SALT LAKE CITY — When it comes to saving the life of a friend or loved one contemplating suicide, there's only one thing you can do wrong — nothing.
That's the message of experts nationwide, who say that while suicide is a public health and community challenge that requires improved access to mental health services, it also requires small steps anyone can make.
Individuals have the power to save lives, asserts Joel Dvoskin, a clinical assistant professor of psychology at the University of Arizona Medical School in Tucson. He says many suicides are not a surprise to friends and acquaintances; many people who die by suicide have made explicit or ambiguous threats. Others have "observable signs of intolerable psychological pain," like expressing or showing inability to think about the future, disconnectedness or anger, among others.
Because people take their own lives "to stop that pain, if there's a nonsuicidal option that's attractive, they might not kill themselves."
Friends, family and even first responders may be able to help ease the pain and find paths to help, from mental health care to spiritual care to a good friendship. Sometimes a friend who will sit with them can be the difference between life and death.
Numerous experts consulted for this story said the first step is a direct, respectfully asked question: Are you thinking of harming yourself?
Express empathy and concern, then listen without judgment, says Craig Bryan, the executive director of the National Center for Veterans Studies and an associate professor of psychology at the University of Utah. He suggests offering something along the lines of "I'm sorry you're having to go through this right now."
Experts used to say never mention suicide, but now agree that approach was harmful. Ask — and be direct.
The trick is to bring up suicide risk in a way that makes it OK to answer "yes," says Bryan. For example, "A lot of people in this situation often find themselves wishing they were dead or thinking about suicide. 'Have you been having thoughts like this, even if only a little bit?'"
If someone says he's going to kill himself, Dvoskin says to call 911. "He might be mad at you, but he won't be dead. If he says something that raises the hair on the back of your neck, ask questions. Show concern."
Bryan suggests that "talking about the person’s reasons for living and sense of purpose and meaning in life can offset emotional distress and reduce suicidal intent." He recommends something along this line: “With all of this going on, what are some things that help keep you going each day? What provides you with a sense of purpose or meaning?”
"What can I do to help?" is a simple way to offer support and assistance. Then follow through and provide that help.
People in despair may lack the ability to make much effort to "get help," Dvoskin says. Make it easy for them. "Would you like me to make an appointment for you? Can I drive you there?" That requires just a head nod. "I statements are better than a you statement: 'I am worried about you,' not 'you seem depressed.'"
If one is not close to the person believed to be contemplating suicide, or if one is worried about his or her own safety, call 911, as well, he noted.
If one suspects a loved one is considering suicide, experts say to make sure guns are not easily accessible. Bryan says they need to be locked away, the ammunition stored separately, in such cases.
Taking that step is "akin to taking someone's car keys when they've been drinking. Although it's not certain that someone who has been drinking will get into a car crash, risk is increased and it's just not safe," he says, "so safety precautions are best. Likewise, it's not certain that someone who is distressed will attempt suicide, but risk is increased and it's not safe for them to have easy access to firearms. Enacting gun safety measures is actually the most important thing people can do. They should also enact medication safety procedures to limit access to meds during periods of distress," says Bryan.
Though slightly more than half of people who die by suicide had not been diagnosed with or treated for a mental illness, Dr. Soroya Bacchus, a Los Angeles board-certified psychiatrist, says increased rates of depression and other mood disorders create increased risk.
"Depression and other mood disorders are often suffered silently. At some point, a trigger can set off an episode that can lead to suicide. The prevalence for depression is about 7 percent of the population," she wrote in an email. "Most people who suffer don't get the treatment they need."
Depression and suicidal ideology are treatable, she says.
It's helpful to know warning signs, including withdrawing from family and friends, losing interest in once-enjoyed activities or talking about feeling hopeless and helpless. Be aware people display different signs and an apparent improvement may be another indication one needs to check in and make sure that individual is OK.
Along with the dos, experts offer don'ts, including don't trivialize someone's feelings or blow it off as attention-seeking. They all say to avoid "judging" the distressed person's feelings. Instead, focus on listening.
Experts are divided on whether "contagion," in which one suicide prompts others, is a signficant concern. But recent high-proflie suicides do make it important to pay attention, says Bacchus. "We do worry about copycat suicides. It's not that people are mimicking the behavior, but to me it's that people are focusing on their own feelings of loneliness and depression when things like this are happening. Copycat suicide is the result of people starting to focus on those feelings in themselves."
She emphasizes that "thoughts of suicide are NEVER normal. The best thing for them to do is reach out if they're noticing any of these feelings. If they start thinking about suicide they need to call a help line, or look through their insurance to find a psychiatrist. Especially if they live alone."
Saving a life sometimes boils down to telling someone or doing something. "If you'll sit with someone and help figure out the next step, you can help save their life," says Dvoskin.
Utah health officials emphasize the importance of knowing about and using resources:
National Hotline: 1-800-273-8255 (TALK)
UNI Crisis line: 801-587-3000
Suicide Prevention Resource Center: www.sprc.org
National Alliance of Mental Illness (NAMI): www.nami.org
Parent Resource Program:www.jasonfoundation.com/community/
The SafeUT app will connect someone directly with a crisis line, as well.
National Suicide Prevention Lifeline: www.suicidepreventionlifeline.org/