Expert Encourages Direct Communication: It’s Okay to Ask, “Are You Having Thoughts of Suicide?”

National Suicide Prevention Month, September, provides us with the opportunity to access resources and better understand the roles we can each play in preventing suicide—from one-on-one conversations to bolstering public health initiatives.

From the sidewalk, under a tuft of grass, on West 32nd Avenue, a picture of a man appearing to be in his 30’s looked up at me. I walked on. A few steps further and I was remembering my brother. Was that a memorial card on the ground, like Tom’s? I retraced my steps and picked it up. “In Loving Memory” for the 35-year-old who is now buried at Crown Hill Cemetery.

Later that night my son picked up the young man’s memorial card, which I had set next to my computer, and asked, “Who’s this? He looks like Uncle Tom.”

I was curious too, so I typed the man’s name into the search bar on my laptop. I scrolled through dozens of photos and touching memories described by friends, family, and his fiancé. I came to know his favorite music, his go-to beers, and his politics. My brother died young from a lung disease, but he outlived this fellow by over 15 years. What took this man? I searched for clues.

And then I came to it, a breadcrumb: “In lieu of flowers the family asks that you donate any contributions to the National Suicide Prevention Lifeline.”

“You call it a breadcrumb,” says Dr. Stacey Freedenthal from the other end of our Zoom interview. “I see it as a megaphone.” Over the last decade Freedenthal, an associate professor at the Graduate School of Social Work at DU and a psychotherapist in private practice, has seen these kinds of brief references more and more. Families are chipping away at the silence created by the stigma and taboo of naming suicide.

I brushed up against this stigma when I learned, just weeks ago, that the founder of the company my dad worked for—George Eastman of the Eastman Kodak Company—died by suicide in 1932 at age 77. I don’t recall a single mention of it during my dad’s tenure with the company from the mid-1940’s until well into the 1980’s.

I began to wonder if the same taboo that keeps us from naming suicide as a cause of death also keeps us from offering support to loved ones who could be struggling with suicidal thoughts.

“Yes,” says Freedenthal, confirming my suspicion. And the consequences of this silence are devastating.

In the U.S., 44,834 people died by suicide in 2020. 1,294 of these deaths were in Colorado; 152 in Denver. And as of 2018, suicide was the second leading cause of death for age groups 10-14, 15-24, and 25-34. (National Health for Health Statistics, CDC).

Freedenthal delved into ways to break the interpersonal silence aspect of this larger public health issue in her March 2021 article for The New York Times, “How Meghan Markle Has Already Changed the Way We Talk About Suicide.”

“To many people, suicide is unspeakable,” she wrote. “Even mental health professionals sometimes do verbal gymnastics to avoid saying the word.” But when Meghan Markle spoke openly about her suicidal thoughts in an interview with Oprah Winfrey earlier this year, Freedenthal saw the potential for a new openness in talking about suicide. 

I confessed to Freedenthal that when I mentally role-played the idea of broaching the topic directly with someone, I started to feel nervous that I could say the wrong thing. Or introduce a dangerous idea. “It’s a high stakes conversation, right?” I asked. She acknowledged my hesitance but was quick to dispel a myth: It’s not true that talking with a loved one about suicide makes suicidal thinking more likely.

Freendenthal gives us these ways to, in her words, “weaken the walls of silence” around suicide:

  • Name it. Ask the question, “Are you having thoughts of suicide?” or “Do you have thoughts of ending your life?” If you are nervous, couch the question: “A lot of people who feel the way you’re describing think of suicide. Do you think of killing yourself?”
  • Frame suicidal thoughts as the mind’s understandable attempt to stop hurting. This can help alleviate shame or embarrassment. For example, you might say, “It makes sense that that’s where your mind goes. We’re biologically wired to avoid pain. But there are other ways to stop the pain, and let’s brainstorm those.” You can empathize with the suicidal wish without validating suicide as an option.
  • Don’t panic. Don’t call 911 unless the person is clearly in danger of acting on suicidal thoughts this instant.
  • Respond with curiosity, not judgment. Ask questions that invite the person to tell their story. “Tell me more.” “What’s happening that’s made you feel so bad?” Don’t respond with clichés, false encouragement or guilt.
  • Connect. Offer emotional support, and help the person find professional help.

And if you’re worried, like I was, about finding the right words: Freedenthal encourages us to do our best with what we say, but don’t let the barrier of finding the perfect words keep us from starting the conversation. Listening can be as important. So too is connecting with professional support. In Colorado, Freedenthal says one place to start—in addition to the National Suicide Prevention Lifeline at 800-273-8255 (TALK)—is a Colorado Crisis Services (CCS) 24/7 walk-in center. Closest to North Denver, there is a CCS Walk-in Center in Wheat Ridge at 4643 Wadsworth Blvd. 

National Suicide Prevention Month is recognized by organizations across the city as a way to help everyday people, as well as our elected officials and mental health care providers, better understand the broader landscape surrounding suicide in our state.

The Colorado Health Institute’s January 2021 report Suicide in Colorado: Complex Issues in a Diverse State points out, for example, that “Many people who have died by suicide in Colorado were reported as having a current depressed mood or a diagnosed mental health problem like depression, anxiety, or other conditions such as schizophrenia. But less than a third were identified as currently receiving mental health care. And “people of color in Colorado who died by suicide were less likely to have mental health treatment than white Coloradans, even though similar percentages of all groups were reported as having a current depressed mood.”

The report, which can be found at details a range of risk factors and protective factors, and highlights initiatives across the state that we can all plug into.

The report notes substance use as one risk factor of note for Coloradans. Alcohol and marijuana are the top two substances detected among suicide deaths. “From 2014-2018, 30% of suicide deaths among youth ages 15-19 had marijuana present, an increase from 19.8% during 2009-2013.  Alcohol was present in 12.1% of suicide deaths among 15- to 19-year-olds between 2014-2018, which is similar to past years, but still raises concerns over access to substances among youth.”

The report goes on to describe unique risk factors for men, veterans, people of color, youth (and specifically LGBTQ+ youth) and for adults over age 65, but it ends on the same note of encouragement I received from Dr. Freedenthal.

Suicide is preventable. A great majority of people who have thoughts of suicide do not die from suicide. And this statistic shows that many have reached out for help: over the last decade, more than a third of Coloradans who lost their lives to suicide had disclosed their intent in the month prior to their death.

So while it’s powerful to understand risk factors and protective factors, Freedenthal reminds us that when we’re sitting in conversation with someone who is having thoughts of suicide, the most important thing is the support and listening we can provide for that person, in that moment, for their unique circumstance.

National Suicide Prevention Lifeline
800-273-8255 (TALK)
Crisis Text Line at 741-741

The Trevor Project 
TrevorLifeline for LGBT youth, 24/7

Trans Lifeline
Peer support by people who are themselves transgender

Peer support by retired police officers, 24/7

Resources gathered by Dr. Stacey Freedenthal


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