Following on from recognising the signs that someone might be thinking of suicide, here's the steps involved in making an intervention, adapted from the ASIST model. Again, doing a suicide intervention course is a great way to get a chance to practice the steps and increase your confidence in talking to someone about suicide. But if you are able to listen and if you care, even just reading this now may some day help you to reach out to someone in dire need.
1. The first step is to "Connect" with the person when you recognise the signs or "invitations" that someone may be thinking of suicide. Talk to them. Be open and direct, pointing out what you've observed and that you are concerned.
Ask them directly if they are thinking of suicide. It is important to use the word 'suicide' or 'suicidal'. Be direct and matter-of-fact about it and be prepared for their answer. If your reaction to a 'yes' answer is shock or anger, it is likely that they will clam up and not say anymore. So your body language and tone are very important. Ask directly and listen to their answer. Do not lecture or judge.
2. The second step is to "Understand". This step involves listening to their reasons for wanting to die. Just listen. While doing this, try to identify any uncertainty or ambivalence they feel about dying. There is almost always a part of them that wants to live. Listen for it carefully, point it out when it comes and reinforce it; “so there’s a part of you that wants to live”.
You then ask the person a series of questions to help you assess the risk. (These are listed on the wallet card you get at ASIST training so you can pull it out and use it if necessary.) They include asking if they have a plan; what method they have chosen (if any) and planned time/place. You also ask if they have pain that feels unbearable and if they feel they have few resources (people to turn to)? Have they attempted suicide before and have they received mental health care? Positive answers ("yes") to all these questions increase the risk.
3. The third step is to "Assist". You begin by making a 'safe plan' with the person to keep them safe from suicide while you both access further help. Ask them how long they can keep themselves safe. Where possible, disable their plan (if they have one) by removing access to their chosen method (e.g. pills, gun, rope). Agree they will not use drugs or alcohol while they are at risk.
Help them identify who might help them and agree the steps you will take together. If you cannot physically stay with the person, these steps may include that they call you if they feel they cannot keep themselves safe. If you are struggling with figuring out what steps to take, call the Samaritans or other helpline there and then. You are not alone - neither of you. Steps could also include talking to a doctor, meeting a counsellor or other support person. Stay committed to the plan until you can hand over the primary care role to some one else who can help.
For some people, the second step may look complex and a bit scary. It's also a lot to remember. If you do an ASIST course, you will receive these steps on a wallet-sized card which you can pull out and use. If you feel unable to cover the steps in number 2, you can jump from number 1 to 3. This will still allow the person to talk about suicide and you will still form a 'safe plan' while you both get more help. These are essentially the steps covered in Living Works 3 hour 'Suicide Alertness' course; SafeTALK (Tell, Ask, Listen, Keep safe).
Fears
You may have fears about asking someone directly about suicide. If so, ask yourself where they come from? In Ireland, as in many places around the world, we don't talk much about suicide. It's no wonder it doesn't come naturally to most of us. However, all suicide prevention training groups point out these same steps. They can't all be wrong! It is also worth noting that the Samaritans have a policy of asking every caller if they have been considering suicide (see Irish Times article here). About 25% say yes. Would they ask everyone if there was a chance it would make the other 75% suicidal?
To see some of the steps above in action and learn more about ASIST, take a look at this 7 minute Living Works video:
Riona, great blog. I found that the information very useful on how to recognise the signs of suicide and pointers on how you can react. As well as that, the stats you posted on suicide rates 2008,2009 and 2010 are very interesting and worrying..the government are doing us no favours
ReplyDelete