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Have you been worried about a friend, roommate, or classmate who is increasingly withdrawn, behaving recklessly, or hinting at self-harm? Joining a college or university campus means joining a community—and within that community, it is likely that someone you know will be seriously affected by mental illness or will contemplate suicide. In an anonymous survey of 44,000 students, more than 1 in 10 (13 percent) said they had seriously considered suicide in the past 12 months (NCHA Canadian reference group, 2016). Two out of three post-secondary students who disclose suicidal thoughts tell a peer first (Professional Psychology: Research and Practice, 2009). Most students want to help others but often aren’t sure how, SH101 surveys show. So here’s how.
Three steps to helping a friend who may be suicidal
1. Notice something is wrong
Warning signs indicate an immediate risk for suicide. Mental health professionals or emergency responders should be contacted quickly. Warning signs can include:
- A threat to self-harm
- Increasing alcohol or drug use
- Dramatic mood changes
- Seeking access to a firearm, pills, or other lethal means
2. Choose to respond
Your concerns are probably valid. It’s appropriate to empathize, listen, and help connect your friend to other supports. Suicidal thoughts are far more common than suicide attempts; your friend may feel relief when you raise the issue.
Reach out to mutual close friends to see if they share your concern, and strategize about how to help. “A key part of suicide prevention is encouraging dialogue,” says Robert Olson from the Centre for Suicide Prevention in Calgary, Alberta.
When seeking help for another person, what’s the deal with privacy?
By Marian Trattner, MSW, suicide prevention coordinator at the University of Texas at Austin, and Charlie Morse, MA, LMHC, associate dean for student development at Worcester Polytechnic Institute, Massachusetts
When the professional is a licensed mental health professional:
- If Student A talks to a licensed mental health professional about Student B, privacy is guaranteed in almost all circumstances. Because of confidentiality laws, the mental health professional can’t reach out to the student of concern. Exception: The professional can contact Student B if there seems to be an immediate threat to Student B or others.
- Counsellors might ask for information about Student B but will not reveal what they know about that student: “Occasionally we do ask for names of students, as it might help us strategize as to how to best approach the situation (for instance, when we know the student is already in counselling),” says Charles Morse. “Students understand that we will never share confidential information, even something as ‘simple’ as whether a student has been seen in counselling before. Unless we are concerned about a student’s well-being, we will not try to take the situation out of their hands.”
When the professional is not a licensed mental health professional:
- If Student A talks to a professional who is not a licensed mental health professional, seeking advice about Student B, then that professional could and should reach out to Student B. Student A can ask that their name be kept out of the conversation.
3. Take action
Your support can be either or both of these:
- Direct: i.e., talking to the person you’re worried about
- Indirect: i.e., talking to or involving another person or resource
Suicide risk factors, warning signs, and what to do
Is it a warning sign or a risk factor?
Suicide risk factors suggest a person may be at higher risk for suicide in the long term (not immediately). For example:
- An alcohol or drug use problem
- A previous suicide attempt
- A mood disorder (e.g., depression)
- Access to a firearm, pills, or other lethal means
Action: Call 911 or seek immediate help from a mental health provider
When you hear or see any one of these behaviours:
- Someone threatening to hurt or kill themselves
- Someone looking for ways to kill themselves (e.g., seeking access to pills or weapons)
- Someone talking or writing about death, dying, or suicide
Action: Contact a mental health professional or call a crisis centre for advice
When you witness, hear, or see anyone exhibiting any one or more of these behaviours:
- Rage, anger, seeking revenge
- Acting reckless or engaging in risky activities, seemingly without thinking
- Feeling trapped, like there’s no way out
- Increasing alcohol or drug use
- Withdrawing from friends, family, or society
- Anxiety, agitation, unable to sleep, or sleeping all the time
- Dramatic mood changes
- No reason for living; no sense of purpose in life
Adapted from table #2: Rudd, D. M., Berman, A. L., Joiner, T. E., Nock, M. K., et al. (2006). Warning signs for suicide: Theory, research, and clinical applications. Suicide and Life-Threatening Behavior, 36(3), 255-262.
How to talk to someone who may be having suicidal thoughts
- Think this through in advance and role-play your conversation.
- Talk about behaviours, not labels: “It’s OK to mention you’ve noticed a change in behaviour,” says Taylor Linseman, Program Coordinator of YouthNet, a mental health promotion and intervention program in Ottawa. “Don’t make accusations or assign labels.” Avoiding labels like “depressed” or “alcoholic” helps take judgment and stigma out of the conversation.
- Talk about being concerned, not worried. “Worried” may imply that friend anxiety is your source of concern, as opposed to your roommate’s state of mind.
- Ask open-ended questions about your friend’s situation.
- Ask your friend about suicide directly, in a nonjudgmental way. Worried that raising the issue may give them the idea? This concern is outweighed by the risk of not raising it.
- Stay supportive. It’s OK that you don’t have all the answers. Refer them to a helpful resource.
Sometimes you are not the best person to intervene, and that’s OK. You can take these helpful actions:
- Involve another helper, such as a friend or resident assistant.
- Consult with the counselling center; the counsellors can help figure out how to support your friend and when to involve outside resources.
- Report an online post that hints at suicide to the relevant social media network, such as Facebook; they can connect the poster to local resources.
- Share urgent concerns about another student’s safety with the counselling centre, or call 911; you should do this immediately if you feel a student is in danger.
Take care of yourself too
Being an active bystander involves recognizing your limits. Take care of yourself, and seek guidance from professionals as needed.
Marian Trattner, MSW, suicide prevention coordinator, University of Texas at Austin.
Charlie Morse, MA, LMHC, associate dean for student development; director, counseling center, Worcester Polytechnic Institute, Massachusetts.
American College Health Association. (2016). ACHA-NCHA-II, Reference Group Data Report. (Spring 2016). Retrieved from http://www.acha-ncha.org/docs/NCHA-II%20SPRING%202016%20US%20REFERENCE%20GROUP%20DATA%20REPORT.pdf
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Hunter Institute of Mental Health. (2013). Conversations matter: Resources for discussing suicide. [Website]. Retrieved from http://www.conversationsmatter.com.au/
Protecting your child’s mental health: What can parents do? (n.d.). The Jed Foundation. [pdf]. Retrieved from http://www.counseling.ucla.edu/pdf/TheJetFoundation.pdf
Rudd, D. M., Berman, A. L., Joiner, T. E., Nock, M. K., et al. (2006). Warning signs for suicide: Theory, research, and clinical applications. Suicide and Life-Threatening Behavior, 36(3), 255–262. Retrieved from http://www.wjh.harvard.edu/~nock/nocklab/Rudd%20et%20al_warning%20signs%20for%20suicide_2006.pdf
Suicide Prevention Resource Center. (2004). Promoting mental health and preventing suicide in college and university settings. Newton, MA: Education Development Center, Inc. Retrieved from http://www.sprc.org/sites/sprc.org/files/library/college_sp_whitepaper.pdf
Suicide Prevention Resource Center & Rodgers, P. (2011). Understanding risk and protective factors for suicide: A primer for preventing suicide. Newton, MA: Education Development Center, Inc. Retrieved from http://www.sprc.org/sites/sprc.org/files/library/RiskProtectiveFactorsPrimer.pdf