While you are waiting for help to arrive (or if there is no emergency):
"Are you feeling so bad that you are thinking about suicide?"
If the answer is yes, ask, "Have you thought about how you would do it?"
If the answer is yes, ask, "Do you have what you need to do it?"
If the answer is yes, ask, "Have you thought about when you would do it?"
Here are those four important questions in abbreviated form:
3.Have what you need?
You need to know as much as possible about what is going on in the person's mind. The more planning that someone has put into a suicide, the greater the risk. If the person has a method and a time in mind, the risk is extremely high and you cannot hesitate to call 911 and ensure that professional treatment is given.
If the person talks about using a firearm that he or she owns for suicide, call the police so they may remove the firearm(s). Firearms are used in the majority of suicides, and those who use a firearm usually do not survive. It is thus an emergency that needs to be handled by the police immediately.
Don't be judgmental. Do not invalidate anything that the person says or feels. The person is probably suffering from a chemical imbalance in the brain, and thus could not possibly think clearly. Be supportive and caring, not judgmental, but get help immediately.
Be careful of the statements that you make. You do not want to make the person feel any worse than he or she already does. Again, the person is probably suffering from a chemical imbalance in the brain and is thus extremely sensitive.
Listen, listen, listen. Be gentle, kind, and understanding. Again, allow the person to talk as much as he or she wants. Always listen very attentively, and encourage him or her to talk more. Be as gentle, kind, and understanding as possible.
Let the person express emotion in the way that he or she wants. Allow the person to cry, yell, swear and do what is necessary to release the emotion. However, do not allow the person to become violent or harm himself or herself.
Again, use the home page of Suicide.org to help the person. Make a copy of it and give it to him or her. This will not only help the person now, but also in the future when he or she needs help. You can also make copies of any of the pages of the Suicide.org site that you think will help the person, and give them to him or her. (There is no charge for distributing copies of pages of this site in print media, not on the Internet, for noncommercial, nonprofit use.)
After the person has received help and is no longer critically suicidal, help the person make an appointment with a medical doctor and a therapist. If the person has not yet seen a medical doctor or a therapist, help him or her make the appointments. Suicidal feelings need to be dealt with on a professional level. Only trained professions should assume the care for the person. This is very important. Do not try to help the person by yourself. Make sure that the person is seen by a medical doctor and a therapist.
Before you leave the person, make sure that he or she has received professional help from qualified mental health professionals or that the risk of suicide has dissipated. You cannot leave the person until the risk of suicide is gone or he or she is in treatment. A person who is suicidal is at risk of suicide at any juncture. Ensure that all appropriate actions are taken to help the person before you leave.
When in doubt about what to do, call 911 immediately. Be safe. A suicidal person needs professional help. Period. If you are not sure what to do, it is certainly better to err on the side of caution and get professional assistance immediately. Again, if you are not sure what to do, call 911.
If someone tells you that you need to keep his or her suicidal intentions a secret, then you never can keep that "secret." Under no circumstances can you keep a "secret" that could cause someone's death. You are not violating a privileged communication; you are taking the steps necessary to prevent a suicide. That is an expression of love, caring, and deep concern, and is the only ethical choice in a situation as serious as this.
Follow up with the person on a regular basis to make sure that he or she is doing okay. Suicidal feelings can come and go, so follow up to see how the person is. It is very important to show continued support. If the person becomes suicidal again, take immediate action to help him or her.
Depression, mental illness and substance abuse
One of the most telling risk factors for youth is mental illness. Mental or addictive disorders are associated with 90% of suicides. One in ten youth suffer from mental illness serious enough to be impaired, yet fewer than 20 percent receive treatment. In fact, 60% of those who complete suicide suffer from depression. Alcohol and drug use, which clouds judgment, lowers inhibitions, and worsens depression, are associated with 50-67% of suicides.
Aggression and fighting
Recent research has identified a connection between interpersonal violence and suicide. Suicide is associated with fighting for both males and females, across all ethnic groups, and for youth living in urban, suburban, and rural areas.
Within the home, a lack of cohesion, high levels of violence and conflict, a lack of parental support and alienation from and within the family.
Youth with high levels of exposure to community violence are at serious risk for self-destructive behavior. This can occur when a youth models his or her own behavior after w`hat is experienced in the community. Additionally, more youth are growing up without making meaningful connections with adults, and therefore are not getting the guidance they need to help them cope with their daily lives.
These young people appear to have no social or emotional support systems.
Low Self- Esteem
Feelings of worthless, shame, overwhelming guilt, self-hatred, “everyone would be better off without me.”
90% of those who complete suicide suffer from undiagnosed and treatable mental health issues.
Abused, Molested or Neglected
Abused youth in a study by the AMA showed significantly greater risk factors for youth suicide, including family disintegration, diagnoses of depression, disruptive behavior disorders and substance abuse and dependence.
Suicides among young people continue to be a serious problem. Each year in the U.S., thousands of teenagers commit suicide. Suicide is the third leading cause of death for 15-to-24-year-olds, and the sixth leading cause of death for 5-to-14-year-olds.
Teenagers experience strong feelings of stress, confusion, self-doubt, pressure to succeed, financial uncertainty, and other fears while growing up. For some teenagers, divorce, the formation of a new family with step-parents and step-siblings, or moving to a new community can be very unsettling and can intensify self-doubts. For some teens, suicide may appear to be a solution to their problems and stress.
Depression and suicidal feelings are treatable mental disorders. The child or adolescent needs to have his or her illness recognized and diagnosed, and appropriate treatment plans developed. When parents are in doubt whether their child has a serious problem, a psychiatric examination can be very helpful. .
There are many of kinds of pain that lead to suicide. Whether or not the pain is bearable may differ from person to person. What might be bearable to one person, may not be bearable to another. The point at which the pain becomes unbearable depends of what type of coping resources one has. Individuals vary greatly in their capacity to withstand pain.
American Academy of Child Adolescent Psychiatry
Centers for Disease Control and Prevention
The Parent Resource Program
•More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease, COMBINED.
•Four out of Five teens who attempt suicide have given clear warning signs.
•More than one in every 10 high school students reported having attempted suicide; nearly 1 in 6 students between the ages of 12-17 have seriously considered it.
•More than 30% of LGBTQ youth report at least one suicide attempt within the last year.
More than 50% of Transgender youth will have had at least one suicide attempt by their 20th birthday.
•Youth suicides outnumber youth homicides.
Four out of five completed suicides give clear warning signs of their intentions. This means that, if we learn the signs and know how to respond, we have an opportunity to assist 80% of those teens who are contemplating suicide.
Many times, signs of concern mimic “typical teenage behaviors”. So, how can we know if it’s just “being a teenager” or something more? If the signs are persisting over a period of time, several of the signs appear at the same time, and the behavior is “out of character” for the young person as you know him/her, then close attention is warranted.
The following are some signs of concern that you may see. This is, by no means, all of the signs. Anytime you have a concern about a young person’s actions and/or behaviors, be proactive – have a conversation with the child. Seek professional help, if necessary.
Suicide Threats: Either Direct or Indirect Statements
People who talk about suicide, threaten suicide or call suicide crisis lines are 30 times more likely than average to kill themselves. Take suicide threats seriously.
◦“I’d be better off dead.”
◦“I won’t be bothering you much longer.”
◦”You’ll be better off without me around.”
◦“I hate my life.” ◦“I am going to kill myself.”
◦Suicide threats are not always verbal.
Previous Suicide Attempts
◦One out of three suicide deaths is not the individual’s first attempt.
◦The risk for completing suicide is more than 100 times greater during the first year after an attempt.
◦Take any instance of deliberate self-harm seriously.
Preoccupation or Obsession with death or suicide
◦Essays, writing about death
◦Poems about death
◦Artwork, drawings depicting death
◦Sudden, abrupt changes in personality
◦Expressions of hopelessness and despair
◦Declining grades and school performance
◦Lack of interest in activities once enjoyed
◦Increased irritability and aggressiveness
◦Withdrawal from family, friends and relationships
◦Lack of hygiene
◦Changes in eating and sleeping habits
Once the decision has been made to end their life, some young people begin making final arrangements.
◦Giving away prized or favorite possessions
◦Putting their affairs in order
◦Saying good-bye to family and friends
◦Making funeral arrangements
◦Experiencing a recent loss – a loved one, relationship, job, etc.
◦Increased use or abuse of alcohol or drugs
◦Recent separation or divorce of parents
◦Feelings of loneliness or abandonment
◦Feelings of shame, guilt, humiliation or rejection
◦Emotional stress and difficulties may result in physical complaints, such as head-aches, stomach-
aches, loss of energy, etc.
◦Taking excessive risks, being reckless
◦In real or serious trouble, especially for the first time
◦Problems staying focused or paying attention
Suicide does not typically have a sudden onset. There are a number of stressors that can contribute to a youth’s anxiety and unhappiness, increasing the possibility of a suicide attempt. A number of them are described below.
Youth who are struggling with classes, perceive their teachers as not understanding them or caring about them, or have poor relationships with their peers have increased vulnerability. Previous attempts Youth who have attempted suicide are at risk to do it again. In fact, they are eight times more likely than youth who have never attempted suicide to make another suicide attempt.
Changes in gender roles and expectations, issues of conformity and assimilation, and feelings of isolation and victimization can all increase the stress levels and vulnerability of individuals. Additionally, in some cultures (particularly Asian and Pacific cultures), suicide may be seen as a rational response to shame.
A history of mental illness and suicide among immediate family members place youth at greater risk for suicide. Exacerbating these circumstances are changes in family structure such as death, divorce, remarriage, moving to a new city, and financial instability.
Self-mutilation or self-harm behaviors include head banging, cutting, burning, biting, erasing, and digging at wounds. These behaviors are becoming increasingly common among youth, especially female youth. While self-injury typically signals the occurrence of broader problems, the reason for this behavior can vary from peer group pressure to severe emotional disturbance. Although help should be sought for any individual who is causing self-harm, an appropriate response is crucial. Because most self-mutilation behaviors are not suicide attempts, it is important to be cautious when reaching out to the youth and not to make assumptions.
Approximately 40% of youth suicides are associated with an identifiable precipitating event, such as the death of a loved one, loss of a valued relationship, parental divorce, or sexual abuse. Typically, these events coincide with other risk factors.
These young people are considered to be at high risk for suicidal behavior because they are the targets of a great deal of victimization. They report not feeling safe in their schools, feeling confused about their sexuality and suffering some form of verbal or physical abuse.