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Mental & Behavioral Health

Know What You Can Do to Help Prevent a Suicide

By on 09/09/2020

A new national survey suggests that more people are seriously considering taking their own lives this year than last year or compared with historic norms.

But it’s a long way from thinking about suicide and actually killing one’s self, says David Greenspan, MD, Chief of Psychiatry for Einstein Healthcare Network. That means there’s a lot people can do to help themselves or  someone they love avoid taking that final step.

“There’s this huge barrier between thinking and acting when it comes to suicide,” he says. “And we rely on that to protect people.”

David Greenspan, MD

A survey of about 5,400 U.S. adults conducted in late June found that 10.7% said they had seriously considered suicide in the last 30 days. This compares with 4.3% in a similar survey in June 2019. The U.S. Centers for Disease Control and Prevention (CDC) published the study Aug. 14 in its journal Morbidity and Mortality Weekly Report.

Suicidal thoughts were even more common among those aged 18–24 years (25.5%), Hispanics (18.6%), Blacks (15.1%), unpaid caregivers for adults (30.7%) and essential workers (21.7%).

No actual suicide increase – yet

So far, Dr. Greenspan says, Einstein has not confirmed an overall increase in hospital patients who are suicidal, although the Emergency Department has reported a possible increase compared with the same time last year. 

He notes that people who think about suicide may not actually attempt it. Or they may not want to seek help because of the stigma associated with mental illness.

Dr. Greenspan said it’s not surprising that coping with the COVID-19 pandemic – not only illness and death, but also social isolation and economic disruption – might lead to more mental health problems and even thoughts of suicide.

“In response to the 2008 financial crisis, and for a few years after that, there was an increase in suicide deaths,” he says. “There were stories about a similar uptick back in the 1929 crash and the Great Depression. And the 20 year trend in this country has been a gradual, continuous increase in suicide.”

He adds, “one of the biggest drivers of suicide is shame or embarrassment, and under circumstances like this, people have lots of shame-driven regret. They lose their employment, and they’re not sure when it’s coming back, they may lose family members to the disease that they may feel responsible for in some way. These losses create the sense of failure, and inadequacy that is the hallmark of shame.”

“Combine that with hopelessness, the idea that there is no way to undo or make up for what has been done, and the pain of it all can become unbearable.”

Thoughts like these can lead to suicide.

Dr. Greenspan also noted that staying home to avoid spreading the virus has cut off many people from social contacts.

“One of the things that is the most protective against suicide is social engagement,” he says. “Well, you know what COVID has done to that. The isolation is terrible.”

Look out for warning signs

Are you or a friend or family member at risk for suicide? Dr. Greenspan listed these warning signs that show a need for action  to prevent a tragedy:

  • Talking about wanting to die or kill oneself  or having no reason to live
  • Talking about feeling hopeless, feeling trapped or in unbearable pain
  • Mentioning being a burden to others
  • Having deep feelings of shame or embarrassment
  • Having extreme mood swings
  • Increasing agitation
  • Increasing use of alcohol or drugs
  • Sleeping much more or much less than usual
  • Withdrawing or isolating from others
  • Obtaining a gun for the first time
  • Giving away belongings and valuables, filling out a will or writing a suicide note

Seek help right away

If you show any of these signs, it’s time to seek help. Call 911 or go to any Emergency Department. Or you can get immediate access to help 24/7 by calling one of these toll-free hotlines:

National Suicide Prevention Lifeline: 1-800-273-8255

Philadelphia Crisis Line: 215-686-4420

Veterans Crisis Line: Dial 1-800-273-8255 and press 1 to talk to someone

Let them know you care

It’s important for friends and family to know the warning signs of suicide risk as well. Dr. Greenspan urged people to pay attention, and not hesitate to act, if someone they know shows any of the signs above.

“The first thing to do is to let them know that you’re worried and ask how they are doing,” he says. “Just asking saves lives.”

That’s because people who have attempted suicide say that “in the moment that they did it, they didn’t think anyone would care or, worse, that they would be pleased,” he says. Showing that you care can make a huge difference.

Ask some simple questions

  1. If people say that they’re not really OK, ask more questions. Dr. Greenspan recommends those from the widely used Columbia Suicide Severity Rating Scale. The first question is “Have you wished you were dead or wished you could go to sleep and not wake up?” Later questions ask whether someone has thought about suicide or done anything to prepare for committing suicide. Access the Columbia scale here.
  2. If people say “Yes” to any question, urge them to seek help.
  3. For those that the Columbia scale identifies as high risk, take immediate action. Call 911 or a suicide hotline, or text 741741. 
  4. In these more extreme circumstance, stay with them, or get someone else to stay with them, until they can get help and a plan for next steps.
  5. And if there is ever concern, it always helps to make it more difficult for someone to act. Remove or disable any potential tools of suicide, such as a gun or pills. If the pills are prescribed medication, leave only a few days’ worth at a time so that overdose is impossible.

Insist on getting help

People may beg you not to call for help because they’re embarrassed, but don’t take no for an answer. Dr. Greenspan says.

“The best answer,” he says, is, ‘I know you don’t want to go through all of this and you don’t want to embarrass yourself. But honestly I would feel so much better if I knew you were safe and taking good care of yourself and the professionals are the best people to do that.'”

All of these steps are aimed toward getting the person long-term help. To do that, it’s necessary to prevent suicide in the moment, he says. “It’s far better to apologize to your son for dragging him to a hospital and finding out he is fine than it is to not drag him and find out he is dead.”

Stop suicide while the impulse lasts

One important thing to know about suicidal thoughts is that they come and go, Dr. Greenspan says.

“For most people they rarely come back. We know people’s impulse to die can be very strong, but usually for a brief period of time. And if you can keep people alive in that brief moment, they could change their mind.”

Many people have more intense suicidal thoughts that come back over and over. With help, he says, “they can live with them and they find ways to cope with them and they get better over time.”

“The great majority of people who have thoughts of suicide never go on to act, and many of those who act don’t die,” Dr. Greenspan says. “So there’s room to get people help.” Asking the Columbia questions, he says, can help anyone know when the need is urgent and what to do.

For more advice and information, see Einstein’s Suicide Prevention Resources.

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Perspectives highlights the expertise and services provided by the physicians, specialists, nurses and other healthcare providers at Einstein Healthcare Network. Through this blog, we share information about new treatments and technologies, top-tier clinical teams and the day-to-day interactions that reinforce our commitment to delivering quality care with compassion. Here, you will also find practical advice for championing your health and wellness. The Einstein Healthcare Network "Terms of Use" apply to all content on this blog.