Everything You Need to Know or Were Afraid to Ask About Suicide

Perhaps no other death carries as much stigma and pain as suicide.

Family and friends wonder what they could have done, how did they miss the signs? They grieve the loss of not only the person but all that they could have become, the life spread out before them unfinished. Suicide has become a larger and larger problem in our country, claiming young and old, rich and poor, crossing boundaries of gender, color and religion. 

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​And yet despite most of us knowing of a suicide in some way -- a classmate, a relative, a friend of a friend, we don't as a society talk about it openly most of the time. So here are some questions you may have wondered and some "straight talk" about suicide. 

Please remember to take ALL suicidal gestures and comments seriously. If someone is talking about suicide call the Suicide Prevention Lifeline at 800 273 8255.  You can also take the person to any hospital emergency room or if you are in Texas you can call 911 and ask for a Mental Health Deputy. These are police officers with additional training in mental health evaluation. They are mobile and can go to the person in crisis.

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• You can't "give" someone the idea to kill themselves by asking them if they are thinking about it. Most people who attempt suicide told someone within a week of the attempt that they were thinking about it. If you are concerned, ask. Be specific, such as "are you having thoughts of hurting yourself?"

• ​The only way to "give" someone the idea to kill themselves is if you yourself commit suicide. In that sense suicides are catching, which is an important reason not to do it!  You do not want to increase the risk that a loved one will follow suit. 

• Most people who are serious about killing themselves have a specific plan with a specific means in mind. Once they start down that road of executing their plan if something goes wrong it creates a temporary opportunity for them to be derailed. This is important to know because if someone has started to plan a particular means, like using a gun or using some pills that are in the medicine cabinet, you can remove the means and create an opportunity for intervention. The person won't just immediately try another means. The depressed brain is SLOW and needs time to think of another plan. So removing means when you have someone who is perhaps contemplating suicide does buy you time. 

• On the other hand, no one can control another person. If a person is hell-bent on killing themselves eventually they may succeed no matter what you do. While in training I was working in a psychiatric emergency room when a woman who had been admitted for suicidal risk. She was placed in an observation room and was getting 10 minute checks when she strangled herself successful with her hospital gown and died. If you fail to keep someone from killing themselves PLEASE do not feel responsible. No one can guarantee another person's safety, even in a highly controlled environment with professionals. But putting your loved one in such an environment is bound to reduce the chances of them being successful. 

• It's harder to die than you think. While working in that same facility in one summer I met a man who jumped 3 stories down in an effort to kill himself and only ended up breaking all of the bones in his pelvis, both legs and both feet. He would never walk normally again and would most likely have pain the rest of his life -- but he did not die. Another patient on the same ward has tried to shoot himself in the temple but the gun jerked as it fired and the bullet actually travelled around the skull and exited the other side of his face, blowing most of that side of his face off and severely damaging his eye. So he was partially blind and severely disfigured -- but very much alive. These are the kinds of things that people considering suicide need to hear about. They cannot guarantee that their attempt will work and believe me if they think their life is bad now it can be A LOT worse after a failed attempt. Telling a suicidal person these types of stories can sometimes cause them to reconsider. Always follow these conversations up with getting the person professional help. Just because they have reconsidered in the moment does not mean that they don't need to talk to a professional as soon as possible. 

• While this sounds distasteful,it's important to combat the romanticized image that a suicidal person has of death. Reminding them of things like how our bowels and bladders release when we die can actually give them pause. Have them think about who will find them and the trauma that person must endure forever with that image stuck in their mind. Make them think about how much worse things will be if they survive but are crippled, or are successful but go to hell (if they are religious). If they have children you can let them know that their kids will be at significantly higher risk of killing themselves due to their parent's suicide. 

• Women tend to use less lethal means such that although they try almost twice as often they succeed only half as much. Men try roughly half as often but succeed twice as often. So take a suicidal male VERY seriously. 

• Being male isn't the only factor that makes a person more dangerous. In terms of "lethality" the following characteristics really up your risk of attempting suicide:  Having sustained a recent significant loss (job, spouse, relationship, money, etc.); being over 40; having access to violent means like a gun; having a substance use disorder; having a mental illness such as depression, anxiety, bipolar disorder, ADHD, schizophrenia, etc.; having a blood relative who attempted or completed suicide, ESPECIALLY a parent; having "reunion fantasies" in which you believe that once you die you will be reunited with a loved one who has passed on; hopelessness (not the same as sadness); social isolation; major physical illness; previous attempt yourself;  and a history of trauma or abuse. A qualified mental health professional will take all of these risk factors into consideration in deciding the best course of action to help someone thinking about suicide. 

• Just because someone has attempted suicide multiple times and not succeeded DOES NOT mean that you should not take them seriously. There are some people who use suicidal threats and gestures (not well thought out and not very lethal attempts) as a means of communicating their distress. While after a while friends and family might feel that this person is "crying wolf" and stop taking it seriously this can really backfire. Often people who do not really want to die but want to solicit the acknowledgement and help of their loved ones will plan a way to make sure that they are rescued such as taking pills right before someone comes home or leaving the bathroom door open while they are cutting their wrist so that someone is bound to see them. Sometimes their plans go awry, however. Sylvia Plath, a very famous poet, stuck her head in the oven to die from gas inhalation but planned it so that a repair person (with whom she had scheduled an appointment at a certain time) would show up and find her. The repair person was late and so she died, despite not having intended to. ALWAYS take suicidal threats seriously. 

• You do not need to take a person to a mental health facility if they are suicidal. You can take them to ANY hospital emergency room. If there are no psychiatrists on staff one will be called in. 

• There is no age too young for suicide. I have seen 5 year old children attempt it. Take all talk about suicide seriously, even in young children. 

• Many non-prescription medications can be lethal in overdose so if someone has taken large amounts of ANY medication, prescription or not, they need to be evaluated by a doctor. What is a large amount? Anything over the recommended dose. You can always call the poison control hotline to ask questions about specific medications. Tylenol and acetaminophen in particular are very toxic in large doses. Do not just tell someone to "sleep it off" if they have attempted an overdose with even non-prescription medication. They need immediate medical attention. 

• DO NOT always induce vomiting when someone has ingested a toxin-- get advice from poison control. Some fluids such as bleach or other cleaning solvents burn esophageal tissue and can do more damage coming up. Contact a poison control hotline to find out whether or not to induce vomiting after ingestion of a poisonous substance. 

Hopefully you will never need this information but it's better to be prepared to deal with this potential mental health crisis in case it happens. If you are feeling suicidal PLEASE contact a hotline, the police or a mental health provider immediately. Suicidal feelings can be treated but only if you ask for help. 

Best wishes,

Dr. Jordan