David Rakofsky, PsyD

This is the final story in a 3-part series about depression and finding support. This installment is directed primarly at those who have an affected person in their life, whether family or friend.

Every day, 123 Americans take their own lives, making suicide a leading cause of death in the United States and an undeniable public health crisis. The Centers for Disease Control recently reported that the rate of suicide has increased by 30% since 1999. Forty-nine states saw a rise of suicides in 2016.

While the data paint a grim picture, there is hope. One of the 12 known warning signs of suicide is isolation, which means that loneliness is a significant risk factor.

This is where your friendship comes in.

Before continuing, I want to emphasize that anyone who is suicidal needs to contact a medical or behavioral health professional for immediate evaluation and treatment. This article isn’t about your being a proxy or saving the day. Rather, it’s about giving you the tools to be a key member of your friend’s support system. Your role as a friend is to be there even if you’re not asked to be, and to address the topic of suicide and discuss it openly because that’s one of the most helpful things you can do.

Here’s how you can make a difference:

Be an Advocate: What to Say to Someone Who You Think is Suicidal

Few people know your friend better than you, which puts you in a good position to recognize if her behavior is out of the ordinary. Some warning signs and suicidal thoughts are clear as day: if your friend is talking about wanting to die or kill herself, it’s a red flag that requires immediate attention. Other signs, like withdrawing, or sleeping too little or too much are not so obvious or definite. If you’re worried, open the dialogue using these recommendations from the National Suicide Prevention Lifeline:

  • Be direct. Talk openly and matter-of-factly about suicide.
  • Be willing to listen, allow expressions of feelings, and accept the feelings.
  • Be non-judgmental. Don’t debate whether suicide is right or wrong, or whether feelings are good or bad. Don’t lecture on the value of life.
  • Don’t act shocked. This will put distance between you.
  • Offer hope that alternatives are available but do not offer glib reassurance.

In addition, ask the following questions:

  • Do you have a therapist?
  • Have you seen your therapist this week?
  • When are you next seeing them?
  • Do they know about your thoughts on this?
  • Are you worried that you might hurt yourself?
  • How long have you been feeling like this?
  • What are things that have helped you in the past when you feel this way?

Offer to sit with your friend as she calls her therapist, or if she doesn’t have one, help her find one. If you happen to know her therapist, you can contact them directly to inform the therapist that you are worried and to please follow up with your friend (note: There is no privacy law that prohibits the therapist from taking a call from you, listening, or taking action regarding the message you might leave with them, which might take the form of a check-in to your friend. But, without an authorization from your friend, they simply won’t be able to acknowledge they are treating them, nor will they offer information about the treatment).

My Friend Sounds Desperate. What the #%$@! Do I Do Now?

In an acute situation where your friend is on the verge of a suicide attempt, call 911. If you can physically be with him, stay by his side--and safely store any medications and/or firearms--until an ambulance arrives. You can also call the National Suicide Prevention Lifeline at 1-800-273-8255. Here’s what you can expect in either scenario:

Calling 911:

  • Share all the information you can with your 911 operator. Tell the dispatcher that your friend is having a mental health crisis and explain his mental health history and/or diagnosis.
  • When an officer arrives at the home, say "this is a mental health crisis." Mention you can share any helpful information, then step out of the way.
  • The officer or paramedic can often talk to a person who is upset, calm him down and convince him to go to the hospital voluntarily.
  • In certain circumstances, police can compel a person in crisis to come to the hospital involuntarily for a mental health evaluation. The laws vary from state to state.

Calling the National Suicide Prevention Lifeline:

  • First, your friend will hear an automated message featuring additional options while the call is routed to the local Lifeline network crisis center.
  • A trained crisis worker at the local center will answer the phone.
  • This person will listen to him, understand how his problem is affecting him, provide support, and get him the help he needs.

It’s important to note that, as a friend, there’s only so much you can do. You are not responsible for saving your friend, but you can help him to safety. To use a boating metaphor, If someone falls overboard, you don’t have to be a strong swimmer to save them, but you can throw the life ring to them. Being present and not just a bystander is significant.

Checking In: Staying in Touch Can Have a Tremendously Positive Impact

You can't be with your friend at all times, and she may not always be in imminent danger. She may still be at risk, however, which is why checking in with her is important. You can tell her, “Listen, I’m going to keep calling you everyday, and if you don’t pick up, I’m going to worry.” You can also involve other friends and create a calling/texting chain to demonstrate your support.

Check on the welfare of your friend if you are worried about her or can't reach her. Call 911 to reach the first responders in your community and explain why you are concerned. Ask them to conduct a "welfare check." It is very important to consider the wisdom of conducting your own, in-person welfare check: It is my recommendation that you defer the welfare check to the professionals in your community, in order to protect your own emotional well-being in the unfortunate instance where you may be the first person to discover the aftermath of a “successful” suicide. The traumatic aftermath of discovering that a loved one has ended their life can leave life-long emotional scars.

Conclusion

Be there. Be there for your friend. You are not an expert but a conduit to the proper professionals in a time of crisis. You should know that the love and support you express is immeasurable and can help your friend during the worst of times. Understand the resources that are available to your friend, including his/her therapist, other friends, and emergency services. Be mindful of the warning signs, and always check in. Don’t be insulted if your friend thinks you’re being a pain in the ass--that means you're doing your job.

Postscript

  • One of the most stunning paradoxes of suicidality is that, sometimes the suicidal person is actually happiest during the days just preceding a suicide attempt and can appear quite up-beat. He’s reached a tonic point and is at peace because he’s made a plan. He has a new sense of hope that his pain will disappear and that his life and the people around him will all be better off for his choice. Be aware that this is not spontaneous recovery, but a red herring of the deadliest kind.
  • Nine of out ten people who attempt suicide and survive do not go on to complete suicide at a later date. It is not uncommon for survivors to gain perspective upon seeking treatment and go on to live wonderful lives.

Dr. David Rakofsky is a Chicago-based clinical psychologist and the founder of Wellington Counseling Group in Chicago and the northern suburbs.