News

Recognizing and responding to warning signs for suicide

April 06, 2017

Suicide Prevention

Suicide is an uncomfortable topic. As a society, we don't like to think about suicide and consequently, we often avoid talking about it. According to the American Foundation for Suicide Prevention, over 44 thousand lives are lost to suicide each year in the United States alone, and most of us have heard about or known someone whose life was directly impacted by suicide.

Research has shown support for spreading awareness about warning signs as an effective means for recognizing them, and thus being more capable of offering support. Although it is important to recognize these warning signs, perhaps more important is what is done in response. It can be difficult to know when a warning sign is serious enough to act, and what the appropriate level of action should be. Research has provided helpful tools to support this process by offering a consensus list of the most imminently threatening signs, as well as less emergent factors, and the appropriate level of support that may be necessary (Rudd et al., 2006).

The following are warning signs that present with the most risk for imminent danger and should be met by calling 911 or a mental health provider that can provide immediate assistance (see resources at the end of the article):

1. An individual is threatening to hurt or kill themselves. This is a threat to safety that has extended beyond thoughts, and progressed to planning and intent. Further professional evaluation and support is appropriate at this point.

2. An individual is seeking access to a method to kill themselves. This may include searching for weapons, pills, or other means. Firearms are responsible for nearly half of completed suicides, and it is helpful when individuals in this state do not have access to them. Sharing any information regarding this with the professional you contact is helpful.

3. Someone is talking or writing about death, dying, or suicide. This is often recognized as suicidal ideation and can be difficult to identify when the conversation may seem to be in a joking or less serious manner. If you are concerned but unsure of yourself and whether support is needed, ask them "Are you thinking about killing yourself?" Mental health professionals regularly encourage friends, family, and other supportive people in an individual's life to be direct and ask this uncomfortable question. It may be scary to be so direct and you may worry about making things worse, but research has supported talking about suicide can in fact reduce rather than increase suicidal ideation. Although it may be uncomfortable, it communicates that you care enough to ask, and it has the potential to save a life.

There are also warning signs that should still be met with concern and action for support, but may not require immediate emergency response. It is appropriate to contact a mental health professional or call a 24/7 support hotline such as 1-800-273-TALK(8255) if you hear, witness, or see anyone exhibiting any of the following warning signs:

- Hopelessness.
- Rage, anger, seeking revenge.
- Acting reckless or impulsively engaging in risky activities.
- Feeling trapped - 'there is no way out.' This is often associated with immense emotional pain that feels unbearable and inescapable.
- Increasing alcohol or drug use.
- Withdrawing from friends, family, or society. Individuals contemplating suicide often feel like a burden on others and will isolate themselves.
- Anxiety, agitation, unable to sleep, or sleeping all the time.
- Dramatic changes in mood.
- No reason for living; no sense of purpose in life.

Educating yourself and becoming familiar with these warning signs is a great first step to being an informed supporter to friends, family, colleagues, and students. In addition to contacting official forms of assistance, there are many ways you can offer support as well. Some helpful strategies include:

- Listening. As previously mentioned, talking about it can reduce risk of suicide and increase feelings of hope when someone cares enough to listen.
- Empathize and show compassion.
- Care. Reassure them that they are important, loved, valued, and with purpose. It can be helpful to remind them of these things, and itâ??s important to be authentic. Follow up at a later time and check in with them about how they are doing.
- Tell someone. Don't assume they will tell someone else what they are going through because they told you. Be intentional about who would be appropriate to tell, and involve them in the process. Try talking to them about how they can get support and who they can get support from. Do they have a therapist? Do they need to call someone? Can you call together and make a plan for support? Can you walk them to the counseling center or drive them to the local crisis center for a safety evaluation and support?
- Connect. Offer to spend time with them, have a meal, or grab a cup of coffee. Connection is a powerful tool to combat loneliness and isolation, and provide a healthy distraction from emotional distress. If you cannot be the one to provide these things, help them connect with someone that can. Help them brainstorm who might be able to stay with them, or who they could talk to that would be a good support. Provide resources for professional support, or offer hotline numbers.
- Prevention. As a follow up to asking if they are thinking of killing themselves, ask them if they have a plan for how they would do it? What is that plan? A big part of prevention is restricting access to means and slowing them down enough to create a window of hesitation. Suicide is often an impulsive act so anything that will delay them from following through on their plan is helpful.

Additional information and resources can be found at suicidepreventionlifeline.org, bethe1to.com, and sprc.org. Suicide hotlines and local crisis center contact information can be found below:

- Tell Someone (a CSU Resource): tellsomeone.colostate.edu; (970) 491-1350
- 1-800-SUICIDE(784-2433)
- Colorado Crisis Support: 1-844-493-TALK(8255)
- LGBT Suicide Prevention: 1-866-4-U-TREVOR(8-873867)
- Trans Lifeline: 877-565-8860
- SummitStone 24/7 Walk-In Crisis Center: 1217 Riverside Ave., Fort Collins

Rudd, M. D., Berman, A. L., Joiner, T. J., Nock, M. K., Silverman, M. M., Mandrusiak, M., & ... Witte, T. (2006). Warning Signs for Suicide: Theory, Research, and Clinical Applications. Suicide And Life-Threatening Behavior, 36(3), 255-262. doi:10.1521/suli.2006.36.3.255

By Julie Benton

Julie Benton was born and raised in Arizona where she also completed her undergraduate degrees in Psychology and Family & Human Development at Arizona State University. Julie is graduating with her Master's in HDFS for Marriage and Family Therapy in May 2017 and is passionate about her work as a therapist with a wide variety of individuals, couples, and families. Julie enjoys being outdoors as well as staying active through exercise and various sports including wake boarding, hiking, snowboarding, and playing with her dog, Maggie. Her favorite pastime is being among friends and family.


Contact:  Center for Family and Couple Therapy

Telephone:  970-491-5991

Email:  cfct@colostate.edu