What to do when you're thinking about suicide

I have heard it stated that everyone has suicidal thoughts, as if it were an accepted fact.

No, everyone does not have suicidal thoughts. They are not a normal part of day-to-day life.

Nor is the statement "I might as well kill myself!" a normal response to frustration or disappointment. Such a statement is dramatic and may get attention, however.

For those who have recurrent suicidal thoughts, they often start with a fleeting idea in the context of disappointment or loss. Sometimes, they initially come as an imagined way to gain control over an overwhelming situation. But they are generally very private and often hidden.

The first thing to remember about suicidal thoughts are that they are thoughts, not actions.

Just because you think it does not at all mean that you will do it or must do it. There are a great many things that we imagine or things that we never do. Like all thoughts, a suicidal thought can be put aside to make room for other thoughts or activities.

In fact, the number one technique for preventing both suicidal thoughts and suicidal actions as well, is distraction — thinking about something else — doing something that engages you, like cooking a meal or writing in a gratitude journal.

People who have survived trauma often struggle with chronic suicidal thoughts.— Dr. Heather Keizer

The second thing to note is what seemed to trigger the thought. Sometimes suicidal thoughts become an automatic response to feeling rejected by others, or performing poorly at a task or feeling fearful of a future event. They are the final outcome of underlying feelings of anxiety and worry and a sense of lost control. 

One way to help gain back that sense of control is to keep a little thought journal with four columns.

Every time you get an anxious or suicidal thought write down:

• The date and time of day.
• What I was doing at the time.
• What I was thinking at the time.
• What made it better.

For example:
1. January 27, at 1:45 p.m. 
2. Just found out I missed a deadline for graduate school.
3. Thinking I'll never be successful if I can't keep deadlines straight. I am hopeless.
4. Going for a walk outdoors and calling my girlfriend to complain.

Over time, you may begin to notice that your suicidal thoughts recur with certain circumstances, and settle well with others. This will allow you to begin to problem solve and protect yourself from such thoughts. The writing out of the episodes gives you back control over your thoughts and your reactions.

Another helpful approach is to keep a gratitude journal. In it record every day something for which you are thankful. Also record every piece of positive feedback you receive: every compliment, kind comment or smile on the street. Separate yourself from sources of negative and critical comments and feedback.

Finally, stop marijuana and alcohol if you are having even fleeting suicidal thoughts. Both can cause your suicidal thoughts to become worse and more intense. Worse still, these substances interfere with the normal controlling function of your brain's frontal lobe and can significantly increase the risk of actually attempting suicide.

Developing coping strategies

Suicidal thoughts and self-harming behaviours are not necessarily associated with depression but they can be.

They are almost always associated with a need to develop alternative strategies to cope with frustration and emotional distress. In addition to journals, exercise, listening and learning music, crafts and talking to others can be helpful approaches.

People who have survived trauma often struggle with chronic suicidal thoughts, which tend to surface in times of increased stress or reduced personal control.

Sometimes these people will replay past episodes of when they were mistreated and struggle to settle and suicidal thoughts will start. For those with chronic and recurring suicidal thoughts it is very important to establish a sense of personal safety in both their living environment and their schedule.

Safety, security and limitation of contacts to only supportive individuals is critical to settling disturbing thoughts. Regular sleep and wake times, regular scheduled meals, and modest exercise provide grounding and emotional settling. 

So when do suicidal thoughts warrant professional intervention like a visit to an emergency room or a psychiatrist?

When a person begins to not only have fleeting, once-in-awhile suicidal thoughts, but has persistent worsening thoughts that are not in sudden reaction to circumstances, they need medical help.

Whatever the underlying cause, suicidal thoughts are treatable and do not need to be part of daily life.— Dr. Heather Keizer

When a person has more than thoughts but is experiencing clearly stated commands from an outside force to hurt or kill themselves, this is serious and needs to be treated immediately by a doctor. 

When someone is intoxicated and is voicing suicidal intent, they must be assessed medically as their suicide risk in the moment is high.

In the first case, gradually intensifying and unremitting suicidal thoughts that may invade a person's dreams indicate untreated depression.

In the second case, hearing internal commands or seeing images of death are indications of psychosis that can be associated with severe depression, or substance abuse or schizophrenia.

In the third case, an intoxicated person must be seen and treated, as the risk of completing suicide in an intoxicated person is very high even though, once settled sober within 24 hours the risk of suicide may be very low.

Finally, if someone approaches you and tells you they are suicidal, what should you do?

Listen.

Allowing a person to talk about their suicidal thoughts does not increase the risk that they will act upon them. Remember that though they may swear you to secrecy, when someone shares their suicidal thoughts with you, they are doing so because they want help and they are hoping you can help them. It is not a breach of a friendship to report a suicidal comment on Facebook or Instagram to the police — it could very well save a life. 

If someone hints about suicide, be bold and ask them directly. Don't be afraid that you will make it worse. 

Not all suicidal thoughts are symptoms of depression or psychosis: some, as mentioned, relate to past trauma or to a need to develop broader and more effective coping strategies. 

Whatever the underlying cause, suicidal thoughts are treatable and do not need to be part of daily life.

Help line information:

Anyone needing emotional support, crisis intervention or help with problem solving in P.E.I. can contact The Island Helpline at 1-800-218-2885, 24 hours a day, 7 days a week.

For more information about mental health services on P.E.I., find resources from Health PEI here, or from the Canadian Mental Health Association P.E.I. Division here.

Islanders can also call the main toll-free COVID-19 information line to find out how to get support and help if they're struggling with stress, anxiety or depression: 1-833-533-9333.