As the coronavirus crisis and its impact on social, cultural, and economic activity wears on, mental health needs are increasing. Mental health providers are receiving frequent inquiries for new clients and in many cases, the mental health conditions of existing clients are worsening.
The uncertainty created by this pandemic can create or exacerbate anxiety, depression, addiction, trauma, relationship problems, and more. Hopelessness and helplessness can increase, leading in some cases to suicidal thoughts and behavior.
In uncertain times, it is important to be aware of signs that loved ones might be thinking about suicide and to be prepared to offer support, guidance, and as necessary, connection with formal mental health services.
Here is an important fact about suicide: Fifty percent of people will have at least one period in their life where they think seriously about ending their own life. Let that sink in. One out of two people seriously considers suicide. Many are surprised to learn how common thoughts of suicide are, partially because of the stigma about talking about mental health conditions, especially in rural communities.
Consider those numbers. Think about the people in your life (spouse, children, parents, siblings, friends, community members) and imagine them feeling so overwhelmed that they think it would be better not to exist. This fact is important to understand, as thoughts of suicide, thoughts of feeling overwhelmed and hopeless are a common part of the human experience.
Importantly, however, suicidal thoughts do not need to lead to action. We must take these thoughts seriously (in ourselves and our loved ones) and intervene to find hope. If you are feeling hopeless and having thoughts of taking your own life, please know that you are not alone. You will need support and connection and typically, mental health treatment, to move beyond that hopelessness.
While thoughts of suicide are common, intent to and action towards taking one’s life are much less common. This is why awareness and intervention are so important. Once we understand that thoughts of hopelessness and even a serious consideration of suicide is common, we are better positioned to look for and intervene when loved ones are struggling.
Another important fact: those with access to lethal means have a much higher risk of completion of suicide. Because it only takes a moment to permanently end one’s life, access to firearms (which are common in rural areas and an important part of the culture and lifestyle), means that rural folks are at increased risk. (There are many other reasons that suicide is on the rise in farming communities, which we can explore another time).
So what do we do with this information? Do not “pull up your bootstraps” and carry on. Bring it out into the open!
Take any expression of suicide seriously. While thoughts of suicide are quite common (cross-culturally and across time and history), they must always be taken seriously. An expression of suicidal thought indicates that someone is feeling hopeless and cannot imagine the future being different from the present. We must help them find (and create) hope. When someone is feeling so depressed as to be suicidal, their brain is literally unable to see beyond the current circumstances/pain/stress/overwhelm, and loved ones and healthcare providers often must hold that hope for them until they are through the crisis. One of the most important things we can do is to be present in their pain and to work hard to understand what they are going through.
Do not dismiss statements or expressions of hopelessness simply because it is (statistically) unlikely someone will follow through. Too many do. Often, the difference between life and death is having another person express care, concern and support in a time of need.
Ask directly about your loved one’s meaning and intention. For most lay people, a mere mention of suicide brings up fear. This is understandable. Unfortunately, sometimes our fears or our own discomfort make us avoid difficult conversations.
Even many healthcare providers become alarmed and can inadvertently make a situation worse by reacting with their own strong emotions and being unable to sit with the pain of the person considering suicide. If you are worried about a loved one, ask “the suicide question.” Ask directly “Are you thinking about taking your own life” and listen to the answer. If they say yes, ask directly, “What do you plan to do?”
Most often, people with thoughts of suicide do not actually want to die. They simply do not have the ability to think beyond the present pain and often, they feel isolated and alone and believe that it would not matter (to others or the world) if they lived or died. They often feel their loved ones would be better off without them. Your presence and willingness to notice and share in their pain, to ask the hard questions, and to help them find resources to get better may keep them alive through a crisis.
If you trust that there is no imminent mental health crisis, offer to help in practical ways. When people are considering suicide, they are often so depressed or anxious that they cannot think well about how to solve problems (or even execute their “normal” life as they are accustomed to). Offering to take work or personal burdens off of someone’s plate can reduce the load they are carrying and help them find the clarity and emotional strength to keep moving forward.
An adult patient will need to set up their own health appointments (except in the case of a true emergency as described below), but an offer to help someone find appropriate mental health resources may be very useful. Navigating the mental healthcare system can be daunting even when not overwhelmed, and unfortunately, there is a real scarcity of high quality mental health services in most rural areas. Doing this legwork for someone who is in crisis might help to relieve their burden and offer needed direction and hope.
Remember that healthcare providers are bound by HIPAA confidentiality, and will not be able to discuss another person’s mental health care or needs with you directly without a signed release of information.
Good places to start include:
- Talk to your local primary care provider; they may be someone you already trust and therefore easier to talk to, and they will know the best local mental health resources
- www.psychologytoday.com (enter your zipcode to search for providers — you may need both a psychiatry provider (medication) and a therapist to work through behavioral change and current/past difficult life circumstances)
- 24/7 National Suicide Prevention Lifeline: 1-800-273-8255
If a loved one tells you they are actively considering suicide (or you have a gut feeling that they are), encourage them to call a crisis hotline or go to the nearest emergency room. If they are unwilling to do so, do not hesitate to call law enforcement.
Explain that you are worried about a suicidal crisis and would like support in getting your loved one to a safe place (typically a local hospital where they can rest and be kept safe so that they can get through the hopelessness and helplessness that make suicide feel like the only option).
It is natural to worry that your loved ones will be upset or embarrassed or angry at you. Oftentimes they are. You might worry if the situation is “really that bad.” It is important to remember that someone in a suicidal crisis is not able to think rationally or beyond the strong emotions in the present moment, and these calls save lives every day.
If you are reading this and considering suicide, you are not alone, though it may feel that way. Look around you and consider that half of the people you see around you may have had similar feelings. They may be just as good as you are at hiding it. Please talk to other people: family, friends, church or other community members, your banker, or a healthcare provider. Let others support you.
Human connection is one of the most important factors in overall well-being and working through mental health crises.
As always, if you are actively experiencing a mental health crisis, call 911 or go to your local emergency room.
In conclusion, emotions, even the strongest ones, do eventually pass. We must support one another through the hardest moments in life.
Dr. Lauren Welter is a licensed psychologist. She lives on a livestock and crop farm near Monticello, Iowa, with her husband and their children. Contact her through www.prairiehomewellness.com or call 319-975-8705.