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Helping Someone Who May be Thinking About Suicide

Andrew MartinAndrew L. Martin, PsyD

It’s always okay to ask someone if they are thinking about suicide. You won’t give them the idea, and it often leads to the person getting help. It will likely feel uncomfortable to ask. Suicide is an uncomfortable topic, but asking shows that you care, and opens the door to help and feeling better.

Suicide risk is fairly easy to treat1. Mental health professionals reduce suicide risk by using psychological treatments that directly treat suicide-related thoughts and behaviors. This includes behavior techniques to immediately reduce distress, and cognitive techniques for discovering and modifying thoughts that may be increasing emotional pain to unbearable levels.

Suicide is extremely rare – so rare that we still don’t fully understand all of its causes. The leading theory on the cause of suicide is the Interpersonal Theory of Suicide,2 which suggests that suicide is caused by thwarted belongingness, perceived burdensomeness, and acquired capability. Thwarted belongingness means the person is feeling alone, rejected, abandoned, or otherwise left alone. This can be caused by a relationship breakup, losing a job, or rejection by family or society in general. Perceived burdensomeness means thinking that others would be better off without one, that one is causing pain to those around them. Acquired capability means the person is either desensitized to the idea of suicide (they’ve known or been close to others who died by suicide), or they have easy access to highly lethal suicide methods.

People who think about or attempt suicide generally DO NOT want to die – they want the pain to stop – physical pain, emotional pain, or both. If you ask someone if they want to die, they’ll likely say “no.” But that doesn’t mean they aren’t thinking about suicide. The best way to ask about suicide is to ask directly, “are you thinking about killing yourself?” Most people who are considering suicide tell at least three people of their plans before acting on them. It’s important to take all talk of suicide seriously. It doesn’t matter why they may be talking about suicide. The risk is the same whether they are communicating distress, trying to cause a reaction, or actually contemplating suicide2.

The Columbia Suicide Severity Rating Scale3 is the most thorough and evidence-supported tool for determining suicide risk. The Columbia Scale contains questions about thoughts and behaviors associated with future risk of suicide, and about the severity and frequency of those thoughts and behaviors. Questions include, “have you had thoughts about killing yourself,” “have you ever attempted suicide,” “have you done something just to harm yourself,” “have you done something dangerous where you could have died,” and “have you started to do something to end your life, or prepared to end your life before?” The scale also includes questions about the severity of suicide thoughts. Suicide thoughts by themselves are fairly common and low risk. As thoughts begin to include a method for suicide, intention to act on thoughts, and detailed planning of the event, risk rises. Risk also rises when these thoughts have occurred within the last 30 days. Suicide related behaviors (attempts, preparation) indicate high risk when they occurred within the last 90 days.

If you ask about suicide and someone tells you they are indeed thinking about suicide, suggest that the two of you go to the nearest urgent care or ER for professional evaluation, or call or text the National Crisis and Suicide Line (988). Since most people want to live, they almost always agree to go get help. Many of them say that the act of someone asking about suicide was what changed their mind about getting help. They felt that at least one person really cared about them – that they were worth caring about.

1Mewton, L., & Andrews, G. (2016). Cognitive behavioral therapy for suicidal behaviors: improving patient outcomes. Psychology research and behavior management, 21-29.

2Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner Jr, T. E. (2010). The interpersonal theory of suicide. Psychological review, 117(2), 575.

3Posner, K., Brent, D., Lucas, C., Gould, M., Stanley, B., Brown, G., … & Mann, J. (2008). Columbia-suicide severity rating scale (C-SSRS). New York, NY: Columbia University Medical Center10, 2008.

 

 

 

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