If you are close to someone who has recently had a suicidal crisis and may not have fully recovered. What do you think of their risk and what kind of support can you give them? It’s likely that you or someone else played a key role in encouraging them to seek urgent mental health care and/or a formal suicide risk assessment. Regardless of the risk assessed at the time, it is important to know that suicide risk is dynamic and subject to change based on a variety of factors.
Factors influencing persistent suicide risk after an acute crisis
- Untreated depression or anxiety
- Ongoing unresolved and/or potentially escalating stressor
- Persistent problems sleeping or ability to function
- Persistent despair and/or pessimism
- Alcohol and/or substance abuse
- Intermittent or persistent thoughts of death or suicide
- Access to lethal means to harm oneself
Supporting people at high risk of suicide
You may have had an initial conversation with a family member, friend, or colleague about their crisis, and your connection may have provided a significant dose of hope and encouragement. It is essential that you convey your continued availability and support to them, that they do not go through this difficult period alone. Your listening and empathetic understanding during this time are essential. The time you spend with them will give you the opportunity to encourage initiation or maintenance of their participation in treatment (medications and psychotherapy have strong evidence to reduce the risk of suicide), monitoring for acute signs of increased risk of suicide (establishes a basis for urgent assessment/care), reminding them of the reasons for living and helping them with the safety of lethal means.
Lethal Means Safety
Restricting access to available means of self-harm has been shown to reduce suicides. Studies have shown that people have a preference for a certain method and many do not seek out other methods if a preferred method is not available. The time between the thought of suicide and the action can extend over a few minutes, but also fade just as quickly. Restricting access to lethal means can allow the most intense suicidal thoughts and feelings of anxiety to dissipate. What is important here is to create time and distance between the person in crisis and the objects that can cause fatal damage. When it comes to lethal means, firearms account for more than half of all suicides in the United States, nearly 7 in 10 veteran suicide deaths, and more than half of all firearm deaths ( according to data from CDC, VA and Pew Research). Some safety guidelines on lethal means applicable to people at high risk of suicide are listed below.
Safe storage and safety practices of lethal means
- Remove firearms and ammunition from the house (best option), perhaps having a trusted friend or relative store them safely.
- Use a locking device, such as a cable or trigger lock, safe or safe to store a firearm, unloaded, with ammunition stored separately from the firearm.
- Medicines (prescription and over-the-counter) should also be kept locked up, like the medicine lock box available at many pharmacies. Other substances that may be toxic (eg pesticides) or overdosed (eg alcohol) should also be removed from the home.
- Sharp objects (eg, knives, razor blades) should be stored safely or removed from the home.
- Ligatures (eg ropes, extension cords, belts, cords) should be removed and suspension points may also be considered to ensure environmental safety.
Assess suicide risk
Although a formal suicide risk assessment is a clinical practice undertaken by a mental health professional, there are tools, based on evidence-based instruments, that can equip each of us to ask a person about his suicidal thoughts. DHS has equipped government-issued mobile devices with the DHS-Columbia Protocol app, which is also available on the iTunes App Store and Google Play Store for free download and use on your personal Apple or Android mobile devices. This was highlighted in Part 1 of the Suicide Prevention Awareness Month article.
988: Suicide and Crisis Lifeline
For confidential emotional support during a crisis, with or without suicidal ideation, the Suicide and Crisis line is available 24/7, simply by dialing 988. Veterans and military personnel dial 988, then press 1. , or text. To find out more, see safety rope (988lifeline.org).