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What to do if your loved one talks or threatens suicide? – Series of articles “How to heal the soul?” Part 11!

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Suicide is a very sensitive topic, it is not widely discussed, but according to statistics, 350-400 people commit suicide every year in Latvia. Respectively, one person commits suicide in Latvia every day, and Latvia ranks 3rd in the EU in terms of the number of suicides[7]. It is in our hands to change these statistics, if we learn to recognize people around us with suicidal intentions in time and act correctly, forgetting about some myths that are widely spread in society. [3]:​

1. Myth: People who talk about suicide won’t actually commit it.
Fact: Almost all people who commit suicide give warnings to those around them. Do not ignore indirect indications of suicide. Statements “you will regret it when I leave”, “I don’t see a way out” – regardless of how seriously or jokingly it was said – can indicate a desire to commit suicide.

Myth 2 : Anyone who tries to kill themselves is insane.
Fact: Most people who commit suicide are not abnormal or mentally ill. They may be sad, sad, desperate, but severe stress or emotional pain are not necessarily signs of mental illness.

3. Myth: if a person has decided to kill himself, nothing will stop him.
Fact: Even severely depressed people waver between the decision to live or die until the last moment before committing suicide. Many suicidal people do not want to die, but want to soothe their mental pain.

4. Myth: People who commit suicide are those who did not want to seek help.
Fact: Studies of suicide victims indicate that more than half sought medical help in the 6 months prior to their death.

Another thing is that suicidal people can also express a markedly ambivalent attitude towards accepting or rejecting offered help and about living or dying: behavior can change rapidly from seeking help to rejecting it, which can be easily misinterpreted by others [1].

5. Myth: Talking about suicide can provoke a suicidal person to commit suicide.
Fact: This is not true; open conversation and discussion of suicide is one of the best options that could help a suicidal person not commit suicide [3].

Not always a person with suicidal thoughts is ready to talk about them openly, there is a chance that he will talk about it indirectly: “life is very difficult”, “I can’t do anything to improve life”, “it’s not worth living”, “nothing makes sense ”, “the world will be better off if I die”. A suicidal person will seek information about possible suicide methods; will talk about himself as a burden to others; will sometimes abuse alcohol or drugs; will criticize himself; will express lost faith in the future. Changes in behavior, withdrawal, mood swings from elation to apathy and vice versa, aggressive or hostile behavior, uncontrolled anger can often be observed. Suicide planning is indicated by such signs as selling, giving away, giving away your favorite, most important things for no apparent reason, relinquishing important property, loss of interest in things that used to be important; passion for the theme of death through poetry or art, absences from work or school [5, 6].

What to do if a close or not so close person speaks and threatens suicide, or do you suspect that someone close to you is planning suicide?

The first step in suicide prevention is always reliable communication. In the course of the development of suicidal ideation, mutual communication between the suicidal person and his fellow human beings is vitally important. The result of the lack of conversation is silence and increased tension in the relationship. The prejudice and fear of provoking a suicidal person to commit suicide is misguided. Not discussing his or her suicidal thoughts and messages often leads to a lack of dialogue. Talking about suicide can be stressful, and the discomfort is sometimes so great that their first response to a depressed or suicidal person is verbal or non-verbal aggression. However, depressed and suicidal people are often very sensitive to the way other people communicate. Body language is as important here as verbal communication. Too rough a conversation can lead to mistrust and unwillingness to talk to you[1].
When you think that suicidal behavior is quite possible, first of all, you should ask the person about it in order to evaluate the current situation and the existence of a suicide plan. Not always the person planning suicide will say so openly. In most cases, people at risk and at risk of suicide also have communication problems, so it is important to have a dialogue with the depressed or suicidal person. Sometimes it is not easy to start a conversation about suicide, so it is better to start a conversation about this topic gradually by talking or asking questions about another topic[2], for example:
  • “I’ve noticed a change in your behavior lately and I want to know what’s going on.”
  • “You’ve been causing me concern lately.”
  • “Are you feeling down and sad?”
  • “Do you feel that everyone is indifferent to you?”
  • “Can you think that life is not worth living?”
  • “Do you think you might commit suicide?”
  • It must be remembered – it is not true that talking about suicide could provoke people to start planning suicide.
  • When is the best time to ask these questions? When a loved one or friend feels that they have found understanding, when it is comfortable to talk about their feelings, when they themselves talk about negative feelings – loneliness, helplessness, etc.
  • If a dialogue develops, it is necessary to ask about suicidal thoughts in more detail to understand how well thought out and serious the suicide plan is, whether a certain method has been chosen, or whether a certain time has already been planned:
  • “Do you have thoughts about killing yourself?”
  • “Have you already prepared the funds? Drugs? Weapon? Insecticides? Or others?”
  • “Do you have them available?”
  • “Have you already chosen a time when you will do it?
  • “When are you planning to kill yourself?”

What to do if a close or not so close person thinks about suicide?

Action depends largely on how serious the suicidal ideation is. The above-mentioned questions can be used to assess the risk of direct suicide in the near future.
Low and medium risk is when a person tells you that they can’t cope or that they would rather die, but they are not planning to commit suicide right now.

What you can do:

  • Offer emotional support. We need to talk about problems that cause suicidal thoughts.
  • Focus on the strong points of the personality – you need to talk and remember how any other problems during your life were already solved without using suicide as a way out. A person must see his strengths and real possibilities to deal with problems.
  • Make a contract – “you will not commit suicide within a certain period of time until you talk to the doctor”.
  • Refer this person to an outpatient psychiatrist or psychotherapist as soon as possible.
  • Keep in touch and talk to that person again about the same thing after a certain period of time.
  • Talk to other relatives of this person, ask them for support.
A high risk for suicide is when a person has already made a plan and wants to carry it out immediately.

What you can do:

  • Do not leave this person alone.
  • Talk to the person sensitively and take away the pills/knife/gun etc. suicide tools. Limiting access to various dangerous drugs, firearms, pesticides, explosives, knives, etc. is important to save life. availability.
  • Call 911 immediately and hospitalize the person.
When a person is aggressive towards himself and openly threatens or tries to commit suicide, it is possible to provide psychiatric help even without his consent, which was established by Article 68 of the “Law on Medical Treatment of LR”! [4] Quick, authoritative and decisive intervention can often save a life.

Never do the following:

  • Don’t ignore the situation.
  • Don’t panic.
  • Don’t say everything will be fine.
  • Don’t argue. Don’t say “you have everything you need to live”, “your suicide will cause pain to the family” or “think more clearly”.
  • Don’t lecture about the value of life or tell you that suicide is wrong.
  • Don’t promise “tell me, I won’t tell” confidentiality.
  • Don’t say that the problems that make a person want to commit suicide are minor and can be easily solved, don’t give advice on how to do it right. It doesn’t matter how bad or how big the problems are, it matters how disruptive and troublesome they are.
  • Don’t blame yourself. You cannot solve another person’s thoughts, control their feelings. You are not responsible for another person’s happiness or lack thereof.
  • Do not leave the person alone [2].

Reference list:

Authors of the article: doctor-resident in psychiatry Alina Kuznetsova, doctor-psychiatrist Pēteris Zālītis.