Talking about the "S" word
If you've never heard a friend, colleague or client talk about suicide, count yourself lucky. According to the CDC, a "History of mental disorders, particularly depression" is seen as a risk factor, but not a cause, of suicide. Just check out the statistics on the website of the Centers for Disease Control and Prevention.
I am not a doctor and I don't play one on TV. I am also not a therapist or social worker. But too many people close to me have had experience with suicide. So I can't bury my head in the sand and say/pray/hope that it is a therapy issue and, therefore, not my problem.
Consider the similarities in these situations: My Uncle Bob is 1000 miles away when he has a sudden heart attack while talking to me on the phone. My friend MaryAnne says she's just taken all the pills in her medicine closet and just wants to go to sleep.
In both cases, I know what to do. Call 911. These are emergencies.
How about this: Uncle Bob tells me that his blood pressure is pretty high and he really doesn't like taking the pills the doctor prescribed. MaryAnne says her life is such a mess, she thinks she'll just kill herself.
Now what?
In both cases, as a friend, acquaintance, or colleague, I must take this seriously. That means I can't brush either conversation under the rug and just hope they don't talk about it again. And as a coach, I know the value of both powerful questions and the space and safety I can give the other person to think through and speak his answer.
According to the American Foundation for Suicide Prevention, "Most suicides give some warning of their intentions." Don't be afraid to ask if you think a person might be considering it. If Uncle Bob tells me he's been feeling jittery lately, I might ask if he's taking his meds. If MaryAnne just wants to sleep, I'll ask her if she's thinking of doing anything drastic, or harmful to herself or to anyone else.
As not-a-doctor, there isn't much I can do about Uncle Bob not taking his meds. As not-a-doctor there is also not much I can actually do for my friend MaryAnne who is thinking about suicide. But what I can do, in both cases, is talk about it. How committed is Uncle Bob to the meds problem? Did he just forget to fill the prescription? Or is it something else? How committed is MaryAnne to her plan? Who else is she talking to about this?
Therapists and doctors have more tools in their kits for dealing with suicidal ideation, as it's called, but not me. That's precisely why I must refer a client who is talking about suicide to a trained medical professional. Nevertheless, I know I can't pull the plug on the conversation just because MaryAnne says she's too tired to live. I can't just shove her out the door, or drive her immediately ... where?
I know this is serious. I also need to know if it was a throw away line or something she is really thinking about. (When I was a kid, if anyone said, "I'm going to kill you," even in jest, it was an infraction worthy of a soapy mouth -- absolutely and totally unacceptable behavior. But I know this is not the case for everyone.) So I have to talk about it. These questions will help me gauge how serious MaryAnne is. The more specific the answers, the more committed she is to the idea.
- Do you know how you will do it? (Yes, I'm going to use a gun.)
- Do you have the means to do it? (Yes, I bought one last week.)
- Do you have a plan for when you might do it? (Yes, I'm thinking I'll do it next weekend when my family is away.)
That part of the conversation is all about her and what she's thinking and planning. This next part is all about me: What the heck am I supposed to do with this information? So I tell her that I can't just sit on it. (Think about it, if I told her this part first, would she share the information that might save her life?)
I tell her she needs to see a therapist right away. Does she have one? I can suggest someone and give her the number. This is where one of those "Permission to consult" forms is particularly useful. Then I ask her a couple more questions.
- Will you promise me that if you decide to go ahead with your plan, you'll call someone first?
- Who will that person be?
- You must talk to a live person, and not an answering machine.
I will wait for her promise and the name. It might be slow in coming. If she says she'll call me, then in my best coaching conversation I'll ask, "What exactly do you want me to do?"
Nothing?
"Sorry, I can't do that. But see, I already have the numbers of your primary care doctor and your mother, so I'll have to call one of them. Is there someone else you'd prefer? Then I'll need that number now."
"Heck, even if it's not alright, I'm going to call them anyway because I don't want to be responsible for you laying dead in a bathtub someplace." Be that specific. Make sure she knows she's made a promise and that you will remember it and hold her to it.
- Ask when will she call the doctor. Ask her to let you know when the appointment is. Check in with her.
In addition and in my experience I have found that using the word suicide in the initial call to the doc will get you an appointment quicker than not. "My wife bought a gun and she's very depressed," will get the woman on the patient list. "My wife bought a gun and I think she's planning to kill herself," bumps her right up to the top of the list.
The AFSP suggests "If professional help is indicated, the person you care about is more apt to follow such a recommendation if you have listened to him or her." That's what coaches do. We listen.
For more information on what to do when you think a person is serious, check out the website of the AFSP.
About the author:
Kerch McConlogue, CPCC, PCC is a Baltimore-based coach in private practice who works with adults who have too many ideas. You can find her on the web at www.mapthefuture.com. Contact her by email using kerch@mapthefuture.com or by phone at (410)233-3274.