Listing of International Suicide Hotlines
Suicide Prevention Lifeline Phone Number
1-800-273-8255
reddit/r/depression Resources on Suicide
How do you know if someone is really suicidal?
First of all, take all verbal and nonverbal indicators of suicidal thoughts or behaviour seriously. Even if they don't indicate high risk of death by suicide, they do indicate that something is profoundly wrong.
Here are some things that suicide hotline responders consider when assessing risk. You may not be able to collect all this information directly, but consider both what the person you're concerned about is saying and what they're doing. Also, remember that if you are urgently worried about someone, you can call your local or national suicide hotline yourself and get their expert help to assess risk and figure out your best intervention options.
Do they have a plan?
In suicide risk assessment, it can help to be clear on the distinction between suicidal ideation, i.e. thoughts of suicide, and suicidal intent, i.e. commitment to an accessible plan to end one's life that carries a high probability of lethality. Ideation without intent usually carries a lesser risk, but it still does mean that the person is deeply troubled.
How immediately lethal is their plan?
For example, a plan that involves a firearm or other weapon is higher-risk than one involving overdosing on medication. In general any plan that involves violent means, with or without (jumping from a height or in front of a vehicle like a train) a weapon is higher-risk than one that does not.
Does the person have the means necessary to carry out the plan? Someone who is preoccupied with shooting as a means of suicide but who would have difficulty getting access to a firearm, for example, is at lower risk than someone who is contemplating suicide by overdose and has a lethal quantity of drugs in their possession.
How specific is it? A person who is focused on one specific plan (rather than thinking of various different ways they might harm themselves) is usually closer to the point of actually carrying it out.
Tips for detecting a undisclosed plan
Remember that someone who is seriously suicidal may not talk their plan, but they may "telegraph" what they are thinking, by referring to the means even though they don't mention suicide, or by using metaphors or imagery in their conversation that relate to the plan they have in mind. If you can identify an underlying theme, pay attention to it. Also, someone who is giving away their stuff, having conversations or sending messages that are of an unusually deep or "final" nature, or putting their affairs in order may have a suicide plan and be in the early stages of carrying it out. Being unafraid to die or especially being preoccupied with the idea of death in a non-fearful way can be a strong indicator that someone has an "exit strategy". Pay attention to changes in habits or characteristic behaviors.
What is their history?
Someone who has attempted suicide or engaged in self-harming behaviors (cutting, eating disorders) in the past is at higher risk of completing an attempt. The higher the lethality of the means they used in their past events, the greater the risk. Previous attempts, especially completed attempts, in the person's family or circle of friends also increase risk.
It's a potentially fatal mistake to assume that someone who has had repeated past attempts isn't truly suicidal. The interpretation that "if they really wanted to kill themselves, they would have actually done it by now" may be understandable, but it comes from a lack of understanding of the suicidal mindset. One of the biggest barriers to suicide is that we have an innate fear and resistance toward anything potential lethal, i.e. our survival instinct. Even people who are desperately committed to ending their own lives struggle against this resistance. Every time they attempt, they get a little more desensitized to lethality and undermine their survival instinct a little more. If they are not helped, eventually they are likely to be able to override their survival instinct completely and end their lives.
What are their outer and inner resources?
The fewer or poorer the resources, the higher the risk. Also, consider factors that are "drains" on these resources.
Outer Resources
Family (if the family is relatively functional)
Supportive friends
Professional supports (counselors, therapists, physicians)
Spiritual supports (clergy, etc. can sometimes be great sources of comfort but some "religions" that are cult-like can be draining rather than helpful)
Inner Resources
Coping Skills
Openness to trying new things (this is sometimes easier to see as its opposite, which is when a person sees no way out of a bad situation, i.e. their life has become a trap they can't see a way to get out of alive)
Hopefulness and emotional resilience
Past experience of recovery from depression or resolution of a personal crisis
Factors that can be a drain on a person's resources include:
Recent losses (due to death, breakups, career or financial setbacks, changes in health status), especially multiple losses
Addiction (alcohol, drugs, gambling, etc.)
Isolation
Abusive or dysfunctional relationships
Financial stress
Mental Health issues
High-stress professions
Personal dependents (applies especially to parents and care-givers)
The "Joiner Factors"
Thomas Joiner is the author of Why People Die by Suicide (2005) and Myths About Suicide (2010). His groundbreaking research has identified 3 necessary and sufficient factors for high risk of death by suicide.
Feeling that they are a burden to others. People who complete suicide usually think, or at least implicitly assume, that their friends and family will be better off without them. Sometimes it can make a difference to remind someone of their past contributions and/or potential for future contributions, either tangible (e.g. things they make or tasks they do) or intangible (e.g. love, humor, insight).
Profound loneliness and isolation. People who feel a genuine connection to even one other person can usually be "reached". That is why the most helpful thing you can do for a suicidal person is often not to "fix" anything about them or their life, but simply to try to understand them as well as you can, and reflect that understanding back to them so that they feel understood. It may seem perverse to agree with a suicidal person about how bad things are, but by trying to "focus on the positive" you might actually be reinforcing their sense of disconnection from the rest of humanity.
Fearlessness and/or desensitization. For example, people who have had a lot of exposure to death and violence due to their profession or their family history, and are thus somewhat desensitized, are always at higher risk of suicide.
The Joiner model factors are not always as easy to detect as the behavioural and circumstantial factors above, but awareness of them can be very useful. If you think it's reasonably likely that someone has all three, it's probably a good idea a good idea to err on the side of caution and either take emergency measures yourself, or consult an expert, as soon as you can.
First of all, take all verbal and nonverbal indicators of suicidal thoughts or behaviour seriously. Even if they don't indicate high risk of death by suicide, they do indicate that something is profoundly wrong.
Here are some things that suicide hotline responders consider when assessing risk. You may not be able to collect all this information directly, but consider both what the person you're concerned about is saying and what they're doing. Also, remember that if you are urgently worried about someone, you can call your local or national suicide hotline yourself and get their expert help to assess risk and figure out your best intervention options.
Do they have a plan?
In suicide risk assessment, it can help to be clear on the distinction between suicidal ideation, i.e. thoughts of suicide, and suicidal intent, i.e. commitment to an accessible plan to end one's life that carries a high probability of lethality. Ideation without intent usually carries a lesser risk, but it still does mean that the person is deeply troubled.
How immediately lethal is their plan?
For example, a plan that involves a firearm or other weapon is higher-risk than one involving overdosing on medication. In general any plan that involves violent means, with or without (jumping from a height or in front of a vehicle like a train) a weapon is higher-risk than one that does not.
Does the person have the means necessary to carry out the plan? Someone who is preoccupied with shooting as a means of suicide but who would have difficulty getting access to a firearm, for example, is at lower risk than someone who is contemplating suicide by overdose and has a lethal quantity of drugs in their possession.
How specific is it? A person who is focused on one specific plan (rather than thinking of various different ways they might harm themselves) is usually closer to the point of actually carrying it out.
Tips for detecting a undisclosed plan
Remember that someone who is seriously suicidal may not talk their plan, but they may "telegraph" what they are thinking, by referring to the means even though they don't mention suicide, or by using metaphors or imagery in their conversation that relate to the plan they have in mind. If you can identify an underlying theme, pay attention to it. Also, someone who is giving away their stuff, having conversations or sending messages that are of an unusually deep or "final" nature, or putting their affairs in order may have a suicide plan and be in the early stages of carrying it out. Being unafraid to die or especially being preoccupied with the idea of death in a non-fearful way can be a strong indicator that someone has an "exit strategy". Pay attention to changes in habits or characteristic behaviors.
What is their history?
Someone who has attempted suicide or engaged in self-harming behaviors (cutting, eating disorders) in the past is at higher risk of completing an attempt. The higher the lethality of the means they used in their past events, the greater the risk. Previous attempts, especially completed attempts, in the person's family or circle of friends also increase risk.
It's a potentially fatal mistake to assume that someone who has had repeated past attempts isn't truly suicidal. The interpretation that "if they really wanted to kill themselves, they would have actually done it by now" may be understandable, but it comes from a lack of understanding of the suicidal mindset. One of the biggest barriers to suicide is that we have an innate fear and resistance toward anything potential lethal, i.e. our survival instinct. Even people who are desperately committed to ending their own lives struggle against this resistance. Every time they attempt, they get a little more desensitized to lethality and undermine their survival instinct a little more. If they are not helped, eventually they are likely to be able to override their survival instinct completely and end their lives.
What are their outer and inner resources?
The fewer or poorer the resources, the higher the risk. Also, consider factors that are "drains" on these resources.
Outer Resources
Family (if the family is relatively functional)
Supportive friends
Professional supports (counselors, therapists, physicians)
Spiritual supports (clergy, etc. can sometimes be great sources of comfort but some "religions" that are cult-like can be draining rather than helpful)
Inner Resources
Coping Skills
Openness to trying new things (this is sometimes easier to see as its opposite, which is when a person sees no way out of a bad situation, i.e. their life has become a trap they can't see a way to get out of alive)
Hopefulness and emotional resilience
Past experience of recovery from depression or resolution of a personal crisis
Factors that can be a drain on a person's resources include:
Recent losses (due to death, breakups, career or financial setbacks, changes in health status), especially multiple losses
Addiction (alcohol, drugs, gambling, etc.)
Isolation
Abusive or dysfunctional relationships
Financial stress
Mental Health issues
High-stress professions
Personal dependents (applies especially to parents and care-givers)
The "Joiner Factors"
Thomas Joiner is the author of Why People Die by Suicide (2005) and Myths About Suicide (2010). His groundbreaking research has identified 3 necessary and sufficient factors for high risk of death by suicide.
Feeling that they are a burden to others. People who complete suicide usually think, or at least implicitly assume, that their friends and family will be better off without them. Sometimes it can make a difference to remind someone of their past contributions and/or potential for future contributions, either tangible (e.g. things they make or tasks they do) or intangible (e.g. love, humor, insight).
Profound loneliness and isolation. People who feel a genuine connection to even one other person can usually be "reached". That is why the most helpful thing you can do for a suicidal person is often not to "fix" anything about them or their life, but simply to try to understand them as well as you can, and reflect that understanding back to them so that they feel understood. It may seem perverse to agree with a suicidal person about how bad things are, but by trying to "focus on the positive" you might actually be reinforcing their sense of disconnection from the rest of humanity.
Fearlessness and/or desensitization. For example, people who have had a lot of exposure to death and violence due to their profession or their family history, and are thus somewhat desensitized, are always at higher risk of suicide.
The Joiner model factors are not always as easy to detect as the behavioural and circumstantial factors above, but awareness of them can be very useful. If you think it's reasonably likely that someone has all three, it's probably a good idea a good idea to err on the side of caution and either take emergency measures yourself, or consult an expert, as soon as you can.
What do you guys think about the prevelance of mental illnesses like depression, narcissistic personality disorder, and spectrum related illnesses in Haven?
