Interview: What should I say if someone I know tells me they're thinking of suicide?

When someone you know approaches you and hints that they’re thinking of suicide, what can you do? How should you respond? Can talking about suicide plant the thought in their head?

White Swan Foundation spoke to counseling psychologist Paras Sharma to understand more. Excerpts from an interview:

What can I do if someone I know says they’re thinking of suicide?
A few things need to be kept in mind when somebody shares that they’re feeling suicidal. I think it’s better to start off with what not to do.

Whenever somebody shares that they’re feeling depressed, low or suicidal, generally the approach people take is to use the language of fear, shame or guilt. Fear by saying, "If you talk about things like this, I’ll go and talk to your family about it." or, "I’ll go and tell so-and-so about it." So, people feel this may not the right place for them to share something. 

When we talk about guilt, we are implying, "What has happened in your life that you’re coming to feel this way?" The person starts feeling that they are wrong to feel that way, or wrong to share it with someone else.

The worst of the three is shame, "How can you even say something like this?" "How can you be so weak? Are you that immature, are you that inconsiderate?" "Do you not care about your family? Do you not care about the impact this will have on everybody else?"

Shame makes them feel that not only are they doing something wrong, but there's also something wrong with them. And they think that all that's going wrong with their life is because there’s something wrong with them, and the world will be a better place without them.

How can I talk to them in a sensitive manner?
What to do comes from what you should avoid.

Avoid the language of fear, shame and guilt. Talk with sensitivity and ask the person:

• How they have been feeling

• How long they have been feeling this way

• What has helped them

• What has not helped

Ask them what kind of help they want from you. Don’t assume they want you to solve their problem.

Sometimes, they may want you to just listen to them. They may just want somebody to assure them, for the time being, that there are ways out of it. So you don't have to take the responsibility of solving somebody's problem or giving them the answers; because quite often there aren't any answers, and somebody's just looking at companionship through that difficult time. So being a good listener and being a good friend is what you need to do. 

If I ask someone whether they’re thinking of suicide, will I be putting the thought in their head?
That's a very common myth — that if you talk directly about suicide, you can introduce the idea in the person's head. Now, you can influence the preventive side of things, but influencing  the causative side of things is very unlikely unless you are actively aggravating the thought by making somebody feel ashamed or making somebody feel guilty about sharing this thought with you.

It is a burden in the sense that it's not easy to listen to somebody's stories. As a mental health professional myself, it's not easy to listen to somebody's story of how they're having thoughts of suicide. But I think we need to understand that there are limitations to what we can do, and we need to only take on that much. We don't have to take on the responsibility of solving the issue. The responsibility at that time is to listen, and understand how long they have been feeling this way, if they have just been feeling this way, or they've actively been thinking or planning about acting on these thoughts, or if there's already been an attempt made. That's the level of work you need to do. You just need to understand how intense, how frequent and how actionable these thoughts have become for the person, and based on that it's your job to connect them to the appropriate resource.

It's not your job to be that one stop for everybody. Even as a mental health professional, I’m not the one-stop solution for everybody. I may connect them to a trusted family person, I may connect them to a trusted friend, I may connect them to another professional for medical treatment, I may need to refer them out to another organization also. So it's never a one-person job. So while it feels like there is a lot of burden, you need to realize your own limitations and be upfront and honest about that.

If someone I know is considering suicide, can I share the information with someone who I think can help?
I think the law is very clear on this right now. We have a Mental Healthcare Act which clearly talks about what is confidential information, what is not confidential information, what can you share, and what can't you share. So whether it's counseling ethics or the Mental Healthcare Act, it's pretty clear that when somebody talks about harm to self or potential harm to others, it's okay to disclose as much information as is needed to save the person's life. The first person that the Mental Healthcare Rct recommends that one should talk to is a nominated representative.

A nominated representative — as mentioned in the Act— is a legal definition. But ethically, it would be advisable to tell the other person that you won't be able to keep the information just between the two of you and ask them to nominate someone you can speak to.

If the person does not agree to nominate a representative, then a trusted family member or a trusted colleague in the organization can be told about it.

You can only disclose as much as is needed to save the person's life. So if somebody is telling you that they are feeling this way, that and only that is what you are supposed to share. You are not supposed to share the entire background of what you know, or your conjecture about why they must be feeling this way; all of that goes into the domain of confidential knowledge. But you can say I have reason to believe that the person is feeling this way, and I'm just bringing it to notice so that something unfortunate does not happen ahead. That much is okay.
 

What is the involvement of the person who is having thoughts of suicide in the gatekeeping process?
It's ideally supposed to be a joint process. The person is supposed to tell you who they are comfortable sharing with. The choice of whether or not someone should be informed is not there. But whom to tell — that is a completely choice-based decision, you know.

The person can decide to nominate a friend and not a family member. They can decide to nominate a family member and not their spouse. They can nominate a colleague and nobody else. Or they can tell family but not an organization. Who this information is shared with depends on the person's wish. As far as possible, it should be collaborative. But if you feel that you may not have the time to get that consent from the person, an informed breach can be made.
 

What is an informed breach?
An informed breach is essentially when you let the person know that you're concerned for their safety, and therefore you will have to tell someone about what they've shared with you. Even if it's a breach, the best thing would be to make an informed breach. But that should be used as a last resort. As far as possible, collaborate with the person and again, not using a language of fear, "Now you'll have to tell me who I can contact."

The explanation has to be pretty clear that one person alone can't be of help. And that you need to know who can reach them in case of crisis. Letting them know that you may not be the person who can do that. 

So generally when I explain to a client that I need an emergency contact, I am saying very clearly that this is the person who will be able to reach them immediately. I'm not saying that this has to be the person they trust the most; I'm not saying this has to be their best friend or a family member. I'm explaining very clearly that the sole purpose of this nomination is to identify if somebody who can reach them in person immediately and help them tide through that time where they might be feeling extremely vulnerable.

So as far as possible, this is an answer that the person themselves can give. But if there is no other option, you can go ahead and share it with somebody who will be able to prevent this from happening. So if it's at the workplace, somebody senior at the workplace who can intervene and have a conversation; if it's somebody who's saying this when they're at home, somebody in the family can be told about it. If nothing else, contact an emergency service, a helpline, or if needed, a legal authority like the police can also be informed  — but then again, as the very last resort.