EMILY KWONG, HOST:
Hey, everybody. Emily Kwong here. So throughout this episode, we'll be talking about suicide and suicidal thoughts. If you or anyone you know has been having suicidal thoughts, I really recommend you call the 24-hour National Suicide Lifeline. That number is 1-800-273-8255.
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MADDIE SOFIA, HOST:
You're listening to SHORT WAVE from NPR.
KWONG: Hey, everybody. Emily Kwong here, SHORT WAVE reporter.
RHITU CHATTERJEE, BYLINE: And I'm Rhitu Chatterjee. I cover mental health for NPR.
KWONG: Today, we're going to talk about how you may be able to help someone who is suicidal. Now, my mom is a suicide attempt survivor, and this topic is really meaningful for both of us because there's so much shame and stigma that can make people who are suffering unable to safely talk about suicidal thoughts and feelings. But as a society these days, Rhitu, we seem more open to talking about it.
CHATTERJEE: Certainly. I mean, we have a long way to go, but yes, we are becoming more open to talking about it.
KWONG: Yeah. Let's talk first about how prevalent suicide is right now.
CHATTERJEE: Well, it's the tenth-leading cause of death in the United States in 2019. And that's the most recent year we have data for. About 47,000 people died by suicide. And according to the American Foundation for Suicide Prevention, about 1.4 million people attempted suicide that year. But here's the thing about suicide. Research shows that suicide is preventable.
KWONG: Yes. And there are things that friends and family can do that are genuinely helpful to someone who is struggling with suicidal thoughts.
DEQUINCY LEZINE: A lot of times, folks feel like suicide prevention is only something that professionals can do.
CHATTERJEE: That's DeQuincy Lezine. He's a psychologist and has struggled with thoughts of suicide himself. And he chairs the Lived Experience Division of the American Association of Suicidology. And Lezine says that, suddenly, getting help from a mental health professional is a very important part of preventing suicide. But there are things that each one of us can do when a loved one is in despair and feeling hopeless.
LEZINE: Often, it is that simple stuff of showing that you care and showing up for somebody and being there for them.
CHATTERJEE: So on today's episode, we'll talk about the signs that someone you love may be thinking about dying and talk about ways you can support them and possibly prevent them from going down that path. I'm Rhitu Chatterjee.
KWONG: And I'm Emily Kwong. And you're listening to SHORT WAVE, the daily science podcast from NPR.
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KWONG: Emily Kwong here. I'm joined by Rhitu Chatterjee, NPR's mental health correspondent. So I want to start this conversation in a place of awareness. How can you even tell if a loved one may be feeling suicidal?
CHATTERJEE: Well, Lezine says watch for certain warning signs.
LEZINE: Most obvious is probably just talking about death and talking about suicide, mentioning it either casually or even if it's jokingly or specifically talking about it for themselves.
CHATTERJEE: And then there are the less obvious signs, like sudden changes in behavior.
LEZINE: There would be changes in their mood, usually towards greater agitation or greater sadness, increased anger and irritability, changes in substance use - so radically increasing the amount of substance use or beginning to use substances if they hadn't done that before. There are some changes in sleep or eating.
CHATTERJEE: Now, during the pandemic, a lot of people may be experiencing these changes in behavior, sleep patterns, moods. It doesn't mean that they're all thinking about dying, but having mental health issues does increase people's risk of suicide. But it can take a while before someone goes from being depressed to feeling so hopeless that they don't want to live anymore. And this gives friends and loved ones opportunities for prevention.
KWONG: Right. The way to think about this is to identify and help people with these mental health problems before they get to a point of crisis.
CHATTERJEE: Exactly. You know, I spoke with psychologist Ursula Whiteside. She studies suicide prevention at the University of Washington and also started this website called NowMattersNow, which feature stories of survivors of suicide attempts. And she says it's important to pay attention if someone is withdrawing from friends and family and their regular activities.
URSULA WHITESIDE: Meaning they're not responding to phone calls, or they're not joining in on maybe a Zoom call with family, or they're not on social media. That's one time that it makes sense to get curious about what's going on with your friend - when people start to disappear.
CHATTERJEE: And she says when somebody is really struggling, feeling hopeless and overwhelmed, keep your eye out for more subtle signs.
WHITESIDE: People often use fewer words and have a harder time communicating. They say things like, I can't do this. I'm just so stressed. They might just sit there really quietly for long periods of time, sort of spaced out.
KWONG: Yeah. So let's say you've noticed some of these warning signs. What do you do next?
CHATTERJEE: First thing Whiteside says is check in, ask if they're OK. Let them know you're there for them if they need you. She says if you're unable to talk to them directly, leave a voice mail, write a letter, send a text message. It seems small, but she says it can have a big effect.
WHITESIDE: A message like that might say something like - you know, refer to a memory that you have of them, like a positive memory. And say that you miss them or say that you're rooting for them.
CHATTERJEE: Also, Whiteside says, be prepared not to hear back. But keep checking in, especially if they don't respond because remember, not responding could be a strong sign that they are struggling.
WHITESIDE: And this is a way to just kind of keep pulling that person back to the reality of your friendship or your family.
KWONG: I love hearing this because it does take some loving persistence, I think, to reach for a person who is withdrawing. And if your loved one responds or just decides to share with you that, yes, I am feeling depressed, overwhelmed, hopeless, or you just worry about a sudden change in their behavior, Rhitu, how do you know if they're thinking about ending their own life?
CHATTERJEE: Experts say just ask them directly.
CHATTERJEE: And I know this can be really hard to do. And here's how Whiteside says she would approach it.
WHITESIDE: I might say, you know, a lot of people I know have been having suicidal thoughts during this period, especially when they're going through things similar to what you're going through. And I think it makes sense that some people just, you know, want to not feel this way anymore. Is that something that's going on for you? Because I'd like to see if there are some things I could do to be helpful.
KWONG: That's great.
CHATTERJEE: Absolutely. She says asking about suicide does not make it more likely that they will attempt to take their own life. But she says if you broach the topic, listen calmly with an open mind.
WHITESIDE: You're asking because you want to be helpful, not because you're going to call 911.
KWONG: Yeah, this is a really important point to talk about because we've been taught to call 911 in emergency situations. But I know that's not always the best approach when a person is feeling suicidal.
CHATTERJEE: That's right, Emily. Suicide prevention experts say that if your loved one tells you, yes, I've been thinking about dying, first of all, stay calm. But if you're worried about them, the first number to call is the Suicide Prevention Lifeline because trained counselors there can connect you and your loved one to support and help in your community. Now, if someone has already hurt themselves, or if they're in imminent danger and are unwilling to keep themselves safe, that's when to call 911. But experts say that calling 911 at the mere mention of suicide often takes away the person's sense of agency or makes them feel scared if the police get involved because calling the police can escalate things.
KWONG: Rhitu, we know that during the pandemic, suicide lifelines and crisis text lines have been flooded with calls and texts, which means a lot of people are going through this right now.
CHATTERJEE: That's right. But Whiteside says...
WHITESIDE: The vast, vast majority of people who have thoughts will not go on to kill themselves. I think there's a lot of hope in that.
CHATTERJEE: And that's great. But how do you know whether your loved one is at high or low risk of acting on their thoughts, right? So researchers at Columbia University have developed a handy set of six questions that can help you figure this out, whether your loved one is at high or low risk of attempting.
KWONG: So how can you find those six questions?
CHATTERJEE: All you've got to do is Google Columbia Protocol. And that protocol has questions like, have you wished you were dead or wished you would go to sleep and not wake up? - as well as, have you had any intention of acting on those thoughts? And someone who answers yes to that last question is at high risk, in which case you should ask them if they have a suicide plan, if they know what means they might use if they attempted. And if they tell you about the means, then you have to prioritize removing those means to make their environment safer. For example, if they're thinking of taking medications, make sure those are locked away. Or if they plan to use a gun, make sure the gun's safely stored, so they can't access it in a moment of crisis.
KWONG: And isn't there a lot of research on how removing lethal means can prevent suicide?
CHATTERJEE: Exactly. That's, in fact, one of the surest way to prevent someone from attempting when they are in crisis because for people struggling with suicidal thoughts, the urge to act on them can come very suddenly. And the good news here is that these intense feelings are usually fleeting. They last about a day or two. And your job during this time is to help your loved one calm down and not act on their feelings. Whiteside says, you know, you can help them relax by literally cooling them down. Get an ice pack for them. Or if you're on the phone with them or on FaceTime, just get one yourself. Ask them to get an ice pack and give them company in, like applying that ice pack to your face and neck and their face and neck. And you can have the same effect by using paced breathing.
KWONG: Isn't paced breathing just deep breathing?
CHATTERJEE: Yeah, it's when you breathe in and breathe out really slowly and through your stomach and try to make your exhales longer than your inhales.
KWONG: (Exhaling). Like that.
CHATTERJEE: That's right. And once you've calmed your loved one down, the second step, Whiteside says, is to tell them...
WHITESIDE: ...To make no important decisions, especially deciding to die. So not panicking, ignoring thoughts that you don't care if you die. Stop using drugs and alcohol and wait.
CHATTERJEE: And the third step, she says, is make eye contact with them.
WHITESIDE: There's not much else that grabs our attention like looking in someone's eyes. It can drag you out of your, like, deepest, almost edge of sleep when you're sitting in a classroom, and the teacher looks into your eyes. Like, it'll just jolt you awake. But also, it can be used to drag yourself out of a negative brain space.
CHATTERJEE: And if you're with them, if you can stick around with your loved one until the crisis has passed.
KWONG: Yeah, the sticking around is important because something else may come up...
KWONG: ...That spurs another difficult moment.
CHATTERJEE: Right. And you want to be there for that sort of fleeting - you know, during the duration of that fleeting urge. And for somebody who's feeling completely hopeless, to know that you're loved and valued can make a huge difference. You know, the first time Lezine had his most intense suicidal thoughts, he told his close friends how he was feeling. And he says most of them told him...
LEZINE: I love you. And I totally want you to stay around. I want you to be here. I think that you have a lot that's possible to live for.
CHATTERJEE: And Lezine says starting a conversation with his friends is what helped him get treatment for his depression. His best friend made an appointment for him with a therapist and even went with him for that first appointment.
KWONG: That's a good best friend. That's an amazing act of love.
KWONG: Last thing, Rhitu - this is the hardest thing to acknowledge in this episode, but it's real. Many people do take their own lives.
KWONG: So what do mental health experts say to those loved ones who may not have been there or were not able to intervene? Because I know there are millions of people out there carrying that grief and the many feelings of that.
CHATTERJEE: Yeah. What they told me was that, you know, you can do all the right things and still lose the person, and it's not anyone's fault. And, you know, the most important thing to do here under any circumstance is to also take care of yourself because this is hard work. Make sure you have social support. And if necessary, seek mental health care for yourself.
KWONG: Yeah. Like you've pointed out, Rhitu, this is daunting and exhausting to walk this road.
KWONG: So being open to seeking help for yourself along the way is key. You can't help someone unless you get help for yourself.
KWONG: And if you're overwhelmed and you don't know what to do next, you can actually call the Suicide Prevention Lifeline, 1-800-273-8255.
CHATTERJEE: That's right, Emily. And there are peer support groups, as well, for the loved ones of those struggling with suicide. A good place to find a peer support group is NAMI. That's the National Alliance on Mental Illness. And you can reach out to your local NAMI chapter for what's available in your area.
KWONG: Rhitu, thank you for having this conversation with me and getting this information out there.
CHATTERJEE: Thanks for having me, Emily.
KWONG: This episode was produced by Thomas Lu, edited by Gisele Grayson and fact checked by Rasha Aridi. The audio engineer for this episode was Gilly Moon. I'm Emily Kwong.
CHATTERJEE: And I'm Rhitu Chatterjee.
KWONG: And you're listening to SHORT WAVE, the daily science podcast from NPR.
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