Resources from Reddit Suicide Watch - To help yourself or others

flickr.com/photos/lloydm/2305701220, Lloyd Morgan

Below are the collected resources from Reddit - Suicide Watch and Reddit - SW Resources, all credits go their maintainers.

You can also download a Word copy of this post.

Sections are the following:

• Hotlines - Worldwide
• Suicide FAQs
• Helpful resources
• Assessing people's suicidal tendencies
• How to talk to suicidal people in case of imminent danger

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Hotlines - Worldwide

United States

1-800-784-2433 (1-800-SUICIDE)

Texting: Text ANSWER to 839863

Spanish: 1-800-SUICIDA

Veterans: 1-800-273-8255, Veterans Press 1

www.suicide.org/suicide-hotlines.html

www.crisiscallcenter.org//crisisservices.html

Europe Wide

116 123 - Free from any number

Australia

13 11 14

Belgium

02 649 95 55

Brasil

141

Canada

Kids Help Line (Under 18): 1-800-668-6868

Alberta: 1-866-594-0533

British Columbia: 1-888-353-2273

Manitoba: 1-888-322-3019

New Brunswick: 1-800-667-5005

Newfoundland & Labrador: 1-888-737-4668

Northwest Territories: 1-800-661-0844 7pm-11pm everyday

Nova Scotia: 1-888-429-8167

Nunavut: (867) 982-0123

Ontario: 1 800 452 0688

Prince Edward Island: 1-800-218-2885 (Bilingual)

Quebec: 1-866-277-3553 or 418-683-4588

Saskatchewan: (306) 933-6200

For more numbers in all areas please see here

Deutschland

0800 1110 111

Denmark

70 20 12 01

www.livslinien.dk

www.Skrivdet.dk

France

01 40 09 15 22

Greece

1018 or 801 801 99 99

Iceland

1717

India

91-44-2464005 0

022-27546669

Iran

1480 6am to 9pm everyday

Ireland

ROI - local rate: 1850 60 90 90

ROI - minicom: 1850 60 90 91

Israel

1201

Italia

800 86 00 22

Malta

179

Japan

03-3264-4343

3 5286 9090

Korea

LifeLine 1588-9191

Suicide Prevention Hotline 1577-0199

http://www.lifeline.or.kr/

Mexico

Saptel 01-800-472-7835

Netherlands

0900 1130113

New Zealand

0800 543 354 (outside Auckland)

09 5222 999 Inside Auckland

Norway

815 33 300

Österreich/Austria

116 123

Romania

116 123

Serbia

0800 300 303 or 021 6623 393

Online chat:http://www.centarsrce.org/index.php/kontakt[2]

South Africa

LifeLine 0861 322 322

Suicide Crisis Line 0800 567 567

Sverige/Sweden

020 22 00 60

Switzerland

143

Turkey

182

UK

08457 90 90 90

text 07725909090

emailjo@samaritans.org

www.samaritans.org

http://www.supportline.org.uk/problems/suicide.php

ChildLine (Free for any #, does not show up on billing) 0800-11-11, http://childline.org.uk/

Uruguay

Landlines 0800 84 83 (7pm to 11 pm)

(FREE) 2400 84 83 (24/7)

Cell phone lines 095 738 483 *8483

Useful Websites

Dutch - www.113online.nl

Greece - http://www.suicide-help.gr/

International - http://www.befrienders.org/index.asp

Spain - http://www.telefonodelaesperanza.org/

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Suicide Hotline FAQs

Why are they asking all these questions instead of helping me?

We're concerned about you, and we need to assess your risk level. We'll probably ask about your feelings, thoughts and especially your suicidal intent. Suicidal thoughts on their own, even if they're intense, graphic, and disruptive are not in themselves an indicator of immediate high risk; crisis responders and clinicians also assess a person's level of intent to carry out a specific, accessible, high-lethality plan to try and end their life. We may also ask about your history, your circumstances, and your support network (family, friends, therapist, etc.), as these things impact risk level.

The best thing you can do is answer the questions as honestly and completely as you can; try not to second-guess or overthink your answers. If you either over- or under-represent your risk factors, we'll probably suggest options and resources to you that aren't helpful. Most crisis lines don't "screen out" first-time callers whose situations aren't "serious enough". We try to connect everyone who calls with helpful resources that are appropriate to their particular situation. Sadly, a few people do abuse these lines, making it harder for the people who really do need help to get through.

Will the police break down my door?

It's extremely unlikely. Involuntary rescues (i.e. dispatch of police or paramedics or both) are not a normal outcome of a suicide hotline call. Anonymity and assurance of confidentiality help callers feel safe in talking to us, and we only breach confidentiality as absolute last resort. Although the percentage of the time that rescues become necessary depends on individual agency protocols, and the availability of alternative resources in the community, at my hotline we contact emergency services for about 1% of the calls we get. Even in those cases, we are usually able to get the caller's consent so they are fully informed about what we're doing. So that means that our rate of involuntary rescues is much less than 1%.

Here are some things to keep in mind with regard to involuntary rescues and confidentiality.

• To trigger an involuntary rescue, a caller needs to be at demonstrable and immediate risk and unable or unwilling to agree to an alternative to carrying out their suicide plan.
• We'd rather do almost anything than an involuntary rescue. Breaking someone's confidentiality is always a traumatic betrayal, and our callers have usually already had too much trauma in their lives.
• Rescues are enormously expensive. Whether the caller or the community ends up bearing the cost, it's not something to undertake if there's another option. Also, if we started sending rescues where it wasn't justified, we'd lose the trust of the community and its police and emergency medical services. A hotline that "cried wolf" would soon be unable to operate.
• You are entitled to to know a hotline's confidentiality policy, including their criteria for breaking confidentiality, before you tell them anything. The doctrine of informed consent applies here -- you are implicitly "consenting to treatment" by disclosing your information to a hotline, and you are entitled to be informed fully about what you're consenting to, and you have legal recourse if you're misinformed. But, the onus is on you to ask.

A hotline can't fix my messed-up life, so what can talking to them actually accomplish?

• We try very hard to meet callers wherever they are -- even if we can't pull you out of the dark place, we can give you the gift of not being alone in it, at least for a while. This works best if you're honest and open with us, but we do understand that it's our job to earn your trust.
• We understand that people in crisis often lose sight of the options that they actually do have, so we often try to help callers work out short-term coping strategies.
• We want to help you not just feel better in the moment but get to a better place in the long term, so we'll try to connect you with appropriate resources and supports.

What if they ask me to do something that doesn't feel right?

It's our job to make sure that the options we offer you are realistic and appropriate. If we get that wrong, tell us, and if you're able to, tell us why.

I called and it was a bad experience. I still need help, what do I do?

Call back, and let the responder know what happened. Crisis intervention, especially if suicidality is a factor, is not easy, and not even the experts get it perfect every time. Personally, if I have a call go "south" on me, nothing makes me happier than to know that the person called back and had a better conversation with one of my colleagues.

If you found yourself being rude or verbally abusive, apologize if you can, but either way try to hang in there with us. We understand that people in crisis struggle with self-control, you don't need to be calm or businesslike but it really helps if you can show that you're trying your best to work with us.

If you have a complaint about a hotline experience, please try to report it to the hotline administration.

I thought "the suicide hotline put me on hold" was a punchline, but it actually happened! Why?

We try to make sure that we have sufficient staffing levels throughout the busier times, but we have no control over when the calls come in. We try very hard to make sure that all calls are answered promptly and all callers get an initial assessment quickly, and sometimes that means we might have to switch lines before we're done with you. We all hate doing this and avoid it unless it's absolutely necessary.

I am worried about a friend or family member. How can I make them call?

You probably can't, but you can call us yourself. Every hotline I know of welcomes third-party calls.

I just don't want to talk on the phone. Can I get help online?

A large and growing number of hotline agencies offer help via anonymous online chat. If you can't find your local or national agency's website to find out if there's a chat service you can access, use the link at right to message the moderators and we'll try to help.

From the reddit moderator: I'm a North American suicide hotline responder IRL. I've done the best I can to ensure that this information will be generally applicable to the majority of crisis lines worldwide.

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Helpful resources for those struggling with suicidal thoughts and feelingsTop of Form

• "Contemplating Suicide: No Way to Understand Unless You've Been There' Blog post at PsychologyToday.com from "Gerri Luce" who's been both a therapist and patient in suicide intervention.
• National Suicide Prevention Lifeline's "Get Help" page gives information about many ways to get help. US-based resource.
• Helping Yourself When You are Feeling Suicidal Practical, comforting tips from SCBS Australia.
• "If you are thinking of suicide..." from rethink.org. Coping strategies and options for help. UK-based resource.
• "Coping with Suicidal Thoughts" from Simon Fraser University. Downloadable PDF workbook with strategies and exercises.
• Worldwide Crisis Centre Directory from the International Association for Suicide Prevention.
• Personal Experiences of Contacting Samaritans. The Samaritans are a UK-based telephone crisis counselling service. Stories and video from actual clients.
• What Happens Now - American Association of Suicidology. Blog by and about suicide attempt survivors.
• Suicide Attempt Survivors - Waking Up Alive Support, stories, and recommended books.
• "Ways To Help Yourself When You're Feeling Suicidal" from mixednuts.net - depression and bipolar information and chat.
• Suggested Reading List from save.org, comprehensive list of books on suicide and related topics.
• Recovery Strategies from J.D. Schramm at TED.com A practical follow-up to Schramm's talk, "Break the Silence for Suicide Attempt Survivors".
• "Suicide: Read This First" from metanoia.org. Probably the most famous suicide prevention text on the internet.

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Worried about someone who may be suicidal? Here's some info about how to assess risk.

How do you know if someone is really suicidal?

First of all, take all verbal and nonverbal indicators of suicidal thoughts or behaviour seriously. Even if they don't indicate high risk of death by suicide, they do indicate that something is profoundly wrong.

Here are some things that suicide hotline responders consider when assessing risk. You may not be able to collect all this information directly, but consider both what the person you're concerned about is saying and what they're doing. Also, remember that if you are urgently worried about someone, you can call your local or national suicide hotline yourself and get their expert help to assess risk and figure out your best intervention options.

Do they have a plan?

In suicide risk assessment, it can help to be clear on the distinction between suicidal ideation, i.e. thoughts of suicide, and suicidal intent, i.e. commitment to an accessible plan to end one's life that carries a high probability of lethality. Ideation without intent usually carries a lesser risk, but it still does mean that the person is deeply troubled.

How immediately lethal is their plan?

For example, a plan that involves a firearm or other weapon is higher-risk than one involving overdosing on medication. In general any plan that involves violent means, with or without (jumping from a height or in front of a vehicle like a train) a weapon is higher-risk than one that does not.

Does the person have the means necessary to carry out the plan?

Someone who is preoccupied with shooting as a means of suicide but who would have difficulty getting access to a firearm, for example, is at lower risk than someone who is contemplating suicide by overdose and has a lethal quantity of drugs in their possession.

How specific is it?

A person who is focused on one specific plan (rather than thinking of various different ways they might harm themselves) is usually closer to the point of actually carrying it out.

Tips for detecting a undisclosed plan

Remember that someone who is seriously suicidal may not talk their plan, but they may "telegraph" what they are thinking, by referring to the means even though they don't mention suicide, or by using metaphors or imagery in their conversation that relate to the plan they have in mind. If you can identify an underlying theme, pay attention to it. Also, someone who is giving away their stuff, having conversations or sending messages that are of an unusually deep or "final" nature, or putting their affairs in order may have a suicide plan and be in the early stages of carrying it out. Being unafraid to die or especially being preoccupied with the idea of death in a non-fearful way can be a strong indicator that someone has an "exit strategy". Pay attention to changes in habits or characteristic behaviors.

What is their history?

Someone who has attempted suicide or engaged in self-harming behaviors (cutting, eating disorders) in the past is at higher risk of completing an attempt. The higher the lethality of the means they used in their past events, the greater the risk. Previous attempts, especially completed attempts, in the person's family or circle of friends also increase risk.

It's a potentially fatal mistake to assume that someone who has had repeated past attempts isn't truly suicidal. The interpretation that "if they really wanted to kill themselves, they would have actually done it by now" may be understandable, but it comes from a lack of understanding of the suicidal mindset. One of the biggest barriers to suicide is that we have an innate fear and resistance toward anything potential lethal, i.e. our survival instinct. Even people who are desperately committed to ending their own lives struggle against this resistance. Every time they attempt, they get a little more desensitized to lethality and undermine their survival instinct a little more. If they are not helped, eventually they are likely to be able to override their survival instinct completely and end their lives.

What are their outer and inner resources?

The fewer or poorer the resources, the higher the risk. Also, consider factors that are "drains" on these resources.

Outer Resources

• Family (if the family is relatively functional)
• Supportive friends
• Professional supports (counselors, therapists, physicians)
• Spiritual supports (clergy, etc. can sometimes be great sources of comfort but some "religions" that are cult-like can be draining rather than helpful)

Inner Resources

• Coping Skills
• Openness to trying new things (this is sometimes easier to see as its opposite, which is when a person sees no way out of a bad situation, i.e. their life has become a trap they can't see a way to get out of alive)
• Hopefulness and emotional resilience
• Past experience of recovery from depression or resolution of a personal crisis

Factors that can be a drain on a person's resources include:

• Recent losses (due to death, breakups, career or financial setbacks, changes in health status), especially multiple losses
• Addiction (alcohol, drugs, gambling, etc.)
• Isolation
• Abusive or dysfunctional relationships
• Financial stress
• Mental Health issues
• High-stress professions
• Personal dependents (applies especially to parents and care-givers)

The "Joiner Factors"

Thomas Joiner is the author of Why People Die by Suicide (2005) and Myths About Suicide (2010). His groundbreaking research has identified 3 necessary and sufficient factors for high risk of death by suicide.

1. Feeling that they are a burden to others. People who complete suicide usually think, or at least implicitly assume, that their friends and family will be better off without them. Sometimes it can make a difference to remind someone of their past contributions and/or potential for future contributions, either tangible (e.g. things they make or tasks they do) or intangible (e.g. love, humor, insight).
2. Profound loneliness and isolation. People who feel a genuine connection to even one other person can usually be "reached". That is why the most helpful thing you can do for a suicidal person is often not to "fix" anything about them or their life, but simply to try to understand them as well as you can, and reflect that understanding back to them so that they feel understood. It may seem perverse to agree with a suicidal person about how bad things are, but by trying to "focus on the positive" you might actually be reinforcing their sense of disconnection from the rest of humanity.
3. Fearlessness and/or desensitization. For example, people who have had a lot of exposure to death and violence due to their profession or their family history, and are thus somewhat desensitized, are always at higher risk of suicide.

The Joiner model factors are not always as easy to detect as the behavioural and circumstantial factors above, but awareness of them can be very useful. If you think it's reasonably likely that someone has all three, it's probably a good idea a good idea to err on the side of caution and either take emergency measures yourself, or consult an expert, as soon as you can.

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Concerned but don't know what to say? Here are some simple, proven strategies for talking to people at risk.

There is no one "correct" way to talk to someone struggling with suicidal thoughts. Real caring is what ultimately matters, and it can take many forms. But if you're not sure what to say, these ideas may help.

Avoid advice and solutions

Suicidal people typically don't feel change is possible. Anything that can be prefaced with “you should” can make them feel even more powerless. They often feel unworthy of help. “Fixing” or “advising” will reinforce that and make things worse.

This gets tricky because suicidal people often don’t see all the options they actually have. It can be of real benefit to point these out, but there is a vital difference between “you should do <action>” and “you could do <action>”. “Have you thought of doing <action>?” or “What do you think about doing <action>?” are other good phrasings. It’s fine to mention something that worked for you, but frame it as an example of something that they may or may not want to try.

If they ask for advice, you could reframe the conversation as working through the “pros” and “cons” of various options together.

If you're worried that someone is at immediate risk, take action yourself, don't tell them to do it.

Listen, empathise, and don’t judge

If they say harsh things about themselves or others, this can be the truth of their experience even if it doesn't match objective reality. Consider the emotions embodied by the self-loathing or the tales of woe. You can connect with the person on a feeling level and simply set aside any questions of "fact".

Examples:

• If they say: “I’m a useless waste of skin. The world would be a better place without me,” simply disagreeing can make them feel even more “intrinsically wrong”. Instead, you might say “It worries me to think of you feeling so bad about yourself. I wish I could help you feel better.” This respects their emotional experience and shares your sympathy and concern, without getting into whether their self-assessment is accurate or not.
• If they say: “Everyone is mean to me”, you could respond with “It must be so hard when every interaction hurts.” This tells them that you hear their pain, but you have not judged (i.e. you have neither supported nor challenged) their assertion about how they’re actually being treated.

Don't disagree with suicidal people about how bad things are. It’s not about their circumstances; it’s about their suffering, and you can’t measure that from the outside. A message that in any way tries to tell or show the suicidal person that “it’s not so bad” is just another way of saying “I don't understand what you’re going through”.

Describing suicidal behaviour as “selfish” is even worse. The suicidal mindset usually includes a firm conviction that “I can improve the world by taking myself out of it.” Telling them how much their deaths will hurt others reinforces their sense of personal failure.

Never use any kind of “tough love”. If you think they’d be fine if they just stopped feeling sorry for themselves, putting up with abuse, or staying stuck in the past, then you are not the right person to help, even if you’re correct. Chances are they’ve tried to do exactly that, over and over again, and failed. Everything you say to suicidal people needs to be grounded in the belief that they are doing the best they can to help themselves. If you don’t believe that, find them someone else to talk to.

Meet them where they are

The greatest gift you can give a suicidal person is the experience of being truly heard and understood. At most suicide hotlines, rapport-building takes up takes up the bulk of the communications training.

It seems natural to try and pull a suicidal person out of whatever dark place they’re in. That almost always fails. What works, consistently, is simply to join them in the dark place and offer a non-judgemental, supportive presence. This is so simple that it can seem like doing nothing, yet it can also be so difficult that we can’t imagine how we can ever get it right.

Sometimes suicidal people can be reluctant to talk. Say that you just want to understand, and that you won’t try to suggest anything unless and until they are satisfied with your understanding of their experience.

Your questioning style can make a big difference: asking open-ended (“How do you feel?”) versus closed-ended (“Are you sad or mad?”) questions will ensure that they feel able to express whatever need to. If you ask if they’re “sad or mad” and they’re actually something else (anxious, numb, etc.), you may not get the information you need, and they may feel invalidated.

Help them by naming the emotions that you hear in their story, but which they may not be expressing, nor fully aware of.

Active listening, which demonstrates and refines your understanding, is a powerful rapport building technique. People in a suicidal state of mind usually feel profoundly alone. Saying “I understand” without proving it will often reinforce this sense of alienation. Some ways you can “actively listen” effectively are:

• Ask lots of open-ended clarification questions. This shows that you care about getting it right.
• Summarise, paraphrase and interpret what you’re hearing. This shows what that you’re taking in what they’re saying, and thinking deeply about it. It also offers them the chance to correct anything that you got wrong.
• React genuinely and supportively. If you feel a strong empathetic response to what someone is telling you, share it. This shows that what they are going through matters to you, and that they’re getting through to you.
• Remember that you’re just building your understanding: suspend your judgement and listen. You may hear some ugly truths, or even ugly untruths. The point is to understand, to go to the dark place with them, and those dark places are often dirty, smelly and full of evil things. Be ready for that.

Sharing your personal experiences can be a great help in building rapport, but it should be done only with the idea of establishing your “street cred” as someone who’s been in a dark place too. The danger is that they can feel like you’re assuming too much, not listening enough, or devaluing their pain.

You may need to ask tough or personal questions. Your goal is to “map” the dark place as well as you can. You can frame sensitive questions with: “Do you mind if I ask you about <subject>?”

If, and only if, they indicate to you that they feel “heard”, you might try some gentle re-framing of their view of the situation. While continuing to stress that you agree with them about how bad it is for them, you can try offering a hopeful perspective, if it's totally genuine. If they reject it, go back to active listening.

Don’t forget to look after yourself!

Deep rapport with someone who’s suicidal can leave you feeling sad, frustrated, hopeless, or disoriented, even if you’ve really helped. This is why suicide hotline responders are typically required to debrief regularly. Be sure to talk to someone you trust if you find the conversation is weighing on your mind.

Keep your expectations realistic. Even with the best training and resources, sometimes conversations with suicidal people will take a wrong turn. Reaching these people is a tricky business, and not even the experts can get it right every time. Remember too that the immediate response isn’t the outcome. It’s not uncommon for callers to a suicide hotline to tell the responder that they weren’t very helpful, then call back days or months later to say “Thanks, you saved my life”.

What’s the rationale for all this?

It comes out of what has been proven to work at suicide hotlines, and what has been discovered in the latest research into suicide, especially the groundbreaking work byThomas Joiner's group at Florida State University. Joiner’s model uses three necessary and sufficient factors for suicide risk, and these can help us identify strategies that will and won’t help:

1. Desensitization to pain and death. We can’t fix this in the short term; it’s acquired by life experience and extinguishes slowly, if ever.
2. Perception that one is a burden. We can prevent this from getting worse by avoiding solutions, advice, and judgements. We can sometimes improve it by reflecting back to the person things that we genuinely value or appreciate about them, but it has to be utterly sincere. If you can't find something specific, positive, and accurate to say, just move on to the next strategy. By building a strong rapport you may discover some genuine positives that you can reflect back to the person.
3. A deep sense of alienation. We can always do something about this one by making a deep interpersonal connection, and since all three factors are necessary for high risk of suicide, it's only urgently necessary to fix one. This is why it’s “all about the rapport”!

Where to learn more

• List of resources for helping someone from the International Association for Suicide Prevention
• Active Listening Tips from the Samaritans
• What can I do to help? from metanoia.org
• Classic 1946 paper on what kinds of conversation really help people, by Carl Rogers, the "Father of Active Listening". An easy read even for non-specialists. The list of 6 factors for helpful interactions apply inside and outside of formal therapy, and have truly stood the test of time.
• Thomas Joiner's books Why People Die by Suicide (2005) and Myths About Suicide (2010) at Google Books.