a Vintage pastor reach out to the person, unless the individual requests it. If they express discomfort with the idea then you can always offer to keep their name confidential.
Asking about suicide brings hope
I’ve regularly noticed that an individual who feels suicidal is unaware of the severity of their state of hopelessness. As a bystander it can be easy to deny, minimize, or avoid stepping into their hopelessness and asking if they are thinking about killing themselves. Yet, it can be the greatest way to step in and help the person. Research has consistently shown that once a person has been asked if they are considering suicide, they feel relief, not distress. Their anxiety decreases while hope increases. By asking this question, we can bring a sense of hope into a place where the person feels entirely alone and numb. I can’t help but think of Jesus stepping into my own story of darkness, and pray that as community group leaders he would enable us to notice, support, and point our church members towards him in this way as well.
Andrea Pratt, LCSW, MSW is a licensed clinical social worker currently providing individual and group therapy at Duke University Health System. She is a passionate practitioner who desires to help patients make new connections between their substance addiction, mental health, stress management, and habit loops in a nonjudgmental and collaborative space. Outside of work, she enjoys spending time with friends and family, participating in her church community, and exercise, including running, biking, and yoga. She has served as a community leader at Vintage Church since 2018.