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How to Help a Friend Who’s Suicidal

Concrete tools for suicide prevention

Twice last week, I was involved with suicide crisis management, where someone was calling me to get advice on how to help someone actively considering suicide.

Being thrown into suicide crisis management, which is not the work I usually do, reminded me how emotionally heavy it is to carry a crisis, to walk around like it’s just a regular day when you’re actually thinking about whether someone you care about will take their life.

I’ve been connected to suicide prevention work for a while, so that heaviness feels different for me now. I’ve become more practiced at behaviors that help me focus so that I’m not as overwhelmed by my own fears, more able to listen actively. As I have been more open about my personal connection to suicide and as this blog gains traction, I have more people who turn to me for advice, and, at each of these times, I feel better prepared to provide the best response I can.

Yet, I am fully aware that suicide prevention on the individual, person-to-person level, can feel, uncomfortably so, more like a game of chance than a game of strategy.

But, there is research to guide crisis intervention in suicide, and this past week especially, I felt more confident providing advice with a bit of science on my side.

One of the most popular questions I get as a suicide prevention blogger is how to help someone in crisis, so I wanted to be sure to share the tools I suggested in real life here on this blog, with the hope that you won’t need them, and the knowledge that, if this past week is any indication, you just might.

Hope Box

A hope box is a tangible collection of items that can be used to focus at times of hopelessness and overwhelm. A hope box -- any box, or as this article says, an envelope or anything that can hold objects -- can be filled with photographs, letters or emails that are meaningful, inspirational quotes, “anything that reminds you of reasons to stay alive.”

There’s research to support that the hope box helps break up patterns of thinking that accompany suicidal thoughts. The Veterans Administration has created an app that allows users to create a virtual hope box. I think, if you don’t happen to have a box but you do have a smartphone, you might be able to organize your own virtual hope box -- an album of pictures, a collection of quotes -- via Pinterest or just using apps already on your phone.

Safety Plan

A safety plan is a go-to list of warning signs (how do I know things are about to spin out of control?), internal coping strategies (things I can do to take my mind off of problems without contacting another person), people to turn to for distraction or help, numbers for professionals and organizations, and ways to make an environment safe for someone struggling with suicidal thoughts. Safety plans are intentionally personalized. It’s reassuring to me that something fairly intuitive -- a list of how to take care of yourself, and the people you can turn to if you need someone -- is supported by research.

A safety plan can go in your hope box, virtual or otherwise. Here’s a template. I particularly like the very last part of this template, which poses this query: “The one thing that is most important to me and worth living for is…”

Staying Grounded

What I was reminded of this week is the importance of “staying grounded” when managing a crisis, whether you’re the one in crisis or the one helping. A hope box and a safety plan allow for the person in crisis to get out of a stuck place, even just a little, and see with some perspective. They’re concrete tools that helpers can use together with the people they care about, and that tangibility can make it feel like there’s something more than words of support being given to a loved one. A hope box or a safety plan can be built by a couple or two friends, a parent and a child, a therapist and a client.

For those who find themselves in helper roles, I also wanted to share the behaviors that I learned to help me focus and be a better listener. From my work in a hospital, where we “pumped in” and “pumped out” using hand sanitizer each time we entered and exited patient rooms, I learned to create a ritual at the beginning and end of challenging, uncertain encounters. I never knew exactly what I’d see when I opened the door to each room, but I knew I needed to be open to what and who was there in order to meet patients with presence and compassion.

Now, I take a moment right before I’m going to begin an important encounter to take a breath and try to clear my mind. In the next moment, I try to keep that openness, that absence of expectation, so that I can free myself of the pressure to be perfect, to say exactly the right thing. I have found that giving myself that freedom opens up a better chance that I’ll say something authentic, comforting, supportive.

After a challenging encounter, I take time to let what’s just happened sink in, even if -- perhaps especially if -- it’s difficult or uncomfortable. These are the moments I’m able to more fully realize the ideas that we are all connected as humans, and that we are all tremendously vulnerable. And then, I try to clear my mind again, not to forget about what has just happened, but to be open to whatever’s next. These are practices I engage in at my best -- there are many times I haven’t taken the few minutes, and in retrospect wished I had.

In that spirit, I want to acknowledge that it was a beyond-tough week for the people who reached out to me to support them as they supported others. I know that it’s not just those two people who’ve been there for someone in need, or just the two people they’re supporting who are struggling. What touched me deeply were the words shared between one set of people, who together wrestled with the idea that when someone takes their own life, the pain of that death will never go away.

I found that statement to be just one of the most true things. It is an honor for me to be a person others turn to in times of crisis, as I am granted such glimpses into the deepest struggles. And it is a true privilege to be able to reflect on and share these tiny holds on humanity, with the hope of making things easier and better.

Copyright 2016 Elana Premack Sandler, All Rights Reserved