Angie Walsh
BSW MSW RSW RCC
It is important to recognize that all humans experience a range of emotions, just like how weather varies day to day. Happiness is not the ‘default’ emotion, just like sunny days are not the ‘default’ weather. Some days will be filled with excitement, overjoy, overwhelm, low mood, sadness, and disappointment. Some moods may persist, but they will not last forever – just like it won’t rain every single day in Vancouver, even if it feels like it will. Some days we feel prepared to cope with those rainy days in our rain jackets and boots or deciding to stay inside; other days we are mentally exhausted and do not feel like we can cope through the hard times much longer. Since life is filled with ups and downs, low mood is normal and often triggered by stressful events and factors. After making a few small changes or after problems resolve, low mood tends to lift after a few days or a couple weeks and people can return to their regular functioning. However, when this low mood lasts for several weeks or months and interferes with one’s ability to participate in life routines (ie. sleep disturbances, loss/increase of appetite, no longer interested in hobbies, socially withdrawn, not attending school, etc.) this may meet criteria for clinical Depression. Not all Depression includes suicidal thoughts and not all suicidal thoughts meet the required diagnostic criteria for Depression.
When people are deep in their struggles and feel hopeless things can change, this can bring on thoughts about no longer wanting to live. Sometimes these thoughts are brought on by an idea of escaping the pain/discomfort, or feeling helpless in creating positive change. Everything can seem outside one’s control, so this sometimes feels like the only option to get ‘out’. Other times, people think they’re doing everyone else a favour by ‘unburdening’ their loved ones by ‘leaving’. There are a variety of reasons and contexts why these thoughts and feelings show up. On these dark days, our mind can get persuaded by these suicidal thoughts. Some days it is easier to lean into the rational mind, knowing these thoughts are untrue and reach out to our loved ones or productively cope. Other days, it can be hard to resist these negative thought patterns and intense feelings, and believe they can only cope through destructive relief (ie. substance use, risky behaviour, self-harm) or suicide.
What do we do when our loved one is struggling with suicidal thoughts?
A thought is just a thought, until it’s not. We need to better understand the risk of these thoughts.
Questions to explore:
Is it a fleeting thought that holds any weight?
How long have they been having these thoughts?
How often are they having these thoughts?
What is the exact thought(s)?
Do they have a plan?
Do they have access to the items/means to make this plan a reality?
When do they plan to put this in action?
How realistic is it that they would go through with this plan?
Do they have a sense of hope that it will eventually get better or hopelessness that feels impossible to come out from under this?
How have they been coping with these thoughts?
Who have they told?
What’s the context when they are having these thoughts (ie. intoxicated)?
Have they made attempts in the past?
Have you noticed a general change in their daily routines and mood (ie. more anxious, not participating in school/social life, low desire to do things that used to be fun to them, withdrawing, etc.)?
All of these questions give a better idea of risk (low, moderate, high) and clarify the likelihood of thoughts staying just thoughts – how influential these thoughts are on one’s actions. That said, even if the risk is low to moderate, this is always an outcry for help and requires attention. These thoughts communicate to the person and their loved ones that this way of life is not sustainable and requires change because it is currently threatening their health and wellness. They require more support and positive influencers. This is the time to maintain and create more support for connection. Often people can feel extremely lonely and isolated during these times. Work to help them feel heard and not alone. If they will talk to you, listen. Paraphrase what they tell you so they know you are listening to them and are trying to understand them. Validate their feelings; these feelings may not be an accurate reflection of your reality of their life, but it is their reflection of their current reality. To try to have your loved one feel heard, it can be helpful to use emotion coaching skills by validating their emotion three times in the format:
No wonder your feeling + (Identify emotion/feeling)
Each reason will provide validation that your not only hearing them, that you understand what they’re saying and that you actually get why they’re feeling the way they do.
If your child/youth already has a counsellor in their life, try to schedule an appointment as soon as possible. If they do not feel like they can be honest with their counsellor, suggest finding a different one. There are various counselling services (public and private) that can be explored to allow your loved one to process and work through these emotions and issues with trained support while creating a safety plan. Encourage participation in their routines to maintain some momentum and motivation to participate in life. Inquire about their interest in increasing school staff awareness and involvement (ie. child/youth care workers or counsellors) to implement daily support outside the home. Don’t let your loved one sit in silence, dealing with these demons on their own. The demons can be mighty persuasive.
What do we do when our loved one has a suicide plan and desire to implement it?
So you’ve determined that the risk is moderate to high, they have an imminent plan and feel helpless, seeing suicide as their only option. The hospital is a community resource where trained professionals can safely assess, monitor and supervise your loved one while creating a treatment plan. It’s important to remember that often these thoughts did not generate overnight, so it will be a process and likely involve ongoing support at home and in the community to stabilize and support your loved one through this tough time. Sometimes children and youth will be referred to a Child and Adolescent Psychiatric Stabilization Unit where they will stay in a secure unit for 1-7 days to prevent further deterioration and stabilize them with psychiatric medication or psychotherapies. The hospital is not a ‘cure’ for mental health issues, just like it is not a ‘cure’ for physical health issues – but it can definitely help and get your loved one stabilized. Chronic mental health issues will require longer term services in the community.
Resources
Suicide risk assessment
Suicide Safety Plan
Youth and Suicide Fact Sheet
Kids Help Phone
Suicide Intervention Toolkits
List of Crisis Helplines and Resources
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