By Andrew McNaughton LCSW CADC
What determines the significance and urgency of the risk if someone expresses suicidal ideation or intent? It is important to recognize it as a cry for help, not a cry for attention. Assessing for suicide risk requires a trained observer. However, in a crisis situation, it is important to be able to communicate the extent of the risk to 911. Do not hesitate to call 911 if your loved one has expressed an intent to commit suicide, identified or acquired a means to do it, developed a specific plan to carry it out, and (most urgently) indicated there is nothing to stop them or that their family/friends would be better off without them. Calling 911 for a suicidal person will almost always result in dispatching emergency personnel (paramedics, as well as police) to your location, which may or may not result in hospitalization, depending on how a therapist or medical professional assesses the safety risk.
Suicide risk assessment identifies four escalating levels of risk with the presence of:
- No Perceived Protective Factors
Expression of any of these factors indicates a serious risk, but when there are identifiable protective factors present (family, friends, pets, religious beliefs, planned special events, etc.), the risk of suicide may not be imminent. A suicidal person who is able to identify and even argue for reasons to live may not require immediate hospitalization, but still ought to seek help from a counselor. However, without protective factors, there might not be anything to hold the person back from carrying out their plan. This presents an immediate risk of self-harm, and this is when it is necessary to call 911.
Anyone expressing any of these escalating factors is a high risk and should be linked with a therapist or mental health professional for further assessment, support, and stability. Here are 5 ways to intervene when encountering a suicidal person expressing one or more of the risk factors:
Crisis Intervention (all 4 risk factors met): When in doubt, call 911, or take the suicidal person to the ER for an emergency psychiatric evaluation. Without proper training in suicide risk assessment, it is better to err on the side of caution.
Removal of means (2, 3, or all 4 risk factors met): This is when the suicidal person voluntarily agrees to give up or dispose of the lethal item. Most people expressing suicidal ideation tend to be locked onto one specific means, method and plan, so removal of the means may deter the person from making another attempt.
Elicit hopefulness (1, 2, or 3 risk factors met): Attempt to get the suicidal person to identify and acknowledge hope in their life, even if it is only faint glimmers. This may bring the person back to reality and become more flexible in their thinking instead of being set on absolutes.
Contract for Safety (1, 2 or 3 risk factors met): If the suicidal person is able to identify protective factors, it could be possible to contract for safety. This can be in writing or expressed verbally, but the goal is to get the suicidal person to agree to seek emergency help or reach out to a trusted support if the risk increases.
- Provide support (1, 2 or 3 risk factors met): This can include going with the person to support groups, religious groups, or time spent with family or friends, instead of in isolation. Also, refer them to a therapist for an assessment, or even invite the person to your own session with a counselor to gain exposure to the therapeutic process.
Again, I cannot stress enough the importance of calling 911 if there is any doubt about the suicidal person’s stability. Let a trained psychiatric professional make the judgment call whether the risk requires hospitalization. If you have concern for yourself or someone you know who is experiencing depression with increasing severity, it is possible for a mental health professional to intervene and even prevent escalating suicidal risk factors. The therapists at Symmetry Counseling are trained in detecting and assessing for suicide risk, and will make all necessary referrals. Contact the Symmetry Counseling team if you have further questions about seeking help for yourself or a loved one struggling with depression or suicide. Help is always available.