Author: Janet McCord, PhD, FT
Published On: April 12, 2024
The QPR Institute in Washington State created a gatekeeper training called Question, Persuade, Refer, a one-to-two-hour training for the general public to learn more about suicide and how to help a person in crisis. Other gatekeeper trainings include Applied Suicide Intervention Skills by Livingworks; Ask, Care, Escort Suicide Intervention Training used in the United States Army; and Community Gatekeeper Training: LGBT Older Adults and Suicide Prevention by the Crisis Support Services of Alameda County, just to name three of many. The aim of these trainings is to prepare individuals from any background to know enough about suicide to help someone they know who are in crisis. Most of these trainings include education on the following helping skills.
Ask: If someone you know is talking about feeling hopeless, saying they have no reason for living, feeling trapped, or like a burden to others, listen quietly. The statements might be direct, like “I wish I was dead.” The statements might be indirect, like “I just want out.”
You can begin by asking if they are very unhappy, unhappy enough to end their lives. Ask them about suicide, simply, respectfully, nonjudgmentally, and directly. Asking this question can be scary, but you can keep it simple: “are you thinking of ending your life? Have you had thoughts about suicide?”
Asking someone this question will not put the idea in their head. It is far riskier to avoid asking the question. Ask the question, then stay quiet and listen, giving the person your full attention.
They may respond that all is well, and you misunderstood. If they are not suicidal, they are likely to thank you for caring enough to ask. You can then brainstorm with them about ways they can address the feelings they have expressed.
Stay Calm: If they tell you they are, indeed, thinking about ending their life, stay calm. Thank them for sharing this with you. Tell them you can hear they are truly struggling, and affirm you are there to listen. Giving a suicidal person a nonjudgmental ear and a caring presence can make all the difference.
The next questions can be simple ones that encourage them to keep talking. Edwin Shneidman, one of the earliest thinkers in the discipline of suicidology, said there were just two questions someone needs to ask: Where do you hurt? How can I help you?
Encourage Them to Seek Help and Offer Choices: Unless you are a psychologist or clinician, you may not know what to do next. People experiencing suicidal thinking often feel they have lost all control over their lives. By asking if they will go with you to seek help or asking them if they will let you help them get help, you are building control into the conversation. Ask them if they have a therapist or counselor and if they want you to help them call that person. Offer to accompany them if you can. Ask if they want to call or text the Crisis Text Line and offer them a choice between calling or texting themselves, or having you reach out first.
You may have little control, as a helping person, over what happens next. If you can get immediate help, that’s great. If not, you will need to trust the person to accept the help and you may have to trust they will make their own arrangements for help. Making a verbal commitment to seek help can be a win.
Safety is Important: Once you have a plan for additional help, discuss ways to keep the person safe in the meantime. Ask them who else the two of you might call, people who might be willing to offer additional support, people they trust: a sibling, parent, faith community leader, peer support specialist, another friend. Generating additional individuals to help support the person you are helping can be invaluable. It can take a village to prevent a suicide. Ask about access to lethal means, especially firearms. Ask if there is a way to temporarily remove firearms from the home and place them in custody of a trusted friend.
If immediate professional help is not possible, sit with the person and brainstorm about additional ways to keep the person safe if the crisis emerges again. This is an informal crisis plan or safety plan. Going into crisis can result in a situation in which the person cannot see anything other than the crisis. Often, they cannot remember who they should call, or what they could do, to help the crisis deflate.
A crisis or safety plan can be written on anything – a 3X5 card, a piece of scrap paper, anything. If possible, the person who is suicidal should write the plan themselves. The person can write down thoughts on the following:
- personal warning signs for crisis (sleeping less; severe anxiety);
- coping and self-management strategies the person finds useful based on what has worked in the past (play with my dog, take a shower, eat cake);
- reasons for living (my children, my spouse, my dog);
- healthy social supports – include names and phone numbers (friends, family, settings);
- a clinician name they can call in a crisis (write the name and phone number)
Once these are written down, the person can photograph it on their phone so they have it when needed.
Follow Up: Follow up with the person you have supported and helped move through a crisis. Visit them if you can. Send them a note. Call them on the phone. Let them know you care.
There is hope for people who become overwhelmed by life and are in danger of dying by suicide. Even if someone seems to have made up their mind, there are almost always windows of ambivalence. In these windows of ambivalence is the chance to help them get the supportive care they need. And the best way to help a suicidal person get good professional supportive care is to be a caring, non-judgmental, and supportive friend.
