Have you ever completed a suicide intervention and then wondered, “What am I supposed to do now?”
Most of the information available to us on working with suicide focuses on the initial in-the-moment contact that we make with individuals who are in crisis. We learn how to look for warning signs and invitations, build rapport and approach, explore risk factors that increase the chance they will make a suicide attempt, gain a commitment for safety, and develop a follow-up plan.
If you are a counsellor or other professional support, it’s vital that you feel confident and competent to move into that next stage of intervention. There are various theoretical approaches you can draw upon at this stage. However, an effective lens to bring to working with suicidality is one of resiliency building.
What Is Resiliency?
Resiliency refers to an individual’s ability to overcome adversity by relying on both one’s internal and external resources. We are learning that resiliency isn’t a quality someone is born with, but rather a quality that can be fostered. We are also learning that one of the best ways to help prevent suicide is to help foster resiliency in individuals, communities, and families.
You can help build resilience in clients who are suicidal:
1. Normalize their thoughts and feelings.
Sadly, suicide is the third leading cause of death for individuals aged 15 – 24 (according to the American Psychological Association). Worldwide, over 800,000 people die from suicide every year. So we know that suicide is common. We also know that for every death by suicide, there are about 20 attempts. About one in five youth consider suicide.
So why would we want to normalize suicidal thoughts with someone? Won’t that increase their risk? Actually, talking about how normal suicidal thoughts are helps individuals feel less different, less “crazy”, and can challenge their perception of themselves as weak or unstable. Talking openly about suicide helps decrease the stigma the person may be feeling. It can not only help them feel stronger individually but often increases their ability to see themselves as a support and advocate for others who are having similar struggles.
2. Help them learn to “ride the wave” of emotion.
The reality is that, typically, suicidal thoughts are not merely fleeting and tend not to just go away. Chances are that if someone is talking to you about suicide, their thoughts have become increasingly frequent and intense. So it’s important that you acknowledge this. Emphasize that despite them now talking about it and seeking support, the feelings may continue for a while.
The key is teaching individuals to develop strategies to manage their emotions – to “ride the wave”. Explore distraction techniques, including ones they are already using and may not have even realized are strategies. These might include going for a run, drawing, yoga, or using the 15-minute rule*. Teach them distress tolerance skills that identify emotions, grounding exercises to engage their senses and mindfulness activities to bring them into the present moment.
*The 15-minute rule – after 15 minutes of distraction check in to see if suicidal ideation persists. If it continues, distract yourself/client for another 15 minutes. Repeat the process until ideation subsides.
3. Explore their protective factors and reasons for living.
Every suicide intervention must include an exploration of the individual’s reasons for living, after giving earnest attention to what their reasons are for dying. We know that this focus is often what allows an individual to turn the corner from being imminently suicidal to being willing to receive support. So if you are sitting with an individual past the crisis stage of intervention, you must take this as a giant opportunity to build upon their reasons for living.
This requires an in-depth assessment of potential protective factors in their lives. Include any positive relationships and support, interests, skills and areas of success, cultural and religious beliefs and values, future hopes and goals, and a sense of belonging and connection. I have yet to meet an individual who couldn’t identify at least one or two aspects of their life that had meaning or potential.
Take this as an opportunity to do some building around their sense of identity. For example, what does their love for their cat say about them? What they can contribute to society with their strong sense of social justice? And so on. This will help them move forward in areas of meaning and wellness.
4. Focus on helping them learn new skills.
We know that individuals who are resilient tend to have strong communication, problem solving and conflict resolution skills. Most individuals who lack this skill have the potential to learn them if given the opportunity.
Suicide tends to be about escaping pain rather than about dying. Individuals who express suicidal thoughts often can’t see any way out, because they don’t know how to express their needs, they can’t figure out how to change their situation, or they don’t know how to improve or mend their relationships. A large part of support must be focused on addressing areas where individuals are stuck – helping them believe that there is a way out.
5. Include their support system.
As Bruce Perry tells us, resiliency is a learned behavior that develops through environmental influences, such as attuned caregivers and healthy and attached relationships (2006). Whether you are working with a child or adult, include the individual’s support system in your work together if at all possible. If the individual has an insecure attachment style, your work may focus on relationship repair or the development of healthier interactional patterns. Sometimes this work is more long-term and in-depth than what you can provide – know when to refer.
The work we do to prevent suicide is not easy and there is no guarantee that we can ensure someone stays safe. A focus on safety and then on wellness and resilience can be our best approach. Ensure your work with suicidality is most effective by moving on to the positive of resilience. Go beyond focusing on what individuals shouldn’t do. Highlight what they can do and are doing.
Perry, B., Szalavitz, M. (2006). The Boy Who Was Raised as a Dog and Other Stories from a Child Psychiatrist’s Notebook: What Traumatized Children Can Teach Us About Loss, Love, and Healing. New York, NY: Basic Books.