Cycling through the peaks and valleys of severe Manic Depressive Disorder, Travis Wilt has experienced a number of moments where his life was out of control.
“I remember being so depressed that I found myself smashing a golf club against a cement wall,” he said. “The head of the club broke off, flew back and gave me a hematoma.”
His experiences with mental health have left him suicidal on a number of occasions, and he admits that identifying someone who is struggling can be very difficult.
“One of the scariest things is that sometimes the one with the biggest smile is the person dealing with the deepest pain,” he said. “It is important to know the signs and to be able to have a conversation that doesn’t focus on the generic, but is truly genuine. It’s the only way to let the other person know you are completely there for them at that moment.”
Changes in behavior over the course of time can be one of the biggest indicator that a person is struggling and may need intervention.
“The person is not functioning like they used to. They may have difficulty concentrating, mood swings, intense fears, appetite changes, sleep is disturbed and start risk-taking behaviors such as driving too fast, using drugs or alcohol or even harming themselves,” said Dr. Lindsay Sauers, of UPMC Susquehanna. “The range of intensity and behavioral shift can be an indicator that requires help.”
Suicide causes and drivers are usually complex, according to Dr. Justin Coffey, of Geisinger, but there are some warning signs that tell when someone might be at imminent risk.
“They may be talking about wanting to die and looking for a way to take their own life,” he said. “There may be talk about hopelessness, feeling trapped and dealing with an intense, unbearable pain.”
Coffey added that physical signs can include withdrawing socially from friends and loved ones, mood changes that are extreme for the individual and changes in sleep.
The feeling of helplessness can be one of the main predictors of suicidal behaviors, according to Sauers.
“Hearing that the person can not perceive life or circumstances improving should be a warning sign,” she said. “If the person starts to give things away and is saying goodbye, it can be an indicator that someone is considering ending his/her life.”
Having a plan to attempt suicide is another red flag that the person needs an emergency intervention.
“Having a plan is a warning in itself. Maybe they talk about using a gun or driving off a cliff or jumping off a tall building or taking a bunch of potentially dangerous pills,” said Dr. Anthony Ragusea, of Evangelical Community Hospital. “If you have concern the person is at a high level of risk, you don’t need to know for certain to take the next step. No one knows what that person is going to do except him or herself. If that person does make an attempt, will you be OK if you don’t do everything you can to get help?”
Addressing a potential suicidal person requires genuine communication — a heart-felt conversation where the person realizes you care and have their best interests at heart.
“Try not to think you are some mental health professional and there is some right or wrong way to engage. Be a concerned friend or loved one and come from that angle,” said Coffey. “Ask open-ended questions and statements, such as: ‘How are you doing?’ and ‘I’m concerned about you.’ There is no wrong way to get the conversation going. And in some cases, conversation isn’t even necessary — just being in the same space is a visual cue that shows you care.”
Ragusea warned that these conversations should not be judgmental — there should be some acceptance and understanding in the questions you ask, suggesting that you can start a discussion like this:
“Look, I’m worried about you. I know you just lost your job and it is a tough loss and you feel as though you can’t go on. You may feel like you can’t wake up in the morning and maybe think that people would be better off without you here, but I’m here to let you know that people care. I care. Have you considered taking your own life? Have you developed a plan? How can I help you?”
One of the biggest myths, according to all three doctors, is that bringing up these sort of questions will only plant more ideas in the person’s head.
“There is no evidence this is the case,” said Coffey. “Your job is to connect and show that you care — to be there for the person and let them know they are not alone.”
Making the call
Seeking intervention by emergency responders and mental health professionals may seem intrusive and some may fear making that call will cause the person involved to be mad — but if there is imminent danger, Ragusea said it is best to get help before something happens everyone may regret.
“They may be upset with you, but they can only be upset with you if they are alive,” he said. “It is better to be alive and upset with you than dead and not.
“Generally speaking, if someone is very seriously considering suicide, they will later appreciate the help you provided by intervening. They may not express it in the moment, but they’ll be thankful that someone cares enough to help.”
He also advises telling the person you are making the call and not covering it up or doing it unanimously in an attempt to continue being genuine and real with the person.
“You can say: ‘I’m concerned about you, and I’m not sure things are OK. I’m not qualified to make that decision, so I am going to call 911 so someone can come and talk. I care about you enough to be here and to be honest with you each step of the way.”
Calling 911 if there is concern of imminent risk is usually the best way to go, but Sauers admits there are a number of resources locally.
“Anyone can always call 911 and the dispatcher will direct you, but there is also a national suicide prevention hotline (800-273-8255) where counselors are available to speak with someone in distress, and the national alliance for mental health also has a helpline (800-950-6264),” she said. “Each county also has a mental health hotline and you can even use a new crisis text line if that is preferred.”
If a person is serious about suicide, typically he/she will have a plan, such as using a gun or taking pills.
“If you know what that plan is, take away the means as a way to help keep them safe,” said Ragusea. “You can say: ‘I’m going to stay with you, but I’m also going to take all the pills out of the cabinet and hold onto them until tomorrow. If you have a gun, I can hold onto it or take it to the police station to hold onto until things settle down.’”
“There is a stigma that people with mental health issues are different or can’t function or may be unpredictable,” said Sauers. “But the reality is that one in five adults will experience some sort of mental health issue in any given year.”
Caring for those who have suicidal feelings is no quick fix, Coffey added.
“Mental illnesses and those who are suicidal are treated differently than sprained ankles and broken wrists. It’s not like you can cast it and a few weeks later, it will be completely healed,” he said. “There is a longterm need for care and coping skills to manage these thoughts and feelings. Keeping a social connection and avoiding isolation is critical for each person — regardless if it is an adolescent, middle-aged adult or grandparent.”
An open social conversation would also help battle the shame of suicide, according to Sauers.
“The more people in positions of power who want to share their personal stories, the more acceptance there would be that this is an issue that affects everyone,” she said. “If they share their experiences, it paves the way for others to share their issues. If we can change the discussion around mental health, we can change the culture surrounding it.”
That change includes letting people know it is OK to struggle — and it is OK to seek help.
“When I was young, I thought therapy was crap,” said Wilt. “I figured it was someone who went to school for psychology, and who knows if the therapist has ever even really gone through something of their own. But, I learned just how important it is to just talk, to let out those feelings and be able to share them with someone safe. It can be very helpful.”