Suicide Crisis Intervention : Working with People who are in Danger of Taking their Own Lives

This is an article for persons who need to work with and help suicidal individuals.

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I am putting together notes from seminars attended and literature read on the topic of working with people who are imminently suicidal. I hope that the information is useful.

Unless one is familiar, or has come to terms with one’s own thoughts of suicide, one cannot really put him/herself in the shoes of a person in the situation of wanting to kill him/herself. The below video of a talk by Kevin Briggs is a good introduction of how to talk to suicidal people.

How to spot a person who is in danger of suicide

Often when a person is determined to take his/her own life, he/she is alone. Being able to spot a person (family member, acquaintance, friends or other loved ones) in a pre-suicidal situation is life saving.

Pre-Suicidal Syndrome

Ringel (1953) writes that pre-suicidal syndrome is characterized by:

  • Narrowing of the ability to act
  • Narrowing of the emotions
  • Narrowing of the perception
  • Narrowing of the relationship capacity
  • Narrowing of the seeing value (or positivity) in the world
  • Increase of the self-directed aggression
  • Increase of the imposing suicidal fantasies

Other signs of Suicidality

  • Feelings of helplessness and hopelessness
  • Feelings of being offended / hurt
  • Unbearable mental pain
  • Guilt
  • Desire to impress or punish others by suicide
  • Long-lasting sleep disorders
  • Affective and aggression congestion
  • Lack of resources
  • Poor impulse control

Some Observable Signs that a Person is Seriously Contemplating Suicide :

  • there is persistent suicidal thoughts.
  • there is no distancing from the suicide ideas.
  • the person has a suicidal plan — take appropriate action when weapons or medicines are easily accessible or if the plan involves the patient going to a place no one can find them.
  • the person sends out recognizable farewell signals such as letters, giving away objects, cleaning up unfinished businesses, creating orderliness.

Send the Person to the Hospital if…

Call the ambulance when, the person in danger:

  • clearly announces suicide
  • is not believable
  • is not conversant
  • denies intention to commit suicide, however, the external circumstances clearly indicate intent to commit suicide (severe previous attempted suicide in case of continuing stress situation, depression with hopelessness, concrete suicide preparation, details of relatives).

How to Act in the Presence of a Person in Danger of Suicide

  • Stay calm, breathe.
  • Try not to be hastily comforting. Comforting is generally not effective.
  • Emphatically empathize instead of admonishing.
  • Concretize rather than generalize. Ask the person specific things, and not talk about hypothetical things.
  • Take the problem mentioned seriously. Do not downplay the problem. Avoid negating the person by using the words “no” and/or “but”. If unsure, say “yes”, “uh huh”.
  • Listen quietly with understanding, instead of judging and commenting.
  • Carefully gather information from the person instead of investigating, questioning, analyzing.
  • Avoid rashness.

Holding a Conversation with a Suicidal Person in Crisis

  • Be understanding to the person in his / her specific situation, especially in the situation that led to suicidal behavior. Ask, “How was that exactly, can you tell me more about it?”
  • Relate to this event. Ask, “That’s a situation where you thought of suicide?”
  • Speak openly when addressing suicidality. “You thinking of ending it all?”, “Can you tell me more about it?”, “I am interested to hear about it.”
  • Talk about the relationship and interaction in the here-and-now between you and him/her. Ask, “How are you feeling with me now, during our conversation?”
  • If you feel touched, or have warm feelings, share this with the person.

Handling Crisis Intervention by Telephone

When someone on the other line of the telephone is in danger of taking their own lives consider the following:

  • Stay calm, breathe.
  • Talk directly about the problem. Encourage him/her to describe the reason for the call. Talk about what concrete help is needed.
  • Discuss what can be done, what realizable help is possible.
  • Invite the person to a face-to-face conversation.
  • Hearing the person out, let him/her talk. Be accepting of what you hear. Respond empathically to sounds of distress. Withhold any judgement, negation (saying “no”, or “but”), blame or preaching.
  • Discuss clearly the next steps about what can be done, if applicable.

Please remember this…

You are in a position to be there for someone in his/her darkest moment. It is a privilege to be there. Be patient and listen with an open heart. Accept what you hear as the other person’s truth. Be present. Focus on your own breathing. If you feel touched, sad or thankful for the contact that you are having, tell it to that person.

Wait for the appropriate time to bring this up…

Acknowledging AMBIVALENCE

Even at moments closest to committing the act of suicide, the person is still ambivalent about his/her death-wish. Verbally acknowledge to this person, that something in him/her still wants to live. 

“Being with you right now, I’m hearing (or feeling, or sensing), that a part of you really wants to live. “

More Notes on Conversation with Suicidal Persons in Crisis

  1. Take every suicide note on the phone seriously A person tired of life is still talking. He/she is still wants to live, otherwise he/she would not be talking to you.
  2. Suicidal behavior is often an attempt of that person to communicate with somebody. It matters not who you are, you are an important listener.
  3. Suicidal remarks must trigger active listening.
  4. People in distress often see black and white. They respond better when you communicate with them clearly, in short, simple language.
  5. The dangerous moments of a suicidal crisis last only a few hours. Do not fear that it would be too much for you to withstand.
  6. If you are someone who is in touch with your own suicidal thoughts and desires, you are more likely to cope with the suicidal aspirations of the other.
  7. Show concern, but do not be afraid of the words and intentions of the other.
  8. Avoid anxious-well-meaning paraphrases. Instead of saying “suicide”, say, “You want to take your life”.
  9. Suicidal callers ambivalently waver between life and death. Talk about this ambivalence and reinforce it. This will help the person to remember that part of him/her still wants to live.
  10. Call the person by the name, in order to develop a personal relationship.
  11. The suicidal person before you has the right to make personal demands and say absurd thing, even though it might get on your nerves.
  12. Talk to the person in the way he/she wants to talk to you. Mirror the person’s kind of talk.
  13. Do not let yourself be drawn into his/her feelings or thoughts of hopelessness. Ask instead about these feelings, and the memories, etc. behind them.
  14. Avoid asking “why” – type of questions. Similarly avoid asking for reasons. These questions are interrogatory.
  15. Encourage mini-actions. “would you like to meet up (if in phone conversation) or “should we have a cigarette?”
  16. Ask about other people who are still important in the person’s life. If there really is nobody, offer yourself as such a person.
  17. Encourage the person to develop fantasies about his/her future, but
  18. do not do it for him/her.
  19. Do not allow his/her conclusions to convince you like “why I have to kill myself “. Turn it around to, “there is still time to do such and such”.
  20. Tell the other how glad you are to talk to him.
  21. Try to reach an agreement that the other before he hurts himself to call you again.
  22. Do not forget, that despite your best efforts, some still would want to exercise their right to take their own lives. Keep this in mind.

Read more: Gestalt therapy approaches to crisis intervention with suicidal patients.

Bibliography

Ringel, E. (1953). Der Selbstmord, Abschlu├č einer krankhaften psychischen Entwicklung.

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