There's a lot of misinformation about suicide circulating in the general public that contributes to the suffering of suicidal individuals. Now that we're all on the same page about our terms, have a shared sense of the phenomena, have learned a little bit about its history, and have considered how to grow our knowledge while balancing ethical obligations. I want to circle back to some of the common misunderstandings you may hold or that you may see in your friends, family, or community. One of the most valuable things you can take from this course is to start to gently educate others who have not had an opportunity to learn about suicide. Next, we'll talk about public health approaches to reducing suicide and about a specific messaging tool ; public service announcements. Fact number 1, asking about suicidal thoughts may save a life. Asking about suicide cannot put the idea in someone's head. In fact, asking someone about whether they have been thinking about suicide or considering killing themselves is one of the kindest and most supportive things you can do. Being a friend, co-worker, or family member who opens that door, identifies you as someone with whom it's safe to talk about really hard things. As well as someone who genuinely notices and cares that something might be wrong. Trust me, if someone is feeling enough pain and hopelessness, your question about suicide is not going to be the thing that makes it occur to them. Often, concerned friends and family also worry. What if I was wrong? Will I offend the person by asking? But really what you've done is quite the opposite. You've demonstrated to your friend that you are a caring, open-minded person who can talk about difficult topics. Since this fear of the response is often what stops people from asking the question, I want to play through two scenarios. First, let's say your friend laughs at you and says, ''No, you're crazy. I'd never think of that.'' You could reply, ''Oh my bad, I heard you say X and worried. I'm glad to know you're doing well. Just know if you're ever having a hard time in the future, you can always talk to me about it.'' What you've done here is acknowledged their denial, but also left the door open in case maybe actually they just weren't really ready to share with you how they were feeling. Again, you've identified yourself as a caring, open-minded, and brave person. Great job. Now let's take another scenario. Let's say your friend says, ''Yeah, actually I've been having a really hard time and feeling really down lately and I really don't know what to do.'' Now first your stomach might drop when you realize you're right, something was going on. But now you've opened the lines of communication. Your only job now is to listen non-judgmentally to what the person has to say. You do not need to talk the person out of killing themselves, guilt them, or provide reasons that they shouldn't kill themselves. In fact, this type of advice giving usually backfires. Instead, you want to use all your best listening skills to understand where they're coming from and to show that you genuinely care. Next, you want to figure out what the next step you'll take is, and this is always going to depend on how much of a crisis the person is in, your relationship to them, and lots of other specifics. It might mean staying with them a while. It might mean making a plan to tell another close family member or friend. It might mean accompanying the person to a doctor's appointment or hospital. Or if a crisis is imminent, it might mean calling emergency services to get them help right away. Well, I can't advise you on each specific situation, know that one, by listening and caring, you're doing your part. Two, your local suicide prevention numbers will be a great resource for you in figuring out what to do in your specific case and what resources are available. Please know that suicide prevention crisis lines are not only for the suicidal individual, but also for concerned others. The counselors that answer the phone can ask specific questions about your situation and help you walk through different options. I strongly encourage you to use this as a resource if you're concerned about someone else. Even better, try to seek out gatekeeper training so you have an entire class on these skills. These trainings will focus specifically on noticing warning signs, starting the conversation, figuring out what to do to help, and also how to take care of yourself. What's available will vary by region. But there are a few common gatekeeper trainings that are common in the United States. While gatekeeper trainings are often offered to teachers and transit workers, clergy members, law enforcement officers, pharmacist, elder care workers, others who might be likely to encounter suicidal people, but are not trained in mental health care. These trainings are really useful to anyone in boosting their skills and comfort with talking about this subject. Fact number 2, most suicidal behavior is preceded by warning signs. It's not the case that suicide comes out of the blue without warning. It can sometimes feel that way to the people around the suicidal individual, especially if they're not aware of what possible warning signs might be or if the suicidal individual is working hard to conceal their thoughts and feelings. But most individuals will have their suicidal thoughts grow gradually and will often show warning signs like mood changes, increasing their isolation, preparing their affairs, researching suicide methods or offering what we call soft signs like saying things like, you'd be better off if I wasn't here, or I wish I could just disappear. Of course, these things could mean a lot of different things, but they really are perfect invitations for you to express concern or to inquire about what's going on. Additionally, at least in Western countries, the majority of suicide diseased visit their primary care doctors in the months preceding their death. Healthcare providers of all types, not just mental healthcare providers play a really important role in screening for suicide risk and helping high-risk individuals get connected with care. Fact Number 3, suicidal thoughts are often short-term and situation-specific. Suicidal thoughts are not permanent. In fact, for most people who experienced them, they'll arise once or maybe a few times throughout their life. The vast majority of people with suicidal thoughts will not die by suicide. Once the pain dissipates or hope for change is restored, the suicidal desire will understandably fade. The thoughts are very specific to the situation. This is particularly true for active suicidal thoughts, which often only last for minutes or maybe hours out of stretch. This is why a prevention strategy called lethal means safety is so effective. Suicide can be prevented. An individual with suicidal thoughts and attempts can live a long successful life. Importantly, it usually doesn't feel that way to the suicidal individual in the moment. For them, it feels like this is the only way they'll feel for the rest of time. However, as a friend or family member, you can support them through this time by showing you care, connecting that loved one to professional help and assisting them in staying safe in the meantime. You can be the one to hold onto hope when your loved one is struggling to access that hope. We're all different of course, and we all feel supported in different ways so don't hesitate to ask a person you care about what would feel helpful and supportive to them. Now there are people for whom suicidal thoughts are much more chronic. When we talk about treatments, we'll learn about one called dialectical behavior therapy, that's particularly helpful for people struggling with more persistent suicide ideation. Fact Number 4, suicidal people are seeking a way to relieve unbearable suffering. Suicidal people are not selfish or self-centered. They are struggling with unbearable pain that is often invisible to those around them. They're also not seeking unwarranted attention. They're in crisis and in need of help. A person who falls and breaks their leg and cries out for help is not judged for loudly and emphatically requesting assistance. People who are suffering to the point they don't think they can continue to live, also need to have their cries for help taken seriously. Now typically people do not die by suicide because they don't want to live. People die by suicide because they cannot see another way to end their suffering. Suicidal thoughts have a way of constricting one's thoughts. It's almost as if you have blinders on and can't see you're brainstorming any other options. These individuals are suffering so deeply, they feel helpless and hopeless. Oftentimes their thoughts will trick them into thinking that actually the most generous thing they can do is to end their life, reducing the burden on others even though this is almost never what those around them think or feel. Understanding that suicidal desire is about ending pain and hopelessness rather than desiring death is important because it points us in the direction of solutions. Treatment providers, friends and family members can serve the role of brainstormer and holder of hope when this is difficult for the individual to do in the middle of their crisis. Fact Number 5, anybody can become suicidal. It's not true that only certain types of people think about or attempt suicide. Anybody can become suicidal regardless of race, class, country of origin, religion, sexual orientation, gender identity, age, or any other characteristic you could name. We learned from the epidemiology lesson that there are demographic characteristics that overall put some groups at higher risk. But when it comes to the individual, it can really happen to anyone. While mental health conditions do confer a higher risk for suicide, there are about one of many, many, many risk factors, people without mental health diagnoses can and do become suicidal. That's something that's often surprising when people are first learning about suicide, especially if they haven't experienced those thoughts themselves. When you haven't had that thought or experience, it can seem "Crazy" or hard to imagine someone having those types of thoughts. Again, if we look back at what we learned about the three-step theory, it might make a little more sense for any person if they experience enough pain, feel enough hopelessness, and become disconnected from their network and the things that give them a sense of meaning, suicidal thoughts can develop. This is why it's important to take these thoughts seriously in others and in ourselves and not to make assumptions based on what someone's life looks like from the outside.
