What do I do if I'm worried about a Suicidal Friend?

Hi, this is Dr. Nicole, and today we're going to talk about the number one most important thing to say if you're worried about a friend being suicidal. And I'm going to talk to you about the number one myth of suicidal inquiry. And we're going to talk about what to look out for and what to do if you're worried about a loved one that may be getting more depressed or is at risk for suicide. And this is a really important topic that we can probably really dive into for quite a lot of time. But I want to try to make this quick and accessible and easy for you, because when the moment comes and if you have a loved one or you yourself are struggling and you don't want to be having to search through all of the different Facebook pages where you saw videos or YouTube channels. And so if this is helpful for you, then bookmark this page and share with the ones that you love or somebody that you think might be benefited by this. And we'll also make sure to transcribe this information so that you can have it quick and handy and saved onto your computer. With everything that's been going on with the economy, with health, there's a greater risk of depression and suicidal thoughts, suicide attempts. And I want you to feel equipped and to have a place where you can come and learn about what do I do? And so I'm really grateful that you're here. And today, like I said, we're going to be talking about what to look out for, kinds of questions to ask and what do you do? And there is one major myth that a lot of people have when it comes to asking about suicide. And so stay tuned, I'm going to share that with you, too. Also going to share with you the number one most important question. And so let's start by talking about what are some signs that a person may be at risk for suicide. And I'm also going to include this in writing so that you can print it out so that you can keep it. And also I want you to know what signs are that are quite unexpected that you would never think might be a risk factor for suicide. And so the first thing is, what are risk factors for suicide? And number one is it could be something that has been slow going and something that's premeditated, that's been coming on for a long time, or it could be something that can come out of the blue and can be really quite quick and impulsive. And so we want to make sure that we're taking into consideration the person's life? Are they impulsive? Do they tend to make decisions on the fly? Are they more slow and deliberate when we're, when we're looking at these questions? And so a couple of things. Is, does the person you love, have they gone through a loss? Have they lost something economic like a job, or did they. Did they lose money in a court case? Is there something happening economically that's adding stress or pressure to them? Is there anything legal going on that could be an external stressor, could be scary? So economic loss is a trigger, and then social loss is a trigger. With a worldwide pandemic, we're dealing with a lot of social loss. We're social distancing. And so we're seeing increased incidents of people feeling alone and feeling depressed, and they're not getting that social support. This is particularly important also in people who are in a social environment that is very unsafe, feels unsafe, or is triggering. And so we want to pay particularly close attention to people who are in households with somebody who struggles with anger, or is the person that they're living with addicted to substances? Is the person struggling with personality disorder like narcissism or borderline personality, Is the person a caretaker? And are they feeling very alone, and they have a lot of pressure on them to take care of another person? Whether that person is older or they have a disability or that person is unable to work, Whatever it is, social variables are really important. Have they lost a friendship? Has somebody they known committed suicide? Has somebody they known passed away or are they in the process of passing? Did they have a fight with their spouse or their best friend? Being away from school, this is huge for kids. And so I'm trying to keep an eagle eye on my adolescent and child patients to make sure that they're getting their social needs met and other creative outlets. So we talked about economic loss, social loss, and then personal health. Has the person experienced health issue, a new diagnosis? And it could be something that you might not expect to be incredibly triggering. To give you an example, when I was working as a resident, after I graduated from medical school and I was doing my residency, I was on a clinical rotation where a woman came in and we diagnosed her with autoimmune thyroid, called Hashimoto's thyroid. And this is generally speaking, a very manageable condition. But for her, it felt really huge and scary. And one thing that we ended up learning is that she went home that night, was feeling suicidal. She felt like her world was ending. She had this really scary diagnosis. And so being able to have that conversation with her and put into place protective factors and support her was really profoundly important. And so even if you feel like, oh, it's just thyroid or it's just you've been diagnosed with migraines, for that person, what's important is does it feel scary and overwhelming and how are they dealing with it? So economic loss, social loss, health loss, and another health loss, social loss combined is, did the person have a miscarriage or did they, are they trying to get pregnant and they can't get pregnant? These are different things to think about. That could be stressors on people and so that increases their risk of suicidality. So we want to know what their risk factors are. Something that contributes to an increased risk factor is impulsivity. Does this person tend to be more impulsive? Do they make decisions really quickly? Do they make rash decisions? If we have increased impulsivity and increased risk factors from their external or internal environment, then we need to keep an even closer eye on them. The second thing we need to do is look at protective factors. Protective factors could be having a spiritual faith, especially one that discourages suicide, whether it's a spiritual practice or a religion or a culture. So do they have a spiritual life or some sort of an external and internal protective factor in that way? And then the second is, what are their social supports? Do they have somebody living in the home with them that is protective for them? Do they have friendships, whether it's in person or even social media? I have a client right now where she doesn't have any in person friendships and all of her relationships are on Twitter. She feels great support from her Twitter relationships. And so that's a very protective factor for her. And right now it's incredibly protective because she's reluctant to go anywhere outside of her apartment. So she's pretty isolated. But she has that external protective factor of online relationships. And so external protective factors, spirituality, relationships, health practices and goals and motivations. So is this person expressing, I'm motivated, I have goals. There are things that I want to do and create as opposed to, on the flip side, feeling like a failure, feeling discouraged, feeling like they want to give up. And so these are things that we want to look at when we're trying to decide if somebody is at a higher, lower risk. And that's not a completely exhaustive list. And so is there anything else that you can think of? There's also resources online that we'll share in the links. Some of my favorite is beyondblue.org that's really, really good. And another one is rethink mental illness, which is at rethink. Org, that's a great website, and they'll give you a ton of information as well on what to look out for. And so the next thing I want to talk with you about is, what do you do? And this is where we get into the number one myth when it comes to suicide, is that people are afraid that if they ask, are you suicidal? That it's going to give them the idea of suicide and increase the likelihood of that. And interestingly, the opposite is true. That's pretty surprising, right? So we think if I ask you, are you feeling suicidal right now, or have you had thoughts of hurting yourself or injuring yourself? I have heard a lot of people worry that, oh, my gosh, I hadn't had that thought. That's a good idea, that that actually doesn't happen. What we've seen in the research is that when you ask them, the likelihood of them doing that goes down. And an important way to ask that question is from a place of love. Nonjudgment from empathy. And being specific could be really important. When I was in clinical practice, this is probably about 10 years ago, I had a patient, she had major economic loss. She just had a new diagnosis, and she was expressing feelings of hopelessness and discouragement and despair. And so I asked her, have you had thoughts of suicide? Have you had thoughts of hurting yourself? And she told me, no. And sometimes people will say no, but if you get more specific, they may express yes. And this is what we did is I said, have you had thoughts of shooting yourself? She said, no. And then I said, have you had thoughts of hanging? And she said, no. And I said, have you had thoughts of overdose? And she said, yes. So we want to figure out specifically, especially if they've talked about it in the past or attempted in the past, or they know somebody that attempted in a specific way, we want to ask them specifically. And so I asked her, she said that she had thoughts of overdosing. And then we want to assess, do you have means in order to achieve this? And so, okay, well, do you have pills? What have you specifically thought of using? And so then you get that information. And then once you have that information, you can find out, well, do you have a plan? And if you do, when, where, what are the specifics? A really good resource is if you end up getting a guest and you're concerned is to call either 911 or the Crisis hotline. And so the crisis hotline, I'll make sure to put that information in the comments for you. But you should never put yourself in a position where you are the only person that's involved in an inquiry like this. Make sure to call the professionals, call the experts so that you don't have that weight on your shoulders. And so stay with that person and then call the crisis line. I'll make sure to give you that number. And then what they will do is they'll speak to that person, they'll ask them questions. Sometimes they'll send a mobile unit out and they're going to figure out what the next most appropriate steps are to protect your loved one. And so we want to make sure that you're able to be there for them, support them, non judgmentally, love them, but don't be afraid to have the conversation. When you have the conversation, we want to increase the likelihood that you're going to help them feel supported, loved and safe so that it isn't further triggering. And so some tips for that is go to a place that feels really neutral, like maybe their place, somewhere that feels good and somewhat safe for them. So it may be able, they may be more able and comfortable to talk with you if they're in their own environment or maybe do something that you enjoy together. So maybe like watch a TV show that you like or play a game, like maybe turn on a video game and while you're playing video games, talk. Or you could wander up to a coffee shop with them or go to a park or walk around the block, or go to the beach or maybe even going for a drive. Sometimes it's easier to have these conversations when there's something else that's going on. So it feels like there's less crap if it's online. Sometimes if somebody posts a comment on a social media page or an online forum or on their page, you should, I think you're going to have better success by sending them a private message that it's okay to talk online, but take that to a private forum where they will feel safer, more protected, less called out in front of everybody. And then when you're doing that, you're able to also look up supports. What do I say? What do I not say? And so we also want to think about like conversation starters. So I had a friend recently who was expressing these thoughts online and so I sent her a message and I said, how are you doing? And when you say that to somebody, you can expect that they're gonna say I'm fine, I'm good, thanks for asking, or I'm feeling pretty crummy. And then you might follow that up with well, how are you really, how are you really doing? You don't seem like yourself. And then you might express to them, I've just noticed that you don't seem like yourself. And I care and I'm concerned and I just want to be here for you and make sure they know that you're not upset with them for behaving differently, but rather you just want to be there and support them. And sometimes aligning with them can be really helpful. And my friend who was suicidal recently, she, she expressed, yeah, I'm feeling pretty crummy. And I aligned with her. And I expressed, yeah, my week has been like total crap. This and this and this happened. And that can be an icebreaker that might open the door for them feeling like they're not a further burden on you by talking about what's troubling them. And then you might specifically ask questions if you know that they have increased risk factors. You might mention, hey, I know that you lost your job. How are you doing with that? Or hey, I know that you got this diagnosis. How are you doing with that? Tell me, tell me how I can support you. And you might want to ask questions that are more open ended or use nonverbal cues, something that feels a little bit less threatening for them. And so when the conversation is winding down and if you feel like they're in immediate danger, you want to make sure that you call the National Suicide Prevention Hotline where the crisis line or there's even a texting where you can text the word talk to 741741. And then there's also a crisis text line. Like I said, I'll give you that information. But sometimes texting is really quick. 741, 741. And talk if you're feeling suicidal, if you're feeling like hurting yourself, you can text this line. And these people are here, they're volunteers, they're trained, they're here to support you, love on you, help you, get you the resources that you need in a way that is honoring and safe. And so I'm going to include a ton of resources for you. But if there are any specific questions that I can answer, leave it in the comments, send me a dm. But I want you to know that right now a lot of people are struggling. It's super difficult to be going through a pandemic and to be isolated. And so we want to make sure that you're protecting yourself, that you're looking out for your loved ones. So we are here, available for you. We're going to include a bunch of resources to support you if you are feeling like you're going through a difficult time, if you're feeling like you want to hurt yourself, if you're feeling like the world would be better without you. I want to encourage you to get some information on how to put the calm at the end of your sentence, because there's so much that we can do to support you. You can feel better, you can get your life back. You are valuable. And so let's do this together. You're not alone. And so check out our resources. Please share this video if it's helpful for you. Make sure to subscribe to our other resources. I have a podcast, a YouTube page, and my name is Dr. Nicole Cain. And in terms of I did have a question about anonymity. And yes, the crisis line is anonymous. And if you call and you're reporting to somebody that you're feeling that way, they're not going to trace your number or hunt you down. It can be totally anonymous. And then if you're calling on behalf of a loved one, you can put in an anonymous call. Oftentimes it's better if you, as a person who's calling to support somebody else, if you can give them that information so that if they need to follow up with you, that they can find you and reach you. But yes, those resources are anonymous, which is great because we don't want you feeling like you can't call because you don't want to to have them coming after you. And so another resource too is there's prayer lines, there's help lines, there's resources for adolescents. And so I'll get those all put together. I'll throw it here on Facebook and I will also put some resources together on my Instagram. So stay tuned. If you have any other questions, send me over a message. I'm here for you. I honor you. We can get through this together. You are not alone. I've been there and I've come to the other side and the view is so lovely. It's worth it. And so check back next week. I'm going to be doing lives every Wednesday and Friday and they're going to be same time, same place. And again, please share if this would be helpful for anybody that you know or love. And I will see you next time. Thanks for being here. Talk to you soon.