Dr. Matthew Sleeth
April 2021 – It is almost certain that at some point in your life, someone you know will be thinking about suicide. As an ER doctor, I rehearsed emergency scenarios. When a life-or-death situation presented, I knew the drill. I had done my thinking in advance. I was prepared to act. Suicide is, by definition, an emergency. How you respond is a matter of life or death. The point of this article is not to make you a professional counselor. Rather, it is intended to help you get your loved one help in an emergency.
First, if possible, pick a safe, quiet place to approach your loved one. Don’t charge up while they are standing at a cash register and ask, “Are you thinking about killing yourself?” Instead, sit down to coffee and begin with something like this: “Courtney, I’ve noticed that you seem preoccupied lately (or a little distracted, sad, different, down). Can you share what’s going on?” If Courtney answers, “I’m fine,” you might follow up with, “Yes, but how are you doing, really?”
In my experience, if you care deeply about a person, they’ll open up. If the person begins to cry, let them. Resist the temptation to hush them or tell them that everything is going to be OK. If they are thinking about suicide, things are not “OK.” Be prepared to listen quietly. Bring a handkerchief and hand it to them, and make sure you have one for yourself too. You want to know how they are really doing. Remember, this isn’t about you or your comfort level; it is about them.
When it comes to communicating and asking very hard things, I’ve found it helpful to have a script memorized that I don’t vary from. Having a script doesn’t mean you care any less; it means you care enough to be prepared. Every single time I have to tell someone that they’ve lost a loved one, I begin by saying, “I have some bad news I have to tell you,” and then I go on to tell them that their loved one has died.
My scripted question for suicide is “Have you thought about hurting yourself?” At some level, every person knows that committing suicide is wrong. I think that most want to be asked whether they are thinking about it. They want to share the burden. Most want to be stopped.
You’d be surprised how forthcoming folks are when you ask about their thoughts on suicide. If someone says they have considered suicide, ask if they have a plan. If they have a plan and the means to carry it through, you must act immediately. This is the time to call 911 and say that you are sitting with someone who is suicidal and has a plan. If it’s appropriate, and you are certain that you and they will be safe, you can take them to the emergency department yourself.
This is an uncomfortable subject, but when asking about a plan, you need to also ask about the means of committing suicide. If someone’s plan is to shoot themselves, get the firearms out of their house. If they plan to overdose, get rid of the pills, leaving them only a day or two’s supply of those medicines they must take. You would be surprised how many people – even trained professionals – forget this step. Ask how they plan to kill themselves, and then as soon as possible remove the means to do so.
If the situation does not require you to call 911 or take the person immediately to an ER, then continue the conversation. Getting a fuller picture of the situation will help you assess how to help and who to call. Below are some examples of how to continue the conversation.
1. Tell me about any experiences with suicide you’ve had in your family or with friends.
One of the best predictors of the future is the past. If your loved one denies feeling suicidal and there appears to be no immediate emergency, you should take time to question them about any personal history with suicide. Is there a suicide attempt in their past? Do they have a family history of suicide? Did someone they know commit suicide? How recent was it? Have they just gone through a major life stressor like a divorce, breakup, job loss, or loss of a loved one? Have they just gotten a serious medical diagnosis?
Bottom line: A past history helps you assess the risk factors that predispose someone to suicide.
2. Are you taking drugs or drinking?
Remember that drugs and alcohol are accelerants to suicide. In fact, the vast majority of the suicidal patients I saw in the ER had drugs or alcohol in their system when they tried to kill themselves. So please don’t forget to ask your loved one if they are using drugs or alcohol.
Parents who ask their children – even adult children – about drug and alcohol use may not get a straight answer. Nonetheless, someone must ask, preferably as nonjudgmentally as possible. This is not to say that the one asking must have no opinions about drugs and alcohol. The point is to get a fuller picture of reality so you know what you are dealing with. Your goal is for them to refrain from using alcohol and drugs while they are depressed and to seek help with quitting if they can’t stop.
One of the best ways to help someone struggling with alcohol or drug dependency is to introduce them to someone who has struggled with a similar addiction and overcome it. You can find that person in nearly every church, and they can take your loved one to their first AA, NA, or Celebrate Recovery meeting.
3. If you do become suicidal, do you know what to do?
If the person you are concerned about has no suicidal plans or thoughts but they are depressed, it’s a good idea to bring up what they should do if they become suicidal. This is similar to the situation of evaluating someone in the ER for chest pain. If I determined that their chest pain wasn’t a heart attack or other serious malady, nonetheless I’d give them a list of warning signs and instructions on when to return.
None of us is perfect. We all make mistakes. Situations change. Leave the door open for someone to get back to you or someone else if they do become suicidal. Make sure that they have a number to call, and that it is written down – whether it is as simple as writing down 911 or the National Suicide Prevention Lifeline, 1.800.273.TALK (8255). You can also text the Lifeline number to them so they have it in their phone.
Jesus made no distinction between healing physical and mental diseases. As our brother’s (and our sister’s) keeper, we are called to follow Christ’s example and do likewise.
Adapted from Hope Always: How to Be a Force for Life in a Culture of Suicide by Matthew Sleeth, M.D. Copyright ©2021. Used by permission of Tyndale House Publishers, a Division of Tyndale House Ministries. All rights reserved.
Dr. Matthew Sleeth is recognized by Newsweek as one of the nation’s most influential Christian leaders. He is executive director of Blessed Earth (blessedearth.org) and lives in Lexington, Kentucky, with Nancy, his wife of 40 years. His new book, Hope Always, will be released May 4.