Patient one is visiting his Family Doctor for a routine visit, which begins with some friendly chatting: “What have you been up to Joe?”  “Oh, being lazy, just sitting on my front porch looking at the bridge.” “You mean the Zilwaukee Bridge? What are you thinking about when you look at it?”  “Oh, I’m going up there to jump off.” “Joe, we’d better get you to a Psychiatrist.”

Patient two comes to the ER with a fractured ankle.  He gets excellent care. His fracture is reduced, casted, and he is sent home, where he hangs himself two days later.  The fractured ankle happened because the rope broke during the first suicide try. Unlike the Family Doctor above, the ER doctor didn’t ask the right questions, and the results were tragic.

Suicide rates are skyrocketing in our society today.  If your friend or family member has not been affected by suicide, it is likely that this will happen at some point, and the results can be devastating for all involved.  

There are still unknowns about the factors that lead to suicide, but it is becoming clear that thoughts of ending one’s life are more common than we think, and that they can occur even in young people.

We do know there are certain risk factors that are red flags; making an individual more prone to suicide.  These include, of course, depression, but also any stressor at all, even childbirth. Included are loss of job, loss of a spouse or other loved one, loss of independence (as for senior citizens), financial setbacks, and PTSD.  Other triggers are knowing someone who has suicided (even a favorite celebrity), problems in school (including bullying), breakups with girlfriend or boyfriend, or school failure.

There may be no obvious signals.  Many, many suicides surprise friends and family, and you can imagine the amount of guilt those friends and family feel that they somehow failed their loved one.  The fact is that some suicide victims will not readily telegraph their intentions even if asked. It is therefore important for friends and loved ones to consider that this is a possibility when a person starts appearing or acting differently in any way. I believe that the Family Doctor in the opening paragraph detected a subtle change in his patient’s mood, which is why he pressed the issue of the bridge.  So, when we ask someone “How ya doin?” and they say “Fine,” obviously that is not enough. We need to follow-up with “No, seriously,” creating a safe space for the patient to be open and honest. 

Suicidality or the merest suspicion of it can be a medical emergency, on the same level as left-sided chest pain or numbness in the arm or leg.  A stroke, a heart attack, a suicide; the end results could all end in death.  

If you are concerned, there are simple questions you can ask.  Doctors use a general depression screening called the PHQ-2, which has two questions:

  1.  Have you been bothered by having little interest or pleasure in doing things?
  2. Have you been bothered by feeling down, depressed, or hopeless?

Depressed people WILL answer these questions.  A more direct question would be:

Are you thinking of harming yourself?

It may take some courage to look a loved one directly in the face and ask such questions.  I have done it…more than once, and I’m glad I did.  

Then, and this will take more courage…if you get anything but a clearly negative response, some sort of action is required.  If you believe that your loved one is contemplating suicide, then you must either: call a suicide hotline, involve other friends or family, reach out to medical or mental health professionals, or all of the above.  Obviously, you would not leave that person alone if you thought that there was an imminent risk of suicide, and access to means for it such as firearms or sleeping pills. 

THRIVE and others, all around our region, are taking steps to address mental health and well-being, from recruiting more mental health professionals, to educating doctors, teachers and caretakers, but they cannot do it alone.  It should be obvious that, with a problem where the signs and symptoms can be so subtle, EVERYONE, including YOU will need to get involved in order to ensure the life and health of your loved ones.