By Deborah Jeanne Sergeant
Why my loved one? Why my friend? What could have kept him from taking his own life?
Preventing death by suicide is not straightforward. But as with any health crisis that causes death, most people want to know afterwards what increased the risk for that individual. Warning signs are common and can point to many other scenarios, yet suicide is rare.
“A helpful way to think about suicide risk is that thoughts of suicide emerge when people are feeling stuck alone with overwhelming pain,” said physician Robert Gregory.
“Feeling stuck” indicates helplessness and hopelessness — even for people who have loved ones near them.
Gregory is the director of the Psychiatry High Risk Program at Upstate Medical University. He also teaches at Norton College of Medicine at Upstate.
It may seem hard to believe that people with loved ones all around them—caring friends and family–feel alone. But it’s not about the presence of other people. It’s how connected individuals feel.
“They may feel alienated from those people and create a false self that appears to be happy and cheerful; but inside they are actually in deep pain,” Gregory said. “For the elderly, the pain may be physical. For young people, the pain is usually an inability to acknowledge and process painful emotions, such as shame, sadness or anger.
“We know that suicidal individuals have deficits in the emotion processing system of their brains, causing them to be easily overwhelmed by emotions and become anxious, irritable or depressed.”
Meaningful connections matter when looking for suicide risk. Watch someone who’s becoming more isolated and adopting unhealthy coping mechanisms like substance use or self-harm. Gregory said these are all red flags.
“There may also be decreased functioning at school or work and a preoccupation with negativity and thoughts of worthlessness or death, which may come out in conversations or artwork,” he said.
It may seem like asking if someone is considering suicide may “put the idea in their heads,” but Gregory said that’s not so. In fact, it shows family members that you care about them enough to ask tough questions.
“An example of how that might be asked includes, ‘I noticed that you have not been yourself lately and wondered if you are struggling with thoughts of ending your life?’” he said. “If the answer is affirmative, ask follow-up questions such as, ‘Tell me more about that’; ‘Have any plans run through your head?’ and ‘How close have you come to carrying out those plans?’ The follow-up questions can give you a sense of severity and imminence. But you also have to watch out for the individual minimizing the risk. Therefore, any thoughts of suicide should be taken seriously.”
It’s not a matter of seeing one or two signs of elevated risk, but multiple factors or extreme examples of one or two risk factors.
Monique Winnett, Ph.D., and clinical psychologist at St. Joseph’s Health, said that the factors that increase suicide risk include “chronic and/or life changing physical health conditions; depression, anxiety, substance abuse, other behavioral health conditions; feelings of hopelessness and helplessness; isolation/lack of community or meaningful relationships; absence of spirituality or faith; and recent psychosocial stressors or losses, such as job, relationships, death of others.”
Like Gregory, she advises worried family members to voice their concerns, as well as keep the person company and offer support. One means of doing that is helping to connect them with professional resources that can help. Of course, in an emergency, call 911 or “go to the local emergency room if they cannot keep themselves safe,” Winnett said. “Contact their primary care provider or their behavioral health provider if they have one.”
Contact Upstate’s Psychiatry High Risk Program (www.upstate.edu/phrp) at (315) 464-3117.
Contact crisis support by dialing 988 or in Onondaga County, The Contact Hotline at (315) 251-0600 or Crisis Connect at (315) 251-0800. All these options are confidential and available 24/7.