National Suicide & Crisis Prevention Hotline: 988
May is Mental Health Awareness Month. The following is an excerpt from the textbook Connecting with Grieving Clients by Laurel Lagoni, MS and Dana Durrance, MA (see copyright below) and is being made available as a free resource for you and your staff.
Suicide Ideation
Although thoughts and comments about suicide are quite common, truly suicidal clients are very rare. Sometimes clients will say something like the following: “Life means nothing to me without Pepper. Sometimes I wonder why I should go on…” A remark like that is usually a normal reaction to loss. These comments are called suicide ideation. Suicide Ideation is simply an indication of the griever’s deep feelings of despair. Many pet owners draw companionship and emotional comfort from their pet. So, it is difficult for them to imagine what their daily routine will be like without their pet. Losing such a significant relationship can feel overwhelming.
Suicide Intent
On rare occasions, there may be suicide intent underlying a client’s comments about wanting to die. This means that a client may be seriously considering suicide. If you are concerned that a client has a suicidal intent, you may ask them. For example: “Joan, you’ve told me how devastated you are feeling right now, and I’m concerned about you. Do you really feel like you might harm yourself right now?” It’s important for you to know how to determine the difference between a normal grief reaction (suicide ideation) and a grief response that is abnormal or extreme (suicidal intent). You also need to know how to help in the latter situation.
Most people who attempt to die by suicide are ambivalent about the act. They don’t really want to die. They just want to find an end to their overwhelming feelings of pain and distress. A common myth about intervening with a person who is considering suicide is that if you ask people directly about their suicidal comments, you’ll somehow condone the act and encourage them to die by suicide. Yet the opposite is actually true. Open, honest discussions about suicide can lower people’s anxiety level. It can help them feel they are understood, cared about, and supported. It can even make the event less likely to occur.
Attending Someone with Suicide Intent
To attend to clients who verbalize suicidal intent, you need to find the courage to ask specific questions. These questions will be about how they feel and why they would want to die. During this conversation, you shouldn’t use euphemisms like “pass away” or “cross over.” Euphemisms indicate that you feel anxious talking about the subject matter at hand. If you are too anxious to talk about suicide, you won’t be able to help your client deal realistically with these feelings.
As with other situations in which you need to communicate with grieving clients, you’ll want to lay a foundation. Occasionally, a client who is preparing for suicide may bring one or more of their pets in for euthanasia. It’s very important to ask why your client is requesting that the animal be euthanized. Before you begin this conversation, it’s a good idea to structure your environment by asking your client to join you in a private, comfortable room where you are better able to talk and assess the situation. Treat this conversation as you would treat an emergency. Alert your staff to your change in schedule and, since pets can be a distraction, ask a staff member to remove the pet(s) while you speak with the client.
Implementing Support Techniques
Next, you’ll want to implement support techniques. Acknowledge every comment containing suicide ideation and take it seriously. Paraphrase what your client has just said, perhaps by saying, “It sounds like you can’t imagine life without Pepper.” Be direct and push yourself to ask the tough questions. Too many questions can make you sound nervous or like an interrogator. Simply say, “Mary, some of the comments you’re making concern me. Are you thinking of taking your own life now that Pepper has died?”
Most often your client will say (perhaps with some embarrassment or anger), “No, of course not. I’m just so upset — I didn’t want to lose him.” In this case, you can relax and be quite sure that your client’s comments represent a normal grief reaction. You might say, “I’m glad to hear that. We take these comments very seriously here, and I always feel it is my responsibility to ask people what they mean when they make them.”
However, if the answer is “Yes, I’ve thought about it occasionally. She’s all I have,” you will need to facilitate an intervention and/or referral by taking the following steps:
- Assess the lethality of your client’s situation (see below).
- Support your client through the immediate crisis.
- Refer your client to an appropriate mental health professional or social service agency or contact the appropriate crisis intervention resource yourself.
Finding Help
If you believe that your client is not in immediate danger, ask him or her to call a crisis or suicide hotline, a friend or relative, a family physician, a member of the clergy, or a therapist while in your presence. Should the client decline to reach out, you may choose to call one of these individuals on their behalf. Whenever you decide you must notify someone, always tell your client. Explain that if they are unwilling to make the call, you will make the call. If you say this in a firm, supportive way rather than a scolding or threatening manner, most clients will agree to your offer of help or decide to call someone themselves.
Where to Find Help
The best strategy to use if you encounter a truly suicidal client is to get help immediately. In most communities, professional help is not hard to find. There are suicide or crisis intervention centers staffed with well-trained people who can provide you with advice or debriefing. You can also always call 988 which is the 24-hour emergency number for the Suicide & Crisis Lifeline. This number can be used by the person who is having thoughts of suicide or to get help for someone else. In addition, most mental health agencies have a professional on staff who is authorized to hospitalize people on a short-term basis for observation and for their own protection. Many hospitals offer this service, too.
In some extreme circumstances, the most immediate resource you can get is the police. The rule of thumb regarding whether or not to contact law enforcement authorities is to do so only if someone makes a serious threat to do harm to self or others. This is the code most police officers use as a guide for intervening in potentially dangerous situations. When they learn that you are concerned about a potential suicide, the police may do what is called a welfare check. This means they will locate your client and either intervene to prevent a suicide that is taking place or interview your client further to make sure the danger of suicide is not imminent.
How aggressive you should be in connecting a potentially suicidal client with appropriate help depends in part on what is called the lethality of the situations (see below).
Assessing Suicidal Lethality
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Determine whether or not your client has a specific plan and how quickly they could put a plan into action. For instance, has your client collected medication and determined the dosage that would be fatal? Does your client now have the bottle of pills in hand, or would the client need to first obtain a prescription and then go to the pharmacy to pick up the medication?
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Assess whether or not the method your client has chosen has a high probability of quick success. For example, is your client planning to take pills that would be relatively slow-acting, or do they plan to use a handgun that is already loaded with ammunition?
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Ascertain whether or not your client is isolated and alone or lives in close proximity to someone who can help.
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If the danger level for your client (or others) is high, call the police and other professionals who can be of immediate help to you and your client. If you are talking to your client on the telephone, try to stay on the call while another staff member alerts the police and other appropriate resources.
Use Caution
When providing client support, some people attempt to make a contract with a suicidal client, insisting that a client agree to call them before carrying through with a suicidal plan. This is not a good idea for veterinary professionals. If a client calls you when the lethality of the situation is high, you may quickly be in over your head in terms of your training and capabilities. In addition, if you receive a call from a suicidal client, you may also be tempted to go to them in order to try to prevent the suicide. However, you should never go to a client’s house or attempt to rescue the client, no matter where they may be. There is always the potential for suicidal clients to turn homicidal, and your own life could be in danger if you attempt any kind of direct help.
Find Support for Yourself, As Well
The odds are high that you will never encounter a truly suicidal client. If you do, you should talk with a trained mental health or social service professional who can advise you about what actions to take and about who can also support you. Being involved in someone’s attempted or completed suicide can be emotionally devastating for you. If it happens, you need to take care of yourself and talk to someone about it. No one can assume responsibility for someone else’s life. You will need to be reassured that you were not responsible, either directly or indirectly, for your client’s death, or attempted death, by suicide.
Thank you for reading this important information. Though this article was originally intended to help veterinary professionals attend to clients who are in crisis, these same techniques are appropriate to use for anyone who is in a mental health crisis. World by the Tail, Inc. donates a portion of our sales of our Heart TouchStones each year to Not One More Vet, whose mission is to “transform the status of mental wellness within the profession so veterinary professionals can survive and thrive through education, resources, and support.”
Please be sure your staff is informed about resources and post the number 988 for the Suicide & Crisis Lifeline in your offices for quick reference. For more information and additional resources, visit the National Institute of Mental Health’s resource page on Suicide Prevention at https://www.nimh.nih.gov/health/topics/suicide-prevention.
Keep up the good work,
Laurel Lagoni
Co-Founder
World by the Tail, Inc.
