Amateur Crisis Counseling
I have been working in suicide prevention since 2006, and have spent hundreds of hours answering crisis line calls. This experience means that members of my social group often do me the honor of coming to me when they have a friend who is in crisis or who feels suicidal. This is a collection of tips for ways you can help a friend who is feeling suicidal, while still maintaining good boundaries.
Levels of Risk
Feeling suicidal comes in a variety of different forms along a spectrum. Sometimes, a person wishes they could go to sleep and never wake up, or they imagine what the world would be like without them around anymore. This is called suicidal ideation, and folks usually don't immediately seek help when it comes up. At the other end of the spectrum is a person who has a plan to kill themself, easy access to the means, and wants to die. This is called acute suicidality, and without intervention folks who feel this way will die by suicide. There are many shades in between, and remembering that one size does not fit all when it comes to crises is important. You'll respond to a friend differently depending on how suicidal they are.
From an institutional standpoint, the options are often limited unless the situation is dire. Hospitals and police stations only have the resources available to intervene if an individual can be placed under an involuntary psychiatric hold, commonly referred to as a 5150. Beyond that reality, many people would (for good reason) prefer not to involve the police in their troubles anyway. I personally tend to view involving these sorts of professionals as disempowering. It's better for someone in crisis to walk themself into the ER than to "get 5150'd" and brought their against their will. One of these processes makes recovery much easier than the other, and it's not the one that involves sirens.
It's Okay to Say "Suicide"
A crisis call is different in method from the way you or I would provide ongoing support to a friend. In a crisis call, I immediately check in with anyone who is feeling suicidal as to whether they have already done anything to harm themself. I always use the words "suicide" or "suicidal," and you can too. You don't need to dance around the word or worry about putting the idea into their head. If a crisis line caller is feeling suicidal, I then create an agreement with them that they will not do anything to harm themself while we are talking. You can make an agreement with a friend, too. Can they call you or your local crisis line before taking action to harm themself? Can they check in with you via phone, text message, or e-mail every Wednesday so you know they're okay? Agreements like these aren't great in the long term, but they can give you enough room to breathe and have a conversation.
Put Off Suicide
If you have a friend who is suicidal, find out how long they've been feeling that way. One person might say "forever" and mean twenty years, while another might mean six months. Context is helpful. Does your friend have a plan and easy access to the means to carry out that plan? If so, find out if they're comfortable getting rid of it -- turn the gun in at the local police station, pass off overdose levels of daily medications to a trusted friend who will dole them out, lock the knives in a drawer and put the key on the other side of the apartment. Generally speaking, suicide is an impulsive, desperate solution to a treatable, manageable problem. People in acute crisis see suicide as their only option...until they've slept for the night, gotten some exercise, read a favorite book, or taken a shower. Try seeing if your friend can "put off" killing themself until next week, tomorrow, or even until an hour from now. This can give them time to get help and feel more clear.
Be There, Be Curious
The most important thing is for a friend in crisis is to know and feel they have a support network who cares about them and is willing to hold their problems for a brief period of time. Your conversations with a suicidal friend do not have to be about solutions and there doesn't have to be a guarantee that things will get better because, well, they might not. That being said, people in crisis have more resources than they'd ever imagine, and the crisis strips them of their ability to see those resources clearly. I've spoken to crisis line callers who have been feeling suicidal every day for twenty or thirty years and part of my work is pushing them to view their continued existence, at whatever level, as an accomplishment. Help your friend assess their own resources and look at their own situation with an analytical eye. Ask when they started having suicidal thoughts. Ask if they're similar to thoughts they've had in the past. If they are, how did they get through it then? Why are they still alive now? Did something happen to trigger the feelings? Look to past experiences and compare them to current situations. What's the same? What's different? How do they see this situation or crisis as resolving? Who else can they reach out to? Who is helping them? How are they helping themself?
Reflect What You Hear
As you listen, try to summarize the story being told, paraphrase the complicated bits, and parrot pieces of it back to your friend. Many people in crisis talk but they don't hear their own words. Hearing someone else say exactly what they're saying can be really helpful. Listen to how they talk about their problems -- do they talk about their situation? Some people tend to intellectualize their problems, so focus in on how it makes them feel. Do they talk about their feelings? Then focus in on what in the situation is triggering those feelings. We all have cadences and habits in our storytelling and having an active listener steering us toward what we're not considering is good. It broadens the picture.
Focus The Conversation
Similarly, having someone listen keeps us from scattering our thoughts to the four winds. Life is overwhelming, especially when we feel suicidal. Focus on one issue at a time. One thing that's bugging you. See if there's a way to resolve that one thing. A person in crisis might be able to mourn the death of their cat, but they can't handle their dead cat, their car that just broke down, their crappy job, their cheating significant other, and their recent medication change. Compartmentalize the problems and take them on one at a time. Letting them become a tangle prevents us from solving one until they've all been solved simultaneously.
Self Care For Everyone
Self care is absolutely essential. When things are bad, we forget to eat, sleep, take medications, shower, call our mothers. How is your friend taking care of themself? If they're forgetting key pieces of what used to be their regular life, can they reinstate any of those routines? Sometimes people in crisis can "fake it until they make it" and pretend life is normal by going through the motions of their not-in-crisis life. This can serve as a stopgap measure until they can get the right ongoing help for themself.
Take care of yourself, too. It's really easy to take on the stress of another person and feel like their problems are our responsibility. Your friend has the power to make their own choices and if that choice is to end their life, that is their right. It isn't your fault. It's difficult, when the people we care about try to place blame for their situation on us, to remember that the situation is a given and that their response is a choice. As an amateur crisis counselor, you can't fix everything.
Be blunt, be compassionate, be kind. Mostly, just being there is enough.
Connecting With Me
My name is MacKenzie Stuart and I'm a licensed marriage and family therapist (LMFT) who specializes in suicidality and chronic depression. I might be a good psychotherapist for your loved one. Feel free to explore my availability for new clients and reach out to me directly.
© 2009, MacKenzie Stuart, LMFT