There are a variety of reasons why people consider, talk about, attempt, or complete suicide. A major reason why MOST people consider suicide is because they feel it is the only solution for their problem(s). Often this problem is some sort of physical or emotional pain. There are of course some other reasons people consider suicide. For some, it may be a way to take control. For example, they have been diagnosed with a terminal illness and they choose to end their life before the disease can ravage their body. Another example can be an individual facing incarceration and chooses to end their life rather than losing control of it in the correctional system. Others may end their lives as the ultimate act of revenge. Some are psychotic, some are impulsive and under the influence of drugs or alcohol. Whatever the reason/motivation if they have not completed the act and will engage us in some form of dialogue; then the door may be open for a POSSIBLE intervention.
In my career in law enforcement as both a responding patrol officer, a crisis negotiator, peer support, and as a crisis counselor on a crisis hotline I have often used a simple strategy with a high degree of success in suicide intervention. My primary strategy is to identify the issue(s) (source of pain) and using collaborative problem-solving. Work toward some sort of an alternative to suicide that may help solve the source of the pain. In many instances, the possible solution does not have to be a slam dunk, 100% solution. Often even with a remotely possible solution, the person may grasp for it as an alternative to suicide. A key component of course is opening communication. We need them to talk to us, to tell us their story. And we need to listen to understand, not to judge. Never say “I know how you feel”. You probably really don’t know how they feel. Even if you have experienced something similar.
Open communications and with a good sincere voice tone ask them how they got to this point today. Beware of your body language and don’t look disinterested such as looking repeatedly at your watch etc. DO NOT APPEAR OR SOUND JUDGEMENTAL! Use active listening skills to not only understand the person but to show them you care enough and want to understand. Use empathy to see the situation through the person’s eyes. In my years of police work, when I arrived on the scene of a completed suicide, as I would begin to learn about this person. I would carefully read their suicide note if there was one (notes are only left about 15% of the time). I would speak to witnesses, family, and friends. In many cases, I could piece together the suicide victims’ story. Using empathy, I would then in my mind go over possible strategies I would have tried to convince them not to take their life if I had been able to speak with them.
The “S” word. It’s ok to use the word “Suicide” when speaking to someone who you suspect is considering it. How do you deal with, and attempt a suicide intervention without talking about suicide? I do however strongly caution about using proper voice inflection when using the word “Suicide”. Don’t sound shocked, disgusted, or judgmental. Being or sounding judgmental may shut the communication down quickly
Our goal is to get the person to discuss with us realistic alternatives to suicide. ACTIVE LISTENING is a key component of crisis intervention. Most people in crisis are not going to consider your alternatives to suicide unless they are convinced you understand their problem. Active listing is essential in this process. It’s worth repeating. Most people in crisis are not going to consider your alternatives to suicide unless they are convinced you understand their problem. Active listing is essential in this process.
The active listing skills are:
- Emotional Labeling
It is important for the emotions of the person speaking to be acknowledged. Identifying the person’s emotions validates what they are feeling instead of minimizing it. By labeling and acknowledging their emotions, we show we are listening. Don’t tell them how they feel tell them how they sound or seem.
- Reflecting/Mirroring
When the person is finished speaking, reflecting and mirroring is a shorter option than paraphrasing as it includes repeating the last words the person said. If the person concluded by saying, “…and she really made me angry,” you would say, “She really made you angry.”
- Minimal Encouragers
Simple verbal actions such as “mmm,” “okay,” and “I see,” and nonverbal gestures like head nodding further establish the building of rapport with the person by you subtly inviting the person to continue speaking.
- Open-ended Questions
Asking open-ended questions solicits the person to speak longer and it can help diffuse the tension as well as provide you valuable information and insight into their perspective of the situation. Open-ended questions in place of direct or leading questions help lessen the feeling of being interrogated.
- Paraphrasing/Summarizing
This includes repeating what the person said in a much shorter format that is in your own words while also making sure to not minimize what the person has experienced. Summarizing is an extended version of paraphrasing. It is wrapping up everything the person said including the things important to the person as well as acknowledging the person’s emotions. Summarizing validates to the person that they have been heard and understood.
- “I” messages
The first responder states, “I feel___ when you ___ because ___.” This provides a “timeout” or reality check to other person letting them know you truly paying attention to what they are doing and saying. “I” messages should be genuine. “I’m concerned when you step towards the ledge.” “When you say people will be better off when your gone, this concerns me because it makes me feel like you are considering suicide”. With I messages we are responding with our own emotions to their words and actions.
Some intervention strategies
- “As I understand it right now you see two options, being in this pain or dying. What other options have you considered?”
We are trying to see how much/involved their own problem solving was before coming to suicide as the answer. Some people think long and hard and consider other options before coming to suicide as a solution. While others have not considered anything else. This strategy helps us figure out where to start with collaborative problem-solving.
- “Have you felt like this before? And if so, what helped you then?”
Here we are exploring options to discuss. In many instances, if they respond with a “yes”, they will then often qualify it with “But that won’t work this time”. Here we can at least explore if there is a variation to what worked before. For example, “medication worked before, but it no longer works”. We may reply “but maybe there is a different medication or a better dosage that will work.”
- “Why today?’
As I previously mentioned, a good basic strategy is to find an alternative to suicide that the person will accept or at least consider. But what if they swat down every suggestion/idea you come up with? I use the “why today?” strategy with these individuals. When the person is swatting down ideas and suggestions such as “Therapy won’t work” “medication won’t work”. I will say something like but let’s try it. You say medication won’t work but let’s try it. If it doesn’t then this can be an option on another day. Why complete suicide today when there may be other options. Let’s explore all your other options. This may sound extreme but in cases like this, I’m trying to get that person away from the ledge or to put the gun down. I generally use this strategy when others are not working.
- “Suicide is a long-term solution to a short time problem” BE CAUTIOUS WITH THIS ONE!
I don’t like this strategy and don’t recommend it. I only mention it because it is widely used. I feel first responders need to understand why they should seldom if ever use this strategy. This is an old standby strategy that is often taught in the police academy or by Field Training Officers. On the surface, it sounds solid. But unfortunately, it’s not well suited in most situations but is often the boilerplate phrase that is spitted out by the first responder. Why is it a problem? The strategy is minimizing the subject problem(s). Is the individual’s problem short-term? If he has terminal cancer is that short-term? Probably only because the cancer will kill him. We all know that after a divorce most people will in time move on to another relationship/marriage. But at that moment is it best to tell the person that their 5,10,15-year marriage coming to an end is a short-term problem? If you said my 30-year marriage ending was a short-term problem I would be highly offended and agitated. This is a valid strategy in a few cases but certainly should not be the “go-to strategy” in every situation.
Be cautious. Many individuals will push you away if you appear to be trying to solve their problem with no input from them or if you appear to not be understanding of their issues. The key with active listening is to try and move into collaborative problem-solving. Help them find alternatives. Don’t just randomly start rattling them off.
Remember MOST suicidal people don’t want to die, they however feel that suicide is their only option. Empathy and active listening are the cornerstones of suicide intervention. Listen, to their story. We learn when we listen. Most of us care enough to help those considering suicide. We just need to make sure we understand how to help.
