Note On Preventing Suicide

Suicide is preventable. Truth is: most suicidal individuals want to live; they are just unable to see alternatives to their problems.

Truth so true: When I was 32, I was severely suicidal. I could see no end to my problems. The pain was all consuming and unbearable. My anxiety level was very high. I could hardly hold my hand still. Death seemed the only way out……..Yet, I really wanted to live.

My husband was a fierce and loving support. He asked how I was feeling. He was there for me, helping me connect with professional treatment. He kept me safe and supported. That someone who knew my worst thoughts about myself accepted me, warts and all, was invaluable. Most of all he taught me to have hope in life again.

The experience of being suicidal at that time and at others times in my life has created in me an empathy for all those who attempt or commit suicide.

Here are some principles of suicide prevention, principles that are used by prevention specialists across America. Please learn them and commit to suicide prevention.

# BeThe1To

If you think someone might be considering suicide, be the one to help them by taking these 5 steps:

  • ASK

Be Aware of the Warning Signs


Rage, uncontrolled anger, seeking revenge

Acting reckless or engaging in risky activities, seemingly without thinking

Feeling trapped – like there’s no way out

Increase in alcohol or drug use

Withdrawing from friends, family and society

Anxiety, agitation, unable to sleep or sleeping all the time

Dramatic mood changes

No reason for living; no sense of purpose in life

Here is some advice for responding to someone in despair and considering ending their life:

(From Mental Health America of Wisconsin)


  • Be aware. Learn the warning signs.
  • Get involved. Be available. Show interest  and support.
  • Ask if he/she is thinking about suicide.
  • Be direct. Talk openly and freely about suicide.
  • Be willing to listen. Allow for expression of feelings. Accept the feelings.
  • Be non-judgmental.


  • Debate whether suicide is right or wrong, or feelings good or bad.
  • Lecture on the value of life.
  • Dare him/her to do it.
  • Ask why, as this encourages defensiveness.
  • Act shocked. This creates distance.
  • Be sworn to secrecy. Seek support.
  • Offer glib reassurance; it only shows you don’t understand.


  • Empathy, not sympathy
  • Hope that alternatives are available

Take action:

  • Remove means!
  • Get help from individuals or agencies specializing in crisis intervention and suicide prevention.


               1-800-273 talk (8255)












I’d like to give you a feel for the burden of suicide in Wisconsin: A joint report released in 2014 (the most current data I have) says that, on average, 724 valued and treasured individuals in Wisconsin take their own life each year.

What do we know about these individuals as a group?

Four out of five persons who died by suicide were male.

For every person who died by suicide there were eleven hospitalizations or emergency visits for self-inflicted injury.  And approximately three out of five patients hospitalized for self-inflicted injury were female.

Taken together, one estimates 8,000 people attempt suicide every year in Wisconsin.  724 die.

Firearms were the most frequent means of suicide.  And Means Matter:  Men use firearms more often than women, and attempts with guns are more likely to result in death than those in which other means are utilized.

Death from a suicide attempt was highest among individuals aged 45-54.

Veterans accounted for one out of five suicides in Wisconsin.

Teens and young adults are more likely to be seen or hospitalized for self-inflicted injuries than any other age group.

Among suicides with known circumstances, fifty percent had a current mental health problem and approximately forty-five percent were currently receiving mental health treatment. Where toxicology testing was performed, 37% tested positive for alcohol and 20% tested positive for opiates.  Of the known life stressors, intimate partner problems, physical health and job problems were most often reported. Significantly, 35% disclosed their intent to die by suicide to at least one person.

724 deaths by suicide in Wisconsin.  Each year.

And yet, as the Harvard School of Public Health reports, 90% who survive their attempted suicide do not go on to die by suicide later.  This is a terribly important fact.  Help is possible.  Those who attempt suicide, much more often than not, do not go on to die by suicide later.

How can we offer help to someone contemplating suicide?

The good news: Everyone can play a role in protecting their friends, family members and colleagues from suicide. However, as a national poll found, 50% of American respondents found obstacles and barriers that stopped them from trying to help someone at risk for suicide. Two barriers were commonly raised: Many feared that something they would say or do would make things worse rather than better. And many, understandably, simply did not know how to find help for a person feeling suicidal.

  • Most suicidal individuals want to live; they are just unable to see alternatives to their deep struggles and setbacks.
  • Most individuals give definite warnings of the suicidal intentions.
  • Talking about suicide does not cause someone to be suicidal.
  • Surviving family members not only suffer the trauma of losing a loves one to suicide, they may themselves be at higher risk for suicide and emotional problems.

Let’s look at what we as individuals can do to help.

  • Hopelessness
  • Rage, uncontrolled anger, seeking revenge
  • Acting reckless or engaging in risky activities, seemingly without thinking
  • Feeling trapped-like there’s no way out
  • Increased alcohol or drug use
  • Withdrawing from friends, family and society
  • Anxiety, agitation, unable to sleep or sleeping all the time
  • Dramatic mood changes
  • No reason for living, no sense of purpose in life
  • Be available. Show the person interest and support.
  • Ask if he/she is thinking about suicide.
  • It’s ok to be direct: Talk openly and freely about suicide.
  • Be willing to listen. Allow for the expression of feelings, and accept them.
  • Be non-judgmental. Don’t debate whether suicide is right or wrong, or if one’s feelings are good or bad. Don’t lecture on the value of life.
  • Don’t dare him/her to do it.
  • Don’t ask ‘why’. This encourages defensiveness.
  • Offer empathy, not sympathy.
  • Don’t act shocked. This creates distance.
  • Don’t be sworn to secrecy. Seek support.
  • Offer hope that alternatives are available, do not offer glib reassurance; it only proves you don’t understand.
  • Take action: Remove means!
  • Get help from individuals or agencies specializing in crisis intervention and suicide prevention. The National Suicide Prevention Lifeline (phone:   text:) is a good place to start.

I was very fortunate when I was suicidal long ago. My husband enacted a good many of these helpful responses to me. He and we talked openly and freely about suicide. I did express some of my feelings about being suicidal and he accepted those feelings. Also important, I was offered empathy and most of all, I was offered hope. Hope offered when I had no hope. What a gift!

Three Key Messages

Suicide is the tenth leading cause of death in our country. Unlike many of the leading causes of death, the suicide rate has shown no appreciable decline over the last 50 years. [see the footnote at the end of this post]That this should be so, losing so many people to this mental illness outcome, is a tragedy. It is also a tragedy we can do something about.

Over 41,000 people in America died by suicide in 2013….

Recently reforms have been recommended in suicide planning and care. The new recommendations, which I will comment on in this post, are found in three documents.

  • The Way Forward (2014 pdf).  Released by the Suicide Attempt Survivor Task Force of the National Alliance for Suicide Prevention.
  • Suicide Care in Systems Framework (2012 pdf).  Report by the Clinical Care and Intervention Task Force of the National Alliance for Suicide Prevention.
  • Continuity of care for suicide prevention and research (2011 pdf).  A report commissioned by the Suicide Prevention Resource Center.

Download links to each of these reports, and much else, can be found here on my website.

What am I asking us to do?  TO INFORM OURSELVES about the reforms these reports recommend in suicide prevention planning and care! TO BRING THE NEW RECOMMENDATIONS to our local institutions, mental health organizations, doctors, therapists as well as to our families and to our loved ones with a mental illness!

In my opinion, these three are the most significant and far reaching of the recommendations:

 1.    Add suicide loss survivors and suicide attempters to the committees or task forces appointed to develop prevention efforts. Representation is an essential and important first step in suicide prevention (The Way Forward, 2014).  We can learn from suicide loss survivors and attempt survivors both what was and what wasn’t helpful and, importantly, what was missing in preventing suicide – and solicit their suggestions for improvement.

2.    Here is the second essential change: As with people who experience a stroke or heart attack, all persons in suicidal crisis should have immediate access to care – effective treatment and support services must be available to persons in crisis, how and when they need them (Suicide Care in Systems Framework, 2012). This report details a successful example of a large organization providing immediate access to care: The Henry Ford Health System restructured its behavioral health care system with the goal of Perfect Depression Care, and now offers same-day-drop-in-care for persons in crisis.

3.    Especially, we need an infrastructure for continuity of care.The third document, (Continuity of Care for Suicide Prevention and Research, 2011) focuses on the care provided after discharge from emergency and in-patient stays, noting: “As many as 70 % of suicide attempter of all ages will never make it to their first out-patient appointment. The report continues: “[Although] patient attributes such as having few skills, minimal resources, socioeconomic distress make it hard to engage them in out-patient treatment … organizational attributes can be altered.”   “Continuity of care and coordination of care require the support of cohesive health services infrastructures rather than numerous disconnected facilities and care provision arrangements.”

Organized, accountable, actionable continuity of care is essential.

The Task Force responsible for our second report (Suicide Care in Systems Framework, 2012) believes that making suicide a never event must be the nation’s vision. “Public and behavioral health organizations save countless lives every day. By creating an organizational culture where suicide attempts and deaths are unacceptable events, and managing a care environment around that cultural shift, even more lives can be saved.”

A powerful statement.  Won’t you, along with me, be participants in advocating these reforms and that vision?


Re “…the tenth leading cause of death” see Targeting Suicide by Thomas Insel, M.D., Director of the National Institutes of Mental Health, April 2, 2015.  “Indeed,” Dr Insel notes, “the rate among middle-aged Americans is increasing, and for young people ages 15-34, it is not the tenth, but the second leading cause of death.”

In contrast with suicide, whose rates have not declined, mortality from other medical causes such as stroke, AIDS, heart disease, has declined significantly.  Clearly our suicide prevention efforts have not been effective enough nor engaged enough people to change this rate.

Eight Core Values

Writing again about new thinking emerging on suicide prevention – The Way Forward: Pathways to Hope, Recovery, and Wellness with Insights from the Lived Experience, 2014 .

There are eight core values The Way Forward’s Task Force agreed should be behind all activities designed to help attempt survivors, or anyone who has been suicidal:

  • Foster hope; help people find meaning and purpose in life
  • Preserve dignity; counter stigma, shame, and discrimination
  • Connect people to peer supports
  • Promote community connectedness
  • Engage and support family and friends
  • Respect and support cultural, ethnic, and/or spiritual beliefs and traditions
  • Promote choice and collaboration in care
  • Provide timely access to care and support

I deeply agree with these core values.

Fostering hope is the very first item. It must be so: Help finding hope can be a comfort, for even small hopes are so valuable. Let’s embrace interactions with the suicidal person that boasts their dignity, for chances are they have only a fragile self-respect — but all of us cling to our dignity. Connecting to peer support can be helpful; working with someone who has been there, knows what is what, someone who can be empathetic and a role model to boot. This is both wise and practical. Connecting to the community brings belonging, meaning and purpose from the community into the self. Thus respect and support for cultural, ethnic and/or spiritual beliefs is a fundamental good within human interaction. Promote choice and collaboration! Don’t we all need to have a say in our care, no matter the circumstance? Choice and collaboration gives us some respect and some feeling of effectiveness in our own care. Timely access to care. Indeed, when people have strokes or symptoms of heart attack, they expect fast, efficient life-saving care. The systems to provide that care exist in every little hamlet and metropolis. Surely we can create a system that continues care through and after a suicidal crisis, care that is intensive, smooth, protective and effective.


“For many years, suicide prevention has not engaged the perspectives of those who have lived through suicidal experiences,” declares The Way Forward.

Let me finish with a word about the two leaders behind this initiative.  They are, respectively, a survivor of suicide attempts and mental health advocate and, the other, a psychologist with years of experience working with people in suicidal crisis:  Eduardo Vega, MA, Executive Director, Mental Health Association of San Francisco and John Draper, PhD, Project Director, National Suicide Prevention Lifeline.

It is the hope of the Task Force and it’s co-leaders that The Way Forward will help bridge conversation about suicide prevention between mental health policy makers and consumer advocates. As a stimulating and thoughtful resource, it “…may enable these two powerful forces for change to come together and develop new, more effective approaches to reducing suicide attempts and deaths”.