Learn How to Support a Suicidal Person | Suicide Prevention

Risk Behaviour is defined as 'Behaviour that is not intended to, but can risk life'.

• This behaviour can be done out of fun or due to stress and negative life issue, but obviously has negative consequences of serious harm. Activities such as drug-taking, alcohol overdose, car antics, daredevil activities, peer dares. or plain stupidity can seem fun, but all carry risk.

• Self-harm also fits into this category. Such as cutting, self-punishment, hitting, scratching, biting

• Self-harm can be perceived as suicidal but is not always true. Make sure you ask pointed questions to evaluate what has triggered the self-harm. Here are 7 reasons why self-harm occurs. (Not a complete list)

• Self-punishment, before others punish you

• Self-loathing of a particular part of your body. "I hate it and want rid of it"

• Cutting, scratching, and beating to give a temporary reprieve from the emotional torment in their heads and physical pain occurring somewhere else in their body.

• Religious reasons, flagellation, to forgive sins.

• My friends do it, so I will, Peer encouragement, the "in thing to do".

• Psychiatric reasons, delusions. believing they are possessed etc.

• Suicidal intent.

  
  

Suicidal Behaviour is defined as the conscious thinking, and planning of how to end one's life.

• It may carry self-harm with it or not.

• The more serious it is, the more it consumes their thinking.

• It is often simply a way to get rid of the underlying problem.

• They have lost all hope, and their mind is now convincing them that they can be free of their situation permanently.

The truth is anyone is at risk, from the young to the very old.  as an example...

Girls attempt more often than boys, but boys succeed more often, perhaps due to the severity of their attempts. Girls may be doing it more often as a cry for help, hence less severe actions

There is a marked increase in males between the ages of 40-50 and then surprisingly between 70 – 84, possibly due to life changes and work changes such as redundancies and retirement that may challenge a man's sense of purpose in life.

Teenage statistics point out that even if you feel someone is low risk, they might not be, you should do all you can you help.

Risk is really about what situation the person finds themself in. It may be caused by culture, societal beliefs, abuse, loneliness, old age, gender confusion, racism, sexism. and the list goes on. the point is. never underestimate how a person could be at risk. Minimising their reasons could be disastrous for them and you.

Causes :

Impulsive behaviour.. i.e. Cortex development doesn't reach maturity till mid 20's ( Frontal and temporal lobes, reasoning. The ability to reason with our emotional decisions, such as feelings and anger, deriving meaning ) vs Limbic system ( Amygdala, hippocampus, hypothalamus, Where emotional decision making, behaviour, motivation. occur) sitting in the now, act now to stop the pain/ lacking the cognitive ability to wait, rationalise.

Other triggers:

• Do not underestimate the simplicity of the trigger or minimalise it either, as you may lose the person's trust/confidence / they may shut down

• Unhappy/violent homes

• Drug use esp P

• Sudden unplanned reaction to simple events. Eg. Teenagers who can't get what they want. Or have an argument, get refused sex.

• Not coping with life's stressors. Feeling that the world is against them.

• Rejection,

• Abuse

• Western culture of entitlement

• Base strength/value

• Shame

• Sexual orientation

• Overwhelmed

• No hope

• No one to listen /trust/non-judgemental

• Isolation/ lack of support

• Medical, chemical/

• Sudden trauma.

• Death of a close person or peer who was their important person.

• Sudden collapse or not being able to cope

• Financial stress

• Swearing friends to confidentiality.

• Depression.

• Depressing, or hopeless talk.

• Saying goodbye, letters.

• Talk of suicide, both negative and viewing it as good.

• Was very depressed, and unhappy, and suddenly they are at peace, giving things away, and tidying up the room.

• Self-harm that is linked to hopelessness.

• Reckless behaviour that's linked to hopeless feelings.

• Revenge talk .. “I'll teach them.”

• Talk of being trapped

Knowing if your the right person to be working alongside others at risk is about knowing your roles, rules and appropriate boundaries.

If there is a connection or friendship, then working with the opposite sex is not recommended.

If there are dual roles, i.e interconnections, e.g. they are a work colleague, plus your the manager,or related to you or they play sport with you. Then pass this situation on to someone else.

Work roles where you are the Boss and they are the employee is not a recommended situation, as there is a power imbalance. Please refer on.

Is there romantic involvement - contact or intimacy creates problems.

Also check out what the requirements and rules of your workplace are? They may have a refer on the basis or an internal counsellor. Do not ignore the requirements of your work for referral.

It pays to clarify your role and how you can help. You need to be able to say no to the things you can't and shouldn't do.

Saying "no", doesn't mean you can't support, It just gives clarity for the other person and stops them from being disappointed in the areas you cant help in. So always clarify your role with the client./ person.

We encourage you to have a list of resources, phone contacts and emergency contacts on hand.

When sitting with a person who is suicidal, your attitude and presence are important. You need to be giving out a sense of calm, hope and safety to them.

How you present yourself becomes paramount for someone in a delicate, emotional state.

• Firstly, decide you're not going to react to their emotions, esp accusative or derogatory, blaming statements about you, or God.

• Remember, God is big enough to look after himself, he doesn't need you to defend him. He can handle it. Your job is to ignore the accusations or anger and focus on giving hope, finding solutions and keeping them safe, or handing over.. So stay calm, be safe, don't react, and stay focused.

• Be blatant and specific about your questions. Make them honest and clear. This gives the person permission to be honest without fear of guilt.

Here are some other pointers;

• let them know you care

• Assure them they are not alone

• never minimize, laugh at or rubbish their reasons, no matter how silly they may seem, if you do this you will lose them.

• listen without judgement

• Find out who they trust to support them, make a list,

• ask permission to contact others

• ask how you can support them best

• continue to keep in contact weeks and months after

• remove any objects of harm

• be specific about intent, and plans.

• Find if there is a reason to live, Positive factors, goals, and dreams.

• ask what is causing the pain and what could be done to remove it.

Finally are there cultural beliefs about suicidal intent that you need to be aware of, or upskill on? Often different cultures have different ways of viewing suicide, and how to care for those suffering from it. Always ask the person you are with, whether this is important to them or their family. For instance, Maori beliefs are very different in their approach and care for others compared to Chinese, western religions, Samoans or others.

1. I'm worried that If I ask "Are you suicidal, Do you think about dying?" It will put thoughts in their head.

Answer. No, it shows you care and is important to ask anyway. Imagine if you didn't ask and found out later, that they were suicidal. Safety is always paramount. Check anyway.

2. If I refuse secrecy, they won't trust me and won't tell me and will think I'm a snitch

Answer. That is a risk, yes, But most times No.  It tells them you care enough to get help if they are in danger. And it lets them know that if they are not coping, they can trust you to get help. Yes, they may be angry but will get over it.

3. Only professionals can help?

Answer. No, the truth is people just want to know that someone cares and supports them and that is something everyone can do. Yes, they may need specialist medical care, but friendship is found in everyone.

4. Suicide is just a selfish act.

Answer. No, many reasons propel people to want to die. e.g.  A desperate need to stop the pain, Hopelessness, Terror, Shame, Psychiatric reasons, and Not being able to cope, to name a few.  Being selfish is often not one of them.

5. Every death is preventable?

Answer. Unfortunately no. And no matter how good your care is, we can't stop all suicides. That is not about us, it's about intent and sometimes desire.

6. If people felt better, they are out of danger so we can stop checking.

Answer. No, it's important to continue to check in weeks and months later.  Look at the triggers; are they still occurring, or do they have good goals and dreams for the future now.

7. It's about people dying.

Answer. No actually, suicide is usually about people wanting to get away from their pain - David Riddell asked me once in supervision - why does this person believe that changing is more difficult than dying. I have also asked people " If we could resolve this problem would you have a need to die?" their answer is almost always "No".

Hope Barometer - 80% full still!

• Ask specifics/be blatant:

• Do you think about dying?

• What's causing these thoughts?

• When do they occur?

• Are they just vague thoughts?

• Do you have plans times dates and the means to do it?

• Have you got still got them?

• How strong is their 'future'?

If the answers to these are minimal, with no intent and a definite desire never to do it. i.e. they have goals and dreams and are passionate about the future, and they have plenty of hope - Then the risk is low. But keep in touch - remember... 'Hope deferred makes the heart sick'.

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Do this five-finger test to see if any complicating factors may have been missed.

1. Have they expressed that they want to die?

2. Are these factors present: Abuse, Illness, Seasonal Affect Disorder

3. Do they have a relevant medical or psych history?

4. Have they (or friend or family) attempted suicide previously?

5. Do they have poor resilience (tend to play the victim and not cope well with life challenges/trauma).

Note: If the answer to ANY of these is YES then consider them HIGHER risk.

Remember: Ask specifics/be blatant!

'Signs'

• Feeling very low, or no hope for future, or change.

• Has a medical or past psych history that is dangerous.

• High or immediate intention, Plan, Timeframe, Ability/Tools

• definite intent, plans, have the means and tools to complete the task, may have set dates,

• said there good byes, written letters, made a will, may have already attempted

• May have sworn others to secrecy,

• my have made pacts

• is intent on leaving your presence to achieve their goal of dying

• do not let them go. Contact help.. have you got a contact list yet?

• make a safety contract

• this requires action now

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Do this five finger test to see if there are any complicating factors that may have been missed.

1. Have they expressed that they want to die?

2. Are these factors present: Abuse, Illness, Seasonal Affect Disorder

3. Do they have a relevant medical or psych history?

4. Have they (or friend or family) attempted suicide previously?

5. Do they have poor resilience (tend to play victim and not cope well with life challenges/trauma).

Note: If the answer to ANY of these is YES then consider them HIGHER risk.

Ask specifics/be blatant:

Signs' It looks like:

• Very low or no hope for the future, or change.

• Desperate, crying, out of control, sobbing, not talking, wanting to get away from you and others

• May be incoherent, not thinking straight, or delusional.

• Has a medical or past psych history that is dangerous

• High or immediate intention, Plan, Timeframe, Ability/Tools

• definite intent, and plans, have the means and tools to complete the task, may have set dates,

• said their goodbyes, written letters, made a will, may have already attempted

• May have sworn others to secrecy,

• May have made pacts,

• is intent on leaving your presence to achieve their goal of dying

• do not let them go. Contact help.. have you got a contact list yet?

• make a safety contract

• this requires action now

   -----------------------------

Do this five-finger test to see if any complicating factors may have been missed.

1. Have they expressed that they want to die?

2. Are these factors present: Abuse, Illness, Seasonal Affect Disorder

3. Do they have a relevant medical or psych history?

4. Have they (or friend or family) attempted suicide previously?

5. Do they have poor resilience (tend to play the victim and not cope well with life challenges/trauma).

Note: If the answer to ANY of these is YES then consider them HIGHER risk.

Do this five finger test to see if there are any complicating factors that may have been missed.

1. Have they expressed that they want to die?

2. Are these factors present: Abuse, Illness, Seasonal Affect Disorder

3. Do they have a relevant medical or psych history?

4. Have they (or friend or family) attempted suicide previously?

5. Do they have poor resilience (tend to play victim and not cope well with life challenges/trauma).

Note: If the answer to ANY of these is YES then consider them HIGHER risk.

This lecture starts with an interview with somebody who was a friend of a suicidal person and their thoughts afterwards on confidentiality.

It follows with an interview demonstration and an explanation.

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Due to the 'vulnerable children's act' (and other good reasons of course), you need to be careful how you approach confidentiality.

As a counsellor, we have a 'speil' that we give clients when we first see them to explain the limits of secrecy that we can keep.

You need to have one also that you can draw on if you feel you are about to be trapped.

It may go something like this: "I can and will keep our conversation in confidence, but I need you to know that I have two exceptions to this. I have a professional supervisor that I speak with (who also keeps confidence) and if I am concerned about your immediate safety, or the safety of others - then I will need to get some backup! Usually, that means, I will likely talk to you first, then we will decide on an appropriate person to bring into the situation."

http://www.legislation.govt.nz/act/public/2014/0040/latest/whole.html

Timing - this is after you have assessed them as low risk - they have left your meeting, and you are now considering how to manage this risk and support this person.

You are possibly part way through the process of supporting this person and now looking to 'tidy up' your approach to this situation. That's great! This isn't a predictable situation - just roll with it, and if you forget a part, just come back to it.

You may or may not have already done steps 1 and 2. If you have not done them, you will need to catch up with the person again to do this.

Step 1: Explain the limits of confidentiality as explained previously.

Step 2: Personalise a support network as explained previously. Part of this is to encourage them to share with 1 or 2 safe/significant people in their lives about how they are doing. I.e a mentor. This need not be a big deal as long as they demonstrate commitment to processing their situation healthily. Consider negotiating a conversation with the parents (after gaining permission) Check the relationship regarding parents, i.e. is it safe? appropriate.

Step 3: Have a follow-up meeting booked with them to see how they are progressing.

Step 4: Regularly check up on them - perhaps weekly - over the next few months. This might just be a phone call or coffee, depending on what kind of support you felt they needed and what role you are playing in their process. Check with the Mentor or trusted person. Has the person at risk contacted them? What did they talk about?

Step 5: Keep your finger on the pulse. Has the risk level changed?

Timing - this is after you have assessed them - they have left your meeting and you are now considering how to manage this risk and support this person.

You are possibly part way through the process of supporting this person and now looking to 'tidy up' your approach to this situation. That's great! This isn't a predictable situation - just roll with it, and if you forget a part, just come back to it as soon as possible.

You may or may not have already done 1 and 2. If you have not done them, you will need to catch up with the person again to do this.

Step 1: Explain the limits of confidentiality as explained previously.

Step 2a: Personalise a support network as explained previously. Part of this is to encourage them to share with 1 or 2 safe/significant people in their lives about how they are doing. Ensure the person you are supporting is crystal clear that they have several emergency contacts, and at least 1 24/hr contact person/organisation.

Be clear about your role so they can't be disappointed in what you are not able to offer them in terms of support.

Step 2b: Asses if confidentiality needs to be broken or if another person needs to be brought in.

Part of creating a support network is deciding who else needs to know. Here you negotiate with the adult about breaking confidentiality, but if it were a person under 18 it would be different, and I would imagine a teacher, pastor or employee would need to call somebody else in and/or break confidentiality regardless.

You need to consider:

• country regulations and requirements

• Is the person under 18 or by law are you required to notify anyone?

• What are the guidelines in your organisation?

• What is your expertise?

• What is your role in this person's life?

• What resources do they have without bringing in extra help or breaking confidentiality?

Ideally, if you consider further help/network is required, you can negotiate with the at-risk person to make contact. If the at-risk person is not agreeable - you need to go with your decision to bring in the support that's required. Decide first, then negotiate, otherwise you may be swayed by their resistance.

Step 3: If you have control over their environment, do what you can to minimise risks. Are there items around the home/office etc that might make it easier for them to hurt themselves? Be blatant, ask the questions. "Do you have items you are thinking of using?"

Step 3b: Have a follow-up meeting booked with them to see how they are progressing. They need to be engaged with a professional therapist/counsellor of some sort.

Step 4: Regularly check up on them - perhaps weekly - over the next few months. This might just be a phone call or coffee, depending on what kind of support you felt they needed and what role you are playing in their process.

Step 5: Keep your finger on the pulse. Has the risk level changed? Ask the question.

Step 6: Record the steps you have taken and your rationale and keep them in a safe and confidential place. You may need this for legal issues, or to justify to higher authorities, such as your immediate boss, the process you took.

Step 7: Take a deep breath, you have done what you can! Just think big picture for a second, and ask yourself - is there anybody else that needs to know about this?

*Don't forget about self-care!

Timing - this is after you have assessed them - **they have NOT left your meeting** and you are now considering how to manage this risk and support this person.

You are possibly part way through the process of supporting this person and now looking to 'tidy up' your approach to this situation. That's great! This isn't a predictable situation - just roll with it, and if you forget a part, just come back to it ASAP.

You may or may not have already done 0, 1, and 2. If you have not done them, you will need to catch up with the person again to do this immediately.

***Step 0: Ensure somebody is with this person at all times until it's handed over to appropriate support. (This might be CAT team, Police, Ambulance, Mental Health, and perhaps parents - don't just leave them with parents though - They are not professionals and may be frightened, or overwhelmed. This is too big a job for them to do on their own.)

Step 1: Explain the limits of confidentiality and why it must now be broken.

Step 2a: Personalise a support network as explained previously. Part of this is to encourage them to share with 1 or 2 safe/significant people in their lives about how they are doing. Ensure the person you are supporting is crystal clear that they have several emergency contacts, and at least 1 24/hr contact person/organisation.

Be clear about your role so they can't be disappointed in what you are not able to offer them in terms of support.

Step 2b: Who do we need to talk with to ensure this person has support? Part of creating a support network is deciding who else needs to know and the best way to go about having those conversations.

You need to consider:

• Is the person under 18 or by law are you required to notify anyone?

• What the guidelines are in your organisation?

• What is your expertise?

• What is your role in this person's life?

Ideally, you can negotiate with the at-risk person to make contact with further support. If the at-risk person is not agreeable - you need to go with your decision to bring in the support that's required. Decide first, then negotiate, otherwise you may be swayed by their resistance.

Step 2c: Bring in support. Contact the appropriate agency/people and stay with your person until they arrive. Keep the conversation light. Be caring, supported, and connected. Consider your environment and transportation carefully if you decide to change location.

Step 3: If you have control over their environment, do what you can to minimise risks. They have said they had the means and intention, so find the means, and remove it from their possession or environment. If you don't know - ask. Be blatant - get the information.

Step 4: Have a follow-up meeting booked with them to see how they are progressing. They need to be engaged with a professional therapist/counsellor of some sort.

Step 5: Regularly check up on them - perhaps weekly - over the next few months. This might just be a phone call or coffee, depending on what kind of support you felt they needed and what role you are playing in their process.

Step 6: Keep your finger on the pulse. Has the risk level changed? Ask.

Step 7: Record the steps you have taken and your rationale and keep them in a safe and confidential place.

Step 8: Take a deep breath, you have done what you can! Just think big picture for a second, and ask yourself - is there anybody else that needs to know about this?

Step 9: Are there others connected/affected that may need support? If this is your role, then check in on them.

*Don't forget about self-care! This now becomes very important. Debrief with a support person.

It has been my experience that people who are suicidal or who talk about suicide, almost always impact those around them, whether they are peers, work colleagues, family or others.

If you find that others are impacted by safety. We would recommend that you call in the help and advice of other professionals who work in this area.

If the suicidal person was part of a youth group or club and they all know about it. We suggest you inform parents and arrange a youth meeting and bring in professional help to work with the group.

Find out the legal requirements of your country ?

Follow their guidelines to ensure against misconduct accusations, or resulting in litigation

In New Zealand:

There is no legal requirement as to who you must contact first. The reason being that the needs of the person and the situation you find yourself in will dictate who you contact. (See summary below)

However..

Life-threatening risk must be reported

Abuse must be reported

the 'Vulnerable children bill' was passed in June 2014 making it mandatory for you to report if you know a child or an adult is vulnerably neglected or abused.

Definition of vulnerability

A. Loss of connection to people or places

B. Isolated alone vulnerable to abuse

C. Unable to seek or receive help and support

D. Placed in danger

E. Believing they are unvalued, lost alone with no one to turn to, Trapped.

If you still feel unsure of assessing vulnerability, you can go to the web and Google HEADSS assessment. download it and use it as a guideline

Summary

Once assessed and you have decided there is risk. Refer on according to need.

Examples:

• If they have disabilities, coping skills or learning difficulties, refer on to Marinoto for learning.

• If it's family abuse, violence, you might call CYFS (Child, youth and family).

• If it's suicidal, or psychiatric, self-harm, you will have several options from alerting the Mental health team in your area,i.e (C.A.T Team), to Police, to youth Justice or care & protection.

• If the suicidal danger is extreme and imminent you will need to call The emergency C.A.T. team in your area. If it's at school or work, follow the requested guidelines for reporting of that school or workplace.

You may find yourself surrounded by concerned peers of the suicidal person. Mates, friends and acquaintances. They will often ask "What do we do."

Helping them to know their roles and limitations is important. Giving them tools to use to protect themselves from being caught up in the situation is vital.

Give them what you know (Listed below) and if necessary, bring in a professional to work with them on other aspects.

If you have concerns about their ability to cope, refer to proper channels such as family, mental health team.

It can be really worrying to know there is a person you care about who is considering suicide.

To help you find peace, it's useful to have a checklist so you can tell your mind that it's ok to leave the topic alone.

Checklist: Have I...

• Followed the steps required?

• checked off the list to ensure they have support?

• I know my role and have done it

• They are as safe as can be because I have put safety measures in place.

• It is not my responsibility to carry this worry.

• There is nothing more I can do while I'm not with them, so I will not think about it.

So, once they are done, know you have done all you can. Know that if they do complete suicide that you know before God that you did what was required of you and then rest. People have their own will and you cannot stop somebody completing suicide - you can only do your part - which you have.

Phone your local DHB Mental Health Crisis Team (CATT team): contact numbers below or phone Health line 0800 611 116 DHB

Area covered Phone Northland Topuni to North Cape Whangarei

(09) 430 4101 ext 3501 After hours 0800 223 371

Waitemata

Wellsford to North Shore West Swanson, Piha & Titirangi
(09) 822 8500 After hours (09) 486 8900

Henderson (09) 822 8600 After hours (09) 486 8900

North Shore / East Rodney (09) 487 1400 After hours (09) 486 8900

Auckland Auckland City Central Auckland 0800 800 717 Counties Manukau
  South Auckland to Te Kauwhata South Auckland (09) 270 9090

Waikato Coromandel, Hamilton to National Park

Hamilton 0800 505 050

Bay of Plenty Tauranga, Whakatane to Te Kaha

Tauranga 0800 800 508

Whakatane 0800 774 545

  Tairawhiti Hicks Bay to Gisborne Gisborne (06) 867 2435
  Rotorua, Taupo, Turangi Lakes 0800 166 167 Hawke's Bay Wairoa, Napier, Hastings, Waipukurau Napier, Hastings 0800 112 334 Taranaki
  New Plymouth to Waverly
  New Plymouth (06) 753 6139 ext 7680

Whanganui

Ohakune, Whanganui to Bulls

Whanganui 0800 653 358 Mid Central

Palmerston North to Waikanae
  Mid-Central 0800 653 357 Wairarapa Masterton to Martinborough Wairarapa 0508 432 432 Hutt Valley
  Lower and Upper Hutt
  Hutt Valley (04) 566 6999

Capital & Coast Kapiti to Wellington Wellington, Kapiti Coast, Porirua City, Wellington City (04) 494 9169

Nelson Marlborough

Top of South Island to Hanmer Springs Nelson (03) 546 1421 After hours (03) 546 1800

Marlborough (03) 520 9907 After hours (03) 520 9999

Canterbury

Kaikoura to Ashburton Ashburton 0800 222 955

Christchurch 0800 920 092

West Coast

West Coast, South Island Greymouth 0800 757 678

South Canterbury

Timaru, Mt Cook, Tekapo, Temuka, Waimate Timaru 0800 277 997 Southern

(Otago & Southland)Dunedin, Milford Sound south to Stewart Island

Dunedin (03) 474 0999 ask for Psychiatric Emergency Services

Gore (03) 208 0299

Invercargill 0800 467 846

  If you need to talk to someone other than emergency services, try our list of helplines, support services and other options.

Thanks for choosing us. We trust this will lead to people choosing life. Remember – there are never any hopeless situations, just people who have become hopeless about them.

Please email or message if you have any questions or ask in the discussion forum.

Don't forget to leave feedback – it helps others know if this is the right course for them!

This is a place where we will collect downloadable forms, resources, links and facilitate discussion about things to support you when supporting people.

Take a moment to browse through the resources here, and add anything that you want in the discussion.

This course is a supplement to your professional training in your context. We hope this to be useful, but we do not take responsibility if the steps outlined do not work in your context.

Before you apply this material please ensure you do your own research for your own context with a professional supervisor to see what needs to be added or removed from this guide to make it relevant to your situation.

The content from this course and within documents provided or links is provided to supplement your helping skills. However, Joel Young and David Sanders cannot accept any liability for its accuracy, content, or other peoples decisions. Students who rely on this information do so at their own risk.