how to respond to someone expressing suicidal intent

[greyspottycushion]

If someone very dear to you continually expresses a desire to die, what do you say ? My closest friend feels the meds are making her feel worse, she has been on reduced hours at work so lack of money is a problem. She may loose her job due to her sick time she has taken. She is disappointed at the lack of support from MH services, although she is in touch with them. She is about to start some private CBT as don't seem to be able to access it on nhs. She does not want to die, she desperately wants to feel better, but at times she feels suicide is the only way forward. I feel completely helpless, and terrified about what she may do.

I don't know, sorry not very helpful Growing up my older bro used to say he should kill himself a lot and as much as I wanted to tell him I loved him I knew there was nothing I could say that he'd believe. I think that we often get wrapped up trying to come up with the 'perfect' response, we want to get it right, but there isn't really a perfect response. I guess just be honest, say what's in your heart - tell her how much you care about her and be there to support her as much as you can.

I have struggled with depression and had a lot of therapy. The big thing for me was what can I do to change this, give myself opportunities to feel better. This is a very simplistic answer after years of therapy.

It sounds as though your friend is still in a position to think through her options. You think she doesn't want to die but talks about suicide as a way out of her problems, and it is indeed one choice, but she is battling on. It sounds like she needs lots of support, including from family and friends and what about samaritans if MH services aren't available? It also sounds like she needs some practical help, if you can help her access it. That could be just as valuable and in many ways easier. Good luck x

Suicidal ideation is very real at the time of the trigger but can recede when the pressure is off.

Private CBT is a good thing if you can find a good person. They can help you to stop and recognise the trigger. Then you can work out how to mitigate the feelings. Even if not successful it can lead to further diagnosis and support.

It is hard to say the right thing, because you can't see in their head. Just tell them that you value them as a friend and would be sad if they did it (disappointed or selfish are bollocks that I have heard before, it just feeds the worthlessness).

Just let them know you are there to talk and that you think they are a good person. It helps a little bit.

And CBT can bring up more issues at first but a good counsellor should be able to work through it. If your friend is actively seeking help then hopefully they will find some support system that works for them.

I agree with ItisntR - talking of wanting to end a life is most often suicide ideation, in the sense that we want the torment of mental illness to end, and at our lowest ebb can only see suicide as our way out. It is a very common symptom of severe depression. I have felt this way many many times and have thought of methods. I think one of the things I find helpful is that I have learned that it is the "depression talking" and putting this idea of suicide into our heads. It's difficult to explain to anyone who doesn't have first hand experience of mental illness, well it's impossible really. The illness drains us of any emotion really, and as I said before, we see suicide as the only way out.

You don't say how long your friend has been on the meds and if it is relatively recently she may need to take them for longer, get the dose increased or even change meds as what suits one doesn't suit another. It's important she has an empathetic GP who will if necessary refer her to a consultant psychiatrist.

Like ItisntR says, just let her talk, don't try to say the right thing, just hold her hand, stroke her back - whatever. You could tell her you know that suicidal feelings are a common symptom of depression and that when she starts to feel better (as she will in time) those feelings will subside. She won't really believe that she will ever feel better because mental illness is a deceitful illness and makes us believe that we'll never get better.

You could have a look on the MIND and RE-THINK websites as there's a lot of information there.

She has been on meds for 7 months, but she finds the side effects very difficult. I have read a bit about CBT and managing the "downward" spirals, and I really hope some help in managing these will happen. She is only able to work part time, but on the days she doesn't work, she gets really bored, and has a lot of time to think, she also worries about loosing her job due to sick time. This is one of the "triggers" worrying about being off sick=worry about loosing job=worry about paying mortgage=feelings of worthlessness=major panic attack=unable to go to work, and so the cycle continues. She is good at her job, wants to work, loves her job, and is popular at work, but obviously she realises she can be unreliable on bad days. Your replies have really given me some understanding