I served two of my 20 years in mental health as a psychiatric screener for a major New Jersey hospital where I gained experience and insight too valuable to not share with as many people as I can. In those two years I interviewed many people in the throes of anxiety, depression, and suicidality. Our lives intersected on their worst day, and my charge was to discern if they met the legal definition of mental illness. When I determined necessity of involuntary commitment, I did so as a protector of people whose impaired insight and judgment rendered them dangerous to self, others or property. Stripping people of their right to remain in a least restrictive environment wore on me at times, but I did so under the protection of Good Faith Laws created to assure my patients and their families I acted in their best interest. The experience so molded me as a clinician that in my therapy practice at the Nutley Family Service Bureau, I experience hypersensitivity toward even the most vague expression of suicidal thought. Any one of us may interact with a friend or family member seized by their worst day, and they may express to us their suicidal ideations (thoughts). The following are questions we can use to engage, assess, and determine a course of action.
1. DO YOU HAVE A PLAN?
Assuming a loved one has already expressed to us a suicidal ideation, the above is a logical follow-up question, the answer to which denotes differences between contemplation and intent. A person who verbalizes a plan is further along in the suicide process. We do not always consider suicide a process, but it is. Depending on said plan, subsequent questions posed could be, Do you have a gun in the house? Have you been stockpiling medications? These questions are part of a dialogue necessary to keep a person engaged and connected, and to compile crucial information to pass along to a mobile crisis unit should a call be made.
2. WHERE DO YOU SEE YOURSELF IN 5 YEARS?
The purpose of this question is to establish hope for the future. Every person who completes an intentional suicide does so because he/she has lost hope for the future. When a patient to whom I have asked the above question tells me he has no future, or all she sees is black, I am alerted to profound hopelessness, and you will be too. Other patients have expressed hope to attain desirable jobs, college degrees or love. Those answers indicate hope for potential end to depression, and an improved quality of life. An expressed suicidal ideation is never to be taken lightly, but there are indicators as to who is more likely to make an attempt, or even complete one.
3. HAS ANYONE IN YOUR FAMILY COMPLETED A SUICIDE?
The answer to this question assists in establishing genetic predisposition to suicide that can be further proven through a blood test written about by Huffington Post Healthy Living Editor, Anna Almendrala. If your family member expresses suicidal ideation, you might know the answer to the question, but if it is your friend, you will want to gain as much information as possible in the event you are on site during a mobile crisis community outreach, or accompany your friend to an emergency room. This is information a psychiatrist and psychiatric screener will find valuable when determining treatment disposition, as it could result in orders for the aforementioned blood test.
4. WOULD YOU STILL WANT TO DIE IF YOUR CIRCUMSTANCES CHANGED?
I used this question often when assessing prisoners whose arrests and sentences caused acute suicidality. The answer helps determine presence of endogenous (biochemical) or exogenous (reactive) depression. If a loved one tells you she would want to live if she found a new job, wealth, or love, the possibility for recovery increases, and it is possible she would benefit from therapy to develop coping skills or initiate life change. However, if a person tells you life is pointless even under optimal conditions; hospitalization may be the more appropriate course of action.
5. DO YOU WANT TO GO TO THE HOSPITAL?
This question determines your course of action. If your loved one expresses suicidality, and agrees to visit an emergency room, you might want to accompany her for support, and be of assistance by providing all information gathered in your collateral role. However, if you are convinced self-harm is imminent, and your loved one refuses to go to the hospital, mobile crisis or 911 is your only option. If you can keep the person attended while the call is made, the process is easier. If the person leaves your company, alert 911 of potential danger, and provide your loved one’s address, and all the information you accrued. There is no room for guilt in this situation. Let professionals decide course of treatment as you rest on the knowledge you acted in good faith. If you call 911, you lose nothing. If you do not, you may lose a loved one. I remind you no expression of suicidality is to be underestimated.
Those are among the questions I have found most effective in determining where a person is on the suicide spectrum. I urge if engaging in this dialogue it be done in a conversational flow as perceptions of being interviewed could lead to defensiveness and disengagement; which is among the worst possible results.
Remember, you may be in the presence of a person during her worst day. Although it may feel helpful to use phrases such as I’ve been there or Things could be worse, they are not as helpful as a simple acknowledgement and validation of your person’s pain. Someone contemplating suicide does not believe things could be worse, nor does he care about your lowest point. The important thing is to remain connected, gather information and have the phone number for your county’s psychiatric screening center handy. Doing so may place you in the rarefied air of saving someone’s life.
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If you ― or someone you know ― need help, please call 1-800-273-8255 for the National Suicide Prevention Lifeline. If you are outside of the U.S., please visit the International Association for Suicide Prevention for a database of international resources.