Recognizing and Addressing Signs of Suicide

When someone is distressed, depressed or has suicidal thoughts, it is often the people who are closest to the person who are able to pick up cues from his or her behavior. Individuals in helping professions, particularly in healthcare, often spend much of their waking hours in the workplace with increasing demands and fewer opportunities to connect with their colleagues. When a healthcare professional is feeling burned out or stressed, or is struggling at home or work, it is often their colleagues who are the first to notice. Being sensitive to these situations can help you play a critical role in helping your colleagues establish and maintain well-being, and move towards healthier coping.

The topic of suicide continues to be a difficult subject to approach especially when you believe your colleague is experiencing significant distress. Contrary to what most people think, asking whether someone is having suicidal thoughts or feelings does not create suicidal thoughts. In fact, it makes it easier for the person to reveal such thoughts. Often a person who is having suicidal thoughts is also ashamed of such thoughts and feels relieved about being able to talk about it without being judged or labeled as weak. When you can give your time and energy to assisting a troubled colleague you can open the gate for someone to seek and obtain the emotional support they need and to seek further support from a mental health professional.

Identifying who is at risk

Suicide is not something that happens out of the blue. It is caused by a convergence of multiple risk factors, the most common being inadequately managed mental health conditions. Among physicians, risk for suicide increases when mental health issues go unaddressed, and self-medication or substance abuse occurs. Additionally, there is often an event or a phase of difficult events that makes a person think of taking their own life. These are usually life-changing events such as losing a loved one, the end of a relationship, losing property or financial stability or any experience that the person sees as shameful or humiliating.

A person who is contemplating suicide may become withdrawn, behave out of character for their personality, or get intensely emotional over events that seem routine to others. Here are some additional behaviors that could alert you to suicidal ideation:

• Mentions of dying, not wanting to live or life losing all meaning
• Talking about being useless or being a burden on family and friends
• Being uncharacteristically subdued or depressed for long periods of time
• Having very frequent mood swings
• Getting overly dependent on substances such as alcohol or drugs
• Uncharacteristic neglect of work, personal hygiene and responsibilities
• Showing interest in practical matters related to death: making a will, benefits of a life insurance policy planning one's funeral

If you observe that a colleague is agitated or distressed, and you know they are going through a bad phase (relationship issues, sudden bereavement, conflict with spouse or parents, financial difficulties, etc.), you can offer your support.

HR and managers should also keep in mind there are other cues that can be picked up from someone who may be significantly distressed:

• Sudden absenteeism or change in work patterns (e.g., a person who was usually on time and finished work long before deadlines is suddenly struggling to cope with office timings or work schedules)
• Concern about downsizing or changing of roles expressed by employees who stand to lose their jobs or who may face a significant change in responsibilities
• Difficulties experienced by employees who are not from the region, and who have to make significant lifestyle changes to adapt to their new roles

It's essential to remember that these risks don't necessarily make a person vulnerable to suicide. Rather, they indicate the person may need additional support to cope with new circumstances.

Do’s and don’ts for supporting a colleague

There are a lot of ways you can help a colleague when they have expressed a need for support. In many cases, simply listening or validating the person's distress can be enough. Here are some helpful tips for what to say and what not to say:

• Don't minimize the other person's problem. Everyone has different tolerance levels and different ways of coping with things that go wrong.
• Avoid clichés like "I'm sure you'll manage," "Be strong," "Suicide is not the answer," or "Everyone has problems.” These can feel dismissive and like their feelings don’t matter.
• Let the person know that you are concerned and that he or she is valued.
• Don’t be critical or judgmental by saying things like, "Suicide is bad," or "Don't be a coward."
• Focus on the person's strengths and try to identify helpful, positive resources within the person and in his or her environment (family, friends, faith, community, etc.).
• Avoid offering advice or suggestions related to life circumstances, unless you are specifically asked to do so. It’s preferable that you listen to the person and then offer suggestions (if needed).
• Do come prepared to offer resources for support, like VITAL WorkLife’s telephonic and face-to-face counseling and prepare for how you will respond if your colleague does indicate suicidal ideation.
• Acknowledge the person's distress and ask what makes life worth living. He or she can create this list and use it as a reminder when feeling low.
• Identify the person's positive coping skills and recall how he or she has dealt with problems earlier.

Suicidal thoughts arise from a person's emotional turbulence and insufficient coping mechanisms for the situation. If you can help decrease the person's distress to a more manageable level in the moment, and offer resources for support, you open the door for the individual to move towards healthier coping. You can help the person manage distress by listening, offering help and creating a supportive network.

When to take a step back

It’s understandable that you may feel overwhelmed with the idea that you are assuming responsibility for a person's well-being. Here are some things to keep in mind if you find yourself in this situation:

• Everyone has a different tolerance for the support they provide to others. It is important to set appropriate boundaries that consider your needs and support your personal well-being.
• It is not your job to fix your colleagues’ problems or alleviate their depression.
• You don't have to do it all yourself. Sometimes, a brief conversation can have a great impact on the person. In-the-moment telephonic counseling is available to you and your colleagues, any time, day or night, through VITAL WorkLife by calling 877.731.3949.
• You can’t help anyone if you don’t help yourself. If you are overwhelmed, seek support for yourself from family and friends.

What can organizations do?

Organizations have a role in helping prevent suicide. Here are some things organizational and physician leaders can do:

• Focus on spotting and addressing burnout. This is where organizations can make the biggest different.
• Make sure work/life balance is a known and practiced priority.
• Support realistic works hours and limit on call hours, when possible, to support a healthy work/life balance.
• Decrease administrative burdens and demands for physicians and providers by offering additional support for completing EHRs, such as assigned medical scribes.
• Make sure your organization’s culture supports openness for employees to share concerns, encourages open communication and conversation and follow-up quick when concerns are voiced.
• Make sure your organizational culture supports eliminating the stigma of seeking help for mental health concerns and treatment for physicians and providers.
• Discuss burnout, depression and addiction honestly and be forthcoming and promote VITAL WorkLife resources.

We Can Help

Whether you are feeling overwhelmed with the stressors of life or struggling to find the right way to support a friend or family member in need, VITAL WorkLife is here to help. We have numerous resources supporting every aspect of your well-being, from in-the-moment telephonic counseling to peer coaching. We are available day and night at 877.731.3949 to support you and those you care about.

Source:

Jeurkar, S. (2016). You can save your co-worker's life (B. Schuette, Ed.). Retrieved May 6, 2016, from the White Swan Foundation website: http://www.whiteswanfoundation.org/