Find Help in a Cri­sis 

What is a cri­sis sit­u­a­tion? 

A “cri­sis” sit­u­a­tion is hap­pen­ing if a per­son with men­tal ill­ness is: 

  • A dan­ger to them­selves 
  • If oth­er peo­ple are in dan­ger 
  • If their symp­toms are esca­lat­ing and their behav­ior is becom­ing out of con­trol or dan­ger­ous 

How should a cri­sis be han­dled? 

When a cri­sis occurs, it is usu­al­ly not expect­ed. It is impor­tant to be pre­pared for the unex­pect­ed; to have a plan in place. Cre­ate a list of impor­tant phone num­bers and infor­ma­tion. Keep it some­where acces­si­ble, next to the phone, in your wal­let, etc. Include the fol­low­ing infor­ma­tion: 

  • Your local cri­sis ser­vices phone num­ber and local ER phone num­ber 
  • The name and phone num­ber of the person’s psy­chi­a­trist and psy­chol­o­gist 
  • A list of the person’s med­ica­tions (the names and dosage infor­ma­tion) 
  • The person’s diag­no­sis and, if pos­si­ble, treat­ment his­to­ry 
  • The name of a friend or fam­i­ly mem­ber that may be of assis­tance  
  • The num­ber for the local police depart­ment 

It is help­ful to speak to a local men­tal health work­er ahead of time, so if ser­vices are need­ed you know what to expect and how to obtain them. 

What ser­vices will cri­sis pro­vide and how do cri­sis ser­vices “work”? 

In emer­gen­cies, local law enforce­ment agen­cies may also play an impor­tant role in obtain­ing men­tal health care. In the event of a cri­sis, cri­sis ser­vices may send an indi­vid­ual to eval­u­ate the sit­u­a­tion. That per­son is usu­al­ly trained to con­duct an eval­u­a­tion for pres­ence of seri­ous men­tal ill­ness and assess the lev­el of dan­ger­ous­ness, if any. Often if the cri­sis work­er comes to a pri­vate home or apart­ment to con­duct an eval­u­a­tion, they will bring a police offi­cer with them for their own safe­ty, and for the safe­ty and pro­tec­tion of oth­er peo­ple at the cri­sis scene. Nor­mal­ly the police offi­cer is not present to arrest the ill per­son unless an ille­gal act has been com­mit­ted. How­ev­er, law enforce­ment pro­ce­dures com­mon­ly require police offi­cers to trans­port the men­tal­ly ill per­son in a police cruis­er to a hos­pi­tal. 

Plan Ahead: If you sense a dete­ri­o­ra­tion in your friend or rel­a­tive’s men­tal con­di­tion, con­tact their doc­tor, case man­ag­er, or social work­er. If it should become nec­es­sary to call the cri­sis emer­gency tele­phone num­ber or the police, have writ­ten infor­ma­tion avail­able about the ill per­son­’s diag­no­sis, med­ica­tions, and spe­cif­ic behav­ior that pre­cip­i­tat­ed the cri­sis. It may be use­ful to have sev­er­al copies to give to the cri­sis inter­ven­tion work­ers and the ER work­ers. 

New Vista Emer­gency Ser­vices 

Many Sui­cides are Pre­ventable 

Sui­cide is a seri­ous pub­lic health prob­lem. In the Unit­ed States, it is the eighth lead­ing cause of death over­all and the third lead­ing cause of death for young peo­ple aged 15–24. More than 30,000 peo­ple take their own lives every year. For every death by sui­cide, there are about 20 sui­cide attempts. 

Near­ly every­one some­time in their life thinks about sui­cide. Most peo­ple decide to live because they even­tu­al­ly come to real­ize the cri­sis is tem­po­rary and death isn’t. It is not unusu­al, how­ev­er, for some­one in a cri­sis to per­ceive “no way out” of their dilem­ma and feel an utter loss of con­trol. When one can’t cope and can’t see how things are ever going to get any bet­ter, des­per­a­tion grows. 

Sui­ci­dal thoughts and behav­ior can be suc­cess­ful­ly treat­ed and often can be avoid­ed if help is obtained soon enough. Rec­og­niz­ing when some­one might be sui­ci­dal and get­ting the per­son help are what’s cru­cial. 

What to do When You Sus­pect Some­one is Sui­ci­dal 

Some peo­ple believe, “If peo­ple are deter­mined to kill them­selves, noth­ing is going to stop them.” This is not true. Again, most sui­ci­dal peo­ple don’t want to die; they want to stop the pain. The impulse to end it all, how­ev­er over­pow­er­ing, does not last for­ev­er. And prop­er treat­ment can elim­i­nate sui­ci­dal symp­toms. If you sus­pect some­one is sui­ci­dal, the first and most impor­tant step is to engage that per­son, to con­nect with that per­son. They may have already “signed off” from the world. Your job is to reestab­lish com­mu­ni­ca­tions. Talk­ing helps ease the pain. Try to gage the grav­i­ty of the sit­u­a­tion. Some peo­ple believe that “talk­ing about sui­cide may give some­one the idea.” This is not true. 

You don’t give a sui­ci­dal per­son mor­bid ideas by talk­ing about sui­cide. Bring­ing up the sub­ject and dis­cussing it open­ly can give the per­son a great sense of relief. They don’t have to keep it a secret any longer, and this allows them to open up about the under­ly­ing issues. Treat all feel­ings, ges­tures, and lan­guage seri­ous­ly. Be non-judg­men­tal. Accept the person’s feel­ings and don’t try to talk them out of those feel­ings. 

  • Don’t debate whether sui­cide is right or wrong, or feel­ings are good or bad. 
  • Don’t lec­ture on the val­ue of life. 
  • Don’t give advice by mak­ing deci­sions for the per­son or telling them to behave dif­fer­ent­ly. 
  • Don’t dare them to do it. Share your feel­ings of con­cern for the per­son. Offer hope that alter­na­tives are avail­able but do not offer glib reas­sur­ances or try to make light of the sit­u­a­tion. It only proves you don’t under­stand. Offer empa­thy, not sym­pa­thy. 
  • Do not make a promise of secre­cy. Sav­ing a life takes prece­dence over con­fi­den­tial­i­ty and loy­al­ty. Ask who else knows. 
  • Do not ask if the per­son wants help but tell them you will help. 
  • Do not allow a rejec­tion of help. Once you have con­nect­ed with the per­son, do not leave them. You are their bridge back to life. Make it clear you will stick with them until they are con­nect­ed with some­one who can real­ly help them. Encour­age an anti-sui­cide pact. 
  • Get a com­mit­ment not to attempt sui­cide, even if it’s short term. 

Take action. Remove means. Get help from per­sons or agen­cies spe­cial­iz­ing in cri­sis pre­ven­tion and sui­cide pre­ven­tion. Get imme­di­ate help for the per­son if they are real­ly at risk of hurt­ing them­selves by call­ing 911. Final­ly, get help for your­self. Tak­ing care of some­one who is hurt­ing and it can take its toll on you. Con­sid­er talk­ing to a pro­fes­sion­al about the expe­ri­ence after it is over. 

HOW TO GET HELP:  

There is a wide range of treat­ment avail­able for sui­ci­dal behav­ior, includ­ing med­ica­tions and “talk” ther­a­pies. The key is to get the per­son pro­fes­sion­al help as soon as pos­si­ble. It is bet­ter to rec­og­nize a poten­tial dan­ger and have it addressed at an out­pa­tient clin­ic than to wait until the only option is the Emer­gency Room. 

If you know some­one who has some of the risk fac­tors above, a first step would be to find out whether the per­son has a “safe­ty net” — a case­work­er or a school psy­chol­o­gist, for exam­ple. Many times, there are pro­fes­sion­als who are already involved with the per­son. If not, then it is a mat­ter of find­ing the right pro­fes­sion­als and get­ting them involved.  

The next step would be to con­tact these pro­fes­sion­als and share your con­cerns. When speak­ing to pro­fes­sion­als, remem­ber that they might be lim­it­ed by con­fi­den­tial­i­ty rules in what they can tell you about the per­son, but they can and should lis­ten to every­thing that you have to tell them. If you notice some warn­ing signs, it is imper­a­tive to get the word out to as many peo­ple who can help as pos­si­ble: not only to a men­tal health pro­fes­sion­al, but to any­one who can help: fam­i­ly, friends, teacher, doc­tor, cler­gy. Find the peo­ple the per­son will respond to and sound the alarm. Fig­ure out the best way to inter­vene to get the per­son pro­fes­sion­al help and then do it. If you are deal­ing with some­one who is in cri­sis, call your local cri­sis line. If there is imme­di­ate dan­ger, call 911. 

Nation­al Helplines: 

 

Final­ly, despite your best efforts some­one may go on to com­plete sui­cide. Their pain and wish to escape may be too over­whelm­ing. They is respon­si­ble for their death, not you. Seek sup­port and coun­sel­ing. 

What are the Warn­ing Signs? 

These indi­ca­tors help one to rec­og­nize the threat of sui­cide in oth­ers. While it is pos­si­ble to mis­in­ter­pret any one of these signs, putting them togeth­er with oth­er indi­ca­tors, such as the risk fac­tors above, should show that action must be tak­en. When the signs are there, it is time to act. The dan­ger of embar­rass­ment through over­re­ac­tion is not near­ly as great as the dan­ger of death through fail­ure to act. 

A sui­cide threat or oth­er state­ment indi­cat­ing a desire or inten­tion to die. Some peo­ple believe that “peo­ple who talk about sui­cide won’t real­ly do it.” This is not true. Almost every­one who com­mits sui­cide has giv­en some clue or warn­ing. Do not ignore sui­cide threats. State­ments like “You’ll be sor­ry when I’m dead,” or “I can’t see any way out” — no mat­ter how casu­al­ly or jok­ing­ly said — may indi­cate seri­ous sui­ci­dal feel­ings. 

Change in per­son­al­i­ty or behav­ior: The changes gen­er­al­ly are sud­den and quite notice­able. The per­son who has been reserved or con­ser­v­a­tive sud­den­ly becomes loud and con­spic­u­ous. The per­son who was out­go­ing and friend­ly becomes aloof and wants to be alone. The one who is usu­al­ly hap­py is sad, sees their options slip­ping away. The one who is usu­al­ly depressed can be much hap­pi­er; they see a “light at the end of the tun­nel.” Unusu­al­ly aggres­sive, destruc­tive or defi­ant behav­ior; a lack of con­cen­tra­tion on school, work or rou­tine tasks; a change in sleep pat­terns, eat­ing habits, and a loss of inter­est in activ­i­ties the per­son pre­vi­ous­ly enjoyed are all “red flags” that some­thing might be very wrong. 

Mak­ing arrange­ments as though for a final depar­ture: Prepa­ra­tions before sui­cide vary with the person’s per­son­al­i­ty or cir­cum­stances. They often con­sist of what is gen­er­al­ly referred to as “get­ting one’s affairs in order.” To the head of the house­hold this might mean prepar­ing a will or review­ing insur­ance papers. To a house­wife it might mean writ­ing long over­due let­ters or patch­ing up bad feel­ings with rel­a­tives or neigh­bors. To a teenag­er, it might mean giv­ing away per­son­al pos­ses­sions with sen­ti­men­tal val­ue – jew­el­ry, skis, CDs. Final prepa­ra­tions may be made very quick­ly, with the sui­cide fol­low­ing abrupt­ly. Pre­ven­tion often relies on detec­tion of the ear­li­er signs, such as com­ments about death, depres­sion and marked per­son­al­i­ty changes. 

Hope­less­ness: A crit­i­cal warn­ing sign is when a person’s think­ing gets so con­strict­ed, they only see things as “black or white” and their life as all black with no patch­es of gray. “This is the way it is,” they think. “It will nev­er get bet­ter.” 

Oth­er warn­ing signs: 

  • Increased drug or alco­hol use. 
  • Tak­ing unnec­es­sary risks/careless behavior/accidents. 
  • Feel­ings of over­whelm­ing guilt, shame or self-hatred. 
  • Fear of los­ing con­trol, “going crazy,” harm­ing self or oth­ers. 
  • Wor­ry about mon­ey or ill­ness (real or imag­i­nary). 
  • Pre­oc­cu­pa­tion with death and dying. 
  • Loss of inter­est in per­son­al appear­ance 

Who Could Be In Dan­ger? (Risk Fac­tors) 

There is no typ­i­cal sui­cide vic­tim. It hap­pens to young and old, rich and poor. There are some com­mon “risk fac­tors,” how­ev­er. While many peo­ple expe­ri­ence one or more of these risk fac­tors and do not con­tem­plate sui­cide, they are use­ful in iden­ti­fy­ing some­one who might become sui­ci­dal. 

Some peo­ple believe that “Peo­ple who com­mit sui­cide are peo­ple who were unwill­ing to seek help.” This is not true. For exam­ple, stud­ies of sui­cide vic­tims have shown that more than half had sought med­ical help with­in six months before their deaths. That is why the Sur­geon General’s Office rec­om­mends train­ing physi­cians in sui­cide risk assess­ment, and also teach­ers and school per­son­nel, cler­gy, police offi­cers, cor­rec­tion­al per­son­nel and emer­gency health care per­son­nel as well. The oppor­tu­ni­ties are there to spot and pre­vent poten­tial sui­cides before they reach the cri­sis stage, if one knows what to look for: 

A diag­nos­able men­tal health prob­lem or alco­hol or drug prob­lem: Sui­ci­dal thoughts and behav­ior can be symp­toms of a men­tal ill­ness or sub­stance abuse dis­or­der. Most often they are symp­toms of mod­er­ate to severe depres­sion. Depres­sion is a med­ical con­di­tion that is often accom­pa­nied by a loss of appetite; sleep dis­tur­bances, gen­er­al bod­i­ly com­plaints, social isolation/withdrawal and a lack of inter­est in or enjoy­ment of every­day liv­ing as well as feel­ings of lone­li­ness, worth­less­ness, guilt and sad­ness. Depres­sion can also be a con­se­quence of a person’s strug­gle to over­come a seri­ous men­tal health or sub­stance abuse prob­lem and the stig­ma of hav­ing such prob­lems. Deal­ing with any debil­i­tat­ing ill­ness can be depress­ing but hav­ing a “social­ly unac­cept­able” ill­ness cre­ates added pres­sures. Acci­den­tal sui­cides are some­times caused by delu­sions and often by drug over­dos­es. Peo­ple who have under­gone drug rehab and go back to using often over­dose because they think their bod­ies can still tol­er­ate the quan­ti­ty of drugs they used to take. Many times, peo­ple have both men­tal health and sub­stance abuse prob­lems that “feed” each oth­er. Both need to be treat­ed at the same time for the per­son to get bet­ter. 

Adverse life events, espe­cial­ly sig­nif­i­cant loss­es: The sig­nif­i­cance of the loss is always sub­jec­tive. It could be any­thing from the loss of a best friend to fail­ure to get an “A” on an exam. It is whether the per­son can cope with the loss that is impor­tant. 

Impul­sive­ness: Even the most severe­ly depressed per­son has mixed feel­ings about death, waver­ing until the very last moment between want­i­ng to live and want­i­ng to die. Most sui­ci­dal peo­ple do not want to die; they want the pain to stop. While the deci­sion to kill one­self may be reached over a long peri­od of time, going through with it often requires “seiz­ing the moment.” Impul­sive peo­ple, or peo­ple ren­dered impul­sive by alco­hol or drugs, are most like­ly to find them­selves “tak­ing the plunge.” 

Pre­vi­ous sui­cide attempt: To be deter­mined to kill one­self takes a lot of “psy­chic ener­gy” which can be sus­tained for only a lim­it­ed peri­od of time, usu­al­ly no more than two to three days. How­ev­er, many sui­cides occur with­in about three months fol­low­ing the begin­ning of “improve­ment” after a sui­ci­dal cri­sis, when the per­son has regained the ener­gy to try again. 

Oth­er Risk Fac­tors: 

  • Fam­i­ly vio­lence, includ­ing phys­i­cal or sex­u­al abuse 
  • Feel­ings of rage 
  • Fam­i­ly his­to­ry of sui­cide 
  • Fam­i­ly his­to­ry of men­tal health or sub­stance abuse prob­lem 
  • Incar­cer­a­tion 
  • Expo­sure to the sui­ci­dal behav­ior of oth­ers, includ­ing fam­i­ly, peers or through the media. 

 

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