People usually attempt suicide as a result of unbearable emotional pain, which can be caused by a wide variety of problems. It is important to note also that it is not necessarily the problems that will bring a person to thoughts of suicide, but rather how they perceive the problem. It is often a cry for help. Persons attempting suicide are so distressed that they are unable to see that they have other options. They are said to be in a suicidal fog. After a prolonged time of severe emotional pain, the person starts to feel there is no way out or that this pain will never change so suicide becomes the only option under their control.

Talking about their thoughts of suicide helps keep people alive. We can help prevent a tragedy by encouraging the person at risk to talk and by listening without judgement. People with thoughts of suicide usually feel terribly isolated and alone. They need to be reminded of the love and support that are available.

In the vast majority of cases, persons at risk would choose differently if they were not in great distress and were thus more able to evaluate their options objectively. Most suicidal people give indications that they are in distress in the hope that they will be helped, because they are intent on stopping their emotional pain – not on dying.

Talking about the feelings surrounding suicide promotes understanding and can greatly reduce the immediate distress of a suicidal person. In particular, it is a gift to that person to ask if she or he is considering suicide in a calm and direct manner, if you suspect that the person is not coping. If the individual is feeling suicidal, it can come as a great relief to see that someone else has some insight into how he or she feels and is willing to listen to their story of pain. Being a witness to that pain will promote life and release feelings of carrying this burden all alone.

This can be a difficult question to ask, so here are some possible direct approaches:

• “Are you feeling so bad that you’re considering suicide?”
• “That sounds like an awful lot to handle. People going through so much may sometimes think of suicide. Are you thinking of suicide?”
• “Has all that pain you’re going through made you think that you don’t want to live anymore?”

The most appropriate way to raise the subject will depend upon the situation and how comfortable people feel. It is also important to take the person’s overall response into consideration when interpreting her or his answer, since a person in distress may initially say “no” even if they mean “yes.” They may not have anticipated someone actually bringing the subject up and when asked they may be concerned about what will happen next should they say yes. What consequences will there be for themselves and perhaps even for the person asking. For instance a person could be concerned about further burdening a loved one with their story of pain. A person who is not feeling suicidal will usually be able to give a firm and convincing “no” answer, and will often continue by mentioning about specific reasons he or she has for living. It can also be helpful planting that seed with the individual that you are okay talking about the subject of suicide at any time, in case they become suicidal at some point in the future, or if they are suicidal but initially feel scared to tell you about it.

People can most often deal with isolated stressful experiences reasonably well, but when there is an accumulation of difficult events over an extended period of time, their normal coping strategies can be pushed to the limit.

The stress of trauma generated by a given event will vary from person to person depending on their background and their ability to cope. Every person's ability to cope is different. There are those who are more vulnerable to particular stressful events. To complicate things further, some people may find certain events stressful where others would see them as a positive experience, such as a wedding or a birth. Individuals deal with stress and trauma in different ways; the presence of multiple risk factors does not necessarily imply that a person will become suicidal.

Research shows that individuals with a history of trauma, particularly childhood trauma, can be very vulnerable to thoughts of suicide as their coping ability has been stunted by these past traumatic events.

Warning Signs of Suicide [source]

• Increased substance (alcohol or drug) use
• No reason for living; no sense of purpose in life
• Anxiety, agitation, unable to sleep or sleeping all of the time
• Feeling trapped - like there's no way out
• Hopelessness
• Withdrawal from friends, family and society
• Rage, uncontrolled anger, seeking revenge
• Acting reckless or engaging in risky activities, seemingly without thinking
• Dramatic mood changes
• Giving away prized personal possessions or seeking long-term care
  for pets

The presence of one or more of these warning signs is not a guarantee that a person is suicidal. The only way to know for sure is to ask him or her. It is not about the events that occur, but rather about a person’s reaction to the events that might bring a person to thoughts of suicide.

Suicide has long been a taboo topic in Western society, which has led a feeling of alienation by those who experience suicidal ideation, and has made it more challenging for their loved ones to support them. We could go a long way to reducing the suicide rate by removing the social stigma associated with suicide, and by telling people that it is okay to feel the way they do. Giving people permission to talk about how they feel will help reduce their feelings of isolation and distress. As they begin to see other options, the immediate risk of suicide often decreases.

Many people will think about suicide but few decide to act on those thoughts. It is our belief that life will prevail over suicide if we can help someone see other options and a way out of the pain.

There are usually people to whom someone at risk can turn to for help. If you know someone is feeling suicidal, or if you are feeling suicidal yourself, seek out people who could help – for example, by dialling the Vancouver Island Crisis Line 24/7 at 1-888-494-3888 or by calling 1-800-SUICIDE (784-2433). From 6:00 pm to 10:00 pm nightly, you can also chat online at vicrisis.ca or text by calling 250-800-3806 on your mobile phone.

People at risk for suicide, like all of us, need love, understanding and care. Asking about suicide shows our respect for the pain that person is feeling, which in turn, reduces their isolation. Those who are feeling suicidal may feel that someone else is beginning to have an understanding of how they feel.

If someone you know tells you that they feel suicidal, above all, listen to them. Then, listen some more. Tell them that they are important to you, that they belong here, that their life has purpose. The important contribution by you at this time is to witness their pain – not to try to solve anything or make it better. They need to be heard and to be understood. Often, once people have a chance to air their concerns out loud, they come to realize how serious their situation is and willingly engage in creating a plan for safety.

As someone shares their story of pain, if they divulge a plan for dying by suicide, it is important to help them problem-solve a way of disabling that plan in order to ensure their safety. For instance, if their plan includes taking medications, it is helpful to ask if they are willing to dispose of those medications or pass them on to someone who could keep them until such a time when they are feeling better and no longer struggling with thoughts of suicide. By disabling the suicide plan, it can build time into planning for safety. A person will not just jump from one plan for suicide to another. They often ruminate about a certain plan for a long time in order to convince themselves that they are able to follow through with it.

Establish a plan for safety with the person at risk. Things to include are making sure they will not be alone for the next 24 hours, safe connections that they are willing to make, and a 24-hour contact that can be used should any of the other supports not be available or work out as planned. Always include a crisis line number: on Vancouver Island 1-888-494-3888 and province-wide in BC 1800SUICIDE (1-800-784-2433).

If the person is not able to agree to a plan for safety, then call the crisis line yourself and problem-solve next steps. If the person at risk is with you, the crisis line worker will ask to speak to them directly and take on the role of assessing the situation and make the plan for safety. If the person is not with you, you can describe the situation to the crisis line worker and they can call out to the person at risk. All calls are made anonymously so they will not use your name but rather state, “a person who cares about you asked us to call”.

And, if at any time you become aware that the person has already done something to put their life at risk, call 911 emergency services right away. Afterward, we recommend that you call the crisis line to debrief the situation for your own support. Self-care is extremely important in these instances. Don’t carry the weight of this situation on your shoulders. You are not alone. There are people who care about your welfare too.

Crisis Line services vary according to their different locations and can be guided by the terms of their contract if they are supported by their local health authority which in many instances is the case in British Columbia.

In general, however, you can call and speak anonymously to a crisis intervention worker about problems or issues, which have you feeling out of control in your life, and be heard and supported in a non-threatening, non-judgemental way. Talking over the situation with a caring, third party can be of great assistance whether you are in a crisis yourself or worried about someone else. Everything discussed in that conversation is confidential with one exception: If a person divulges that they are in the process of harming themselves or others, it is our legal duty to share that information with the intent to intervene with emergency services. We encourage people to not wait until their concerns become overwhelming or until they have a life-threatening problem before they seek help. We hope people will connect with us prior to that; call, chat or text when a problem or concern begins to interfere with your normal daily activities.