How to talk suicide prevention with the mentally ill person in your life

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It’s small comfort, but I’m in good company. Most parents of children who suicide had no idea the stakes were fatally high.*

In hindsight, I made a number of fatal assumptions. First, I assumed my son Josh was telling the truth when he informed me, his doctors, and his therapists that he never contemplated suicide. I assumed he was like me, that his depression could be intense, but not life-ending. I assumed my powers of discernment would note if he became despondent, overriding my parental optimism to believe only the best about my child.

Parents, family, friends of those who struggle with mental illness: don’t make the same mistakes I did. It’s better to talk about it, rather than regret it later. Decades of research unambiguously show that 90-95% of those who take their lives suffer from major mental illness. Those at higher risk include people afflicted with clinical depression, bipolar disorder, schizophrenia, borderline personality disorder, PTSD, and other anxiety disorders. Individuals on the autism spectrum are also more likely to take their lives.

And please rest assured, by talking constructively about suicide, you’re not feeding your loved one bad suggestions. If they’re already considering suicide, they’ll probably feel relief they can open up about it, that it’s not a taboo subject between you. If they’re not, conversations like these can strengthen their armor against even weighing it as an option.

Because words matter. On the harmful side, we’ve known this since Johann Wolfgang Goethe wrote The Sorrows of Young Werther in 1774. A Romantic-era tale of a young man taking his life, copycat suicides followed in the train of its publication. We saw the same thing happen after Netflix released its reprehensible series 13 Reasons Why,as suicide rates increased by 28.9% among American youngsters in the month after Season 1 dropped.

On the positive side, we’ve learned that evidence-guided interventions in high schools suffering a suicide can drastically reduce contagion. Please note I said “evidence-guided.” General school assemblies that skirt around mental illness, but instead suggest that suicide was a choice among many in response to a breakup or low grades, can actually do harm.

I’m living proof of the power of words. When I was at a dangerous low point after Josh took his life, Jennifer Michael Hecht’s book-length argument against suicide, Stay, cast a preventive roadblock in my path. Her canny word choice, describing suicide contagion as “delayed homicide,” was the decider for me. I’m sure as hell not going to elevate my surviving children’s risk of self-murder.

Mental illness adds strain to relationships. But relationships are so much more than our worst moments. We will smooth out our disagreements. We will apologize to each other again. The love remains.

So, if I could hit the rewind button to the month before Josh died, these are some of the things I would say to my marvelous but mentally ill son.

If I could, I would tell him you won’t always feel this bad. 1980’s talk show host Phil Donahue may have opened the Pandora’s Box for Jerry Springer and the quack doctors Phil and Oz. But he was absolutely correct in describing suicide as a permanent solution to a temporary problem.

In my decades as a mental health caregiver, out of the thousands of people I’ve seen, I can count on one hand the patients I fretted were irreparably stuck. For everyone else, therapy and medication work if you give them a chance, though not always as fast as we’d like.

Suicide is commonly contemplated for weeks, if not years, before the thought is acted upon. More often than not, however, there’s an immediate stressor triggering the deed. This was true for Josh, as he felt shame in being caught playing hooky from his job. It’s important to validate that the breakup, divorce, lost job, or failed college course truly does suck, but let them know from your own experience that the intensity of their distress will diminish, given time.

Be sure to communicate you are infinitely more than your mental health problems. You are a good person. You are caring and funny. Your worth is not measured in what you do or don’t accomplish, whether you hold down a job or finish a college degree. I will be here for you if you end up on disability. I treasure our connection unconditionally.

Along those same lines, you are not a burden or bother. When I read accounts of near-suicides, the inevitable theme is a belief among the despondent that their friends and family would be better off without them. This is not fucking true. The world would be barren without you. Your absence would leave a lacerating vacuum that could never be filled. (That’s a mixed metaphor, I know, but an accurate one.)

Mental illness adds strain to relationships. This was definitely the case between Josh and me. So I’d have been sure to tell him our relationship is so much more than our worst moments. We will smooth out our disagreements. We will apologize to each other again. The love remains.

Now comes the responsibility part. If you take your life, you make it more likely that other people you care about will follow suit. Your family members, your friends with mental illness will see suicide as an option, in a way they had never considered before. Do you really want to commit delayed homicide? Even if you don’t want to live in this moment, stay alive for those you love.

I know the last thing you need right now is the burden of added responsibility, but this is the price of entering this life. Forget about the onscreen deeds in the Marvel movies you once loved. Sticking around for the sake of others when you feel hopeless? That’s the truly heroic shit right there.

Could I do it over, I would ask Josh for his own reasons to stick around. I suspect he would’ve mentioned his family and his beloved black cat Martha. I wouldn’t have been surprised to hear him single out his favorite manga and anime, his desire to read the next Junji Ito horror compilation or further installments of JoJo’s Bizarre Adventure. Never judge these things as trivial, if they’re meaningful to the person you love.

Since Josh was not a religious believer, he would not have listed belief in hell as a suicide deterrent, but I hear this routinely when I ask depressed patients why they haven’t acted on their death impulses. Now is not the time to engage in counter-apologetics. If religious faith, even the fear-based sort, is keeping someone you love vertical, by all means affirm it.

For the rest of this column, I’m addressing the reader directly, not the imagined Josh in my head. If your loved one expresses suicidal thinking, you may want to nudge them towards making a written safety plan, as I described in this column. You may want to call their doctor and/or therapist, too—preferably but not necessarily with their consent. Don’t assume they’re confiding these things to their mental health professionals. They may be reporting only positive things in these sessions, out of an irrational need to please or a fear of hospitalization.

If you deem they’re mired in the quicksand of imminent suicidal danger, I advise calling 911 or ensuring they get to an emergency room. Follow up by conversing with the mental health staff in the ER and telling them what you know, so your suicidal loved one doesn’t smooth talk their way back home. (Back when I was a hospital-based shrink, I always appreciated this supplemental info.)

Please don’t go this alone. It is taxing to worry about someone who battles suicidal thinking. Enlist the support of trusted friends or family.

And if the unthinkable happens or has happened, remember that you do not hold the power of life and death over anyone. These conversations can move the needle away from death and towards life, but we don’t have final say.

*Most of the statistics in this column are from Kay Redfield Jamison’s grimly readable Night Falls Fast. From my review of later studies, any numbers that have changed since its publication have only gotten worse.