You Make Today Better: Suicide Prevention

Trigger warning: This post includes stories of suicidal ideation. If you or a loved one is considering suicide, get help! You can call the Suicide Prevention Lifeline at 1-800-273-TALK (8255). If you are experiencing a mental health emergency or crisis, call 911.

Suicide affects us all. As the tenth leading cause of death in the United States and the SECOND leading cause of death among 15- to 24-year-olds, I believe we all know somebody who has considered suicide, attempted suicide, died by suicide, or survived the suicide of a loved one.

Suicide is an uncomfortable topic, but we need to talk about it. Because suicide continues to be ignored and stigmatized, fewer people have access to mental healthcare than need it. We cannot wait any longer; now is the time to start talking about suicide.

September is National Suicide Prevention Awareness Month, September 8th through the 14th is National Suicide Prevention Week, and September 10th is World Suicide Prevention Day. Let’s use this time to kick-off an ongoing conversation about suicide.

My Story

I have loved several people who have struggled with suicide ideation.

It started early in my life. A person I cared dearly about in high school talked about killing himself regularly. He even mentioned methods. People laughed and said he was looking for attention, but I became anxious and overwhelmed, not knowing what to do. I felt like it was my responsibility to keep him alive. Eventually, I told an adult, who told his parents. He was put on suicide watch, saw a psychologist, and survived; he is now thriving. There is hope.

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This high school experience was traumatic for me and a major reason I became involved in suicide prevention. I participated in suicide awareness and prevention events, such as walks hosted by “ASK.LISTEN.SAVE” and “Out of the Darkness.” People began to realize they could safely talk about there mental health with me – that I would respond with empathy, not judgment.

One of my closest college friends, a member of the LGBTQ+ community, opened up to me about his own suicidal ideation. The LGBTQ+ community is disproportionately affected by suicide. People who identify with the community often suffer from bullying, rejection, and isolation; college, however, provided him with the community and resources to help him grow and flourish in his identity as a gay man. He is doing well. There is hope.

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After I left college, another friend opened up to me about his suicidality. He had been sexually assaulted and was experiencing PTSD and depression. He planned his suicide, but his brother intervened to save his life; he no longer suffers from his mental health issues. And, for over a year now, has been thriving in a new career with a fresh outlook on life. There is hope.

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I went to an eating disorders treatment center to help me recover from anorexia nervosa. This treatment center had inpatient, residential, partial hospitalization, and intensive outpatient programs. I began my stay in residential treatment, alongside inpatient patients. Spending 24 hours a day seven days a week with a community of people to whom I could relate and who understood my struggles, I quickly became very good friends with many of the other patients. As an empathetic person, this was devastating for me.

Knowing the heightened risk of suicide among people struggling with eating disorders, the treatment center staff proactively reduced our exposure to lethal means. We couldn’t have safety razors, scissors, or even metal clips on our pens. (In fact, one time we went into lockdown when a kiddy-scissors went missing from the art room.) These preventive measures did not, however, stop people from trying. It was scary and painful to see. I can recall the noises that accompanied some attempts and the rush of staff to intervene; they got there in time. There is hope.

When I graduated into partial hospitalization and had access to my phone, I was the only person aware of a friend’s plan to die by suicide. She was at uniquely high risk for suicide due to mental health struggles (depression and an eating disorder) and being a member of the LGBTQ+ community. I called the police, and thank goodness the police and I got to her before she could execute her plan. This experience haunted me for years. I can still see the flashing lights and hear the sirens when I think about it; I also, however, get to see pictures of her smiling and living life with loving relationships and joyful experiences. There is hope.

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I have also struggled with suicide ideation. This is not surprising given my struggle with mental illnesses, including depression (i.e., biological), and my survival of traumas (i.e., environmental and social), including those listed above and a handful of very abusive relationships. Luckily, I knew the likelihood of surviving an attempt, and there were people in my life who knew how to intervene; I no longer consider suicide. There is hope.

My story matters, and your story matters. It matters that we share our stories when we feel safe to do so. It matters that we fight stigma and encourage people to get the help they need and deserve.

Relationship with eating disorders

As mentioned above, suicide disproportionately affects some communities more than others. For example, suicide is more likely among people who struggle with mental illness (e.g. depression, eating disorders), people who have marginalized identities (e.g. LGBTQ+ people), and people who have experienced trauma.

At about 10%, anorexia has the highest mortality rate of all mental illnesses, and one-fifth of anorexia deaths are by suicide.

And, it is not just anorexia. There is an increased risk of suicide for all eating disorders that have been included in the research. Many people with eating disorders also struggle with substance abuse. People who struggle with both an eating disorder and alcohol-dependence are at a higher risk of suicide.

If you need help with an eating disorder, call the Helpline (800) 931-2237 or use the “click to chat” function, or text NEDA to the Crisis Text Line at 741741.

Warning signs and risk factors

In addition to belonging to a vulnerable group of people who struggle with mental illness, who are part of marginalized communities, and/or who have experienced major or multiple traumas, there are many other risk factors and warning signs indicating who may be considering suicide.

Warning Signs

• Talk of killing themselves
• Talk of hopelessness
• Talk of being a burden
• Talk of not having a reason to live
• Talk of feeling trapped
• Talk of unbearable pain (emotional or physical)
• Substance abuse
• Researching suicide methods
• Acquiring a gun
• Isolating
• Changes in sleep patterns
• Changes in eating patterns
• Changes in libido
• Changes in school performance
• Inability to think clearly or concentrate
• Giving away important possessions
• Saying goodbye to people
• Aggression
• Fatigue
• Depression
• Anxiety
• Rage
• Mood swings
• Fear of weight gain/concern with appearance
• Loss of interest
• Increased irritability
• Shame
• Risky behavior
• Sudden relief

Risk Factors

• Brain chemistry
• Low self-esteem
• Depression
• Anxiety
• Schizophrenia
• Personality disorders
• Substance abuse, including alcohol abuse
• Isolation
• Chronic or acute physical pain or illnesses
• Access to firearms
• Stigma
• Lack of access to mental healthcare
• Chronic or acute stress or social pressures
• Feelings of hopelessness
• Exposure to another suicide
• Previous attempts of suicide
• History of trauma, including childhood trauma
• Family history of suicide

Prevention

There are many ways that you can help prevent suicides. The Suicide Prevention Lifeline provides five steps to prevent suicide: Ask, Keep Them Safe, Be There, Help Them Connect, and Follow Up. I want to highlight three of these: Ask, Keep Them Safe, and Help Them Connect.

Ask

If someone you care about is showing warning signs or is at risk for suicide, it is so important to ask: “Are you considering killing yourself?” Give them an inviting, stigma- and judgment-free opportunity to share their story. If they do open up about suicidal ideology, connect them with professional help. Asking someone if they are suicidal does NOT make them more likely to consider suicide; talking about suicide is proven to save lives.

Keep Them Safe

Reduce your loved one’s access to highly lethal means. In 2017, firearms accounted for more than half of completed suicides. It is crucial to prevent access to guns when somebody is undergoing a crisis.

Extreme Risk Protective Orders (ERPO), which are sometimes problematically called “Red Flag Laws” by the media, are a very useful tool in preventing suicides. ERPO allows families and law enforcement to ask a judge to temporarily prohibit an at-risk person from purchasing or possessing a firearm.

At the time of this writing, 17 states (California, Colorado, Connecticut, Delaware, Florida, Hawaii, Indiana, Maryland, Massachusetts, Nevada, New Jersey, New York, Oregon, Rhode Island, Vermont, and Washington) and the District of Columbia have some form of an ERPO law. If you live in states without ERPO, encourage your legislators to pass it. It has already saved many lives.

Help them connect

Luckily, with broader Internet accessibility and a reduction of mental health stigma, accessible resources for people who are struggling with thoughts of suicide and their loved ones have become increasingly prevalent.

Emergency

As always, in the event of an emergency, call 911. Don’t hesitate. This is a valid way to save a life.

Talk to someone

Crisis Text Line – Text HOME to 741741
Suicide Prevention Lifeline – 1-800-273-8255 (TALK)

Find professional mental health support

• Mental Health America – B4Stage4 – Where To Get Help
• Psychology Today – Find a Therapist
• TWLOHA – Find Help Tool
• If you have health insurance, your health insurance’s website

Learn more about suicide and suicide prevention and read stories of solidarity, hope, and recovery

• American Association of Suicidology
• American Foundation for Suicide Prevention (with Out of the Darkness community walks)
• Mental Health America
• National Alliance on Mental Illness
• National Institute of Mental Health
• The Mighty
• The Trevor Project
• To Write Love On Her Arms

Remember, there is a huge list of intersecting risk factors for suicide. Thus, although suicide is preventable, if you have lost or do lose someone to suicide, it is not your fault.

Let’s fight the stigma and continue to talk about suicide! Let’s invite people to share their experiences, separate them from lethal means, and help them gain access to professional help without feeling judged or unsafe. Let’s help people survive and even thrive.

And, as reminded by TWLOHA, you matter, your story matters, tomorrow needs you, you are already enough, and you make today better. Stay.

You Make Today Better is a campaign of To Write Love On Her Arms. I do not write for or have any affiliation with this organization. I support their work to prevent suicide prevention, but this post may not reflect all of their views.

If you or a loved one is considering suicide, get help! You can call the Suicide Prevention Lifeline at 1-800-273-TALK (8255). If you are experiencing a mental health emergency or crisis, call 911.

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The information above about the intersection of eating disorders and suicide was shown in the following research articles:
Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with Anorexia Nervosa and other eating disorders. Archives of General Psychiatry, 68(7), 724-731.
Papadopoulos, F. C., A. Ekbom, L. Brandt, and L. Ekselius. “Excess Mortality, Causes of Death and Prognostic Factors in Anorexia Nervosa.” The British Journal of Psychiatry 194.1 (2008): 10-17.
American Journal of Psychiatry, 166(12), 1342-1346. DOI: 10.1176/appi.ajp.2009.09020247
Crow, S. J., Peterson, C. B., Swanson, S. A., Raymond, N. C., Specker, S., Eckert, E. D., & Mitchell, J. E. (2009
The National Center on Addiction and Substance Abuse (CASA) at Columbia University. Food for Thought: Substance Abuse and Eating Disorders. The National Center on Addiction and Substance Abuse (CASA) Columbia University; New York: 2003.

The information above about warning signs and risk factors was compiled from the following resources:
– AFSP: Risk Factors and Warning Signs
– Suicide Prevention Lifeline: We Can All Prevent Suicide
– NIMH: Warning Signs of Suicide
– NAMI: Know the Warning Signs