Suicide Prevention: A Guide to Providing Psychological First Aid
Every 40 seconds, someone in the world dies by suicide. For every one of those deaths, 41 people are left behind, shattered and searching for meaning in the act. In Israel, not a day goes by without at least one person dying by suicide—hundreds of people every year. Some are well-known and famous, attracting media attention and public conversation, while others remain as anonymous in death as they were in life. The common thread among them all is the terrible emotional pain they sought to end at any cost and the unfortunate way they chose to do it.
In the vast majority of cases, suicide is preventable, and prevention isn’t just the domain of professionals. The listening ear and social support of those around a person can be invaluable and can save lives. So how can you identify suicidal distress, and what steps should you take?
Step One: Recognize Risk Factors and Warning Signs
Most people who die by suicide were suffering from severe mental distress, primarily depression. Key signs include:
- A persistent low mood
- Loss of interest and pleasure in previously meaningful activities
- Changes in sleep and eating patterns
- Chronic pain
- Pessimism and feelings of emptiness
- Difficulty concentrating and making decisions
- Recurring thoughts of death
- Low energy
- Social withdrawal
Beyond these signs, certain populations are at a higher risk and require extra vigilance. These include teenagers and young adults, the LGBTQ+ community, survivors of sexual assault, violence, and abuse, single and divorced men and fathers, immigrants, and the elderly. The risk of suicide increases significantly in cases of a previous suicide attempt or a family history of suicide.
Additionally, specific or ongoing stressful events can be extreme triggers for suicide. These events include:
- Loss (death, separation, or divorce)
- Bullying (in-person or online)
- Harm and violence
- Humiliation or loss of dignity
- Unemployment or retirement
- Diagnosis of a serious illness
- Criminal entanglement
- Exposure to suicide (contagion)
The more risk factors present, the greater the risk of suicide. It’s important to remember that people react differently to life crises. The presence of personal and environmental resilience factors—such as a strong ability to problem-solve, an optimistic outlook, a willingness to ask for and accept help, and a support network—can act as protective elements that reduce risk, while their absence can increase it.
In most cases, people who are thinking about suicide send out signals to those around them (either explicitly or implicitly) about their intentions. We must be attentive and sensitive to these signals and not let them go unnoticed.
Verbal expressions of concern can include feelings of hopelessness, meaninglessness, and desperation. Warning signs also include statements about irreversible and final actions, or descriptions of the benefits that will come from the act (ending suffering, solving problems, finding peace, avoiding being a burden). Suspicious actions may include settling personal affairs, giving away possessions, or obtaining means that could be used to self-harm.
Step Two: Listen, Start a Conversation, and Ask the Question
Listen to the person and show genuine interest in their well-being, feelings, and thoughts. For example, you can ask:
“I’ve noticed you’ve been looking sad/worried/stressed lately. What’s been going on with you?”
During the conversation, pay attention to any risk factors and warning signs, and allow the person to express themselves freely and openly.
Don’t be afraid to ask about suicide directly.
After identifying the warning signs, it’s crucial not to avoid asking about suicide. The question should be direct, sensitive, and non-judgmental. You can simply ask: “Have you had thoughts of suicide?” or “Have you thought about or planned to die?” Research shows that asking this question does not put ideas into people’s heads, but it does have the potential to save lives. Avoid asking the question in a judgmental or critical way, such as, “You’re not going to do something stupid, are you?”
The lonelier a person feels, the greater the fear that they will harm themselves. Emotional understanding of their distress is the best antidote to the terrible loneliness they are experiencing. We must make the person feel understood and less alone in their suffering. We are required to accept the person we are with, despite the difficult situation they are in, without judgment or criticism of their feelings, thoughts, or actions.
Our understanding and acceptance do not make the pain disappear, but they do enable the person to deal with it from a position of greater strength and with the knowledge that they are not alone. We distinguish between understanding and accepting the dark feelings and suicidal thoughts versus justifying them. We can understand (as opposed to agree with) the circumstances that led a person to have suicidal thoughts, while at the same time rejecting the act itself.
Step Three: Refer for Professional Help and, If Necessary, Call Emergency Services
At this stage, our mission is to instill hope and a belief that there is a way out. Key messages to convey include:
- “You are not alone, you are important to me.”
- “Even for difficult and complex problems, there is more than one solution.”
- “Even strong people have ‘weak’ moments of helplessness, anxiety, and doubt. Crises are a part of the human experience.”
- “Asking for help is a sign of mental strength and resilience.”
- “There are professionals and experts who know how to help you. Give it a chance.”
When a person is at immediate risk of suicide (threatening to harm themselves, has left a suicide note, or has posted a disturbing message on social media), it’s crucial to make contact, remove any dangerous objects, and not leave them alone until emergency services arrive or until they can be taken for a professional evaluation and receive help.
Psychological first-aid services, available via phone and internet, are a crucial and unique resource for preventing suicide and suicide attempts worldwide.
Efforts to reduce suicides and suicide attempts are aimed at preventing pain and suffering for all the circles closest to the suicidal person. Every suicide leaves a “scorched earth” in the person’s immediate environment, affecting the lives and well-being of thousands of people for years to come.
Each year, the volunteers at ERAN (the emotional first aid organization) provide support and assistance to hundreds of thousands of callers. A preliminary classification of calls by risk level shows that out of all the calls, thousands were classified as suicidal, and hundreds of suicidal incidents required the activation of a life-saving emergency protocol.
Friends and family members of a person in crisis also need support so they can be there for them.
Don’t stay alone with the pain and distress—contact ERAN by phone or online for information and help.
This article was written by Dr. Shiri Daniels, the National Professional Director of ERAN.