Talking to a veteran who may be in crisis

Your buddy calls you late at night, wanting to hang out because he or she doesn’t want to be alone. While talking they make a few comments that stand out to you: I mess everything up; I’m worthless; people would be better off if I wasn’t around anymore. You ask them if they’re having thoughts about suicide, and they so “no” or they refuse to answer. They might not be saying they want to kill themselves, but they are very clearly distressed and you’re worried. What do you say? What do you do?

Most of us have participated in some sort of suicide prevention training. For those of us who have served in the military, we’ve participated in many, many such trainings, most of which emphasize the importance of being alert to suicidal thoughts in others, and encourage us to directly ask about these thoughts. This focus on suicidal thoughts makes sense: research has repeatedly shows that thinking about suicide is a very strong predictor of later suicidal behavior. Consistent with this line of research, the DOD has rolled out standardized screening tools that ask about suicidal thoughts and behaviors.

What suicide prevention trainings often leave out, however, is that the majority of individuals who die by suicide do not talk about suicide, and in some cases deny or conceal their suicidal thoughts, before they die. In fact, more than half of those who die by suicide fall in this group. Our own research showed that less than 5% of military personnel who died by suicide explicitly talked about suicide or death on their social media profiles during the year leading up to their deaths. The infrequency with which service members talk about suicide even when thinking about it is probably due in part to the fact that service members are much more likely to conceal their suicidal thoughts when their identity can be known.

Asking about suicidal thoughts is important, but it’s not enough. We need to be alert to other signs of severe distress and elevated suicide risk, even when someone isn’t talking about suicide. Newer research has shown that military personnel who attempt suicide often have very negative perceptions of themselves that can be identified in the statements they make. These statements indicate elevated suicide risk even though they do not include explicit mention of death or suicide. For example:

• “I can never be forgiven.”
• “I mess everything up.”
• “I can’t take this any longer.”
• “No one can help me solve my problems.”
• “I deserve to be punished.”
• “People would be better off without me.”

These statements and perceptions have been shown to predict later suicidal behavior better than explicit thoughts about suicide. In that sense, these statements can be described as the “coded language of suicide.” It is during these times that you can have the largest impact in a person’s life. Because they reached out to you, you already know you are trusted. So what should you do? Below we provide some tips on how to help someone in need.

If you hear someone using the coded language of suicide, it’s time to act, even if they deny suicidal thoughts. We need to stop waiting until someone is comfortable enough to disclose his or her suicidal thoughts to intervene; by then, it could be too late.

Do:
• Invite them to tell the story of how they got to this point
o Listen – they are trusting you with their personal thoughts
o Be present — giving one’s full, undivided attention to the person is important.
o Be open-minded — showing a willingness to see things from their perspective.
o Be neutral — putting aside one’s own views and remaining non-judgmental.
o Be aware — paying attention to both the other person’s words (verbal cues) and his/her unspoken signals (non-verbal cues).
• Help them to develop a concrete plan of action to help themselves keep control
o Ask about their reasons for living (they reached out for a reason)
o Plan meaningful activities to do together
o Help them get connected with appropriate resources ( https://rly.pt/Utah )
• Offer temporary solutions to store or secure firearms until they are no longer feeling this way
(One suggestion could be as simple as a trigger lock or a lock for a pelican case and offer to hold the key temporarily)

Don't:
• Interrupt them to tell them about the time something similar happened to you; hear them out.
• Shame or guilt-trip the veteran; they may already be feeling a lot of shame and guilt
• Say that suicide is “cowardly” or “selfish”
• Make assumptions
• Try to fix them
• Fail to pay attention to the “coded language” of suicide
• Go it alone: provide support and help them find the appropriate resources ( STRIVE2Be.org )
• Don’t wait to hear the word suicide, by then it might be too late.

*To learn more about the National Center of Veterans Studies programs visit: https://rly.pt/Utah