Suicide: Let’s Talk About It – An algorithm for awareness and prevention, by Brenda Mayfield

Brenda Mayfield, MSN, CRNP, PMHNP-BC (MSN 2018) is an instructor of nursing and is co-director of the Birmingham Veterans Affair Health Care System/UAB School of Nursing Mental Health Nurse Practitioner Residency Program.

Losing someone to suicide creates a tsunami of pain, guilt, shame, anger and confusion, and leaves a plethora of unanswered questions in its wake. Nearly 800,000 people worldwide die by suicide annually, and another 1.2 million attempt suicide. It’s one of the top five causes of death in the United States for ages 10-44 and ranks 12th among all-cause mortality. Recognizing when someone may be at risk, knowing how to talk to them, and knowing how to help can save a life.

Suicide is complex. It is often the result of a multifaceted interaction involving a person’s biology, psychology, environmental and social areas of functioning in shaping behaviors. Knowing the language is essential to gauge where a person may be when assessing and understanding risk. Early intervention could be an effective strategy for preventing death and decreasing risk.

Step 1: Be present.

1. Being present physically, on the phone or online when someone is in need shows caring and support.
2. Following through with commitments of support and presence demonstrates to a person they are not alone, limits isolation and increases connectedness.

Step 2: Open up a dialogue.

1. Know that asking about suicide does not encourage someone to start thinking about it. Asking about someone’s thoughts and feelings often elicits relief for the person who may be in crisis.
2. Encourage reflection on the future with questions such as, “What are you looking forward to?” “Where do you see yourself in a year?”
3. Understand warning signs. If someone is asked, “Do you ever feel like life is not worth living?” and provides no response or has long pauses.

Step 3: Assess connectedness and community.

1. Connectedness is a sense of purpose and meaning that keeps one invested in living.
2. Assess for social support, hobbies, engagement in activities, pets and employment.
3. Suicidal ideation becomes strong when pain overcomes connectedness.

Step 4: Determine if there is a suicidal capacity present, and keep them safe. Regardless, help them connect to resources.

1. Helping someone connect with support can serve as a safety net in times of crisis.
2. Call the National Suicide Prevention and Crisis Line at #988, or #1-800-273-TALK (8255).
3. Have a written safety plan in place so a person has access to immediate resources in times of crisis.
4. Connect with community, spiritual or professional resources as these are protective factors.

Step 5: Maintain contact and be sure to follow up.

1. Check on your friend, loved one, colleague or battle buddy.
2. Call them, send a text, leave a message, send a postcard and see how they are doing.
3. Follow-up can increase feelings of connectedness, support and belonging.
4. Follow-up and support are an integral part of suicide prevention. Follow-up matters!

Asking about suicide can be difficult and uncomfortable, but it is a crucial conversation we must have with anyone who may be thinking about it. When we are prepared with the proper tools, knowledge, understanding and compassion we can be the light in someone’s darkest times.