How To Talk About Suicide & Self-Harm With Someone Who Is Struggling
There is no easy or straightforward way to talk about suicide and self-harm with someone who is struggling with these issues (and it’s always best to refer to professional mental health resources and supports). Proper suicide intervention training (such as ASIST) is a helpful skill set to have, but there are some general things to know that can be helpful to keep in mind when venturing into these delicate conversations with people. It is important to remember that every person and every situation is going to be unique and when in doubt, always refer someone to professional services.
That said, here are some general tips based on personal experience and the personal experiences of others (gathered informally through our Peer Support Group).
It sounds so simple, just listen, but actively listening to someone is a skill that takes a great deal of practice, especially when the topic is pain so significant someone is thinking of ending their lives. Knowing someone is suffering is difficult for us to sit with; it’s human nature to want to ease that person’s suffering and to soothe the pain they’re feeling. That is not a bad thing in and of itself, but it can tend to get in the way of actively listening to the person in that moment. We start to think about how to help because we want to help, but sometimes we become so focused on trying to offer solutions we limit the conversation and the other person being able to fully express what they’re struggling with. It is of course essential to know there are options for support, but the person who is struggling may already know about those options and may simply feel shut down if re-directed elsewhere for support (however, sometimes this is necessary). Medications, therapy, crisis lines, distraction techniques, peer support, etc. are all important options that can be explored with the person, but sometimes all they really need is for someone to listen. Don’t be afraid to ask them what they feel need (although they may not know.)
It takes practice, but trying to keep your own anxiety at bay as well as putting aside your other thoughts and feelings (as best you can) when someone is trying to talk about suicide or self-harm, allows you to be more present with them in the moment. Sometimes we can get so caught up in trying to be a good support person that we shift the focus from the person we’re trying to support to ourselves and our ability to support. Again, it’s just about bringing ourselves back to the present moment with the person and being with them in that moment.
You can be the best listener in the world and have plenty of experience supporting people through crises (maybe you’ve gone through a similar situation yourself,) it’s still going to be uncomfortable, you’re still never going to know the “right” thing to say (because there is no “right” thing to say) and that’s okay. You’re trying and that’s all that matters.
Making Space For Heavy Emotions
In general we are really quite terrible at allowing people to feel their feelings, especially when those feelings are considered unpleasant ones: pain, sadness, and anger. We try to quiet these, fix these, get rid of these kinds of feelings, but these are part of a healthy range of human emotions. These emotions tell us something: pain tells us we are hurting, sadness tells us we have lost something, and anger tells us that our boundaries have been crossed. The risk with trying to soothe someone’s suffering is that we add to the sense that these are feelings that need be gotten rid of, but it is okay to sit in pain, sadness, and anger and do nothing to “fix” them. It is probably better to feel these things all the way through instead of trying to avoid them. It is uncomfortable though and it takes practice to know that we can survive such intense hurt. Let the person know it is okay to feel what they’re feeling. They don’t need to feel anything other than what they feel in the present moment. It will pass, they just might not have any sense of that being possible in the moment they are feeling such intense emotions.
Patience & Perspective
Picture a blindfold being placed over your eyes. There is just darkness with no sense of light ever having been there or ever being there again. This utter blackness will seem absurd to anyone who is not blindfolded, experiencing that darkness, pain, and fear. However, the person who is blindfolded has no sense of perspective outside of that darkness and while it is important to remind them that there is something outside of that experience, it is also important to remember they may have a very difficult time picturing what you’re describing. This can be frustrating. There are many problems in the world much larger than each of us, but again, when you’re shrouded in darkness, you cannot see anything but the blackness around you. People who are struggling with depression are so limited in their ability to feel anything. There is just a blank desert of hopelessness before them so trying to give them some perspective on their problems is very limited in its usefulness. It takes patience to even try to understand the black hole they are experiencing, even if you’ve gone through depression yourself, when you’re not in it, it’s hard to remember how all-consuming it is. This is why it’s so important to meet the person where they are at. You’re walking alongside them and sometimes you have to slow your pace to what seems like a painful crawl to you, but it’s all they can manage in that moment.
Do You Have a Plan? (Crises VS. Chronic Suicidal Thoughts)
The first thing any suicide intervention training is going to teach you is to assess for a plan. This is of course important and I highly recommend suicide intervention training such as ASIST (Applied Suicide Intervention Training) to help everyone feel more comfortable talking about these things that we really need to talk about.
The problem with focusing intensely on a person’s plan (their access to means, and the degree of risk associated with the means that they are considering) is that we again run into the risk of shutting the person down. Unfortunately a lot of crisis services are just “do you have a plan? No? Okay you’re discharged.” Or “Have you tried A, B, C? Try A, B, C.” And while that makes sense - it’s a quick triage assessment that reflects how our busy healthcare system has to prioritize care - the issue is that this doesn’t work very well for mental health care. A lot of people who have experienced this in a crisis will never use the service again if that is the treatment they’re met with and the next time, they might take their lives or do some serious damage in the attempt.
Of course if you are worried that someone needs an intervention, don’t hesitate to direct them towards these services. They need improvement, but they’re better than nothing.
The point I want to emphasize here is that even if someone doesn’t have a plan, listen to them. Their pain is still valid. We need to do better at talking to people about incredibly difficult emotions and situations even when they aren’t crises and not making the person feel that the only way they can talk about their pain or get the help they clearly need is by resorting to extreme means.
Taking Care of Yourself & Setting Boundaries
The people who tend to want to know how to support those struggling with suicide and self-harm tend to be people who put others before themselves a lot of the time. This is not a negative quality, but it’s important to remember a few things when you’re dealing with heavy situations that can be emotionally exhausting. Like the crashing airplane principle, you put your own mask on before you go about helping others.
It sounds harsh, but you do not actually owe anyone support through a crisis. Sometimes someone struggling experiences suicidal ideation and self-harming behaviours frequently and this can be exhausting. If you don’t feel like you can focus on supporting that person, you’re dealing with your own life situations, or you even feel manipulated or frustrated by the person, it’s probably best that you take a step back. It’s not your responsibility and it probably won’t help the person struggling. In that moment they need someone who is able to listen and be with them in the pain they’re feeling. That doesn’t mean it has to be you. That is what a crisis line is there for. You can be a loved one, a parent, a friend, a support, but you are not a therapist looking after a patient (even therapists have clear boundaries). It is always okay to say “I don’t think I can give you the support you need right now, but I want to make sure you get it” and then refer them to a crisis line or chatroom or emergency services. It is less than ideal, but it is reality.
It is also okay to feel you have to call the police if you’re afraid for someone’s life. Sometimes you’re in a situation where you’re really not sure and there’s no clear way forward. The person may not want help and you may feel afraid that they’ll be angry with you, but they’ll be alive to be angry and as long as someone is alive there’s a chance that things can get better.
No matter what, these are difficult and uncomfortable conversations and that’s okay. All that matters in the end is having the courage to venture into those difficult and uncomfortable conversations with people. Having the courage to be with them in the pain they’re feeling even if it isn’t something we can imagine or understand ourselves.
- S. Ritchey