Suicide prevention

What to do when a friend needs help

By Amber Harding with Leah Roman, MPH

Have you ever worried about a friend whose emotional struggles seem to be getting worse? Maybe they were behaving recklessly or hinting at self-harm. Joining a college or university campus means joining a community. Within that community, it is likely that someone you know will be seriously affected by mental illness or contemplate suicide. Almost all of us would want to help—but how?

studentvoice

Students trust their peers

Here’s why you could play an important role in suicide prevention:

• Two out of three college students who disclose suicidal thoughts tell a peer first, research shows.
• Many students are willing to accept that role. Six out of ten Canadian students are interested in receiving information about how to help others in distress, according to the American College Health Association.
• Campuses across the country are affected by suicide deaths and emotional health issues that can precede them. In a 2013 survey by the ACHA, about one in three Canadian students reported feeling so depressed at some point in the last 12 months that it was difficult to function.

Why is it so hard to talk about suicide?

The biggest barrier to talking about suicide is fear and discomfort. “There is an overwhelming stigma attached to suicide, which often involves fear and misunderstanding,” says Robert Olson from the Centre for Suicide Prevention in Calgary, Alberta. “A key part of suicide prevention is encouraging dialogue.” But students don’t always know how to talk about it. Some of the concerns he hears are:

• By asking my friend about suicide, what if I put the idea in their head?
• I might say the wrong thing and cause harm.
• This is not my business. My friend has a right to privacy.
• It could ruin our friendship.
• What if I come off as judgmental or stigmatizing?
• What if my friend is asked to leave school or hospitalized?
• I might be overreacting.
• I don’t know if these behaviours actually indicate a risk of self-harm.

Active bystanders make a choice to help

In schools, “active bystander” suicide prevention programs are designed to help students overcome these barriers. Helping another person involves three steps, says Dr. Jitender Sareen, Professor of Psychiatry, Psychology, and Community Health Sciences at the University of Manitoba, Winnipeg, who researches suicide prevention and emotional health.

• Notice something is wrong.
• Choose to respond.
• Take action.

Your support can be either:

• Direct: e.g., talking to the person you’re worried about
• Indirect: e.g., talking to or involving another person or resource

What to do if you see suicide warnings

Call 911 or seek immediate help from a mental health provider when you hear or see any of these behaviors:

• Someone threatening to hurt or kill themselves
• Someone looking for ways to kill themselves (e.g., seeking access to pills or weapons)
• Someone talking or writing about death, dying, or suicide

Contact a mental health professional or call a crisis centre for a referral when you witness, hear, or see anyone exhibiting or expressing one or more of these signs or behaviours:

• Hopelessness
• Rage, anger, seeking revenge
• Acting reckless or engaging in risky activities, seemingly without thinking
• Feeling trapped, like there’s no way out
• Increasing alcohol or drug use
• Withdrawing from friends, family, or society
• Anxiety, agitation, inability to sleep,
  or sleeping all the time
• Dramatic mood changes
• No reason for living; no sense of purpose in life

Adapted from table #2:
Rudd, D.M., Berman, A.L., Joiner, T.E., Nock, M.K., Silverman, M.M., Mandrusiak, M., Van Orden, K., and Witte, T. (2006). Warning signs for suicide: Theory, research, and clinical applications. Suicide and Life-Threatening Behavior, 36(3), 255-262.

How to be an active bystander on social media

If you encounter a person who is expressing thoughts about suicide on social media, take the following steps:

• Encourage them to contact their local crisis centre or VISIT HERE.
• Talk to them privately. Let them know you care. Offer support and help them find resources.
• Contact the social media site’s safety team.

Build your own protective factors

Protective factors make it less likely that someone will consider, attempt, or die by suicide. Here’s how to build your own protections:

• Increase your connectedness on campus. Join an activity, club, or group involving other students with shared interests.
• Develop your coping skills for dealing with academic or personal challenges. These skills can be strengthened through counselling, trainings, and support from friends and family. [See our feature on resilience in the April issue of Student Health 101.]
• Draw on campus resources for emotional health, physical health, and academic counselling—early. It’s better not to wait until you’re in crisis.

Are you talking to someone who understands suicide?

How to know
Mental health professionals and other clinicians receive varying levels of training on suicide prevention. Here’s how to know whether you’ve found an expert:

If it’s a mental health professional
“Contact the centre and check out the organization or reputation of the person. Ask for references either endorsing the professional or not.” —Robert Olson

Whoever it is
“Make sure the person is open to having direct conversations about suicidal thoughts.”  —Robert Olson

When you’re seeking help for another person, what’s the deal with privacy?

“Students often get stuck on the issue of privacy. We encourage students to talk to mutual friends when concerned about a peer, to see if they have the same concerns and strategize as to how to best support that friend. The intention is to coordinate help for a friend.” —Charles Morse, Director of the Counselling Centre at Worcester Polytechnic Institute, Massachusetts.

When the professional is a licensed mental health professional

• If a student (“Steve”) talks to a licensed mental health professional about another student (“Jared”), privacy is guaranteed in almost all circumstances. Because of confidentiality laws, the mental health professional can’t reach out to Jared.
• The exception is when there seems to be an immediate threat to Jared or others.
• Counsellors might ask for information about Jared but will not reveal what they may know about him: “Occasionally we do ask for names of students, as it might help us strategize as to how to best approach the situation (for instance, when we know the student is already in counselling). Students understand that we will never share confidential information, even something as ‘simple’ as whether a student has been seen in counselling before. Unless we are concerned about a student’s well-being, we will not try to take the situation out of their hands.” —Charles Morse

When the professional is not a licensed mental health professional

• If Steve talks to a student affairs professional who is not a licensed mental health professional, seeking advice about Jared, then that student affairs professional could and should reach out to Jared.
• Steve can ask that his name be kept out of the conversation. —Marian Trattner, Suicide Prevention Coordinator at the University of Texas, Austin.

When you’re seeking professional help for another person, what are the goals?

For a student (“Janella”) who is trying to support another student (“Beth”), the goals are:

• Advice and consultation on how to help their friend, e.g., connecting Beth to counselling services and resources on campus or in the local community
• Support and self-care for Janella, including the opportunity to talk to a professional
• Relief in no longer feeling solely responsible for Beth

For Beth, the student who may be at risk, the goals are:

• Confidential support around how to address the problems that are causing the distress (unless the situation is immediately life-threatening and she could harm herself or others, which merits emergency intervention)
• Information about connecting to counselling services and resources on campus or in the local community

Key messages for students who want to help a peer

“Speaking with a mental health professional will help you feel more supported when talking to your friend,” says Dr. Jitender Sareen.
Here are his key messages for students who want to help.

• Your concerns are probably valid. The support you are providing (e.g., empathy and referrals) is appropriate: “If you’re concerned that there might be something going on, there probably is.”
• Your friend may feel relief when you raise the issue. “Someone having these thoughts will usually feel ready to open up when a family member or friend brings it up with them.”
• Get to the direct question. So that it doesn’t seem to come from nowhere, ask, “I’ve noticed that you’re not yourself. How can I help?”
• If you have an urgent concern about another student’s safety, you should call a crisis line and find out how to help in that moment. “Even if your friend won’t call, you should call on their behalf. The person on the phone can help you navigate that process.”

Notice something is wrong

What are the red flags for suicidal intention and behaviours? Students are often unsure, according to a recent Student Health 101 survey. Here’s the difference between risk factors and warning signs.

Risk factors suggest a person may be at higher risk for suicide over the long term. This does not in itself mean they are at immediate risk for suicide.
Risk factors can include:

• An alcohol or drug use problem
• A previous suicide attempt
• A mood disorder (e.g., depression)
• Access to a firearm, pills, or other lethal means

Warning signs indicate an immediate risk for suicide. Mental health professionals or emergency responders should be contacted quickly.
Warning signs can include:

• A threat to self-harm
• Hopelessness
• Increasing alcohol or drug use
• Dramatic mood changes
• Seeking access to a firearm,
  pills, or other lethal means

How to intervene directly

You might not be the best person to intervene and that’s OK.

Indirect ways to help

• Involve another helper, such as a friend or resident assistant.
• Consult with the counselling centre. You should do this immediately if you feel a student is in danger. Alternatively, alert the dean or call 911.
• Call a Crisis Centre for advice.

Take care of yourself too
Being an active bystander involves recognizing your limits. Conversations about suicide and mental health are difficult and draining. “Part of your role as the friend is to guide them to professionals specifically trained to deal with suicide,” says Robert Olson. “Don’t be too hard on yourself when you are in the role of the bystander.”

How To Help A Friend Who May Be At Risk For A Suicide Attempt

Whatever the situation, think it through in advance and practice. Role-playing can help you find your voice, suggests Taylor Linseman, Program Coordinator of YouthNet, a mental health promotion and intervention program at Children’s Hospital of Eastern Ontario in Ottawa.

For more guidance

SCENARIO 1

Your roommate is floundering academically and drinking heavily

Fear: I don’t want my roommate to feel judged or stigmatized.
What to say: “I noticed that you’ve been going out a lot and missing classes. I’m concerned about you.”

Good to know

• Talk about behaviours, not labels: “It’s OK to mention you’ve noticed a change in behaviour,” says Linseman. “Don’t make accusations or assign labels.” Avoiding labels like “depressed” or “alcoholic” helps remove judgment and stigma.
• Talk about being concerned, not worried. “Worried” may imply that friend anxiety is your source of concern, as opposed to your roommate’s state of mind.

SCENARIO 2

Your friend tells you she often feels hopeless

Fear: What if I say the wrong thing?
What to say: “Sometimes when people feel hopeless, they have thoughts of ending their life. Is this happening for you?”

Good to know

• Ask open-ended questions about your friend’s situation.
• Ask your friend about suicide directly and in a nonjudgmental way. This is important, because feelings of hopelessness are a warning sign for suicide.
• Stay supportive. Don’t worry about having the right answers. “The most important thing you can do is be there for them,” says Dr. Sareen.

SCENARIO 3

A Facebook friend writes posts that hint at suicide

Fear: This isn’t my business.
What to say: Immediately contact your friend directly (by messenger, phone, text, or email). Say, “I saw your post on Facebook and am concerned about you. Do you have time to talk?”

Good to know

• Contact them directly and encourage them to chat with you in private.
• Report the post to Facebook, Twitter, or the relevant social media network. “They usually track these posts, but it’s best to take immediate action rather than depend on the social media network to respond,” says Dr. Sareen.
• Consider posting about their local crisis centre