SUICIDE PREVENTION HOTLINE (212) 673-3000

The Keys To Effective Suicide Prevention

This overview provides a basic outline of how to respond to a potential suicidal situation based on the Samaritans "befriending" model practiced at our centers throughout the world. To help someone who is experiencing a crisis we suggest following these basic guidelines:

1. Get Involved and Use "Active Listening"

   By listening to what the person in crisis has to say and by asking direct and open questions, we show our willingness to talk about anything with that person, including his/her feelings about suicide.

2. Recognize the Warning Signs of Depression and Suicide Risk

   Research suggests that the majority of people who attempt suicide literally do something to let others know their intentions before they act. These "warning signs" consist of personal behaviors, verbal and non-verbal communications, and include but are not limited to:

   • changes in personality: sad, withdrawn, irritable, anxious, tired, indecisive, apathetic
     
   • changes in behavior: can't concentrate on school, work, routine tasks
     
   • changes in sleep pattern: bedridden, constant fatigue, insomnia, frequent nightmares
     
   • changes in eating habits: loss of appetite and weight or overeating
     
   • loss of interest in friends, sex, hobbies or activities previously enjoyed
     
   • anxiety about money, personal health and other illness, either real or imagined
     
   • fear of losing control, going crazy, harming self or others
     
     
   • feelings of helplessness, hopelessness and low self-esteem
     
   • feelings of overwhelming guilt, shame, self-hatred and no hope for the future
     
   • drug and/or alcohol-related problems or abuse and/or sexual promiscuity
     
   • loss(es), real or imagined, tied to health, career, employment, economic status
     
   • loss of religious or spiritual faith or in other personal beliefs or philosophies
     
   • talk and preoccupation with the themes of illness, death and dying
     
   • giving away prized possessions
     
   • previous suicide attempts

   Most depressions contain some element of grief and/or recent loss(es) tied to death, divorce, separation, broken relationships, personal status, etc. Watch for statements like "nobody cares", "everyone will be better off without me" and "I wish I were dead". Mental and emotional illnesses such as bi-polar disorders are often tied to suicidal feelings.

   REMEMBER: The risk of suicide may be greatest as the person's depression begins to lift.

3. Don't Be Afraid to Ask: "Do You Feel So Badly You Are Thinking About Suicide?"

   Almost everyone thinks about suicide at some point in their life. By listening and observing the "warning signs" of suicide and asking direct questions, we demonstrate our willingness to talk about anything with the person in crisis, including his/her feelings about suicide. It can be a great relief to the person if his/her suicidal feelings can be brought out into the open and discussed freely without shock or disapproval; it shows that you are taking the person seriously.

4. If the Answer is "Yes," Take the Person's Response Seriously and Continue the "Suicide Risk" Assessment Questions:
   • "Do you have a plan to take your own life?" or "Have you thought of how you would do it?"
     
   • "Do you have the means or materials available to act out your plan?" If so, "What/where are they?"
     
   • "Have you set a time?" or "Have you decided when you would do it?"

     If the answer is still "Yes," ask:
     

   • "Have you ever attempted suicide before?"
     
   • "What happened then?"

   If the person has a definite plan, the means are available and the time is set and immediate, you should consider the person to be high risk for suicide.

5. Do Not Leave a Person Whom You Feel is"High Risk" For Suicide Alone, Even For a Moment

   If a person has expressed suicidal feelings, has a plan, the means available and has a time set, you should always take him or her seriously. If there is any doubt, take him or her seriously. A person who is "high risk" for suicide should not be left alone. Keep talking to that person, stay with him or her or arrange for another party (someone who that person trusts and feels comfortable with) to stay with them.

   Most people can be helped in getting through their moment of crisis if they have someone who will spend time with them, listen, take them seriouslyand help them talk about their thoughts and feelings. Almost every suicidal crisis has at its center a strong ambivalence: "I can't handlethe pain anymore," but not necessarily, "I want to be dead forever!" What most suicidal people want is not to be dead but some way to get through the terrible painthey are experiencing and someone they can turn to during those terrible moments of fear and desperation.

   At Samaritans we say, "You don't save the life of a person who is feeling suicidal, you help him or her get through the moment."

6. If the Person in Crisis Has Taken Some Form of "Life-Threatening" Action, Get Help Immediately

   If a person has taken any action that you believe could be considered life-threatening, don't hesitate to get that person to a hospital yourself (if practical)or call an ambulance or emergency services.