Editor's Note: September is Suicide Prevention Month. While often a difficult topic to discuss, it is one that hits rural America particularly hard. Over the past two decades, suicide rates have been consistently higher in rural America than in urban America, according to the CDC. With that in mind, we are reposting this article on suicide prevention that originally ran in May as part of our special "Mental Health Hope & Help" series. If you or someone you know is having thoughts of suicide, call 988, the national suicide and crisis lifeline.
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When rural North Dakota resident "James" drove by his neighbor "Bob" sitting in his vehicle near a field, something seemed off -- the time and place for Bob to be there were unusual. James immediately turned around and went back to ask Bob if he was all right. A long conversation revealed Bob was dealing with a great deal of stress and struggling emotionally. James persuaded Bob to get help, and thanks to that assistance, Bob's situation improved. Later, Bob admitted to James he probably wouldn't be alive if James hadn't stopped to ask him if he was OK.
This real story is an example of how the simple act of reaching out to someone who is struggling emotionally and having thoughts of suicide can potentially save that person's life, said Katie Henry, a family and community wellness Extension agent with North Dakota State University.
Henry is a certified trainer for a suicide-prevention program called "QPR," which stands for "Question, Persuade, Refer." The program -- and others like it -- teach people how to recognize the signs of mental health distress and empower them to provide lifesaving assistance.
The key message of these training programs is that, like many other health issues, suicide is preventable. Each program teaches a slightly different approach to giving help, but at their core, all focus on the same basic principles: recognizing the warning signs that people may be considering suicide, reaching out to them, and connecting them with the appropriate mental health help.
WATCH FOR WARNING SIGNS
The training program "Talk Saves Lives" teaches that the first step in preventing suicide is to recognize the warning signs that someone is struggling, according to Becky Wiseman, a clinical social worker and family consultant case supervisor for Cornell University's New York FarmNet Program. In a recent Rural Minds webinar on rural suicide awareness and prevention training, Wiseman said suicide warning signs are typically displayed in three ways: through people's talk, behavior and mood.
Examples of things people might say if they're considering suicide are that they're feeling trapped, they have no reason to live, they feel they are a burden to others, they're in unbearable pain, or they're thinking about ending their life, Wiseman said.
Behavioral warning signs may include an increased use of alcohol or drugs, sleeping too little or too much, acting recklessly, withdrawing from activities they normally participate in, isolating from family and friends, looking for a way to kill themselves, or giving away possessions, she said.
Moods that may be warning signs could include depression, apathy, rage, irritability, impulsivity and anxiety. "We all have ups and downs in our moods, but if you notice something that's changed, (and) it's uncharacteristic or concerning, it's really important that you speak to that person about what's happening and what you're noticing," Wiseman said. "And then trust your gut; our gut really tells us what we need to do."
If you're on the fence about whether to reach out to someone, Wiseman stresses you should always assume you are the only one who is going to do it. "In too many instances, people talk about their concerns for someone amongst themselves, but they hesitate to reach out to that person directly."
HOW TO REACH OUT
Often, the hardest thing to do is ask people if they are considering suicide. A common fear many people have is that asking someone whether he is considering suicide could put the thought in that person's head or make him more likely to follow through. That fear is unfounded, mental health experts say.
"We know that asking somebody directly if they're having (thoughts of suicide) actually lowers their anxiety and opens up that critical line of communication between you and that person and gives them an opportunity to ask for help," said Madeleine Smith, an NDSU Extension agent and certified QPR trainer, who participated in a recent QPR training webinar sponsored by NDSU.
Wiseman recommends that if you suspect someone might be suicidal, talk to the person privately. "Listen to their story, express concern and caring, and ask directly. Don't be afraid to ask, 'Are you thinking of ending your life?' 'Are you thinking of suicide?'" she said.
Don't worry about saying the wrong thing when talking to someone about suicide, Wiseman and other experts agree. The fact that you ask the question is more important than how you word it. However, they do caution against minimizing a person's feelings or offering judgment. Avoid a question such as "You aren't considering suicide, are you?" which may come across as judgmental.
Then, the best thing to do is to listen, Wiseman said, without trying to offer solutions to the issues that may have led the person to consider suicide.
GETTING A SUICIDAL PERSON HELP
If you suspect someone has a plan to end his life soon -- especially if it comes up in a conversation -- don't leave the person alone, said Wiseman. Stay with the person and help him connect with professional help. If the person is in immediate danger of harming himself or others, call 911, Wiseman said. If the danger is less immediate, urge the person to call 988, which is the national suicide and crisis lifeline, or offer to call the line with the person. Experts also recommend offering to take the person to someone who can help, such as a mental health professional, a clergy member or someone the person trusts.