I learned a lot about suicide during my six years working in Polunsky prison unit in east Texas.

As the mental health manager and, for most of that time, the overseer of psychological observation cells, we had over 1,000 suicidal outcries but no suicides from our mental health caseload.

There were some suicides, but one was a guard in the parking lot, one was an offender in general population, and one was a death row inmate who chose suicide rather than allowing the state to execute him.

However, out in the “free world” as it was called in the prison setting, suicides were, and are, an ongoing issue that cuts across all ages and all ethnicities.

COVID has seen a spike in diagnoses of anxiety, depression and suicidal outcries with an increase in suicides.

The early data shows a significant rise in anxiety and depression (up to a 40% increase) while suicides have climbed a little. That, though, is during a trend of upward suicide rates in most age groups.

So, here are some things to know about how you can respond if someone confides in you about thoughts of suicide.

First, in broad categories, suicidal outcries generally fall into one of two categories: hopelessness/despair or manipulation.

Hopelessness or despair can be ongoing or short lived, which is the logic behind suicide hotlines to help talk people through such moments and then connect them with ongoing help and support.

The national suicide hotline number in the U.S. is 800-273-8255, which also has a texting feature. However, counties and communities may also have crisis lines. One client mentioned to me that when she called the national number, she was put on hold.

Suicidal thoughts can often be helped by talking with someone, and often that conversation carries them through the worst of the suicidal thinking. However, that is not true for all.

There is another feature of the hopelessness/despair which happens, and I have seen this clinically as a client recites previous attempts to kill themselves.

The most recent setting I was in was a practicum for the Eye Movement Desensitization and Reprocessing class I was taking. One clinician shared that she was working with a girl who had attempted suicide 17 times.

I was shut down by the leader, but what I wanted to say was, “Suicide is easy. If you have attempted suicide 17 times, you have other issues. More likely, she needs the care of a psychologist who is more fully trained in personality disorders, especially borderline personality disorder.”

There is another aspect of some suicidal outcries: manipulation. Such was a significant feature of offender suicide outcries, which meant the clinician had to sort out the difference between the ones experiencing hopelessness/despair and those who were manipulating to get something.

Outside of prison, one young lady came to see me because she was “suicidal.” I listened and finally said, “You are not really suicidal at all are you?” To which she replied, “No, I just needed someone to listen to me.”

So, I suggested my working with her was contingent on her not using the “suicide” card again.

I also made her a promise. “If you forget, and say you are suicidal, I will suggest your family call 911, or take you to the ER where they will hold you and have the mental health crisis team come and evaluate you when they can fit it in,” I said.

There were no more suicidal outcries from her during our time working together.

Over the years, I have changed the way I talk about suicide to others and with others.

As a pastor, I would tell the congregation never, ever allow anyone to swear you to secrecy when they tell you they are “suicidal.” This is especially true for teens because such confidences can be shattering. Never promise not to tell.

I would also tell the congregation and the youth to take suicidal outcries seriously. In other words, tell someone who can intervene or someone who is more skilled at evaluating the outcry. For teens, that could be the youth pastor or, if you know the family, a parent.

Knowing the parents is important because they can be the reason for the teen’s real despair if they are in a chaotic or dysfunctional family. In that moment, it is also important to offer to go with them to see the youth pastor, pastor or even to the doctor if that will make a difference.

So, if you are struggling with suicidal thoughts, get help.

From experience both in my family and as a professional, I will tell you suicide is absolutely the meanest thing you can ever do to your family. You will leave them feeling helpless and confused, with questions that will never be answered because the one who has the answers is dead. The survivors carry the guilt.

For those of us who are concerned about family members, friends or co-workers, take the time to connect with them in a private moment. If they open up to you, all but a suicidal outcry should be considered confidential. In other words, it should not become fodder for family or office gossip.

During these conversations, reflect your concern about how they are “doing.” You can be specific about the things you notice: low energy; loss of enthusiasm; letting things go; letting themselves go.

Truly listen with empathy. If they share that they are depressed, down or any other words for feeling hopeless, it doesn’t hurt to ask what they are thinking about doing about their situation/mood?

If the question seems appropriate, you can ask, “Are you thinking about suicide?”

While this is a huge question, if they are, you are not going to give them ideas. Rather, you are simply bringing it into the light. If they are not, they often will tell you. Something about feeling hopeless can allow a person to be honest when they might not be in other moments.

Sadly, lots of people “think” about suicide, but moving from thinking about it to developing a plan of how they would do it is a step that necessitates intervention.

What you do next is important. You can insist they talk to someone and, if it is in the workplace, you may find his or her boss, or the human resources person on site. At that point, it is the employees’ responsibility to speak, not yours.

If it is a teen, insist that they speak to a trained professional and tell that person what they are thinking. At this point, being accused of “not being their friend if you tell” should be the least of your concerns. Once again, once you’ve notified the appropriate person, the teenager needs to say what they are thinking. It is not your story to tell.

If it is a family member, call 911 or take them to the emergency room. This is the reason why on every therapist’s and most physician’s voicemail the directions are, “Call 911 or go to the nearest emergency room if this is an emergency.”

Hopelessness and despair are horrible places to be. And when people are caught in those emotions, the world looks very dark, very small and the pain is very real.

In those moments, however long they last, suicide seductively offers an out without any regard for any other living being. Knowing how you can respond and intervene constructively could literally save a life.

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