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Simple things you can do to help someone who may be thinking about suicide

This problem is bigger than numbers. It's people. It's moms, dads, kids, siblings, grandparents, friends, and partners.

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Sometimes it's hard to recognize if someone is depressed.

Suicide affects people across race, age, gender, and socioeconomic status. Quite frankly, suicide doesn't care.

More than 45,000 people died by suicide in 2020 alone, according to the Centers for Disease Control and Prevention. For people between ages 10 and 34, it's the second leading cause of death. While thousands complete suicide each year, an estimated 9.4 million adults in the U.S. had serious thoughts of committing suicide.

This problem is bigger than numbers. It's people. It's moms, dads, kids, siblings, grandparents, friends, and partners.

These are complex but treatable issues, and yet too often it's still considered taboo to discuss or speak frankly about suicide or mental health.

When a friend, loved one, or colleague appears to be suicidal, it can be hard to know what to do or say. But the numbers don't lie. Our silence won't slow this public health crisis; when it comes to helping someone in need, inaction is not an option.

Health professionals and people who specialize in suicide prevention say there are small actions you can take to help.

Here are some simple things you can do to help someone who may be thinking about taking their life:

1. Know what to look for.

Familiarize yourself with the warning signs. People thinking about suicide or self-harm may talk about feeling hopeless, trapped, or in incredible pain; withdraw from friends or family; experience drastic changes in mood; and/or increase their use of alcohol or drugs. Someone considering suicide may also talk or write about wanting to die. But the warning signs aren't always cut and dry.

"We tell people to look for changes," says Andy Cartmill, a trainer of suicide and intervention models and senior program educator with Addiction Services for Washington County, Oregon. "Trust your intuition. If you think something is up, there's no harm in being honest and saying, 'I just noticed a change. Are you doing OK?'"

2. Show support without judgment or anger.

Even if your friend hasn't reached out to you, check in. Let them know you care about them and you're concerned. This isn't the time to panic, argue with them, or even to try and talk them out of it.

"We tend to fix things and point out people's strengths and say, 'What about your wife?' 'What about your kids?'" Cartmill says. "It's possible they might not perceive those as strengths. So they very well might think, 'I'm doing my wife or kids a favor by relieving them of a burden.'"

Simply listen. And allow them to speak without judgment.

3. Ask specific questions.

If you're not sure if your friend is in immediate danger, the best thing to do is ask.

Individuals at the highest risk for suicide in the near future will often have a plan, the means to put the plan into action, a time frame, and intention. Asking questions will help you determine immediate risks, and the answers may inform what you do next:

"Do you have a plan to harm or kill yourself?"
"Do you have access to weapons or things you can use to harm yourself?"
"Have you thought about how or when you would do it?"
"Are you thinking about suicide?"

If you don't know what a statement or response means, ask for clarity. This may feel awkward or intimidating, but it's important to be direct and honest. And don't worry, talking about suicide won't plant the seed in someone's head.

"Research over and over again says that is not going to happen," Cartmill says. "That's one of the things people are afraid of ... 'If I ask that question, am I going to get them thinking about suicide?' and the answer is no."

4. It's OK to not know what to say.

If you're not a trained health professional or crisis counselor, this territory can be tough to navigate. It's OK to not have the perfect speech or talking points. It's first and foremost your job to listen and recognize they're hurting. That means not changing the subject or minimizing their pain.

"You don't have to be an expert; you really don't. Listening respectfully and being honest is OK," Cartmill says. "It's OK to tell people, 'What you're saying is scaring me. I want you to be OK,' and go from there."

5. Suggest professional help, or offer to help them find it.

This is not an effort to pass them off to someone else and instead aims to get them to a doctor or therapist better equipped to help with their pain. If they're seeing a professional, encourage them to get in touch with them immediately. You can even offer to accompany them to the appointment.

If they're not under a doctor or counselor's care, help them find a mental health professional or call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255). It's a free, 24/7 service that can provide people thinking about suicide and those who care about them with support and connections to local resources.

6. Remember, if it's an immediate or crisis situation, it is OK to use the emergency room.

If you wouldn't hesitate to call for a broken bone or allergic reaction, don't hesitate with suicide. In a true crisis, it can't wait.

Suicide doesn't care. But lots of people do.

Keep the number for the National Suicide Prevention Lifeline in your phone, 800-273-TALK (8255). In an emergency, having that number handy for yourself or someone you care about may make all the difference.

Even talking about suicide or suicidal ideation may seem overwhelming or scary, but experts agree: Hope and recovery are possible. There are many treatment options available, with several at low or no cost. It starts with paying attention to warning signs, reaching out, and getting help if you need it.

This article originally appeared on 04.12.17

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A guilt-free, doctor-approved guide to indulging when you need it.

Seriously. Doctor's orders.

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Self-care is a term for the things we do for ourselves to manage stress and to maintain or improve our health.

But we're diverse people from all walks of life, so self-care naturally means something different to each of us. In recent years, the self-care conversation has attracted everyone from fitness trainers to spiritual coaches to activists.

But what might an actual health expert have to say about self-care?

Meet Stuart. That's short for Dr. Stuart Lustig, M.D., M.P.H.

Lustig harvests greens from his backyard garden on a sunny day in San Francisco, California. Photo by Maz Ali/Upworthy.

Lustig is a psychiatrist for children and adults and supports doctors all over the country. Self-care, as you might guess, comes up in his work pretty frequently, for all sorts of reasons and for both patients and health care professionals. Over the years, he's stood by one piece of advice when it comes to self-care and stress management: "Have a PLAN for yourself."

PLAN is an acronym representing the most basic components of a sound self-care strategy.

P is for a period of time.

Image via iStock.

"It should be regularly planned time that's yours alone to do what you want with it," he says. On most nights, for example, Lustig knows he can count on at least 30 minutes of relaxation once his kid's tucked in and his wife starts her own self-care rituals.

L is for a location.

Image via iStock.

Think of it as your "happy place." Have a few locations in mind that put you at ease and that are easily accessible and reliably there for you, whether it's your bedroom, your favorite café, your gym or yoga studio, or the nature trail just beyond your fence. One of Lustig's go-to places is his backyard, amid the beauty and abundance of his garden.

A is for an activity.

Lustig also happens to be a beast on the piano. Photo by Maz Ali/Upworthy.

"When we ask people, 'What's your activity?' we'll get responses like, 'brushing my teeth,'" he says. "Sure, that's good hygiene, but it's not long enough, and we kind of have to do that. Or we hear things like, 'going on vacation.' But how often can you do that?" Instead, he says, choose activities you want to do and that you can integrate into your regular schedule. As for Lustig, he finds escape in the intricacies of classical compositions right from his piano bench.

N is for the name of someone you can count on.

Image via iStock.

"For some people, it’s their mother or their best friend. For some, it’s a therapist," Lustig says. The idea is to have that someone who will listen to what you’re going through, empathize with you, and share with you in that moment to help relieve stress.

How will you know if your self-care practices are actually working?

According to Lustig, to commit to better self-care is to acknowledge that you deserve time to yourself, to accept that it's OK to indulge a little — so long as it doesn't engender too much guilt — and to "turn off" the parts of your brain that are overworked.

Image via iStock.

If you're doing self-care well, you'll feel it. Your stress will become more manageable. You'll tackle the tasks and challenges of your day with greater ease. And you may even begin to feel better physically.

"When we’re stressed mentally, we have a lot of physical problems as a result," he says. "We have more headaches, we have more ulcers, we have more back and joint pain, and we go in for all sorts of other things."

Mental stress also triggers behaviors that can make matters worse, like eating more unhealthy foods or retreating into extended periods of inactivity. "As a result, your cholesterol goes up, your blood sugar goes up, and so on," he says.

Cigna's Go. Know. Take Control.℠ preventive health campaign educates people about their four health numbers: blood pressure, cholesterol, blood sugar, and body mass index. Images by Cigna.

Self-care has the potential to make the world a better place — one person, one family, one community at a time.

"When we’re in a good space, we do a better job of communicating and understanding each others' perspectives," Lustig says, channeling his own experience as a husband and father. "When it’s been a long day and we’re exhausted, we are not terribly empathic."

Image via iStock.

"When we feel we have everything we need for ourselves, we’re more generous and willing to share what we have more openly and lovingly," he adds.

He then closed with a final doctorly reminder to take good care: "Get your needs met — your physical needs, emotional needs, spiritual needs, cultural needs, community needs, all of it — and we’ll all be much better off.”

Even without seeing tragedies firsthand, it’s still likely that most of us are grieving.

Last Sunday night, my fiancé and I went to an early evening viewing of "Ghostbusters."

We grabbed our snacks, settled into our seats, the lights dimmed, and then the standard pre-movie reminder about "noticing which exits are around you in case of emergencies" was announced. And I felt a wave of panic grip me.

"What on earth is this about?!" I thought to myself shakily.

Taking some deep breaths, I put on my therapist hat and suddenly remembered 2012’s "Dark Knight" shooting in Colorado and 2015’s "Trainwreck" shooting in Louisiana.

Photo by Kevork Djansezian/Getty Images.

My panic was tied to a subconscious fear of being in danger at a movie theater.

It was a very real stress response to the seemingly endless violence and tragedy I've been seeing on the news.

And it was especially poignant for me after watching mass shootings on the news in recent years and the past few weeks, many of which have taken place in otherwise "safe," contained environments like dance clubs, concert venues, cafés, McDonald's, traffic stops, and churches.

In fact, scientists now know that this is pretty common. Being exposed to violent news events via social media can cause us to experience symptoms similar to post-traumatic stress disorder (PTSD).

According to a 2015 paper from The British Psychological Society:

"Social media has enabled violent stories and graphic images to be watched by the public in unedited horrific detail. Watching these events and feeling the anguish of those directly experiencing them may impact on our daily lives."

This phenomenon is called "vicarious trauma."

It is something that helpers like psychotherapists, social workers, doctors, and aid workers (among others) often deal with as an occupational hazard from being exposed to the repeated violent or traumatic stories of those they serve.

But because of everyone’s constant exposure to terrible events on the news these days, all of us are at a heightened risk for experiencing vicarious trauma, no matter where we are.

So those feelings you have after watching the news these days? The numbness, the apathy, the persistent anxiety, the intrusive thoughts, the feelings of hopelessness and helplessness? Those are all normal. You’re probably experiencing grief.

"Vicarious grief" might look familiar to you because you've probably seen the stages of it in your news feed: denial, anger, bargaining, depression, and acceptance.

This five-step process of grieving is sometimes called the Kübler-Ross model after the pioneering grief work of Swiss psychiatrist Elisabeth Kübler-Ross, M.D. And now, social media has given us all a way to see and express our individual and collective grief in public.

Photo via iStock.

Here’s what I mean:

Scrolling through our feeds, we’ve all inevitably seen people express sentiments of shock, disbelief, and denial about yet another mass shooting, another incident of police brutality against unarmed black men, another horrific hostage situation, or a frustrating election cycle.

Denial can be seen when hashtags emerge and trend; shock is expressed, and disbelief is shared.

Anger, the second stage of grief, can be seen when a social media wave of anger breaks across our smartphones and laptops. We see and feel anger over someone who was taken away too soon from us, and we feel anger that we live in a world where traumatic news weeks are the norm, not the exception.

Changing profile pictures and banners, sharing and signing petitions, making donations and sharing articles of thought leadership — all of this can allow us to use social media take some kind of action, however small. For many of us, this can help to counter the inevitable feelings of helplessness and hopelessness these traumatic events can trigger. This, in essence, is bargaining — an attempt to take action to avoid encountering bad things again.

And as for depression and acceptance? Perhaps these stages of grief are less visible online. Often, depression can look more like what you might be feeling this week — perpetual feelings of apathy, numbness, and hopelessness. Perhaps depression looks, for you, like avoiding all media consumption. Or maybe it even looks like an increased sense of irritability and weariness in your own life.

As for acceptance, it’s debatable whether or not that’s even possible online or off these days given the never-ending series of tragedies. My hope is that we’ll get there.

Grief — whether online or off — is not clear cut. It’s not compartmentalized.

The people who were present at a traumatic event will experience grief and trauma differently than the rest of us will as secondary witnesses.

But without seeing an event firsthand, it’s still likely that most of us are grieving the tragedy, terror, and loss of direction that is 2016. You are allowed to have, and to share, those feelings.

Plus, grieving online is a new phenomenon: It is complex, multilayered, and often unconscious, and it looks far more like a tangled wire ball than a linear line of conscious emoting.

So what’s to be done, then, about the state of things?

We live in challenging, hyper-connected times. Social media is at the core of many of our interactions, if not constantly in our hands.

What’s the balance to strike when it comes to using social media to stay informed and to grieve in this new digital age while being mindful of how strongly this can affect our own emotional well-being?

As a therapist, I’d like to recommend that you practice self-care, get support from those who love you, seek out help from professional mental health experts when you need it, and remember that watching these events from afar can affect you.

As you work through your own grief, as you make your way toward acceptance, as you take action against the difficult things you’re seeing, and as you scroll through Facebook before bed, please take very good care of yourself, online and off.

Feel what you feel. Share what you need to share. You are worth it.

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I practice self-care 11 simple ways every day, and it's not always pretty.

Practicing self-care is harder than it looks in this messy life.

The bathroom is my special place. When I sit on the toilet and read articles about 100 ways to change my life, I feel empowered and ready to shake my world upside down.

Then I lock my iPhone and leave the bathroom … and I fall right back into wishing I could just sulk in a corner.

Especially as the adult child of an alcoholic, a lot of people advise me to figure out how to put myself first. Family, friends, and professionals want me to learn to love myself in ways that I didn’t learn during all the years when caring for an addict took precedence.

"Close your eyes in the steam of hot lemon water. Sink into your warrior pose while reflecting on the ocean’s tide. Just take deeper breaths and count to 10 to conquer the world’s pain."

Photo via iStock.

I know the authors of these articles mean well, but sometimes I don’t think they understand how hard it is to make self-care a priority. Most days, grabbing hold of my "self" feels like trying to grab fistfuls of air, not breathing as calmly as an ocean tide.

Instead of drawing a bubble bath or lighting a candle or writing down my thoughts and dreams in a journal, I’m more focused on making baby steps in caring for myself. Here are a few:

1. Getting up on the right side of the bed is a big deal.

Most days, I don’t want to cuddle a kitten. On the days when it’s easier to smile, it’s a really good day. Sometimes my self-care is cherishing those days.

2. Instead of dreaming of all the things I'll get around to in my next life, I have to pick one small thing a day.

Waiting for the next cymbal to crash wipes me out. In my next life, I’ll color 50 shades of happiness in my adult coloring book. And then I’ll hang it on my fridge to show off to all my cheerful dinner guests.

But in this life, faking Pinterest-style perfection is exhausting. Instead, I’ve started getting to know my personal energy levels and choosing my daily activities based on how much "gas" is in my tank. I want to be a hustler and say yes to everything, but I have to know if today is a day where taking care of myself also means taking a nap.

3. I'm great at telling someone else, "Go love yourself." Now I need to take my own advice.

I could have written those articles about 100 ways to change your life. I might even inspire you to learn to love yourself because I’m a champ at doling out expert advice. But taking my own advice is an entirely different game.

Whenever I feel like stuffing my emotions away with dozens of Oreos, I remind myself that I’m committed to living out what I write.

Photo via iStock.

I want you to read who I am on the screen and then meet the same person in real life.

4. I'm addicted to someone else’s addiction. I probably need to implement my own recovery plan.

Honest moment: I’m afraid of what my life would look like without the rush of implementing great recovery plans for someone else, like my dad who struggles with addiction.

But truthfully, I know that self-care starts with putting my whole self first. I’m learning how to make my own recovery plans, including a rush of adrenaline while working out to the perfect pump-up playlist.

5. "It is what it is" helps me move forward.

I picked up on this phrase as a little girl, and for me, it became one of those sayings your kid repeats in the backseat so many times you wish they'd never heard it.

Believing in change requires a huge shift in my stale and stubborn mind, but remembering that "it is what it is" allows me to recognize what I can’t control and then focus on what I can.

6. I will learn to trust that good things can actually stick.

This is kind of the idea that every good book comes to an end. I always wonder: Why should I fall in love with these characters when they’re going to leave me on the last page anyways? I think this has a lot to do with my dad’s story and growing up with an alcoholic parent.

Instead, I have to work on trusting in chapters of goodness, like when joining a book club is fulfilling and reading a book gives me happiness in the moment — it’s not just a countdown until our relaxing times together end.

7. I’ll figure out how I like my eggs or other little things about my identity.

In the movie "Runaway Bride," Julia Roberts’ character has a father who drinks too much. She lost her identity in the process of trying to save him, so she always just likes whatever kind of eggs her boyfriend at the time liked.

Photo via iStock.

Self-care requires knowing what would help me. I can’t love myself if I’ve never taken the time to figure out who I am. It turns out I like my eggs over easy. Like my grandma always said, "Don’t knock it until you’ve tried it."

8. Life doesn’t have to feel so serious.

I picked up a briefcase around the age of 10, and the weight of the world felt comfortable in my little hands. I made myself grow up too quickly, mostly so I could stay out of the way and not make any more waves.

But I think I missed the step where you roll down the hill and get grass stains, so sometimes it’s hard as an adult to kick back and get a good belly laugh. I forget that life is more than filing my taxes while sitting up straight in my leather chair. When I know I need a deep laugh, I go out to dinner with a friend who knows me to my core and can pull out a memory that leaves me sculpting those six-pack abs.

9. I've made it a habit to expect the worst. And, you know what they say: Old habits die hard.

I’ve come to expect disappointment to walk through the door. Hearts have this crazy power to shape habits. And broken hearts have this bad habit of wanting to stay broken.

Sometimes I think that stories about miracles and people overcoming adversities are only written about other people, and quotes that tell me to OVERCOME just annoy me. That’s just not me. Making it a habit to expect good things to happen will start with believing with my whole heart that I actually deserve good things. For me, I go for a walk and listen to audiobooks that encourage me and keep my mind from wandering to self-destructing places.

10. I’ll stop waiting for someone else to bring me flowers.

This past year, I had a roommate who nurtured her plants every day. This felt completely foreign to me. But when someone told me to go buy flowers for myself and make it a habit to care for those flowers, I started thinking about it differently.

Image via iStock.

In fact, this is one of those cliches that actually kind of works for me. I never realized how much I was sitting back and waiting for someone to knock on my door and deliver beauty on a silver platter. Inviting beauty into my daily life takes effort and patience and persistence. But one day at a time, I’m learning how to water these flowers and watch them grow.

11. Learning to love myself will require repetition over time to make it a new daily habit.

Over time, I’ve caught this heart bug where I tell myself I’m not worthy of a life where I love myself and love my life. I want to check off every single item on the list of 101 ways to change my life instead of trying to make one new self-care habit that I can actually stick to.

So my advice? Just do one thing. Because one small thing — not 100 — can help change one day. And one day at a time, that’s enough.

I want to learn to love myself and make self-care a priority.

I want to be addicted to love, like the good kind of habits and the real kinds of love.

For today, though, I’ll reflect on taking one little step at a time while reading on the toilet. Realistically, that one step for me is probably dancing to a new Katy Perry song: "I won’t just survive. Oh, you will see me thrive."

Don’t judge :)