I'd consider a suicide prevention hotline before 911.

I have no advice to offer except to do what you do: Be there. Listen.

You are a good person for doing this.

Call the crisis center now and talk to somebody about it. Train hard, fight easy, as they say in the Red Army.

As you said, just listen. Validate what he's feeling with phrases like "That sounds hard" or "It sounds like you're having a hard time."

Try to avoid anything like "It's not that bad," "Don't cry," "Don't get angry," "That's silly," etc. That can just make him feel like he's abnormal or weird or awful for feeling what he's feeling, which doesn't help anything.

Try, if it's appropriate, to point out the resources he has to solve his own problems, but let him figure out how to use them. "Is there anyone else you can talk to about this? What's making you feel better? Are there others things/people you could rely on?" Don't solve his problems for him; try to avoid things like "You need to talk to X" or "You should..."

If it gets time to leave, ask him what he's going to do right now, or tomorrow, to feel better. Bath? Tea? Journal? I don't know the guy, but take whatever he's talked about as making him feel better and see if he can do that right after you leave.

If he does mention suicide, try not to flip out. Lots of people think about it, few people (relatively) do it. You can even ask him flat-out if he's thought about it; if he says yes and sounds comfortable or open to talking about it, then find out if it's just idle "I wish I were dead, I'm so tired of dealing" or if he actually has a plan in place (how he'd do it, when, etc.). If he has a plan in place, that's when it's time to call for help. If he's just idly talking about not wanting to be alive anymore, it can be helpful to validate his feelings as normal so that he doesn't feel so alone -- I think a lot of people think they may was well kill themselves because what they're feeling is so far out of the range of normal human feeling that they won't ever get better, and it can be helpful to have someone say that yes, this is normal, you're OK for feeling it, it doesn't make you a monster or worthless.

(I did some training for an AIDS hotline, hosted by the suicide prevention hotline, which is where this is coming from. If you want more, I can go dig out my notes, but I think I've probably gone on long enough for now!)

Just for the record, although I'm not sure it needs to be said, occhiblu is one of the wisest people in the world and you should always do what she says.

Best of luck, Heatherann.

Also, some of the best advice I got (on AskMe, actually) when my ex flipped into what increasingly seemed like bipolar mania: Your ex may need help, but you may not be the best person to help him right now. If he doesn't respond to you, or if he does hurt himself, don't fall into the trap of blaming yourself. Wanting to help him is admirable, but given your past relationship, there's a chance that it just won't be able to work, and that's not your fault.

On preview: Awww. Thanks, mudpuppie!

I should answer this, having experience being that friend, but I need some time to think about it. In short, though, be available and take it seriously. (And if you really think the friend is seriously suicidal, then a "contract" is a very effective tool. "Will you agree not to do anything tonight?" "Will you agree not to do anything without talking to me?" and similar. What's appropriate for the contract is situation dependent involving your relationship with the person, among other things. But the contract is a proven effective tool.)

I also sort of want to say not to be the first to bring suicide up; but that's almost certainly something at least some actual mental health professionals would disagree with me about. I guess I'm just thinking about that middle-ground where it's conceivable but not necessarily conceived. I personally would want to avoid encouraging suicidal ideation by introducing it. On the other hand, it's probably the case that if a person is having suicidal ideation, they would be regardless. This in-between area is murky.

Talking intensively about any real-life matters that are proximate causes of the intense depression may or may not be a good thing. A willingness to talk about them, if the friend wishes it, is a good thing. You might take your cue from the friend. The mostest importantest thing, though, is being there.

I guess I feel that if it's on heatherann's mind that much, it's almost better just to get it out on the table so it doesn't become the elephant in the room that he can't bring up because it's awkward. But that only works if heatherann's willing to listen to what he says about it; if she's uncomfortable talking about it, then I would agree she may not want to bring it up herself, for all the reasons you mention.

Or, I meant to say, if his thinking of suicide is on heatherann's mind so much that she's having a hard time listening to him, because she's spending all her energy trying to suss out if he's thinking of killing himself. Which may make him go out of his way to hide any suicidal feelings he may have, so as not to upset her further, etc.

Like I said, it can work perfectly well either way. I just think a lot of us are scared to bring it up, and it's helpful to know that if you mention suicide to a seriously depressed person, it's unlikely that that's the first time they'll have thought about it. And in my personal experience, your being OK with talking about the worst that could happen tends to free up the other person to talk about better options -- he's not going to be worried about shocking you by going too far.

Thanks for all the advice, guys. I am totally willing to talk about suicide with him. My uncle committed suicide a few years back and I take it very seriously. I called the crisis line a few minutes ago and got some advice from them too, pretty much the same as what's been said here. I have their number in my pocket just in case.

I'll also be taking my mother's advice, which is not to sleep with him. Geez, mom.

occhiblu has great advice. The best way to help is to help your friend reconnect with the things that will prevent him from harming himself. Don't try to be his therapist, you're his friend. Tell him he hasn't ruined his life. Tell him you love him (or whatever). Tell him other people do too.

Suicide assessment is a tricky business and not really something for an untrained friend to do. If he begins to really scare you I would tell him that, share the dilemma with him, ask him what to do. If he doesn't ease your mind call 911. Intent (active or passive), plan and means to carry out that plan are the things really looked for in assessment, but the bottom line is that if someone really wants to commit suicide then they will lie to you and do what they want to do.

I have to argue against kmellis's suggestion regarding a contract for safety. There is not, in fact, much research supporting the efficacy of such contracts for keeping people safe. As a therapist, and an instructor of ethics for therapists, I urge people to avoid such contracts. If the person seems like they aren't going to hurt themselves such a contract is not needed; if they seem like they will, they should be gotten to the ER, rather than using a contract.

just how depressed is this guy, anyway? (like on a scale of 1-10?) is he bummed out or flipping out? is he medicated?

From how his emails sound, 8-10. He's having complete breakdowns in public. He's telling me he's not worth helping, that he's never been so afraid in his life, that he's ruined his life. That he's no good, that he doesn't have anything to offer.

And yes, he's on medication, the same medication his stupid doctor has had him on for the last six months, and it's clearly not working, and he keeps upping the dosage—he's at the highest legal dosage now. I could punch that man, because that is absolutely irresponsible. I've been on anti-depressants, they helped within a month.

And he has a therapist, who is similarly unhelpful. ("Have you considered that maybe your friends do care?" isn't really helpful. Of course he hasn't considered that, he's depressed and not thinking straight!) They've both got to go, need to find someone who will help.

Good luck, heatherann.

((hugs))

And I'd love to hear how it went, if you're willing to share. If not, then I'll just hope it went well.

But not tooooooo well. Your mother's advice still stands, young lady :-)

"I have to argue against kmellis's suggestion regarding a contract for safety. There is not, in fact, much research supporting the efficacy of such contracts for keeping people safe. As a therapist, and an instructor of ethics for therapists, I urge people to avoid such contracts. If the person seems like they aren't going to hurt themselves such a contract is not needed; if they seem like they will, they should be gotten to the ER, rather than using a contract."

Thanks for the correction. I apologize for being wrong on such a critical thing. I suppose I was basing my confidence on how effective they've been with me (as the suicidal person). And pretty much every counselor and psychiatrist I've been involved with has used them. And it was part of my training at rape crisis.

A cursory Google search supports Omiewise's factual statements—there is little to no research on the efficacy of no-harm contracts. They have been increasingly used for a number of years; but along with the increase have come increasing numbers of skeptical objections to their utility and, of course, their ubiquity.

A good Google search string for no-harm contracts brings up a great number of hits, including at the top a few Google Scholar results.

However, I think I have a fairly major disagreement with Omiewise's point which I quote above:

"If the person seems like they aren't going to hurt themselves such a contract is not needed; if they seem like they will, they should be gotten to the ER, rather than using a contract."

Honestly, that seems to me to be good clinical instruction but a great deal less useful in the real world. It ignores a huge number of practical, real-world considerations. The first and foremost of these considerations is that sending every potentially suicidal person to the ER is unrealistic. Even for those who are quite certainly suicidal—and I know this from experience—there are usually not enough beds, or professional help, in the US to do much about it. There'll be an assessment by ER personnel; if the patient is lucky they'll call a real psychiatrist to come in and evaluate the patient. If the psychiatrist thinks the patient should be hopsitalized, and there's a bed available, then the patient will stay. I didn't, even though the psychiatrist thought I should—there were no beds. I gave them a name of someone to pick me up, and they released me to that person.

Not all, but many, people who kill themselves are people who have been having suicidal ideation relatively frequently. You can't send those people to the ER every time they are having the ideation. To the degree to which professional counselors take Omiewise's advice, is the degree to which the ER visit will be unhelpful because of a scarcity of resources.

And then, of course, we live in a country where health care is increasingly difficult to obtain because of being uninsured. My advice was to a non-professional attending to a friend who she suspects is suicidal. She has not the professional experience to adequately assess just how suicidal her friend really is. But she, like the 50 other friend, non-professional visits to every 1 professional visit, is nothing more than a person who cares for the depressed person, with no real qualifications. Should every one of those people on every one of those visits where they think the person is truly at risk call 911 and have that person taken to the ER? That's absurd.

No, this friend is mostly in the position to detect only the extremes of a risk of suicide (and that not very accurately, either). And as Omiewise says, if a person is about to attempt suicide, the proper course is to call 911 and not to solicit an agreement on a contract. The contract is only useful when the possibly of suicide is ambiguous—a situation completely elided in Omiewise's hypothetical.

Contracts have worked for me because there's the background of suicidal ideation, close, very close, "I can't believe I'm about to do this" close, and "I'm doing this" close. At the last stage, there's nothing anyone can do unless they're right there. But right about at the transition between the penultimate stage and the one that preceeds is, is a point at which an obstacle to progression might really be effective. The chief obstacle, in my opinion, is that there is someone the person trust available that that person can talk to RIGHT NOW. But a good secondary obstacle is that simple no-harm contract.

I can see that this will only work on a range of personalities and on others it would have no effect. But I'm inclined to believe that on those types that it would have no effect, almost nothing would have an effect. They're not socialized enough to care about such a committment.

kmellis-

I agree with you that they can be helpful, and that they can be at their most helpful with friends and relations, in other words, people with whom we have enough knowledge, and a compelling relationship, which makes of the contract something significant. But the contracts present a kind of double blind: either they are given to people who are a low suicide risk as part of an effort to make them less of one (in which case they are helpful but not pivotal), or they are given to people who are dangerously suicidal who absolutely need to be evaluated (in which case they may well be worthless). (While ER care is spotty and not always reliable, your argument about resources being scarce does not convince me that such resources should not be used for suicidal patients.) The real danger in the use of safety contracts is confusing category 2 with category 1, and therefore overestimating the power of such a contract. In all cases I say whatever it takes to make someone a lower risk for suicide, but it's part of my job to make a judgement about their suicidality independent of assurances that the person might be giving to me. That should also be the job of anyone in the real world (in which, by the way, I work), but not everyone is trained well enough or detached enough from the situation at hand to make good judgements. Relying on a safety contract, even thinking that one is reliable in the abstract, might lead to a tragedy from which it can be difficult to recover.

On the other hand, I always keep in mind Slavoj Zizek's comments about his analysis, in which he said that it kept him from killing himself because he was very aware that he needed to be at his appt the next day.