Image Alternative Text: The health communication image reads, at the top, "#BeThe1To. If you think someone might be considering suicide, be the one to help them by taking these 5 steps: Ask. Keep them safe. Be there. Help them connect. Follow up" in white and bright-colored green font.
The background of the image, at the top, depicts hands meeting in support; the bottom of the image depicts a question mark icon and reads, "Find out why this can save a life at BeThe1To.com. If you're struggling, call the Lifeline at 988" in bright-colored green and white font against a bright-colored blue background.
The image is via the Substance Abuse and Mental Health Services Administration (SAMHSA).
Written by:
Patricia Fortunato, Content and Program Manager, Clinical Research and Grants, NeuroMusculoskeletal Institute (NMI); and Mental Health and Suicide Prevention Training and Content Developer, Department of Psychiatry, Rowan–Virtua School of Osteopathic Medicine (Rowan–Virtua SOM) (fortun83@rowan.edu)
Thank you to medical, clinical, and administrative colleagues at the Division of Diversity, Equity, and Inclusion (DEI) at Rowan University; Rowan University Wellness Center; Rowan University Academic Affairs; Rowan–Virtua School of Osteopathic Medicine (Rowan–Virtua SOM); and Cooper Medical School of Rowan University (CMSRU) for collaborating and helping to provide input and resources at go.rowan.edu/bethe1to.
Together with all Rowan colleges and schools, we are committed to supporting our campuses and communities and helping one another in prioritizing mental health and preventing suicide.
Warning: This content discusses suicide. If you or someone you know is in crisis, call or text the 988 Suicide and Crisis Lifeline at "988." Additionally, all Rowan University students from all Rowan colleges and schools including the Rowan–Virtua School of Osteopathic Medicine (Rowan–Virtua SOM) and Cooper Medical School of Rowan University (CMSRU) can call Rowan Public Safety at 856.256.4911. If these resources do not meet your needs and you or someone you know is still at risk for harm from yourself or others, please call 911. If you are supporting someone in need, do not leave the person alone until emergency medical services arrive.
The 988 Suicide and Crisis Lifeline, in partnership with the National Action Alliance for Suicide Prevention, advise five action steps to help safeguard people from risk of suicide and support them when in crisis.1 These action steps are supported by evidence in the field of suicide prevention.
Step 1: Ask
Asking "Are you thinking about suicide?" in a direct manner communicates with others that you're open to talking about suicide in a stigma-free way. This can open the door for an at-risk person to engage in dialogue about their emotional pain/distress. Follow-up questions that you can ask include, "How can I help?" Do not ever promise to keep a person's shared thoughts of suicide a secret.
The joint side of the "Ask" step is to "Listen." Take the other person's answers seriously—do not ignore them, whether they indicate they are emotionally distressed and/or are experiencing suicidal thoughts. Listen to their reasons for being in emotional pain/distress and having suicidal thoughts, and any reasons that they want to stay alive they may share with you. Help the person focus on their reasons for living and staying alive.
Research indicates that asking at-risk people if they are suicidal does not increase suicidal thoughts, behavior, or suicide.2 Further, research indicates the opposite—that acknowledging and talking about suicide may reduce rather than increase suicidal ideation.3–4
Step 2: Be There
"Be there" can mean being physically present for an at-risk person, speaking with them on the phone or video conferencing, leaving a voicemail, and any other way that shows support. It is important to follow through with ways in which you say you can support the person.
If unable to be physically present with the person, talk with them to help develop ideas for others who may be able to be physically present with them. Listen to their thoughts and find out what and who will be the most effective and safest sources of support for them. "Being there" for an at-risk person can be lifesaving. Helping to increase their connectedness to other people and limiting their isolation is a protective factor against suicide.5–6
Step 3: Help Keep Them Safe
After the "Ask" step, and that you've determined the at-risk person is having suicidal thoughts and talking about it, the next step is to help the person establish immediate safety. Find out if they have already enacted a plan to try to die by suicide before they talked with you. Also find out if they know how they would try to die by suicide and if they have a specific plan. Is there a timing for the plan? What types of access do they have to the planned method? Knowing these answers can help you determine the severity of danger for the person. More steps in place equate to a higher risk and capability for the at-risk person to enact the plan.
If the at-risk person has immediate access to a firearm and/or other lethal means (such as alcohol, opioids, and/or other substances) and is serious about attempting suicide, calling for emergency help at 911 and/or driving them to a local emergency department (ED) may be absolutely necessary. If you are unsure, call or text the 988 Suicide and Crisis Lifeline at "988."
Finally, reducing a suicidal person's access to lethal means is a critical part of suicide prevention. Research indicates that when lethal means are reduced, made less available, or made less deadly, suicide rates by that method decrease and more frequently suicide rates overall decline.7 The "Help Keep Them Safe" step focuses on showing support for an at-risk person during the time when they have suicidal thoughts by putting time and distance between the at-risk person and their selected method.
Step 4: Help Them Connect
Helping an at-risk person with suicidal thoughts connect with ongoing support and resources (such as the 988 Suicide and Crisis Lifeline) can help them create a safety net for crisis moments. Connecting them with community-based support and resources can also help them establish their safety net. Possible support and resources include helping them find a mental health professional for counseling/therapy; a peer specialist; community spaces where they may feel safe and connect with others, such as community centers and support groups; and other social determinants of health (SDOH) resources.
Consider working with the person on creating a safety plan document or journal. This can include ways for them to self-identify if they begin to develop severe thoughts of suicide, and what to do and who to contact in those crisis moments. A safety plan should include a list of contacts ranging from crisis hotlines to mental health support to loved ones/family members.
Research indicates that people who called the National Suicide Prevention Lifeline (now known as the 988 Suicide and Crisis Lifeline) were significantly less likely to feel depressed, overwhelmed, and suicidal (in addition, they felt more hopeful) by the end of calls with Applied Suicide Intervention Skills Training-trained counselors (ASIST). Improvements were linked to ASIST-related counselor interventions: listening without judgment, exploring reasons for staying alive, and creating a network of support.8
Step 5: Follow-Up
After contact with a person experiencing suicidal thoughts and after you've connected them with immediate support systems and contacts, follow-up with them to see how they are feeling and doing. Send a supportive text message, call, or leave a voicemail. This step is also an ideal time to check-in with them and see if you can further support them within your capability, or if there are things you previously committed to supporting the person that you haven't yet completed.
This follow-up contact is critical to keeping in touch with the person and can continue to increase their feelings of being connected. Sharing your ongoing support with the person is important to their connectedness and healing process. Further, there is evidence that a simple act of kindness such as sending a supportive postcard or text message can potentially reduce their risk of suicide attempt.9
Seek Help Now
If you or someone you know is at risk for harm from yourself or others, call 911 or go to your local emergency room.
Additional Resources
Learn more about #BeThe1To at bethe1to.com, and learn more about the 988 Suicide and Crisis Lifeline at 988lifeline.org.
Learn about the physician suicide crisis, suicide prevention resources, and how to help create a culture of mental wellbeing, via the Vital Signs: The Campaign to Prevent Physician Suicide website.
Additional educational information and supportive resources focused on suicide prevention are available at go.rowan.edu/bethe1to; and educational information and supportive resources focused on stigma, substance dependence and substance use disorder (SUD)/addictions treatment, and related terms and issues are available at go.rowan.edu/recovery.
Please know that there is no shame in seeking support and treatment. You are important and your life matters.
Interested in contributing to the Rowan University DEI website/blog and/or social media? Please complete the following brief interest form and share with student groups and colleagues across all Rowan colleges and schools: go.rowan.edu/deicontent
References
- Substance Abuse and Mental Health Services Administration (SAMHSA), 988 Suicide and Crisis Line. Be the One to Help Save a Life: The 5 Steps. #BeThe1To.
- Mathias, C. W., Michael Furr, R., Sheftall, A. H., Hill‐Kapturczak, N., Crum, P., & Dougherty, D. M. (2012). What's the Harm in Asking About Suicidal Ideation?. Suicide and Life‐Threatening Behavior, 42(3), 341-351.
- Gould, M. S., Marrocco, F. A., Kleinman, M., Thomas, J. G., Mostkoff, K., Cote, J., & Davies, M. (2005). Evaluating Iatrogenic Risk of Youth Suicide Screening Programs: A Randomized Controlled Trial. JAMA, 293(13), 1635-1643.
- Dazzi, T., Gribble, R., Wessely, S., & Fear, N. T. (2014). Does Asking About Suicide and Related Behaviours Induce Suicidal Ideation? What is the Evidence?. Psychological Medicine, 44(16), 3361-3363.
- Joiner Jr, T. E., Van Orden, K. A., Witte, T. K., Selby, E. A., Ribeiro, J. D., Lewis, R., & Rudd, M. D. (2009). Main Predictions of the Interpersonal–Psychological Theory of Suicidal Behavior: Empirical Tests in Two Samples of Young Adults. Journal of Abnormal Psychology, 118(3), 634.
- Klonsky, E. D., & May, A. M. (2015). The Three-Step Theory (3ST): A New Theory of Suicide Rooted in the "Ideation-to-Action" Framework. International Journal of Cognitive Therapy, 8(2), 114-129.
- Harvard T.H. Chan School of Public Health. Means Reduction Saves Lives. Harvard University.
- Gould, M. S., Cross, W., Pisani, A. R., Munfakh, J. L., & Kleinman, M. (2013). Impact of Applied Suicide Intervention Skills Training on the National Suicide Prevention Lifeline. Suicide and Life‐Threatening Behavior, 43(6), 676-691.
- Falcone, G., Nardella, A., Lamis, D. A., Erbuto, D., Girardi, P., & Pompili, M. (2017). Taking Care of Suicidal Patients with New Technologies and Reaching-Out Means in the Post-Discharge Period. World Journal of Psychiatry, 7(3), 163.