In response to the stress of the last two years, loss has exceeded that of a viral disease, worsened and uncovered mental health issues, and lead many to suicide (Courtet & Olié, 2021). Especially in rural communities, suicide rates have soared (Brown & Schuman, 2021). In this prolonged time of loss, feelings of helplessness, hopelessness, and isolation can swell within us. Tragically, these same feelings are also risk factors for suicide. Numerous studies have already identified the correlation between increased suicide rates and the COVID-19 pandemic (Abi Zeid Daou et al., 2021). Despite the insidious myth about suicide that still circulates the media, talking about suicide can be one of the most helpful interventions (Substance Abuse and Mental Health Services Administration [SAMHSA], 2012).
Suicidal ideations, meaning thoughts about killing oneself, can be a part of the human experience. When emotions or circumstances overwhelm us, the desire for relief can be a logical and common conclusion; in a year, about 12 million people will experience thoughts of suicide, 3.5 will plan to suicide, and 1.4 million attempt to die by suicide (Center for Disease Control [CDC], 2021). Suicide is not a failure or a success for those experiencing suicidal ideations. One does not “succeed” in taking their life, nor do they “fail” to kill themselves. Such language insinuates and implies a morality around suicidality that can further contribute to guilt and shame. Moreover, people do not need a reason to be suicidal and may not be aware of a trigger for suicidal thoughts (CDC, 2021).
How do I know if I need to talk with someone about suicide?
Many behaviors or invitations can indicate that someone is feeling suicidal and in need of assistance. Invitations of suicide may include making passive statements about death (e.g., “Guess I’ll just kill myself”), struggling with recent life events, increased substance use, and mood changes such as increased anxiety, depression, mood swings, irritability, and rage. Other common forms of invitations include preparatory behaviors. Emptying bank accounts, giving away or selling personal items, purchasing a gun/ substance/ rope/ over-the-counter medication, collecting pills, and making sure people are “taken care of” or “tying up loose-ends” can all classify as preparatory behaviors and indicate that someone is preparing to end their life (SAMHSA, 2012).
How do I talk about suicide?
Suicide is an emotional topic of conversation. Talking about suicide requires vulnerability; to ask another person about feelings of suicide means admitting concern and care, while admitting thoughts, ideations, or plans of suicide requires sincere trust. While mentioning suicide to a loved one will not compel them to take their own life, they may feel attacked, defensive, angry, or any number of big emotions. When confronting a loved one on their suicidality, prepare to hold space for them (Substance Abuse and Mental Health Services Administration [SAMHSA], 2021).
If you feel that a loved one demonstrates the signs and symptoms, asking about suicide may be helpful. When initiating the conversation, ask your loved one directly, “Are you thinking about killing yourself?” or “Are you thinking about suicide?” to avoid any ambiguity. Talking about suicide does not implant the idea in someone’s mind. If a loved one reveals they have been thinking of suicide, listen nonjudgmentally to their story. Remember to breathe and check-in with your own emotions. Having a loved one who is suicidal can feel personal and regulating your own emotions can help comfort the other person (SAMHSA, 2012).
The severity of the suicidal thoughts, feelings, and/or plans often determines the level of care needed for safety. One of the most accessible options are the National Suicide Prevention Lifeline and the Trans Lifeline which are available 24/7. Calling the Lifeline generally involves talking with a crisis counselor to get through the presenting crisis (Suicide Prevention Lifeline, n.d.). If your loved one is considering suicide, has a plan, but does not have a strong intent or timeframe, you may consider taking measures towards harm reduction (SAMHSA, 2012):
Help your loved one find ways to remove items that would aid suiciding; examples of harm reduction include firearms, pills, hanging devices, knives, sharps, chemical substances, etc. If the individual needs to have these items in the house, help them brainstorm ways they could decrease access to these items. Having a lockbox and gunlock for a gun, having a pill box, putting knives, sharps, hanging devices, and chemicals away from the individual or under lock and key are all examples or reducing risk of suicide.
In other cases, your loved one may need more emergent care. For instance, if your loved one has a plan, a timeframe, means, and desire to kill themselves, it may be necessary to call 911, visit the emergency department, or find an access center for a crisis bed (Suicide Prevention Lifeline, n.d.).
While talking about suicide can be essential in connecting your loved one with the care they need, it is natural to fear the possible side effects of asking someone about suicide. As the days get darker earlier, holidays round the corner, and the future of COVID-19 remains uncertain, you may be more likely to notice invitations and behaviors from your loved ones. If you or a loved one needs support, consider setting up an appointment with us at the Olson Clinic to speak with one of our student therapists. If you or a loved one is in crisis, please use the following resources:
Foundation 2: 319-362-2174
Mental Health Access Center in Cedar Rapids: 319-892-5612
GuideLink Center in Iowa City: 319-688-8000
National Suicide Prevention Lifeline:1-800-273-8255
Trans Lifeline: 1-877-565-8860
Abi Zeid Daou, M., Rached, G. & Geller, J. (2021). COVID-19 and Suicide. The Journal of Nervous and Mental Disease, 209 (5), 311-319. Doi: 10.1097/NMD.0000000000001338.
Brown, S., & Schuman, D. L. (2021). Suicide in the time of COVID‐19: A perfect storm. The Journal of Rural Health, 37(1), 211–214. https://doi-org.proxy.lib.uiowa.edu/10.1111/jrh.12458
Centers for Disease Control and Prevention. (2021). Facts about suicide. U.S. Department of Health and Human Services. https://www.cdc.gov/suicide/facts/index.html
Courtet, P., & Olié, E. (2021). Suicide in the COVID-19 pandemic: What we learnt and great expectations. European Neuropsychopharmacology, 50, 118–120. https://doi-org.proxy.lib.uiowa.edu/10.1016/j.euroneuro.2021.06.005