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Jun 14, 2012

We Are Needed...Reducing the Risk of Suicide at JMU

Any member of the JMU campus community may come into contact with someone struggling with thoughts of suicide. Being aware of distress signals, ways to intervene, and sources of support for the student can help us respond more effectively to such situations.  Saving the life of a student might come down to us having the right knowledge and being available in the right place at the right time. The Counseling Center clinical staff is available to students, faculty, and staff for consultation regarding these issues.

How We Can Help:

  • Know the warning signs of suicide
  • Familiarize yourself with the facts about suicide
  • C.A.R.E.

Suicide Warning Signs

To help us develop some of the knowledge and skills we'll need to help students thinking of suicide, let's begin by reviewing twelve warning signs that might tip us off that a student is thinking about taking his or her own life.  For many individuals that are contemplating suicide, there may be signs.  This list is not exhaustive and the presence of one or two of these does not mean that someone is definitely contemplating suicide.  It does mean that we need to talk with them and show that we CARE.  

  • Talking about or making references to suicide. Some statements may be direct and declarative (e.g., "I'm going to kill myself"), while others may be more vague (e.g., "I don't know how much longer I can take this," "It won't matter soon," "Everyone would be better off without me"). All such statements must be taken seriously.
  • History of past suicide threats or attempts. All studies agree that one of the warning signs for death by suicide is a past suicide attempt and that the more serious and lethal the past attempt, the more serious the current risk.
  • Developing a plan and/or obtaining the means (e.g., buying a firearm, collecting pills) to complete suicide. A student who has developed a plan to complete suicide or collected the items necessary to carry out a plan should be considered at heightened risk for suicide.
  • Recent significant failures, rejections, or losses (e.g., ending of a relationship, family problems, death of an important person, financial problems, some traumatic event). The impending or actual loss of a romantic relationship seems to be particularly traumatic for many students, with feelings of being overwhelmed and distraught increasing the risk that students may act impulsively to end their emotional pain.
  • Helplessness/hopelessness (e.g., person may be unable to see a future without intense, interminable pain and suffering; nothing will get better, nothing will ever change). Students who see their life as an endless road of suffering that they can do nothing about are much more likely to think about taking an early exit ramp of their own making.
  • Impulsive, reckless, or risky behavior. Individuals who display such behaviors are more likely to act out on suicidal impulses. In fact, people who die by suicide are often described by those who know them as "wild" and "willing to do anything" and "the life of the party".
  • Changes in academic performance such as skipping classes, failing grades, falling behind, etc. A sudden worsening of school performance in which a typically good student starts ignoring assignments and cutting classes may indicate a student is in distress.
  • Abuse of alcohol and/or drugs. Research suggests that the abuse of substances plays a role in the majority of completed suicides, especially drugs that act as depressants (e.g., alcohol).
  • Withdrawal from people and previously enjoyed activities. Students struggling with mental health issues and/or suicide often isolate themselves, even from their friends and family. Even when they are in the middle of a group of friends, they may feel psychologically isolated and alone. Activities they used to enjoy no longer excite them.  As a result, their world may become more and more limited and confined.
  • Changes in eating patterns (e.g., loss of or increased appetite) and/or sleeping habits (e.g., insomnia or oversleeping). Changes in both eating and sleeping patterns are associated with mental health problems like depression and anxiety disorders that increase the risk of suicide.
  • Changes in personality (e.g., more noticeably sad, irritable, anxious, indecisive, apathetic, etc.). A sudden change in personality or dramatic mood swings in which a student becomes sullen, withdrawn, or angry without apparent reason may suggest that personal problems are overwhelming the person's coping abilities, with suicide seen as an option to end the distress.  Also of note, is a shift from being very down and isolated to the “life of the party.”  This may reflect the person’s sense that their pain (physical, emotional, mental) will be ending soon, as they have made the decision to attempt suicide. 
  • Has experienced the loss of a close family member or friend to suicide. Research suggests that suicidal behavior is much higher among people who have first degree relatives or close friends who have taken their own life through suicide.

Myths and Facts About Suicide

Myth: Suicide typically happens without warning.
Fact: Most people who attempt or complete suicide give some indication of their intentions.

Myth: Suicidal people want to die.
Fact: People struggling with suicide are typically ambivalent about dying and will often seek help immediately after attempting to harm themselves. Part of them desires to stay alive in the hope that their distress will end and their lives will improve in the future.

Myth: Asking people about suicidal intentions will "put the idea into their heads" and increase the risk of an attempt.
Fact: Asking direct, caring questions encourages emotional ventilation and shows that someone cares and is willing to help.

Myth: All suicidal people are depressed.
Fact: Depression is often associated with thoughts of suicide, but not all people who kill themselves are noticeably depressed. Paradoxically, an observed improvement in mood may be attributable to the person having decided to "solve" their problems by completing suicide.

Myth: There is no correlation between drug and alcohol abuse and suicide.
Fact: Alcohol, drugs, and suicide often go hand in hand. Even people who do not typically drink or use drugs may use substances shortly before killing themselves.

Myth: Suicide is most common around Thanksgiving and Christmas.
Fact: Research suggests that suicide peaks in the spring. The reasons are likely complex but seem related to heightened distress over the contrast between the awakening springtime world and the experience of a bleak inner life. College students may be especially vulnerable during this period due to the build up of academic stress.

Myth: Once someone attempts suicide, that person will always be “suicidal.”
Fact: If the person receives the proper support and assistance, he or she is normally able to manage life successfully and to experience no further suicidal action.

Myth: Mental health professionals are the only people who can help a person struggling with suicide.
Fact: Professional counseling is very important in reducing the risk of suicide, but nonprofessionals also play an important role in detection and early intervention. It is important that students, faculty, and staff who may interact with a struggling student (i.e., everyone) know what to do in such circumstances.

C.A.R.E. - Suggestions for Helping Someone Who is Struggling with Suicide

C - Show that you Care

  • Work to remain calm. It is normal for the topic of suicide to evoke anxiety and apprehension, even in experienced mental health counselors. It may help to remember that we are responsible for the process (e.g., assisting the student in seeking help from a professional), not the outcome (e.g., solving the student's problems).
  • Be a good listener. Listening to the student is more important than coming up with the "right thing" to say. Stop talking. Show that we are paying attention. Maintain eye contact, don't interrupt, and nod when appropriate. Also, check out our understanding of what the student is saying. We might say something like, "Let me see if I understand . . ." and then paraphrase for the person what we've heard them say to us.
  • Be non-judgmental. It is typically not helpful to debate whether suicide is right or wrong, moral or immoral, or to lecture the person on the value of life. These actions may cause the person to shut down and stop talking with us. Remember, our primary goal is to have the person openly share thoughts and feelings with us so that we can better understand his or her situation and secure needed help.
  • State directly that we care about the person. Talk about our feelings and our concerns. We might say to the person, "I'm concerned about you...about how you feel" or "You mean a lot to me and I want to help" or "I'm on your side...we'll get through this together." The person may not appear to appreciate or even hear what we say in the moment, but these statements may have an important and lasting impact in ways that are not immediately noticeable.

A - Ask Calmly and Directly About Suicide

In the "Suicide Myths" section of this web site, we learned that asking about suicide will not put the idea into a person's head but actually decreases the risk by providing the person an opportunity to talk about their distress.

  • "Has it gotten so bad that you thought about suicide/killing yourself?" It is important that we ask calmly and directly about suicide. Our frankness will communicate to the person that we care and that it is safe to talk about this "taboo" subject with us.
  • Ask follow-up questions, such as:        

"Have you thought about how you would do it?"
"Do you have access to what you would need to carry out your plan?"
"Have you ever tried to hurt or kill yourself in the past?"
"Are you able to see things getting better in the future?"

The risk of suicide increases if the person (1) has a specific plan and the means to carry it out, (2) has made past suicide attempts, and (3) feels helpless and hopeless about the future.

R - Refer the Person to the Counseling or Emergency Services

Once we've asked about suicide and the person confirms that this is, indeed, a concern, we then enter the third part of the C.A.R.E. process. Our goal now is to get them connected to a mental health professional. For most students, the best initial referral option is the JMU Counseling Center. The Counseling Center (CC) is located on the 3rd floor of the Student Success Center (SSC).  If the student is in imminent risk of suicide, the Sentara-RMH may be a better option.

We might say something like "Let's talk to someone who can help you feel better. . . Let's get in touch with the folks at the Counseling Center right now."

  • Remember, our role is not to take on the person's problems or to provide counseling. Our primary goal is to get the person into the care of the mental health specialists. Here's how:
    • Call the CC at 540-568-6552 between 8 am and 5 pm, Monday through Friday, or come to the 3rd floor of SSC. The CC offer emergency services throughout the work day. 
    • After 5 pm, over weekends, or when there is imminent danger, call the Office of Public Safety at 540-568-6911. The dispatcher will gather information about the situation and, if necessary, contact the CC on-call counselor.
  • Public Safety is our first call when there is imminent risk of harm to the person, including if the student is intoxicated, violent, or unconscious.
  • Do not leave the person alone. JMU faculty, staff, and students often escort students in crisis to the CC to provide comfort and reassurance, and this type of support is critical with those at higher risk of suicide. It is also important to remove firearms, drugs, sharp objects, and anything else that could be used in an impulsive suicide attempt. However, if there is a possibility of being harmed by the person, leave the area and call Public Safety at 540-568-6911.
  • Let the individual know that CC services are free and confidential. Students are often concerned about the cost of receiving crisis services and, even more commonly, about who will know about their situation.  In situations where a student is assessed to be at significantly high risk to attempt suicide the CC clinician may need to break confidentiality to ensure the safety of the student. 
  • Remind the individual that the decision to seek help is a courageous, mature choice. Because of the stigma that is still associated with mental health issues, people often mistakenly see going to counseling as a sign of weakness. To counter this belief, frame the decision to seek counseling as a mature choice which suggests that the person is not running away from their problems.
  • Follow up with the person after the appointment. The counseling process is often most difficult at the very beginning, particularly for suicidal students in crisis, and our follow up support may help to get the person over this initial hurdle.
  • Do not fall into the "confidentiality trap". Once we believe that a student is at risk of attempting/completing suicide, we must never agree to keep this information secret or confidential. The student may say, "You're making this worse than it already is," but despite any protest by the student, we must relay information about the situation to the CC, Public Safety, Residence Life, or some other responsible professional party. One helpful strategy is to point out the bind in which the student is placing us. We might say, "On one hand, you're expressing these serious desires to end your life, and on the other hand, you're basically asking me to ignore what you're telling me. Do you see the bind that puts me in? If you were in my situation, what would you do?" Whatever we do, do not keep a secret that may cost a life.
  • If the person refuses to seek help, contact Public Safety, CC, or Residence Life. If all else fails, we may have to take a more assertive, even authoritarian, approach. We might say something like, "When a person tells me things like you have today, I feel obligated as someone who cares about you to do all that I can to stop you from hurting yourself." 

E - Encourage Hope for the Future

Now that we have expressed our caring, asked about suicide, and referred the person to a mental health professional, the final step of helping a suicidal student is to encourage them to begin developing some positive expectations for their future. People considering suicide tend to share a common mindset that is characterized by overly negative views of the world, themselves, and their future. These include:

"I will never feel better, life will always be awful, I will always be in pain."
"I can't do anything to improve my situation. I am helpless and hopeless."
"I can't change my past, but I can't live with it either."
"I am so tired. I have to get some relief, some rest, an escape."
"I do not deserve to live. I contribute nothing. I am unlovable."
"I have no control over anything -- except this."
"I want to be missed by someone."
"I want someone to know how much I hurt."

These thoughts are often accepted without any challenge or debate, and thus the individual sees them as true and unchangeable. Our goal is to begin to help the person challenge some of these automatic thoughts and to instill some reality-based hope that the future will be brighter.

  • Don't debate the person about the right to die. In our effort to be helpful, don't argue with a student to try to convince him or her that suicide is wrong, immoral, or illegal. Because suicidal people frequently feel out of control in many important areas of their lives, they will often vigorously defend their perceived right to remain in control of whether or not they will continue living. Once the student feels that he or she can retain this power, they will often be more open to considering other alternatives.
  • Don't make statements that blame the student or dismiss the pain he or she feels. For example, in an effort to "snap" the person out of it, we may be tempted to say things like "You're just feeling sorry for yourself" or "Other people have a lot more to worry about than you do." These kinds of statements are likely to cause the person to shut down and withdraw.
  • Work to frame suicide as a permanent solution to a temporary problem. Remind the person that crises and problems are almost always temporary. Problems are solved, feelings change, unexpected positive events occur.
  • Offer alternative solutions. The intense emotional pain they're feeling frequently blinds suicidal students to alternative solutions to their problems. Alternatives include going to counseling, taking medication to reduce the acute distress the person is experiencing, and engaging in spiritual/religious practices.
  • Explore and reinforce the person's reasons for living. Reasons for living can help sustain a person in pain. Victor Frankl, a survivor of a Nazi concentration camp, noted that a person who has "a why" (a reason for his or her life) can live with almost any "how". Family ties, love of art or nature, spirituality, pets, and dreams for the future are just a few of the many aspects of life that provide meaning and gratification but which can be obscured by the pain of the person is experiencing.

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