If there’s anything Anthony Bourdain and Kate Spade’s deaths have taught us, it’s that even people who seem happy and successful may be going through something, and it’s important to check in on our loved ones.
But what do you do if your friend really is thinking about taking his life after all? Dealing with a friend who has suicidal thoughts is very difficult, especially since most of us haven't been professionally trained to do so. You certainly want to show your friend that you care about and support him, since it's you he turned to in his time of distress, but you don't know what to say or do.
We asked Renz Argao, supervising psychologist at University of Santo Tomas' Psychotrauma Clinic, along with Dr. Harry Trinidad and Raffy Inocencio, founding partners of Better Steps Psychology, about the best ways to help a friend, whether he's thinking about suicide or actually about to take his own life.
If You Think a Friend is Contemplating Suicide
Sometimes your friend isn’t actually on the point of taking his own life, but he’s thinking about it—something mental health professionals call suicidal ideation. This is definitely still cause for concern, and something to be taken seriously. Here’s what to do.
1. Ask Them If They’re Thinking of Killing Themselves
Many people are afraid to ask their loved ones if they’re contemplating suicide, for fear that if they weren’t already doing so, it will plant the thought in their minds. But according to Argao, it’s actually better to ask them directly so that you know clearly whether or not they’re planning something.
“They might be telling you, 'Wala na akong ganang mabuhay' or 'I don’t know what to do anymore,' but it’s really just how they feel and then you start thinking he’s suicidal, then you panic,” Argao explains. “And it could make them feel worse and wonder if they’re abnormal for thinking that. Don’t be afraid to ask or use the word suicidal because it helps clear things up and helps the person verbalize. Again, saying things can lighten the burden.”
On the other hand, Inocencio says that professionals ask this question in a clinical setting to gauge a client’s risk of actually proceeding with the act. “In the layperson setting, a person shouldn’t ask this question unless they are prepared to hear all the details,” he explains. “Ensure that the other person knows you are present and willing to support them and to make sure that you draw up plans that ensure their safety.”
2. Assess the Risk
If your friend confirms that he’s having suicidal thoughts, ask him how he plans to do it and where so that you can find out how feasible his plans are, and act accordingly. For example, if he plans on taking his life in a public place, that’s less likely to happen since there will be other people present. But if he plans on locking himself up in his room in the middle of the night, then that’s a high-risk case. Find out if he has the means to access the tools with which to kill himself, and whether he's already attempted suicide before.
Nevertheless, whether your friend is at a low or high risk of killing himself, Argao says you should still take his words seriously. The reason you’re evaluating your friend’s risk is because if he’s high risk, then you should bring him to the emergency room. If he’s low risk, then you still have time to seek professional help.
And while there are some people who do mention suicide in order to get attention, it’s still a cry for help that should be addressed. “Sometimes it can start with them just trying to get your attention, and then they really do it. There are also cases of suicide by accident, where the intention is really just to get attention, but things went wrong along the way,” Argao explains. “Whatever the risk is, seek professional help.”
3. Refer Them to a Psychologist or Psychiatrist
When you encourage your friend to get help, make sure not to say anything stigmatizing—the last thing you should tell them is that they need a psychiatrist because they’re crazy. And don't trick them into seeing a psychologist or psychiatrist—that will only enforce their belief that seeking help is shameful and betray their sense of trust in you.
Instead, make them feel that seeking therapy doesn’t automatically mean you’re insane—it’s taking care of yourself. If they still resist the idea, compare it to getting treatment for a physical illness. For example, there’s nothing wrong with consulting a neurologist if you have persistent headaches that won’t go away, and it doesn’t immediately mean you have brain cancer.
Some people aren’t sure whether they should see a psychologist or psychiatrist. The main difference between a psychologist and psychiatrist is that the latter is trained and licensed to prescribe medication. Whether you see one or the other is more a matter of personal preference and whether or not you feel you need medication.
If your friend is still unsure, he can start with a psychologist, since they would know when it’s time to refer their client to a psychiatrist. Some people—if they can afford it—even consult both a psychologist and psychiatrist, who collaborate with each other on the patient's treatment.
4. Lend Them An Ear
Sometimes, no matter how you try, people will still refuse to get professional help because of the stigma surrounding mental health conditions. If this is the case with your friend, just offer to listen to him, and let him talk about his problems without judging him or offering unsolicited advice.
Avoid invalidating his emotions by giving him reasons to live or telling him other people have it worse. “Sometimes the best thing to say is to not say anything, especially if you’re not familiar with the problem or it’s something you haven’t experienced personally,” Argao says. “Talking about the problem is cathartic for them and can already lessen their burden.”
On the other hand, some people try to be empathetic by saying, “I understand what you’re going through.” But Argao discourages this as well, since some people who are thinking of suicide may have already reached the point where they feel no one could possibly understand what they’re going through.
“The best response is to let them know that you’re listening,” Argao says. “So acknowledge and tell them, ‘Okay, I hear your problem. I may not be able to tell you what to do but I can listen.’”
Avoid making promises you can’t keep, such as offering assistance that you might not actually have the capacity to give. After all, if you aren’t able to keep your word, you might end up making them feel more isolated in the end.
5. Give Them Something to Look Forward To
You can make plans to meet up and talk with your friend, and tell them to rest in the meantime. “Someone suicidal has lost hope,” says Argao. “So if there’s something they’re looking forward to [like], ‘Okay, I have to live until tomorrow afternoon because I have to meet this friend,’ then that’s enough. Make them promise not to harm themselves until you meet tomorrow.”
After you meet you can make plans to watch a movie the following week, and go on from there.
6. Have Them Sign a Contract of Life
Another way to make sure your friend doesn’t harm himself while you’re apart is to make him promise to call you or two other designated friends any time he feels distressed and gets tempted to take his own life. Psychologists often do this with their patients and call this a “contract of life.”
“You can have a ‘contract of life’ where you tell them that you will be there to support them and that if they feel overwhelmed, the first thing they should do is to call you and talk it over,” says Inocencio. “In this ‘contract of life,’ you and the person agree to follow a series of steps that ensures their safety. Eventually, when they are at a more stable state, you can ask them to help you guarantee their safety.”
This way, you can also ensure that you’re not solely responsible for keeping your friend alive, and avoid promising to keep their suicidal ideation a secret. After all, even if they haven’t attempted suicide yet, it’s important to let other trusted friends know so that they can watch out for him as well.
You can ask your friend to download My3, a handy suicide prevention app that helps them build a safety plan, list their three designated friends, and access online resources.
7. Don’t Forget to Take Care of Yourself
Looking out for a friend who is suicidal can be pretty stressful, and it’s important to take care of your own mental health as well.
“Remember that you cannot save everyone. Remember that there will be instances where whatever you do, something will happen. The important thing is that you remember you did your best to help the person,” Argao says.
If you’re worrying about the person every day and begin to feel that it’s a burden on you, then Argao suggests taking a step back. “Stop worrying about the person and tell them that if they need anything, you’ll just be around.”
Of course, that’s easier said than done, especially if the person is someone very close to you. In that case, Argao says to take at least one day off where you focus on taking care of yourself. You can watch a movie or talk to someone, whether that’s another friend or a professional.
“It will be very helpful that after, or even during, the course of having to watch out for someone who has suicidal tendencies, that you actually go for counseling yourself,” Dr. Trinidad says. “The process of psychotherapy, involving professional guidance in sorting through your thoughts and emotions, getting clarity about questions that you may have about the whole incident, and learning to comprehend and deal with your own psychological issues and emotional self-care are essential in maintaining one’s own mental health. When you are exposed to potentially traumatic incidents, even if they don’t directly involve you, it helps to gain insight as to how you have dealt with it internally.”
If Your Friend is in Immediate Danger
1. Make Sure They’re Safe
Remember to stay calm and not to panic—after all, your friend is already very agitated, so the last thing you want to do is make things worse by freaking out.
“You need to establish a feeling of calmness and safety,” says Argao. "Your goal is to bring your friend into a more relaxed state, so it’s important to model the behavior that you want.
The next thing to do is ask them how they plan to kill themselves. “Ask first where they are because if they’re about to do it, it’s best to know where they are,” Argao adds. If they’re holding the means with which to kill themselves, ask them to put it down and go somewhere they can be safe—basically somewhere with other people around.
2. Ask If There’s Someone With Them
“When someone’s suicidal, their emotions are usually high, so sometimes they cannot think properly,” Argao explains. “So even if you tell them calm down and wait for you there, something can happen along the way. So the thing we need to establish is that there’s someone who can at least be there to help them and watch over them.”
3. Ground Them in Reality
As you make your way to your friend, keep talking to him. “The most important thing is to ground them,” says Dr. Argao. “So you ask them, ‘Where are you now? What do you see around you? What do you see inside your room?’ We call it grounding because you put them down in a sense where they move away from their thoughts. It’s some sort of distraction but it’s buying you time until you get there.”
4. Once They’ve Calmed Down, Ask Them What’s Going On
A word of caution: it might be best to wait until you’re physically with your friend before asking him about his problems. After all, asking him could trigger negative emotions again and cause him to go through with killing himself. So it’s important to gauge whether your friend has really calmed down before getting to the root of the issue.
If you do decide to ask your friend, remember that the most important thing is to just listen to him. “Allowing him to express his emotions about whatever’s going on would already be helpful,” Argao explains.
If your friend actually asks you for solutions to their problems, Argao says to start with something that’s manageable. For example, if their parents are splitting up and their family problems affect their performance at work, you can’t do anything about their parents. However, their work is still something that’s within their control, so you can start from there.
“‘Okay, so you want to kill yourself. What do you want to do first? Let’s go somewhere, let’s eat, let’s talk, let’s meet up.’ Those small things can distract them but at the same time it’s really buying you time,” Argao adds. “If it’s really beyond what you can help them with, that’s the time we personally recommend professional help.”
5. Take Them to The Hospital
If your friend is only contemplating suicide, then you can get by with talking to him or taking him to see a therapist. But if he is actually on the point of taking his own life, Argao says there’s no other thing to do but bring him to the hospital—preferably one with a psychiatric ward. But if you don’t know which hospitals have psychiatric wards, at least bring him to an ER. The doctors will know how to calm him down if he’s aggressive or violent, and can refer him to a psychiatrist.
It’s best not to call the authorities unless your friend is holding a weapon, because our police haven’t been properly trained on how to handle these situations. Argao recalls an incident in which the friends of a suicidal person called the police, and they took him to the station and interrogated him like a criminal, resulting in further trauma. Argao doesn’t blame the police, since they probably had good intentions, but lacked training. In any case, it’s best for your other friends and family to take charge of bringing your buddy to the hospital.
6. Alert Friends and Family
If your friend is on the point of killing himself, his family has the right to know. “Often we get asked, ‘What if the family is the problem? What if the family is the main reason that they’re suicidal?’ I have to insist that you really talk to the family,” Argao says. “It’s their responsibility.”
After all, if your friend manages to hurt himself, it’s his family who has the right to make medical and legal decisions at the hospital. Even if your friend is already an adult, his family has a right to know, whether it’s his wife, parents, or siblings.
“If the family is the one concerned, tell them first that there’s a problem with your friend and that you need to bring him to the hospital. If they ask what, tell them that you can discuss it with them at the hospital since you think it’s something best discussed in person,” Argao recommends.
Ask your friend what kind of information he’s willing to share with his family. After all, in some circumstances, telling the family everything could make the problem worse. “In a way, you’re giving the person the power to be the one to tell them the whole story. As a friend, you’re just telling the family that there’s an emergency and you need to bring him to the hospital,” Argao explains.
If your friend’s immediate family and relatives live in a different part of the country, then you should still inform them, but also contact other friends or coworkers who can meet up with your friend at the hospital. If you’re unable to bring your friend to the hospital, then you could also ask them to do so—just remember to always stay on the line with your friend while you’re contacting his loved ones.
7. Never Promise Secrecy
When you’re dealing with someone who’s suicidal, it’s important for them to be surrounded by friends and family who can watch out for them. This is why you should never promise to keep their suicidal attempts or thoughts a secret, even if they beg you to.
After all, if you agree to keep things a secret and then tell your friend’s family, you’ll only leave him feeling betrayed, and he might avoid confiding in you again. The best thing to do is to explain that you are telling others because you want to keep him safe.
“You have to tell them that you respect their need for privacy but that to ensure that they are safe, then they should consider telling other people,” says Inocencio. “You have to try to maintain the trust of your friend but at the same time impress upon them that you alone, being untrained or ill-equipped to deal with his/her situation, need the input or advice of someone that they also know and can trust.”
8. What To Do If They Hang Up
Sometimes, in spite of your best efforts to calm your friend down, the conversation can go awry, causing them to become even more distressed and hang up on you. This is why the first thing you should do is ask them where they are and how they plan on killing themselves.
If they’re in a condominium, office, or school, you can call the management to check up on them. This is also why alerting other friends and family is critical. “If communication has been cut off, and you feel that there is an impending threat to the safety of your friend, it is important that you notify the closest family member of the nature and the content of your recent interactions with your friend as they relate to his/her current state of mind,” says Dr. Trinidad. “If action needs to be taken, this may require someone with the proper moral and/or legal authority to decide on the action needed.”
But if you aren’t able to contact any friends or family, then the best thing is really to go to your friend yourself.
If you are having suicidal thoughts, call 24/7 suicide hotline Hopeline at (02) 804-4673; 0917-5584673; and 2919 for Globe and TM subscribers. You can also call Manila Lifeline Centre at (02) 896-9191 and 0917-854-9191, or In Touch Community’s Crisis Line at (02) 893-7603 / 893-7606, 0917-800-1123, or 0922-893-8944.
You can also check out this directory of Filipino mental health professionals and organizations on Reddit.