If you are close to someone who has experienced a recent suicidal crisis and who may not be fully recovered. How do you think about their risk and what kind of support can you provide? It is likely that you or someone else played a key role in encouraging their pursuit of urgent mental health care and/or a formal suicide risk assessment. Regardless of what the risk was assessed to be at the time, it is important to know suicide risk is dynamic and subject to change based on a variety of factors.
Factors Influencing Continuing Suicide Risk Following an Acute Crisis
- Untreated depression or anxiety
- Ongoing stressor that is unresolved and/or subject to intensify
- Persistent problems with sleep or ability to function
- Unrelenting hopelessness and/or pessimism
- Misuse of alcohol and/or substances
- Intermittent or persistent thoughts of death or suicide
- Access to lethal means to harm oneself
Supporting Those with Elevated Risk of Suicide
You may have had an initial conversation with your family member, friend, or coworker about their crisis and your connection may have supplied an important dose of hope and encouragement. It is vital that you convey your continuing availability and support, that they are not traversing this difficult time alone. Your listening and empathic understanding during this time is indispensable. Your time spent with them will afford you the opportunity to encourage initiating or sustaining their participation in treatment (medication and psychotherapy have strong evidence bases for reducing suicide risk), watching for signs of acute increased risk for suicide (establishes a basis for urgent evaluation/care), reminding them of reasons to live, and assisting with lethal means safety.
Lethal Means Safety
Restricting access to the available means to harm oneself has been shown to reduce suicides. Studies have shown that people have a preference for a given means and that many do not seek out other methods if a preferred means is not available. The time between thinking of suicide and acting on it can span minutes, but also subside as quickly. Restricting access to lethal means may allow suicidal thoughts and the most intense feelings of anguish to dissipate. What's important here is to create time and distance between the person in crisis and those items that can cause lethal harm. With regard to lethal means, firearms account for more than half of all suicides in the U.S., nearly 7 out of every 10 Veteran suicide deaths, and more than half of all firearm deaths (according to CDC, VA, and Pew Research data). Some lethal means safety guidelines applicable to those at elevated risk for suicide are listed below.
Safe Storage and Lethal Means Safety Practices
- Remove firearms and ammunition from the home (best option), perhaps by asking a trusted friend or relative to store it safely.
- Use a locking device, such as a cable lock or trigger lock, or safe, or lock box to store a firearm, unloaded, with ammunition stored separate from the firearm.
- Medications (prescription and over-the-counter) should also be kept under lock and key, such as medication lock box available at many pharmacies. Other substances that can be toxic (e.g., pesticides) or ingested in overdose (e.g., alcohol) should also be removed from the home.
- Sharps (e.g., knives, razor blades) should be safely stored or removed from the home.
- Ligatures (e.g., rope, extension cords, belts, cordage) should be removed and suspension points might also have to be considered to keep an environment safe.
Gauging Suicide Risk
While 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 any of us to ask a person about their suicidal thoughts. DHS has equipped government-furnished mobile devices with the DHS-Columbia Protocol App, which is also available at the iTunes App Store and Google Play Store for free download and use on your personal Apple or Android-based 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, accompanied by suicidal thoughts or not, the Suicide and Crisis line is available 24/7, by simply dialing 988. Veterans and military members dial 988, then press 1. Support is available by phone, chat, or text. To learn more, see Lifeline (988lifeline.org).