You Are Needed...Reducing the Risk of Suicide at JMU
Any member of the JMU campus community may come into contact with a suicidal student. Being aware of distress signals, ways to intervene, and sources of help for the student can help you respond more effectively to such situations. Saving the life of a student might come down to you having the right knowledge and being available in the right place at the right time. The psychologists and counselors at the CSDC are available to students, faculty, and staff for consultation regarding these issues.
How You Can Help:
- Know the warning signs of suicide
- Familiarize yourself with the facts about suicide
- Follow the our suggestions to C.A.R.E.
Suicide Warning Signs
To help you develop some of the knowledge and skills you'll need to help suicidal students, let's begin by reviewing twelve warning signs that might tip you off that a student is thinking about taking his or her own life.
- Talking about committing 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 commit suicide. A student who has developed a plan to commit 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 commit 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. Depressed and suicidal students 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, since the world of a suicidal student tends to get more and more limited, more and more constricted.
- 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.
- 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 commit suicide give some indication of their intentions.
Myth: Suicidal people want to die.
Fact: Suicidal people 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 suicidal feelings, 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 committing 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 suicidal person.
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 suicidal student (i.e., everyone) know what to do in such circumstances.
C.A.R.E. - Suggestions for Helping A Suicidal Student
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 you 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 you are paying attention. Maintain eye contact, don't interrupt, and nod when appropriate. Also, check out your understanding of what the student is saying. You might say something like, "Let me see if I understand . . ." and then paraphrase for the person what you've heard them say to you.
- 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 you. Remember, your primary goal is to have the person openly share thoughts and feelings with you so that you can better understand his or her situation and secure needed help.
- State directly that you care about the person. Talk about your feelings and your concerns. You 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 you 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 Frankly About Suicide
After telling and showing the person that you care, the next thing you need to do to help a potentially suicidal student is to ask about suicide. In the "Suicide Myths" section of this web site, you 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 you ask calmly and directly about suicide. Your frankness will communicate to the person that you care and that it is safe to talk about this "taboo" subject with you.
- 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 CSDC/Varner House
Once you've asked about suicide and the person confirms that this is, indeed, a concern, you then enter the third part of the C.A.R.E. process. Your goal now is to get them into the hands of a mental health professional. For most students, the best initial referral option is JMU's Counseling & Student Development Center. Located in Varner House by the statue of James Madison, the CSDC provides a variety of free, confidential services to assist a suicidal student and others who are concerned about him or her.
You 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 CSDC/Varner House right now."
- Remember, your role is not to take on the person's problems or to provide counseling.
Your primary goal should be to get the suicidal person into the care
of the mental health specialists in Varner House. Here's how:
- Call the CSDC at 540-568-6552 between 8 am and 5 pm, Monday through Friday, or come to Varner House. To ensure a quick response to these types of emergencies, the CSDC reserves a limited number of crisis hours each day on counselors' schedules.
- 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 CSDC on-call counselor.
- Public Safety should also be your first call when there is imminent risk of harm to the person for example if he or she is intoxicated, violent, or unconscious.
- Do not leave the person alone. JMU faculty, staff, and students often escort students in crisis to the CSDC to provide comfort and reassurance, and this type of support is critical with acutely suicidal students. It is also important to remove firearms, drugs, sharp objects, and anything else that could be used in an impulsive suicide attempt. However, if you feel in danger of being harmed by the person, leave the area and call Public Safety at 540-568-6911.
- Let the individual know that CSDC services are free and confidential. Suicidal students are often concerned about the cost of receiving crisis services and, even more commonly, about who will know about their situation.
- 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 your follow up support may help to get the person over this initial hurdle.
- Do not fall into the "confidentiality trap". Once you believe that a student is at risk of committing suicide, you 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, you must relay information about the situation to the CSDC, Public Safety, Residence Life, or some other responsible professional party. One helpful strategy is to point out the bind in which the suicidal student is placing you. You 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 you do, do not keep a secret that may cost a life.
- If the person refuses to seek help, contact the CSDC, Public Safety, or Residence Life. If all else fails, you may have to take a more assertive, even authoritarian, approach. You 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." If the situation occurs during a weekday, you should call the CSDC or come to Varner House and ask for assistance. After normal working hours and on weekends, you should contact Public Safety.
E - Encourage Hope for the Future
Now that you have expressed your 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. Suicidal people 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 suicidal people see them as true and unchangeable. Your 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 your 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 being suicidal, you 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, religion, 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 emotional pain of a suicidal person.