Listening Helps Prevent Suicide
MADISON – In talking with people who might be contemplating suicide, it is most important to listen first, and listen well.
Then there's what not to do: Don't blithely tell a suicidal person to "cheer up, things will get better," or offer advice without hearing the person's full story.
Allow People to Talk About Their Feelings
"About the worst thing you can do is to dismiss suicidal feeling with casual reassurance," says Dr. Ronald Diamond, professor of psychiatry in the UW School of Medicine and Public Health. "That just emphasizes that no one understands the pain the person is feeling."
Diamond, who is also medical director of the largest community mental-health program in Madison, Wis., says that allowing people to talk about their suicidal thoughts is the first step to healing.
"If you bring up suicide with people who are struggling with those thoughts, invariably they are relieved because someone understands, and because it's not a secret anymore,” Diamond says. "Give the person a chance to talk about wanting to die and wanting to live before helping them decide to live."
Diamond trains physicians and medical students on how to recognize patients who are suicide risks. He says that some of the techniques can also be used by friends and family to assess whether a loved one is at serious risk of suicide.
Certainly, the need has never been greater.
Suicide is Becoming a Public Health Epidemic
More Americans -- about 30,000 -- kill themselves each year than the number who are murdered each year. Suicide is the 11th leading cause of death in the United States, and occurs at even higher rates among certain age groups. Diamond says that two groups at highest risk for suicide are young people between the ages of 15 and 24, and single men over the age of 65. Other groups are seeing their suicide numbers rise, as well.
"Suicide is becoming a public health epidemic," Diamond says. "There is major concern in the Army about the increase in suicides among active Army personnel."
Diamond says it can be tricky to assess whether someone is at serious risk for suicide. Besides the higher-risk age groups, there are certain factors that can make suicide more likely. They include:
- Depression and other mental illnesses, including schizophrenia, panic and anxiety disorder, bipolar disorder, and borderline personality disorder
- Substance abuse
- Pre-menstrual and post-childbirth times for women
- Life changes, such as divorce, a recent death of a loved one or a recent humiliation
- Financial problems
- Health problems
- Unemployment, and belonging to a higher-risk occupation, such as police officer, musician, dentist, physician, lawyer, or insurance agent
- A history of previous suicide attempts; those who have attempted suicide before are more likely to succeed the next time.
"If people have 'cried wolf' or made what we call a 'suicide gesture,' that needs to be taken very seriously," Diamond says. "Even if the first attempt wasn't serious, those people are at higher risk."
Adopt an Attitude of "Gentle Assumption"
To elicit the most helpful information, Diamond advises adopting an attitude of "gentle assumption,” assuming that they may already have thought about a plan.
"Instead of being shocked, ask things such as, "In what ways have you thought of killing yourself?" he says. "Gently assume a specific behavior."
After using active listening, and hearing the story, try to engage the person as a collaborator in getting help. Ask the person what has helped in the past, what reasons he or she has to go on living, and what options are available. Then consider the next steps.
First, make sure the person isn't alone, and doesn't have access to easy means of suicide. Ask if they have access to drugs and firearms; 92 percent of teen suicides are by guns.
"Most young people kill themselves with a gun that is in the family home or the home of a friend," Diamond said.
Next, decide what help the person is willing to accept, and what other people should be involved, including physicians, counselors and the police. It's important not to make promises of pseudo-confidentiality.
"Never promise that you're not going to tell anyone, because what if the information is, 'I just bought a gun?'." Diamond said. "I tell patients that they need to let me use my best judgment about what to do with the information they share with me."
Date Published: 04/28/2009