September is National Suicide Prevention Month. Unfortunately, there are very few people in the U.S. that haven’t been touched in some way by suicide, either through direct contact with it, knowing someone in their community that died from it or through hearing of it on the news. According to the American Foundation for Suicide Prevention (AFSP): suicide is the 10th leading cause of death in the country. On average there are 13 successful suicides per day in the U.S.
Statistics such as these is what led JF&CS mental health counselor Dr. Mary Chase Mize to train in Applied Suicide Intervention Skills Training (ASIST). She wanted to help. “When I did this training, I learned the skills to do an intervention when someone needs help the most, at their worst moment. It’s like suicide first aid.” It made a huge impression on Dr. Mize. “It was such a powerful training. I learned how to recognize who might be at risk of suicide and talk to someone struggling with suicide. It was very hands on and practical.”
When she decided to go for a PhD, helping those thinking of suicide continued to interest her. “I did my doctoral dissertation on suicide in the aging population. I worked on how to equip those in nutritional services who deliver meals for older adults (like the programs run by JF&CS) with suicide intervention skills. A lot of people don’t realize that older adults have one of the highest rates of suicide in the United States and in the world.” Dr. Mize has also worked in a hospital setting both in the emergency department and a crisis stabilization unit to assess, work through and help those dealing with suicidal thoughts.
Understanding Suicide
When hearing of a suicide attempt, the first thought many people have is “why.” It’s hard for most people to understand the urge to kill oneself. It’s easier to see the situation from an outsider’s perspective and think, “how could this happen” or “how could they do this to their family.” It’s hard to for people to put themselves in that person’s shoes.
To look at how a person reaches that point of killing themselves, Mary Chase brought up a seminal work by Dr. Thomas Joiner, Why People Die By Suicide.
“In this book, he discusses the Interpersonal Theory of Suicide, which is a guiding theory about suicide and holds up through a great deal of research,” says Dr. Mize. “Dr. Joiner argues, in simple terms, people die from suicide because 1. they want to – they have the desire for suicide – and 2. because they are capable of doing it.”
A closer look at the Interpersonal Theory of Suicide explains three constructs, that when they happen at the same time, result in serious suicide attempts:
- Thwarted Belongingness – People feeling that they don’t belong. They think, “I’m alone” or “nobody understands me” or “I don’t belong in my community and family.”
- Perceived Burdensomeness – They feel that they are a burden on those around them. They think “my death would be better for those around me than my life.” They have this perception that they are only causing problems and pain to those around them. (Of course, they couldn't be more wrong!) When thwarted belongingness and perceived burdensomeness happen at the same time, a person may shift from having passive thoughts of death to a desire for suicide. But there’s a third piece:
- Acquired Capability – It takes a lot of effort, energy and thought to die by suicide. It’s hard. The capability of suicide, according to Joiner’s theory, is something that builds up over time through exposure to pain. So for a person who is experiencing desire and has had the capability to enact lethal self-harm, then that’s when a suicide occurs.
“The desire for suicide can develop quickly,” says Mary Chase. “They may be experiencing a conglomerate of stressors that build. There is also a number of risk factors that can add to the person’s risk for suicide, such as adverse childhood experiences like abuse, substance abuse, a family history of suicide and hundreds of factors that we know have a correlation to suicide.”
“Understanding the why,” says Mary Chase, “is important to think about. You can then understand how to talk to someone thinking about suicide.”
Warning signs of suicide
Beyond the theory, however, it’s important to learn how to spot warning the warning signs that someone is considering suicide. According to the AFSP, there are three main categories of warning signs:
Watch the person’s mood. How a person may project themselves says a lot about their thoughts. You should be concerned if someone is consistently:
1. Angry or irritable
2. Depressed or feeling despair
3. Distant or numb
4. Feeling hopeless
5. If there’s a loss of interest in everything
6. Or if they suddenly feel relieved
A person’s behavior also can give some warnings. Some signs include:
1. Increased use of alcohol or drugs
2. Stopping all eating or drinking
3. Withholding medications
4. Losing or gaining a lot of weight
5. Isolating from friends and family
6. Always feeling tired
7. Giving away prized possessions
8. Calling people to say goodbye
9. Not caring for their personal hygiene
Of course, the most direct way to learn that a person’s considering suicide is to listen to what they are saying. Are they talking about:
1. Killing themselves
2. Feeling hopeless
3. Having no reason to live
4. Being a burden to people
5. Feeling trapped
6. Being always tired
7. Feeling like they can't do anything right
“Of course, gaining weight, feeling down and not taking care of their personal hygiene could describe half the people dealing with the pandemic,” says Dr. Mize. “The only way to know for certain if someone is considering suicide is to ask them as directly as possible. You must come up to them and say, ‘are you thinking about killing yourself.’ If there is one thing that I could say to parents, teachers, friends, anyone in the world who wants to know if someone is considering suicide, it is to ask them and ask them directly.”
“Early in my career I was working with someone, and I asked them if they were thinking about hurting themselves. They said ‘no.’ There were a lot of warning signs though, so I asked if they were thinking of killing themselves. They then said ‘yes, but it’s not going to hurt and my pain will be over.’ It has to be clear.”
It’s a hard question to ask. Many people are scared to even talk about it. Dr. Mize's answer to that is, “Research shows that asking about suicide does not give anyone the idea of dying by suicide. If someone is having thoughts of suicide it actually helps them in that moment to have someone ask them directly about it.” It helps that person to know that someone cares and are worried about them. If they aren’t considering suicide, then they’ll tell you.
What to do if someone is thinking about suicide
If the person does reveal that they are considering suicide, the first thing to know is that you are not alone when it comes to helping that person. There are resources. The national suicide prevention hotline is 1-800-273-8255. You can reach out to JF&CS and put the person in touch with a counselor.
“The important thing is that they have put their trust in you,” says Dr. Mize. “You’re in a very sacred space with them because of that trust. You’ve made that clearly warm connection. But you don’t have be trained in suicide prevention or have all the answers. You can tell them, ‘I am so glad you told me. I want to be able to help you so let’s get connected with someone who can help even more.’ It can make all the difference and is often a matter of life and death.”
“It’s never all on you to fix the problems and stressors in someone’s life. You can’t take away the things that brought them to the point of suicide. You can’t wave a magic wand and take away their thoughts of suicide,” says Dr. Mize. “That’s not how it works. But you can just say, ‘I see you. I care enough to ask about this. I want to help you through this. I want to connect you with someone who can help.’ That can save someone from suicide.”
Just the fact that they are telling you that they are considering suicide could mean they have some hope. It’s a sign that there is at least a part of them that wants to live. That’s what’s important.
If you want to learn more about taking the Applied Suicide Intervention Skills Training (ASIST) or learning more about suicide prevention, please give us a call.
JF&CS also has one-on-one therapy, group sessions and support for adolescents, adults, older adults and families dealing with suicide and suicidal thoughts.
Please take advantage of these resources if you or anyone you know is thinking about suicide.