“I can’t take this anymore.”
Many of us who care for someone with a mental illness have heard these words before. We’ve watched friends and family members battle the pain and challenges, and we’ve worried for their safety when they say some days feel too overwhelming.
This leaves many of us to wonder: What should we do when someone we care about says they wish they were gone? What do we do if we suspect they are thinking of harming themselves?
Ask them how they are — what they are thinking and how they are feeling. Asking someone if they are suicidal won’t put the idea in their head or encourage them to go through with it. Checking in and asking will likely make talking about a difficult subject easier and lessen some of the shame and guilt they might be feeling.
When you ask from a place of genuine care and concern, you create a powerful emotional bond that helps bring someone who is struggling out of isolation and darkness and back to a place of feeling connected to others.
These questions can include:
- “How are you doing?”
- “How are you getting by?”
- “Have you thought of hurting yourself?”
- “Do you ever think of killing yourself?”
If their answer to the last two questions is “yes,” here are some important follow-up questions:
- “Have you ever tried to harm yourself before?”
- “Have you ever tried to kill yourself before?”
- “Have you ever thought of how you would do it?”
- “Do you have a plan in place?”
If they answer “yes” to any of these, it’s important to get more information. Previous attempts make future attempts more likely, and planning or acquiring the means for self-harm are signs that they may be actively suicidal.
Important follow-up questions include:
- “What might make you act on these thoughts?”
- “What holds you back?”
Their answers to these questions are key to determining what support they may need. For example, if the answer to the first question is “loneliness” and the answer to the second question is “connection,” it can give you a clear picture of how to help and support them.
Next, you’ll want to ask about sources of emotional support. If they don’t have appropriate emotional support, you’ll want to ensure that they can find help. Don’t promise to keep their feelings and plans secret. A better response is to offer to work with them as best you can; however, their long-term health and safety is the priority.
You’ll want to ask about:
- Finding a therapist
- If they have a therapist, have they spoken with them recently or called them to talk about this crisis?
- Would they consider going into a hospital?
Show Your Concern Through Active Listening
Your friend or family member may be experiencing deep pain. Rather than trying to lighten the situation, try to listen and understand what life is like for them in this moment. What is their pain? What are their fears?
Remember, when having these conversations, the focus should not be solving their problem or “fixing” them. Instead, your goal is to truly hear and understand them. Depression often convinces people that nobody understands them, loves them or wants to be around them. Depression can trick a person into believing their friends would rather not be bothered. They may be caught in this web and pull away or isolate themselves from a support system.
Here are some key steps to being an active listener.
Communicate a Non-Judgmental and Accepting Attitude
Listen without making judgments. See the situation through the other person’s eyes. One of the most basic emotional needs of human beings is to be heard and feel important. Validation is essential.
Validation can include statements like:
- “I understand how that would upset you.”
- “I probably would have reacted the same way.”
Show You Are Paying Attention
Make eye contact; maintaining connection conveys caring.
You can communicate your attention by:
- Leaning in toward the person when your interest peaks.
- Offering brief verbal affirmations such as, “I see,” “I get it” or “sure.”
Clarify Through Restating and Summarizing
Give a short summary to show you heard and understood what they have told you. This gives them a chance to correct you and keep the conversation on track. Even better, this helps them hear themselves; allowing them to think about what they’re saying and feeling.
- “So for you, it feels like [short paraphrasing what the other person said].”
- “What I hear you saying is [briefly restate what you think they’re saying].”
Respect the Pace and the Flow of the Conversation
Allow your loved one time to finish their thoughts. With emotionally difficult topics, there may be brief periods of silence. If you are unsure, it is better to wait rather than speak too soon and interrupt their answer. If they are having a hard time opening up about a painful topic, it’s okay to provide a little encouragement to help them continue speaking. Remember to do so gently, as you don’t want to rush or push too hard.
- Short and simple questions
- Verbal encouragers, such as “and then?” or “what happened next?”
Watch for Non-Verbal Cues
Most of what a person communicates comes through body language and tone of voice, not the words they’re actually saying.
- How are they sitting or standing
- What their posture is like
- If (and how) they are using gestures
One of our greatest needs is to feel connected and cared for. When our bond with others is weak or broken, we feel hurt and lost. In our pain and isolation, we can despair and turn to extreme measures that seem like our only choices. In those dark moments, making a connection or receiving concern and care can be a life-saving event.
Don’t let your friends or family go through it alone. When in doubt, reach out. Ask the difficult questions. Follow-up and follow-through.
If you or someone you know is in crisis, contact the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) or text NAMI to 741-741.
Kevin Connors, MS, MFT is Senior Vice President at the Hecht Trauma Institute creating trainings on interpersonal trauma, a licensed Marriage & Family Therapist, and a national and international presenter on trauma and dissociation. He is co-author of “Treating Complex Trauma and Dissociation: A practical guide to navigating therapeutic challenges.”