Suicide Prevention Month: An Opportunity to Practice Compassion for Ourselves and Others

What can I do when I’m feeling suicidal? 

Even if you feel that no one cares about you in a particular moment, it can be helpful to remember that this is very likely a temporary experience that will go away. Sometimes when one feels they ought to die, something else needs to change. Everyone deserves time to figure out what change they might need to cultivate their own life, so that they don’t need to resort to killing themselves. Tolerating the distress of SI can be hard to do by yourself, and it’s not necessary to do everything on your own.

Help is available for you. You can call or text 988 or chat 988lifeline.org to reach the 988 Suicide & Crisis Lifeline. Those of us in Colorado can call 1-844-493-8255 or text “TALK” to 38255 to reach the Colorado Crisis Services. 

What happens when I call a suicide hotline or a crisis center for suicidal ideation?

When you call or text a lifeline for suicide prevention, you receive access to a professional who is trained to able to speak compassionately with you and help you write/create a safety plan. If it appears that more help is needed, they will potentially help you get to a crisis center, a nearby emergency room, or call an ambulance to come help. Not everyone who calls a lifeline or visits a crisis center is hospitalized; for many people, suicidal ideation can pass after several minutes or hours, and people on the lifeline and at the crisis center are trained to be able to assess whether this is the best option for you. Talking with a trained professional who can help you craft a suitable safety plan may be all some people need in order to feel better enough to return to their regular activities.

If you find yourself on hold for a call with the hotline or crisis line, you can use that opportunity to check on your physical needs: you can eat a snack and drink some water, or even engage in another self-care task like taking a shower or finding a soft blanket for comfort. If you find your suicidal ideation escalating and you feel you are unsafe, it is recommended to (in a safe manner) take yourself to the emergency room or crisis center in person rather than waiting on the phone so that you can receive immediate care. 

What happens if I do end up going to a hospital, rehab, withdrawal center, or other inpatient treatment center?

When individuals visit an emergency room or crisis center when they are having suicidal ideation, they are assessed and they are offered some initial treatment. If they find that an individual appears to need more help than they can provide, they will then begin the process of transferring them to the psychiatric ward, a withdrawal or detox center, or another wing of the hospital. A visit to the hospital emergency room usually lasts 3-4 hours but can last more if needed. When people are hospitalized, which can be voluntary or involuntary, most inpatient stays in the psychiatric wing of your local hospital last 3-10 days. Professionals assessing a patient’s need for an involuntary hospitalization have received ample training on how to make the safest and most ethical decision in a variety of situations; it is common for people to feel angry, resentful, or scared when being told they must be involuntarily hospitalized however this is done with the intention to keep that person safe from hurting themself or others. The decision to hospitalize someone involuntarily is complex, and takes into account standards of medical care, beliefs about best practice, whether the individual is safe at home, any legal issues at play, and that individual’s particular physical and mental health needs. Often, if people are under the influence of drugs or alcohol, they must be transferred to a withdrawal or detox center to be more closely monitored for their health and safety needs before being transferred to the psychiatric ward. Specific policies vary at different inpatient centers, with some (but not all) sites having separate rooms available for non-binary and trans individuals so they are not forced to sleep in the same area as those of their assigned gender. Some, but not all, hospitals and rehabilitation centers have group therapy and art therapy activities for people staying inpatient. Some hospitals have more limited resources. While it can be intimidating to make a call to a lifeline for the first time, and visiting an emergency room can be stressful, the doctors, nurses, physician assistants, social workers, crisis counselors, mental health counselors, technicians, and other helpers that one encounters in these environments have been specifically trained to offer you the best mental care that they can, and they are bound by the laws of their state, the ethics of their professional boards, and the specific policies of their employer. In an inpatient setting, the primary goal is most often to keep you safe, rather than to provide therapeutic treatment. With that said, it is important upon leaving inpatient hospitalization with an intention and plan to find ongoing psychiatric support and/or outpatient therapeutic support. Though a hospital stay can be healing for some people, the purpose of a hospital stay is generally stabilization, not healing. 

If the person does not have access to help from a trained professional, and it appears that you are not able to personally stay with them without putting yourself in harm’s way or otherwise endangering yourself, you may inform a family member or another friend of the situation and ask if they can take over for you. You yourself can also call or text Call or text 988 or chat 988lifeline.org to reach the 988 Suicide & Crisis Lifeline, and inform them of the situation. If there is immediate danger (such as your loved one threatening you directly, your loved one is refusing to come out of a locked room in which they have a weapon or various medications, or your loved one may have already attempted suicide), you ought to call 911 or the local crisis line directly and explain the situation in detail. Let a family member or friend know what is going on so they can come by and support you both as well. If your loved one is willing to be taken to the hospital emergency room, take them to the hospital emergency room. 

How can I help prevent suicide in others? (Part 2: Emotional Considerations)

Though we can’t always be there for friends and loved ones, being emotionally available during a crisis can be an honor and a joy. Showing up for our friends and loved ones can be a gift that we give them that can deepen our relationship, though it also poses a variety of possible challenges. If you are going to show up for your friend or loved one, and navigate being with them during their crisis, it is best to do so wholeheartedly and without violating your own boundaries. Double check with yourself if you have the spoons to help, and, if you do, then the next section is for you. If you don’t, then it may be more supportive to follow the more practical guidelines in the above section and don’t even read the following section until you are more resourced.

It is still important to try to follow the above guidelines to help your friend or loved one, but if you have the ability and desire to sit with them until they are able to receive help from a trained professional, then here are some considerations about how to best sit with them. You may have already tried reminding your friend or loved one that though they are not feeling well, their issue is likely temporary and they do not need to feel ashamed of getting help. But sometimes, people are very upset and easily triggered when they are already in crisis mode. So, if reminding them that you care about them and that it is not their fault for feeling this way appears to be upsetting them rather than causing relief, then you may instead try to offer them distractions by playing music they like, or putting on a tv show or podcast.

You can try asking them directly what they need, but know that sometimes when people are very mentally distressed they are not easily able to tell you what they need or even know what they need. Providing nonverbal comforts, like bringing them a comforting blanket or a warm cup of tea or (if consent is given) gently putting your hand on their back, can also be an effective way to comfort a friend in distress without overwhelming them more. Everyone is different, so what helps one person may upset another person; try to calm yourself down by taking some deep breaths and drinking water yourself so that you can be better at paying close attention to your loved one or friend. Remember that your friend or loved one is having a hard time, so if they are struggling to use their words, express what they need, or do not appear to appreciate the care you are trying to give them, then that doesn’t mean you are doing a bad job or that they don’t like you, it just means they need a different kind of help. If your friend becomes so distressed that they become nonverbal, you may try communicating by texting to them or writing to them. 

Be mindful of the setting and place of the situation. Perhaps you are not at home, and are in public somewhere. Or perhaps you are sitting in a parked car with them, or in the process of driving to an event. If your friend is verbal and open to talking to you about what’s going on, you may want to get out of the public eye and find a more private area. If you are on the phone with your friend, and you are able to go meet with them face to face, you can keep them on the phone while you drive or get a ride to their place. If you are in a parked car, you might consider asking your friend if they might prefer to walk and talk, or drive to a nearby park to be in nature, as having difficult conversations in a parked car can sometimes escalate “trapped” feelings, and some people find being in nature very calming.

Drawing their attention to the choices and autonomy they do have in the situation might help them feel more in control, which might help them feel a little better and more willing to receive help. 

If there is not an imminent crisis happening, but you are concerned about your friend’s behavior, such as if you see your friend giving away their favorite games and toys, or you hear your friend making dark jokes that are out of character for them, you can have a conversation with them. Directly from the NAMI.org website, “You can explain why you are concerned about your friend and tell them what you have observed. The more specific and clear you can be the better. For example… You seem sad all the time and have stopped communicating with your friends… You always seem very tired and distracted… You are posting really scary messages on social media… Tell them you are worried and let them know they can talk to you if they are experiencing a problem. It can feel awkward to ask about this, but it could be the encouragement they need to be able to open up about what they are experiencing. Remember that it is not your responsibility to try to solve their problem or fix the situation. Listening patiently and asking them to tell you more will help you understand what your friend might need…” You may gently try to get more information from them about whether they are thinking about killing themselves. If they have already told you or someone else that they are thinking about killing themselves, or posted about it on social media, then the next step is getting them connected to help. However, if they have not said anything about killing themself and they are simply behaving in an odd or uncharacteristic manner, the best first step is to try to get more information and express your care and concern. From NAMI.org, “Once you know how your friend is feeling, ask if they have any ideas for what might help. You can ask if they are taking steps to get help from family, friends or professionals. If you are comfortable, and they are open to it, you can offer to check in again with them sometime soon to see how they are doing and whether the situation is improving or getting worse. Think about how you might feel if you were in a similar situation and what might be helpful to you. Remember that you don’t need to solve the problem. Often, just being open to listening and being supportive is helpful.

Do not agree to keep your loved one’s thoughts of suicide or self-harm a secret. Even if they don’t want anyone to know about it, it is important to get help if you are truly afraid that they might attempt to kill themselves; again, if you are not their therapist, psychiatrist, or doctor, then you are not qualified to assess how in danger they are. If you think they might be in serious danger, and they are not responding to your request for them to get immediate help or providing more information to you, and you feel the problem is urgent and serious, call or text 988 or chat 988lifeline.org to reach the 988 Suicide & Crisis Lifeline. If there is immediate danger to your friend or others, you should either try to take them to a local hospital emergency service or call 911.

Being able and willing to stay with them until they have gotten help and you know they are safe can be a compassionate way to help your friend. Staying with them until they are more stable can be especially important if your friend is dangerously intoxicated, or if they are experiencing serious mental health symptoms, like psychosis. Whatever steps you take, know that you are not alone. There are others who can help support you too, and who understand how hard it can be  to be in this kind of situation. Your support could make a huge difference for your friend, but it’s also important for you to be willing to receive help from crisis support lines, first responders, health care providers and others. Having strong social, family, and community connections can help protect someone from suicidal ideation and behavior, and there are a lot of other factors involved as well.

(Nami.org, 2024)

How can my community help prevent suicide?

While individual action is priceless, collective action can make an even more lasting difference. Change at the community, state, and national levels can lead to widespread systemic and structural change that can become sustainable staples in our lives. The U.S. Department of Health and Human Services released, under the Biden and Harris administration in April 2024, a  2024 National Strategy for Suicide Prevention (which can be accessed here in PDF form here. This new 10-year plan provides concrete recommendations for addressing gaps in the suicide prevention field at the national, state, tribal, local, and territorial levels. The plan addresses not only suicide risk prevention, but the identification of and support of people with increased risk through treatment and crisis intervention, prevention of reattempts, promotion long-term recovery, and support of survivors of suicide loss.

The goals of the plan also include reducing access to lethal means among people at risk of suicide, integrating suicide prevention into workplace culture, improving the quality and accessibility of crisis care services across all communities, improving quality and scope of data in suicide research and promoting and supporting research into suicide prevention, increasing focus on suicide prevention for historically marginalized communities and youth, just to name a few. We suggest using this guide to find inspiration for how you might get engaged to prevent suicide at a local, community, state, or even national level.