What is Depression?
The term depression is tossed around so often that it’s easy to get a little confused. While everyone feels down from time to time, when we refer to depression we mean feeling down for longer periods (usually weeks, months or even years) and having those feelings interfere with a person’s daily life.
What is Crisis?
While many people feel depressed, it does not mean they are in crisis or suicidal. Suicide attempts usually happen during crisis periods. Crisis is usually short term in nature, often lasting hours to days, and in some cases weeks. It does not go on forever. And during this time, the person’s normal problem-solving strategies are not sufficient to bring the individual to his or her usual steady state. In short… the person is at risk of doing impulsive acts while in crisis, perhaps a suicide attempt or perhaps other risk-taking or health-harming behaviors.
Goals When Someone is in Crisis
When someone is in crisis, our goals tend to be short-term in nature.
We try to:
- Bring the person back to the pre-crisis state
- Keep the person supervised and safe until the crisis feelings pass
- Remove potential methods of harm from the person’s surroundings
- Help the person feel more control over their problems or life circumstances
- Help the person create an action plan or help the person use mental health or other services
- Help the person grow and become stronger as a result of effective problem solving
- And if the situation is out of control or very high risk, call 911 and have the person taken to a psychiatric emergency service.
Nine Steps to Help Suicidal Friends and Family Members
- Don’t be afraid to ask.
Often people who feel suicidal put out clues about their intentions, because they are afraid to talk about their feelings. When no one picks up these clues, it further reinforces the idea that suicide is not a topic they can talk about with friends or family. If you sense that someone is suicidal, you need the courage to start the conversation. People are often afraid to start this conversation because they fear they will say the wrong thing. You can trust yourself. The only wrong answer is ignoring the situation.
- Let the person talk.
In most cases, talking is good. If the suicidal person is talking out their problems, they are not harming themselves. Listen without judgment and do not try to make the suicidal person feel guilty. Suicide happens when there is too much pain for someone to tolerate. Think of the people you would turn to if you were in a crisis and act as you would want them to act.
- Safety Comes First.
However in some cases, you may need to assess if the person has completed an act of harm, before talking out problems. For instance, a person may have taken an overdose of pills, and then calls you on the phone to talk. Evaluating suicide risk early in the conversation may be critical to saving a life.
- Evaluate the Risk.
Ask direct questions about the person’s suicide method and plan. The more well thought out the method and plan, the more dangerous the situation. (Learn more about the warning signs.) Ask if the person has already completed the act of harm. You may need to call 911 now.
- Remove the Method of Harm.
In some cases you can reduce the risk of suicide, by removing the method of harm (guns, pills, keys to the car, etc.) from the person’s immediate surroundings.
Usually, suicide is a solitary act. People tend to do it when they are alone. Sometime just having people stay with a suicidal person for hours to days, until the crisis passes, can make all the difference. Sometimes family members or groups of friends take shifts to assure 24 hour supervision. Also it reinforces to the person that someone truly cares.
- Get Help.
Work with your loved one to get help. There are many mental agencies in your community that can help, Find referrals in San Francisco.
Contract (i.e., make a verbal or written agreement) with the person to contact help whenever they feel in crisis and before they make an act of harm. That helping person could be you, a crisis hotline, or their counselor. Contracting to contact more than one person is better, because a single caregiver might not be always available. Also honor your end of the contract. If you tell a person in crisis that you will call tomorrow, call the person!
- Reduce Isolation:
Depressed and suicidal people often feel very alone and isolated. Hang out with friends or family members feeling depressed or alone, even when you feel too busy. It helps them. They may help you someday.