Suicide prevention's front line: Family and friends

Although New Jersey has the country's third-lowest suicide rate (behind New York and Massachusetts), its numbers are on the rise, increasing almost 26 percent from 1999 to 2014, notes the New Jersey Department of Health. On average, one person dies by suicide every 11 hours in the state.

Peers, mental health specialists and clinicians at the New Jersey Hopeline (855-654-6735, njhopeline.com), the state's first suicide prevention hotline, operated by Rutgers University Behavioral Health Care, have been concerned with this uptick in deaths by suicide. "There remains a lot of stigma associated with people who seek help for mental health, which prevents them from getting the assistance they need," says William Zimmermann, the Hopeline's clinician supervisor. "We need to pay more attention to suicide prevention."

On the occasion of National Suicide Prevention Week (Sept. 5 to 11) and World Suicide Prevention Day (Sept. 10), Zimmermann discusses how individuals and communities can address the increase in suicides and aid in prevention.

Who is often the first line of defense in suicide prevention?

Everyone can participate in suicide prevention. Family, friends and acquaintances should be alert for signs an individual is contemplating suicide and take action.

A misperception is that suicides happen without warning. While this does occur, most of the time the person suffering has attempted to communicate his or her distress or plans to someone else. It may not be clearly stated, so asking direct questions about suicide [see below] can start the conversation and help-seeking process.

What are some signs that someone is suicidal?

Increased substance abuse, anxiety, agitation, difficulty sleeping or dramatic mood changes can indicate someone is at risk. A feeling of hopelessness and being trapped or having no sense of purpose can be warning signs. Social withdrawal, uncontrolled anger and reckless behavior also are causes for concern. Most importantly, if people talk about wanting to hurt or kill themselves, threaten to hurt or kill themselves or indicate they are attempting to find a method to kill themselves, seek immediate help or guidance by contacting a mental health professional or the New Jersey Suicide Prevention Hopeline, where specialists will listen to your concern and, together with you, develop a plan to get your friend or family member the help they need.

If you notice signs that someone is suicidal, what should you do?

Don't let it go and hope they aren't thinking about suicide. Ask them directly if they are thinking about suicide. You can say, "I care about you. Some of the things you've said or done have made me wonder. Are you thinking about killing yourself?" It's that simple.

If they say they are considering suicide, don't judge, don't deny and don't dare. Telling them "Don't say that" or "You shouldn't feel like that" will likely send the message that you aren't interested in continuing this important conversation. Saying "Oh, you don't mean that; you have so much to live for" shows you are not listening. Denying their perspective diminishes the likelihood of having them open up to you. Don't promise to keep it a secret. Get support for yourself and for the person talking about suicide. Personally, I'd rather have a friend angry at me than one who died by a suicide I might have been able to help prevent.

What are some public misperceptions on suicide?

At the Hopeline, callers sometimes express fear that asking directly about suicide will "put the idea in a person's head." This is a myth. Opening the topic for discussion gives an opportunity to share something painful that had previously been borne alone. It also provides an opportunity to intervene.

Also, viewing suicide as an act of aggression or revenge bears some clarification. Most people who die by suicide feel disconnected or that they are a burden to those closest to them. Their thinking gets distorted to the extent that they come to believe their death will somehow benefit those around them.

How can society reduce the stigma surrounding a person who seeks help for a mental health condition?

Education and open discussion are essential. The statistics show that each year, nearly one in five Americans will experience a mental health illness. Nearly three times more people die by suicide than by homicide in the United States, and for each death by suicide there are 25 attempts. That's over one million attempts a year. This is not a rare phenomenon or one that can be marginalized or relegated to discussion in academic journals. It's important that we have a public discussion.