What can we do to reduce the risk of suicide?

What can we do to reduce the risk of suicide? April 18, 2013

One of the most important ways we can reduce the incidence of suicide is become more willing to talk about mental illness. If people are identified early, before their illnesses get so severe, they may respond to treatment and this whole post might be unnecessary in their case.

We need our communities to become places where it is considered normal to ask people questions like:

  • How have you been feeling in your mood recently?
  • What has been on your mind lately?
  • Does anyone think that you something that you have said is odd or unusual?
  • Are you sleeping OK?
  • Are you eating OK?
  • How are your stress levels?
  • Are you able to get things done, or is it all getting a bit much?
  • Have you had any unusual experiences lately?
  • Are you hopeful about the future?

We can all play our part in screening for mental illness and encouraging people to reach out for professional help.

But we need to go a step future too. Mental illnesses will be associated in some people with Suicidal thoughts or acts. It is vital to appreciate that at points during their illnesses some patients will pose a threat to their own safety, or even (much more rarely) the safety of others. One thing that all pastors, and Christians who want to care need to learn is how to sensitively address this issue.

Some people are afraid of asking someone a question like, “Have you ever wished you were dead or wished you could go to sleep and not wake up?” One concern is that asking the question might prompt the act. But, provided it is done sensitively there is no evidence to support that fear. On the contrary, simply discussing the dark thoughts with another caring person can sometimes alleviate them. There is no doubt that asking such a question during pastoral care, or even a conversation between friends can save lives.

I am not at this point proposing it should be asked in every single pastoral interaction, as clearly it needs to be appropriately framed. If, for example, a couple came to you asking for pastoral counseling about their recent engagement, it might be a bit odd to ask them if they were suicidal. But the question could definitely be asked whenever someone appears distressed, hopeless, or in any sense desperate for help. Of course, some people are very good at hiding their distress. If a person visiting with you seems like they have something they want to talk about but appear not ready to speak, asking this question could open them up, even if the answer is “Oh no, pastor, it hasn’t got that bad!”

If you ask this question and the answer is “yes,” don’t panic. First, ask them “When did you feel like this?” They may reply, “Twenty years ago, once.” The timing is critical. If the thoughts are current, it is really the time for a non-expert to hand over the case to an expert assessment. It is often not inappropriate, however, to briefly explore a little further, and the next question would be “have you had any actual thoughts of killing yourself?

The CSSRS is a suicide assessment scale used by professionals. You should not try and second-guess an expert in mental illness, but a review of the scale’s risk factors, and the questions used will help you gain at least a basic understanding of how psychiatrists view the risk of self harm. Training is available in the use of this scale for non-psychiatrists.

There are several levels of risk, and again, you are probably not best placed to determine for sure where to put someone on that list, but I will give you the broad outlines anyway:

  1. The general wish to be dead without any thoughts of harming yourself (this should still be taken seriously, but is a lower risk than the other levels).
  2. The presence of thoughts to kill yourself without any thoughts of how you might kill yourself.
  3. The presence of a method This is a general idea only, without specific details or any wish to actually carry it out, i.e the thoughts may feel quite alien to the person.
  4. The presence of some intent to actually kill yourself, but without specific plans.
  5. The presence of a detailed plan with methods, timing, and some form of plan to carry it out.

Of course, any actual suicidal act is especially concerning, and will definitely require immediate assessment of a person by a psychiatrist. Even “cutting” or other self-harm acts can be indicative of a very serious underlying problem.

I haven’t gone into much detail about harm to others, but clearly a similar principle applies. If you are concerned a person has ideas about harming themselves or others it is not the time to call a prayer meeting. First, get the patient assessed by a professional. At this point it really doesn’t matter whether that expert shares your faith or not.

Don’t attempt to handle all this informally within a church. Far better to take someone in for an assessment and be told that the doctor believes they are fine than to not act. By all means pray once the person has been taken to hospital, or get a group to pray while that is happening.

Even before such a situation happens, I would urge every pastor to become familiar with how to access urgent psychiatric help in their area. Why not reach out to local services, and ask for their advice how you can best serve church members who may have mental illness. There may even be a need for a local drop-in service which perhaps you could help them with.

There are procedures in most countries for getting an at-risk person assessed even against their wishes. Find out how to request that before you are facing the situation. If you are unsure, a primary care physician (GP in the UK) is likely to be able to help you understand the appropriate steps to take.

People can also be referred to suicide prevention helplines like The National Suicide Prevention Helpline in the USA, and The Samaritans in the UK. Both organizations are willing to take a call from a friend, family member or pastor, and have advice pages for those who are concerned about someone (see the USA and UK pages). Speaking on the phone on its own should not take the place of getting a face-to-face professional assessment.

There are other things that are important including reducing access to means of suicide. Society as a whole can do a better job of making it hard to get ahold of ways to kill yourself. There is lots of evidence that suicide is usually an impulsive act, and an attempt will not always be repeated if it is aborted because the method is not available or turns out not to be deadly. This is one of the strongest arguments for gun control. Suicides were reduced by a change in the form of gas pumped to peoples homes, and governments often consider other means of making popular methods obsolete.

There are some things that friends and families can do to restrict someone’s access to ways to harm themselves. But, if you are finding that you have become an informal policeman, this is not sustainable, and the time has definitely come to seek professional help.

Even with the best of care, not every suicide is preventable. It is impossible to reduce the risk to zero while we live in a free society. There is no doubt that dealing with potential and actual suicides is one of the hardest things friends, family and pastors have to face.

I hope this post has been helpful, and now it is over to you. Are there any other useful resources or tips you would like to share with my readers?

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  • One thing that mentally ill people need that is hard for them to obtain is friends. People are often afraid of those who suffer from schizophrenia and other illnesses. I don’t have a formal solution, but I think that it is important for churches to have a plan to assist current members and future members suffering from mental illness with developing and maintaining relationships. In order to prevent a suicide, we must be close enough to share our vulnerabilities and struggles.

    • I love that thought. When I talk about treatment in a later post I will be emphasizing the social aspects of treatment but to be honest one massive thing is that people need to feel and be significant to others. One of the challenges is that some of these diseases impair social ability. So we need to learn ways of serving people who struggle to reciprocate. We must care without expecting much in return sometimes.

      • These articles are very helpful Adrian, thanks
        Most of the stuff my widowed Dad does screams out to me that he is depressed (even his GP prescribed something which contained an anti-depressant, but he refused to take it.) All you say about needing to feel significant (he doesn’t want help) & social ability being impaired (keeps people at arms length), it’s all so true. I have to limit the amount of time I spend with him for my own well-being.
        Any pointers for ways to deal healthily when it’s close to home, as with a parent, particularly one who is stubborn & knows everything (retired teacher!)?

        • Well maybe you could start by having a chat with the GP and explaining your worries to them. They are usually very approachable. Otherwise, it’s about having a conversation with him at the right time, maybe highlighting some of the specific issues I wrote about in some of these posts.

          • He’s mildly depressed & it kind of leaks everywhere – perhaps screams was a bit strong in first reply, I know my own experiences with d/p flavour the outlook. Good to know that keeping on trying to have those conversations & praying for breakthrough is way to go (he’s not a christian himself), as well as calling on GP if needs be.
            Am anticipating a bumpy road ahead with cancer treatment for another close family member imminent.

  • Sherri

    “If you are concerned a person has ideas about harming themselves or others it is not the time to call a prayer meeting. First, get the patient assessed by a professional. At this point it really doesn’t matter whether that expert shares your faith or not.”

    I disagree. Prayer should always be our first resource, not the last. It seems that you are saying that God isn’t big enough, or good enough to handle the situation without the intervention of “professionals.” I have experienced the power of the effectual fervent prayer of righteous men. It truly does avail much. I think there will be a lot of accountability to God someday for Christians taking the “easy way out” by handing over the neediest and weakest of the flock to the “expertise” of the unsaved.

    God is the Great Physician. He is enough. The question is, do we believe it?

    • Look, I am not trying to denigrate the importance of prayer. And the reality is if someone told you they were suicidal you would no doubt be praying *while taking them for help*

      If someone had chest pains suggestive of a heart attack we would call an ambulance *then* call a prayer meeting. Suicidal thoughts are every bit as much an emergency in many cases.

      • Great analogy Adrian, thanks.

  • Tanya Marlow

    This is great, Adrian. One thing I would add is if you ask the person if they have suicidal thoughts, and they say no, don’t reply “oh good!” with a look of obvious relief on your face. That happened to a friend of mine, and she made a mental note to herself not to ever tell that person if she did have suicidal thoughts. It is scary – but it is scariest for the person involved, not for the carer or listener; we need to communicate that it is okay to feel what they are feeling and that we are a safe person to tell.

    • Thanks Tanya, great point. I’ve added a line into the article about that.

  • Hi Adrian. Thanks for writing the article. I often have problems with being depressed. Especially during times when I have had a seizure. I don’t have Gran Mal seizures but other kinds where it starts to affect my thinking and makes it hard for me to function long before I pass out. And even when I am thinking normally I still struggle because of how badly I can act towards people when I am having a seizure because I can be so angry and not a lot of fun to be around. My emotions and thoughts become very erratic, and it is hard for me not to be angry, depressed, and even to have the thoughts that I wish I could go home to the Lord around the time of having a seizure. Fortunately I have a wife who never wavers in love and helps to keep me sane. She also does an amazing job of guiding me towards God, and not making me dependent on just her. With her love I don’t have anywhere near the suicidal thoughts I used to have. And I can be honest with her. I think that is what it is to try to get back to the original intent God had for marriages, where we are naked and yet unashamed. I think the church needs to strive to help husbands and wives do that with each other.

    I think something important things for churches to let people know that are having struggles with suicidal thoughts is that they are not alone. There is no sin, struggle, or temptation that is not common to man. That doesn’t mean everyone has the exact same issue, but there is no such thing as a person who has a struggle or issue in their life that someone else can’t relate to having. And God always gives a way out, even if that way out is his Grace and Mercy in our inability to overcome the situation. (Think of Paul and his thorn) All this to say that a person who is struggling with depression can take consolation in the fact that he is merely another person living in a sin cursed world, and that God is faithful and will not abandon that person. And when I say merely another person, that isn’t meant to mean another person with little worth. If we belong to God we are adopted sons and daughters just like everyone else who belongs to the Lord, with all the love that entails from God.
    And I think that we also need to stop the lie that someone else who hasn’t been through exactly what we have can’t possibly understand how we feel. They might not understand exactly how the issues we have make us feel, but they have a whole host of issues in their own life that probably make them feel similarly. Everyone in this sin cursed world can relate to being under the curse and wishing to be out from under it. My wife has no idea what it is like to have a seizure and to be depressed because of it, but she knows what it is like to suffer other thoughts and ideas she wished she didn’t have and to be angry and depressed about it, and she can relate to wanting to be different and to get out of the struggle and to be set from our imperfections.

  • R

    How do you counsel/disciple a young Christian who is on medication for depression, but almost seems to cling to it as their primary identity? They don’t want to pray for it to get better, and they almost seem to boast about their condition and it’s effects to others.

  • Hi. Thanks for sharing so honestly. Please know that however low you are feeling right now things will improve! I’m sure that help can be obtained from somewhere. Have you tried speaking to your primary care physician? If you have one your pastor? The national suicide prevention line? Praying for you as I wrote this. God wants you to be much more than just another statistic!

  • Samantha Paradinha

    I actually know how you feel. God kept me and He can keep you, too. He is Hope and never runs out. Knowing that suicide is against the law helped me. I pray that God communicates to you in a way that means something to you a reason why not to kill yourself and a reason to want to live. There is a lot of research online for different problems. You can pray, Jesus please help me, and see what you find. Calling a hotline is really good, too. I believe you and how you are feeling. It is very good that you wrote this comment. Your life matters to me. I hope you write again another day.