How Do I Support Someone Who Is Suicidal?

If you are concerned about someone's safety, there are several ways to get them connected to services in Virginia.

Immediate Safety Issues

If there is an immediate concern for safety, ask them if they are willing to go to the local hospital emergency department for an assessment. If they will go voluntarily to be evaluated, it makes the entire process a lot smoother. There are professionals at the hospital that provide risk assessments and will refer them to services. If they will not go voluntarily, your primary goal is to get professionals involved to ensure their safety.

• Immediate Safety Concern - The best predictor of someone attempting suicide is them making a direct threat about killing themself. That coupled with previous suicide attempts, and a lack of protective factors increases the risk substantially. If someone threatens to kill themself or you are worried about someone's immediate safety, call 911. Don't try to evaluate their intentions or decipher if they "really" mean it. Don't try to predict the likelihood that they will actually do it. Don't dismiss it as a "cry for attention." Call 911. The police will arrive and determine the best course of action depending on the situation. It's better to have someone alive and mad at you believing you "overreacted" than regretting not acting at all. Don't fall into the secret keeping trap. If they share something with you that needs to be addressed, do something about it. It stopped being private once immediate safety became an issue.
  

• Local Magistrate - If the police do not witness anything concerning or if the person is not cooperative and denies safety concerns, the police are limited in what they can do unless the local magistrate gets involved. If there is a probable cause that someone dealing with a mental health issue is an immediate danger to themself, someone else, or cannot care for themself, you can provide this information to the local magistrate who can issue an Emergency Custody Order (ECO). That gives the local police 8 hours to locate and transport the individual to a crisis evaluation by someone from the local Community Services Board. If the individual meets criteria for involuntary hospitalization, they will be held for 72 hours for evaluation, observation, and treatment.
  

Non-Emergency Situations

It's more likely that you encounter concerning behaviors or suicidal statements that aren't an immediate safety concern. Someone may share with you that they think about death and would be relieved if they could "escape" or "not wake up." They deny wanting to kill themself and have no history of suicide attempts. Hearing about these kind of thoughts is scary. However, they are often a byproduct of something else (e.g., the stressful situation, the amount of pain or distress the individual is feeling, or related to something else like the side effect of a medication. The vast majority of individuals who have suicidal thoughts do not ever attempt suicide. Not everyone with suicidal thoughts needs to be transported to the hospital for evaluation. However, there are things we can do to support them and services that can help.

• Welfare Check - Sometimes you are really worried about someone's safety but you aren't sure if it is a crisis or you aren't in a place where you can stop by and assess the situation. You just want to know that the other person is ok. You can call the police for a welfare check. Let's say you have plans with a friend who cancels last minute, which isn't like them. The last message they post on social media is cryptic, "I don't see the point. Everyone would be better off if I was gone. " Despite your best efforts, you can't reach your friend and confirm they are ok. You might be out of town, at work, or unable to locate them. To initiate a welfare check, contact your local police non-emergency number and tell them the details about who you are worried about, why you are worried, and other details like description, address, etc. They will send an officer to the location to check in on the person. If the person is injured or in a mental health emergency, they will contact EMS or transport them to the Emergency Department at a local hospital. The police dispatcher may call you back with an update about the situation.

  
  

• Counseling Services - Just because you are offering support, doesn't mean you are their counselor or responsible for keeping them safe. If you have the capacity, you can continue supporting them by connecting them with counseling services. Ask them if they are in counseling. If they are, have them reach out to their clinician. They may be able to consult or schedule an earlier appointment. If they are not, would they like your help connecting with a clinician? Anything you would be willing to do to help could be appreciated (e.g. calling to see who is accepting new clients, identifying providers who accept their insurance, etc.). You can also contact your local Community Services Board and ask them what hours they have for walk-in assessments.
  

• 988 - Is a suicide and crisis hotline that individuals can call, text, or chat. Some people use it late at night when everyone is asleep or when no one in their support system is available to talk. Others prefer to use it over interacting with their friends or family because they don't want to worry others about them or be judged or criticized. Either way, it's available 24/7.
  

• Psychiatric Services - Are they taking any medication for these issues? If so, you can ask some follow up questions - Are they taking it regularly, do they need a refill, do they have enough medication? Suggest that they contact their prescriber and provide updates about their symptoms to see if recommendations can be made over the phone or if they can get a sooner appointment. A lot of folks will say, "I have an appointment in two weeks." There is no reason to wait. Contact the prescriber before then, even if you know they are busy. If the prescriber doesn't hear any updates, they assume everything is fine.
  

• Tasks - Some people want to do something concrete for someone they know is struggling. They aren't sure how to help, but they can get stuff done. See if there is anything you can do for your friend that would be helpful. Do they need help completing tasks that feel overwhelming or difficult to complete? Do they need help paying bills, buying groceries, making an appointment, cleaning the kitchen, or mowing the yard? Not everyone is the most comfortable talking with people about challenging issues. There may be some others things you can do to help. Also, people may not know what to ask for if you say something like, "Let me know if there is anything I can do." It may be helpful for them to be presented with some options that they might not even think to ask for.
  

• Listen - You aren't their counselor and shouldn't try to be. However, you know and care about them which is just as important. Ask them how they are doing, what's been going on, what's changed, etc. Don't fall into the trap of trying to solve the problem, making it your problem, or trying to fix their mental health. Listen and offer support. Suspend judgments and criticisms and let them know that you are there for them. It is relieving for people to know someone out there knows what's going on and that they are available if needed.
  

• Consult - Helping people with their issues and listening to their problems is stressful. Consult with people in your life about how to navigate the situation. It may be helpful to consult with people and family who know them so that there is a complete picture of what is going on. Are other people concerned as you are? Do they know things you don't? It can be really validating to know that others are aware and may have suggestions. Brainstorming ideas with others can give you strategies you wouldn't come up with on your own. Check out our upcoming post on "How to Refer a Friend to Counseling."

If you or anyone you know could benefit from counseling services, complete the Contact Us form and schedule your free 20-minute consultation today.