Kansas City has been devastated by the on-the-job deaths of two Kansas City Firefighters, John Mesh and Larry Leggio. As a wife of a fireman in Kansas City, it brought the reality of death all too close to home, and my heart shattered for the families, both biological and fire families. We were further rocked three days ago when a fireman died by suicide in front of the fire station. This broke my heart even more, because I know what it is like to feel so much pain that it doesn’t even make sense to live. Not only have I been there myself in my life, but I have seen it over and over in my career.
I worked at an in-patient mental health hospital for three years, in an emergency room for three years, in a doctor’s office for two years, in a cancer support non-profit for almost 2 years, and have now been in private practice almost two years. I have known too many people who have felt suicidal, survived suicide attempts, or have not survived suicide attempts. I have done CPR on people have attempted suicide. In my current practice, I have seen people who have had suicidal ideation, and I take it very seriously, as we all should.
Oftentimes talk of suicide is language for, “I’m hurting so intensely and nothing makes sense, and I’m hopeless.” When someone expresses suicidal ideation, it tends to make people panic or freeze, and kick into “tell them the reasons they shouldn’t” mode. A person who is not experiencing depression, PTSD, panic attacks, or acute stress will be in a completely different mindset than a person who is, and this makes it very difficult to connect.
The desire to inspire someone to live obviously comes from a good and loving place. I’m hoping to help you talk to your hurting loved ones by outlining a few things NOT to say, followed by some things TO say and do.
“You know the door is always open, I’m always open to talk.”
That is like pulling your boat up to someone who is drowning in a lake and saying, “hey, let me know if you need some help.” We have to assume they need us, even if they can’t acknowledge that themselves. People who are having suicidal ideation are often not even capable of calling, texting, or saying, “I need help.” When we say something like, “you know you can talk to me,” is actually heaping shame upon an already broken person because they literally can’t take advantage of that. If someone is in that deep and dark place, their brain is literally not functioning properly at a neural level. They probably know somewhere in their mind that they have support and people who love them, but that is not the predominantly functioning part of their brain right now.
“It can’t be that bad, things will get better.”
Cue the drowning-in-a-lake metaphor: people who are underwater are not going to benefit from you talking about the respite of the boat, or even from you teaching them how to swim at that moment. They have to be out of the panic mode of drowning before they can comprehend anything else. The truth is, to a person who feels like death is a better option than life, they DON’T know that things can get better. All they know is that here and now, in this moment, life feels intensely horrible. In their current reality, it is that bad. It doesn’t need to make sense to you, the goal is to not understand why they are wanting to die. The goal is to connect and keep them alive.
“But you are so blessed/have so much to live for.”
Yes, this is true, but again from a neuroscience perspective, this literally cannot make sense when someone is in this much pain. When someone is in crisis, they won’t be responsive to our messages of hope and joy. What they know is that in this given moment, none of that matters.
Now, for the part about what you CAN do.
- Ask them directly about their suicidal ideation. When someone expresses suicidal ideation in my office, we talk about it directly. I ask them if they’ve thought about how, when, and where. This does not give them any ideas, it assesses where they are. This can also give you information on how to crisis plan if it is an urgent threat (removing guns, pills, etc.)
- If it scares you, tell them. If it breaks your heart, tell them. Let them know that you care about them so much that you don’t even know what to say. When we are in serious emotional pain, we simply need connection with someone. Connection at a basic level means to feel seen, heard, and valued. This is tricky because pain and shame make us want to isolate, when connection is the very thing we need.
- Don’t be afraid to get authorities involved if you are afraid this is a serious situation. When it is a legit crisis, the goal is to keep someone alive, even if it isn’t pretty.
- Consider taking them to a therapy session. Sometimes people are too freaked out or hopeless to come to therapy, and a loved one coming with them can be an enormous confidence booster.
- Get others involved, don’t try to handle this alone. Obviously be sensitive to the delicate nature of the situation, but call in a couple friends to express support.
- Stay in close touch, or set up a network of friends to be in close touch. In in-patient mental health, we would set up 1:1 monitoring, or 5, 10, or 15 minute checks for a suicidal person. You can do this in the home.
- Make them promise to not hurt themselves. I have people sign commitments to not harm themselves in my office. If it comes down to crisis, and simple commitment to someone helps them change their mind, it is worth it.
- Plug the suicide hotline into their phone, or call it with them. 800-273-8255
- Above all, tell them that YOU LOVE THEM and that they matter, and you’re in this with them.
Here are some resources for more information:
http://www.suicidepreventionlifeline.org/
https://www.veteranscrisisline.net/
The Imperfect Therapist 