Reaching out to save a life
- Published: July 5, 2018
This article is third in a series on suicide and mental illness in the village.
In the depths of depression, a young Abraham Lincoln wrote a letter to his law partner in 1841 that hinted at possible suicidal intentions.
“I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth,” Lincoln wrote. “To remain as I am is impossible; I must die or be better, it appears to me.”
During that period, friends and family removed the guns and knives from his home and helped Lincoln get medical treatment, according to Paul Quinnett in a booklet on mental health crisis intervention. Although the future president suffered from depression the rest of his life, by the following year, Lincoln had found some hope, writing to a friend to give this advice:
“Remember in the depth and even the agony of despondency, that very shortly you are to feel well again.”
There are many ways to offer hope to those considering suicide, and all begin with reaching out and opening the lines of communication with the person who is struggling, according to trainers at a recent suicide prevention training in the village.
“There are times when we are hopeless and we need someone to help us,” said Adriane Miller of the Mental Health and Recovery Board of Clark, Greene and Madison counties.
“Sometimes just listening and being present with someone can give them that hope that they have lost,” Miller added.
About 35 villagers completed a training last week in the QPR model for suicide prevention developed in 1995 by Quinnett, a clinical psychologist.
QPR — an acronym that stands for Question, Persuade, Refer — is a method to intervene when someone is showing warning signs of suicide. Like CPR, QPR is designed to increase the chance of survival in the event of a crisis, according to QPR’s website. What CPR can do for cardiac arrest, QPR can do for a mental health crisis — namely, buy a person time until they are able to get medical care.
Co-trainer Angela Dugger, of the National Alliance for Mental Illness of Clark, Greene and Madison counties, emphasized at the meeting that it’s everyone’s responsibility to act to help prevent a suicide.
“If you see a person on a ledge, whether physical or figurative, please stop and say hello. That is our responsibility as community members,” she said.
Dugger also said at the meeting that people shouldn’t blame themselves if someone close to them kills themselves.
“If someone takes their life, it’s not your fault,” Dugger said.
According to villager Cheryl Meyer, co-author of the 2017 book “Explaining Suicide,” some suicides are more difficult to prevent than others, especially when the intent to kill oneself and the amount of chaos in one’s life are high.
Above all, it’s important to remember that the burden shouldn’t be placed on survivors, who may not have been able to prevent the suicide, according to Meyer in an interview.
“Ultimately there are many that are just unpreventable,” said Meyer, who is also a clinical psychology professor and the associate dean of the Wright State University School of Professional Psychology.
After an unusually high concentration of suicides in and around the village over the last six months, area organizations have begun to focus their suicide prevention efforts on Yellow Springs. This was the second QPR training organized by the Greene County Suicide Prevention Coalition since the start of 2018.
In recent years, most suicides in Greene County have occurred in Beavercreek, Fairborn and Xenia, according to Miller at the training. But that trend is changing, with three confirmed suicides in and around town since December 31, 2017.
“Yellow Springs didn’t make the list [in past years],” said Miller, who lives in the village. “This is very unusual. We’re looking at Yellow Springs and how we can help.”
After the training, Miller was encouraged that there is now a group of villagers to reach out to those with ongoing mental health issues or who are experiencing a major life crisis, even though more will likely have to be done.
“We have a whole bunch of people now who will check in,” Miller said. “I know it’s not that simple, but it’s a start.”
The need to intervene
According to a report released this month from the Centers for Disease Control, suicide in the U.S. has risen to its highest levels in 30 years. In 2016 there were more than 1 million suicide attempts in the U.S. and close to 50,000 deaths from suicide, which means that there are 20 attempts for every suicide.
The good news is that most people who attempt suicide won’t try again, according to Dugger. The bad news is that a previous attempt is a risk factor for a future suicide, she said.
Importantly, suicide is not inevitable, and most people who are suicidal actually want to live, according to Miller at the training.
“They don’t want to die, they want the pain to end and they don’t know how to end it,” Miller said. Or, as framed in a slide in her presentation, “suicide is not the problem, only the solution to a perceived insoluble problem.”
In addition, suicidal people are not likely to reach out, according to Dugger, which means that friends, family members, acquaintances, teachers, ministers, first responders and others might have to become “gatekeepers” to stop a suicide.
“They can’t muster up the nerve to reach out,” Dugger said, adding that many suicidal people will not willingly take themselves to their therapist or doctor.
Instead, such gatekeepers are needed to intervene directly by following the three steps of QPR: asking a question such as “Are you thinking of killing yourself,” persuading them to stay alive and getting them to agree to go with the gatekeeper to a mental health professional.
Miller likened the efforts of gatekeepers to temporary, but critical, band-aids.
“We’re trying to step in in that moment to help them stay alive a little bit longer so we can help them navigate the mental health system,” Miller said.
Another tactic, to take away someone’s means to complete a suicide, was suggested as helpful at the meeting, whether it be a firearm or pharmaceuticals.
“If you take away someone’s means to do a suicide, they likely won’t find another way,” Dugger said.
However, Meyer said that for some, the intent to kill themselves is so strong that they will find alternate means, so other interventions should be pursued as well.
Meyer underscored that suicide interventions may differ depending upon the case. Those with a history of domestic violence at risk of committing a murder-suicide should be dealt with differently than someone who is grieving the death of a spouse, for instance.
“The way you would intervene would be different,” Meyer said of such cases.
The three steps of QPR
Contrary to popular myth, asking someone if they might harm or kill themselves will not make them more likely to do so, trainers said at the meeting.
“People think if I ask them either I’m going to plant a seed [of suicide] — not true — or I’m going to make them angry — not true,” Miller said.
According to Meyer’s book, provided that inquiries are made sympathetically, the risk of the person killing themselves does not increase. Instead, “asking someone directly about suicidal intent lowers anxiety, opens up communication and lowers the risk of an impulsive act,” according to a presentation slide at the meeting.
Asking the question shows the person that someone cares about them, which can give them hope, trainers said.
“Say, ‘I want you to live,’ or ‘I’m on your side … we’ll get through this,” according to a presentation slide.
How a person asks the question is not as important as asking it, trainers affirmed. They then guided attendees in a partner exercise to practice asking a question such as, “You look pretty miserable, I wonder if you’re thinking about suicide?” or “Have you been so very unhappy lately that you’ve been thinking about ending your life?”
Trainers added that gatekeepers should not wait, be persistent, talk to the person privately and allow them to talk freely and without judgment.
The next step is to persuade someone to stay alive, and to offer hope in any form. Persuading also involves getting the suicidal person to agree to be accompanied to help or to at least promise that they won’t harm themselves until they’ve found help.
When it comes to referral, the best option is to take the person directly to someone who can help, according to one slide. The next-best referral is getting a commitment from them that they will accept help and then arranging it, and the third-best referral is to get a commitment that they won’t attempt suicide and will at some point get help.
The responsibility of helping should not fall on only one person though, Miller said. That way the person in need has more options for reaching out, and gatekeepers can share the load.
“You don’t want to be the only person, you want to be one of many,” Miller said. “Make sure to bring other people in, because we have to take care of ourselves as well.”
Warning signs and risk factors
The opportunity to intervene in a suicide often does exist, according to the training. Most suicidal people communicate their intent during the week before they kill themselves.
According to Meyer’s research, based upon a study of 1,280 suicides in Montgomery County, coroner’s reports often mentioned that the suicidal person made suicidal threats that witnesses and survivors didn’t believe.
There are a host of warning signs that could mean someone is planning to kill themselves and all should be taken seriously, trainers said. The strongest predictors of an imminent suicide are a previous attempt, talking about suicide, being preoccupied with death, being depressed, substance use or a recent attempt by a friend or family member, according to a presentation slide.
Those considering suicide give hints with statements such as “I wish I were dead,” or “My family would be better off without me,” according to the training.
“There are little seeds that people drop,” Miller said.
The person might also display such behavioral clues as acquiring a gun or stockpiling pills; giving away their prized possessions; putting their affairs in order; becoming moody, depressed or hopeless; a sudden interest or disinterest in religion, or engaging in drug and alcohol abuse, sometimes relapsing after a period of recovery. Loneliness, going from very sad to very happy and being suddenly content, could also indicate the person might be set on killing themselves.
Recent difficult life events combined with a warning sign could also signal suicidal intentions. Those include being fired or being expelled from school; a recent move; the loss of relationship; a death; a diagnosis of illness; the anticipated loss of financial security, or the fear of becoming a burden to others.
In addition, suicide risk increases with alcohol use, untreated depression, using alcohol while depressed, Post Traumatic Stress Disorder, or “overwhelming stress” from such life events as the loss of a child or spouse, a divorce, being convicted of a crime or a number of others, according to one slide.
Whether or not someone seems to be emotionally strong should not be an indicator of whether or not they need help, Miller pointed out.
“In our world, there are a lot of people in pain, and the people that seem strong, we need to check on them too,” she said.
In Meyer’s book, “Explaining Suicide: Patterns, Motivations and What Notes Reveal,” the motivations for suicide are spelled out in great detail.
Various theories on why people take their own lives have been proposed over the years, beginning with a seminal 1897 book that shifted the way society viewed suicide from “lone acts of sin or madness” to having social factors, according to Meyer’s book.
Alienation from a social network, “thwarted belongingness and perceived burdensomeness,” unbearable psychological pain and escape from an insoluble problem emerged as additional theories over the years, Meyer explained.
But Meyer’s book also explores the flip side of the coin — motivations for living. Even though tens of thousands of Americans kill themselves each year, “many more go on living,” Meyer wrote.
Looking at what makes a person, and a community resilient, is another way to prevent suicide, Meyer explained.
“People talk about risk factors and we chose to focus on resilience,” Meyer said. “We talked about not why people die young, but why people live long.”
Meyer went on to cite research on “blue zones,” areas in the world with high rates of longevity, to see how what factors could help prevent suicide. Belonging is the most essential factor, according to the research, followed by eating wisely, a hopeful outlook and “moving naturally,” which involves exercise but also walking to the grocery store or gardening.
“Nutrition and exercise are important, but what they really found is the role of social support,” Meyer said.
As social isolation increases, so does suicide, which could be one reason why the three states with the highest suicide rates are those with lower population density — Wyoming, Alaska and Montana, according to research presented in Meyer’s book.
The same factors that allow people to live longer may be what is missing in the lives of those who complete suicide, Meyer said. And in spite of the recent deaths by suicide here, Yellow Springs seems to be better than many places in those measures, she added.
“Yellow Springs people are concerned about health and walking, there is a lot of interacting, so Yellow Springs would be a community that might have longer lifespans.”
For more information about QPR, contact Miller at firstname.lastname@example.org.
Those in a suicidal crisis can contact the national suicide prevention hotline at 1-800-273-TALK (8255), Crisis Text Line by texting “4hope” to 741 741, or the TCN Behavioral Health 24-hour Crisis Line at 937-376-8701.