I’ve been writing recently about asking about suicide. Last time, I suggested what to do if you ask the Question and receive a ‘no’ or ‘not really’ answer.

So what do you do when the person says ‘yes,’ they are thinking about suicide??

First off, don’t panic. Try to do your best SGT Joe Friday (Dragnet) impression and not overreact. Accept what they are telling you just like they had revealed their favorite color is blue.

I believe you are now at a decision point – either you go further down the path of asking them about their thoughts and intentions or you prepare to get them to the next higher level of care.

If you decide that you are not comfortable asking any additional questions beyond ‘are you thinking of hurting or killing yourself,’ that’s fine; however, now that the person has shared what I consider one of their deepest darkest secrets – “I feel so badly I’d rather be dead” – I believe we need to help the person get to a higher level of care.

Let’s focus on the ‘next higher level of care’ option. This phrase comes from my military background and refers to someone or somewhere with more available resources or a higher level of training especially in healthcare. In the Army, we have a number of levels of medical care on the battlefield from the extremely basic aid station to an advanced hospital setting, the Combat Support Hospital. The aid station is close to the battle lines and has minimal resources while the CSH is situated well away from the main fighting and has many resources. So, to go to the ‘next higher level of care’ is to get the person to a person or place with more resources.

Let’s start with helplines or hotlines. I’ve written before about the National Suicide Helpline, 1.800.273.TALK (8255), which is a great resource. Remember, if you are talking with a veteran, have them press “1” after “8255” and this will redirect them to a military specific help center.

You may also be able to find a local helpline through your phone book (yes, those are still available) or via your preferred search engine.

If you are talking to a first responder, there are a couple helplines specific to first responders, such as Safe Call Now at 1.206.459.3020 or the Fire/EMS Helpline: 1-888-731-FIRE (3473).

If the person works for a company which offers access to an Employee Assistance Program (EAP), this EAP often has a 24 hour hotline.

Remember that the most hotlines are not specific to suicide like the National Suicide Helpline.

Another ‘higher level of care’ resource are Mental Health Professionals (MHPs) like psychologists, psychiatrists, social workers, counselors, marriage and family therapists, and others. MHPs generally have training in suicide awareness and prevention. If you are looking for training in suicide prevention, please visit my website, for information on my online training.

Many Chaplains or faith leaders also have training in suicide awareness and prrevention. In addition, Washington State, and other States, are joining in the effort to train more healthcare professionals in suicide awareness.

Your highest level of care is your local hospital emergency department, where the person who is suicidal can be evaluated by a professional.

Since we’re almost into football season, let’s use a football example. When you make a referral to any of the above resources, please use a ‘handoff’ mindset. In a handoff, both the quarterback and whomever he is giving the ball to have their hands on the ball to minimize the chances of dropping the ball. Contrast this with a Hail Mary pass, which is where the quarterback, in a desperate attempt to score a touchdown, throws the ball waaayyyy down the field in hopes his team will catch the ball and score. Please think ‘handoff’ when you are making a referral, not a Hail Mary pass.

This means don’t just tell them to find someone to talk with – help them find an MHP or a Chaplain and make an appointment. Don’t just give them a phone number – help them make that connection. And, if you think a hospital is best, take them to the hospital.

Remember, a handoff is much more effective than a Hail Mary pass.

Next time, we’ll look at some further questions you can ask about their thoughts and intentions, if you feel comfortable doing so, after you get a ‘yes’ answer to the question about suicide.

If you are interested in my upcoming trainings or my online suicide prevention training, please visit my website at

Last time, we talked about asking the question, “Are you thinking about hurting or killing yourself?” and I encouraged you to ask boldly and openly. Generally, a direct question pulls for a direct answer.

There are really only three answers to the Question: no, not really, or yes.

If they say ‘no,’ and you are comfortable with their answer, you can move on. A response like, “That’s good to hear. I’m happy to listen when you are ready to talk,” might be helpful.

If they say ‘not really,’ to me that usually sounds like a veiled ‘yes.’ Maybe you don’t have good enough rapport yet to get an honest answer. Maybe they need a little more time or support in order to feel comfortable saying ‘yes.’ Or maybe they are just unsure. Whatever the case, focus on building rapport or making a deeper connection with the person, then try asking the question once again.

If they say ‘yes,’ remain calm and don’t panic. I recommend you continue your conversation and explore their life situation and resources a bit. We’ll talk about what to do next time.

If you are interested in my upcoming trainings or my online suicide prevention training, please visit my website at

I’ve been talking with people about suicide for a long time. And the question I am most often asked as a speaker and an expert is, “How do I ask someone about suicide? I don’t want to give them the idea!”

Please be assured, you won’t give them the idea to end their own life. If you see enough signs or clues that you are worried they may be thinking about suicide, they’ve already had the idea.

It is very difficult for someone to walk up to you and ask, “Would you help me? I think I want to kill myself.” After working in mental health for 30+ years, I can say this very rarely happens!

Honestly, it is actually much easier for that person if you approach them and say, “Bob, you and I have known each other for awhile, and I am concerned about you. I’ve heard you are having some troubles at home and you’ve been late to work a couple times recently (or whatever is happening in their life). I’m worried – have you been thinking of hurting or killing yourself?”

Or ask, “Have you been thinking about suicide?”

Yep – that’s right. Boldly ask “The Question” right out there in the open. The more you ‘uhm’ and ‘uh’ around The Question, the more uncomfortable you appear in asking The Question, which lowers the probability that the person will answer openly.

You don’t want to bias their response, so don’t ask “You haven’t been thinking about doing something stupid like killing yourself have you Angie?” They will key in on “stupid,” and of course say no.

Ask “Have you been thinking of hurting or killing yourself” or “Have you been thinking about suicide?”

This direct question pulls for a direct answer – yes or no.

Next time, we’ll talk about what to do with their answer to The Question.

If you are interested in my upcoming trainings or my online suicide prevention training, please visit my website at

Small Differences Add UP

My last couple blogs have been about the large impact small differences can have. Over time, these small differences can grow to become significant differences. I have 2 examples for you to consider.

“Make your bed.” This could be something you remember hearing when you were a child, but as a commencement speech at the University of Texas?  Not a topic you might expect.

This, however, was the title and theme of Admiral William McRaven’s (US Navy Retired) address to the 2014 graduating class at the University of Texas. He then expanded his address into an excellent book by the same title. You can watch the video of his commencement address here.

Admiral McRaven’s point is that the act of making your bed every day, and doing it well, can give you the lift you need to get started. “If you want to change your life and maybe the world – start off by making your bed (p. 8).”

The second example is a short video by Stephen Morris of a domino chain reaction. We’ve probably all stood up a line of dominos then delighted in knocking them over, right? Stephen’s dominos, however, begin at a tiny 5mmX1mm domino and grow to the largest at over 3 feet tall and weighing 100 pounds. Each of the 13 dominos is successively 1.5 times larger than the prior domino in the chain.

Stephen’s point is that the energy in standing up and tipping the tiniest domino over into the next largest can eventually lead to knocking over the large 100 pound domino at the end of his chain reaction.

Small differences can grow to become significant differences much like the pace of a camel walking across the horizon significantly altered the course a colleague and I took while driving in the desert during the First Gulf War (see Camels, Compasses & 1% Better).

Your smile, your encouraging word, your small act of kindness may have a significant positive impact in someone else’s life. Just try it.

If you are interested in my upcoming trainings or my online suicide prevention training, please visit my website at

I recently read a post by someone quoting Navy Seal Commander Mark Divine: “Be 1% better than yesterday.”

I often tell this story on myself in my trainings to illustrate a similar philosophy when it comes to suicide intervention: by helping someone considering ending their own life make a very small shift in thought or perspective, we can make a significant difference in that person’s life.

My camel example: During the 1st Gulf War, I was assigned to the 1st Armored Division as the division psychologist. CPT S. was the psychiatrist of our team, and she and I daily drove around the desert, visiting troops and command staff prior to the start of the ground war.

This was before the commonality of GPS, so to drive from one unit to another, we needed a compass heading to the next unit, say 97 degrees, and a distance between the two points, say 14 kilometers.  To advance, we picked a point on the horizon in a straight line with 97 degrees and drove to that spot, then picked another point on the horizon, and drove to that spot, until we accumulated the distance and, hopefully, arrived at the next unit we were visiting.

And, we always hoped that the person giving directions did not utter those fateful words – “You cannot miss it…”

One day, CPT S. was driving our HMMWV and she suddenly stopped.  Since we were nowhere near any visible units or vehicles, I was first puzzled, then worried.  After asking her why she stopped multiple times, she finally responded in an apprehensive voice, “We are in deep trouble. The last point we picked on the horizon are camels walking across the desert!”

This meant we had drifted off of our planned course, and were somewhere unknown in a combat zone! Fortunately, our story ends happily. Two soldiers driving a water truck knew their exact location and were quite happy to help two ‘lost’ medical officers find their way to safety.

The point? All it took was the pace of a camel walking across the horizon to significantly alter our course.

If you have changes you’d like to make in life, remember “Be 1% better than yesterday.” Small changes add up over time.

Feeling alone?

Especially during the holiday season, people may feel alone, left out, or isolated.  Maybe you’ve recently moved, are deployed military, or are emotionally or geographically separated from loved ones.

Whatever your life circumstances, please remember you are NOT alone. There are people willing to help you all around you.

Who can you talk to?

Family, friends, neighbors

Mental Health Professional – psychologist, social worker, psychiatrist, counselor

Faith based person – Chaplain, Father, Rabbi, Deacon, Priest, Imam, etc.

Your company EAP (Employee Assistance Program)

Coworkers, supervisor

Healthcare provider

In many states, dialing “211” provides a shortcut through what can be a maze of health and human service agency phone numbers.  By dialing 211, those in need of assistance can be referred, and sometimes connected, to appropriate agencies and community organizations.

Text 741741 from anywhere in the USA to text with a trained Crisis Counselor. Every texter is connected with a Crisis Counselor, a real-life human being trained to bring texters from a hot moment to a cool calm through active listening and collaborative problem solving.

If you are feeling suicidal, call the National Suicide Prevention Helpline at 1-800-273-TALK.  Or you can text or use their chat room to talk with someone.  They also have Spanish speakers available plus you can contact the Lifeline via TTY by dialing 800-799-4889 if you are hard of hearing.

If you are a veteran and feeling suicidal, call the above number (1-800-273-TALK), then press “1” and you will directed to someone who understands the military.

If you are a first responder, call Safe Call Now at 1-206-459-3020 or the Code 9 Project at 1-(929) 244-9911 to speak with someone who has first responder experience.

This is just a sampling of resources.

What other resources would you recommend?

We’ve reached the end of my series on the Safety Plan as a brief suicide intervention. The Safety Plan has a distinct advantage over the no-harm/no-suicide contract because the Safety Plan helps patients develop a plan for how to care for themselves while the no-harm/no-suicide contract is a “promise” not to try to end their life.

The Safety Plan is often a collaborative effort between the healthcare professional and the patient or client, developing the lists of options for each step.  One of the aspects of SPI that I really like is that the plan is developed when the patient is not in acute crisis and is available to use when they are in crisis.

The Safety Plan consists of 6 steps:

Recognition of warning signs

Internal coping strategies

Socialization strategies for distraction and support

Social contacts for assistance in resolving suicidal crises

Professional and agency contacts to help resolve suicidal crises

Means restriction

For a copy of the Safety Plan form or for the manual, go to and request access.  The Safety Plan form is also included in the manual, along with ‘brief instructions’ which are very helpful.  The manual is for the VA, but can be used in any setting.

Remember that the Safety Plan can be completed either on paper, as referenced above, or there are at least 2 apps available for smartphones or tablets.  The 2 apps are named MY3 and Safety Plan.  Both are free and available from the Apple app store or Google Play.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at

Two massive hurricanes.

A large earthquake in Mexico.

The horrific mass shooting event in Las Vegas on Sunday.

If you feel overwhelmed with recent events in our world, you are not alone.

Many resources exist to help us deal with these critical incidents.  Allow me to share just a few.

The American Psychological Association has many resources on their site,  They also just posted an article, “APA Resources for Coping with Mass Shootings, Understanding Gun Violence” which details several resources, including a guide for talking with children.

SAMHSA (Substance Abuse and Mental Health Services Administration) offers a Disaster Distress Helpline providing 24/7, 365-day-a-year crisis counseling and support to people experiencing distress related to natural or human-caused disasters.  More information is available at the Disaster Distress Helpline. Call 1-800-985-5990 or Text TalkWithUs to 66746.  For the deaf/hard of hearing, use your preferred relay service to call the Disaster Distress Helpline at 1-800-985-5990.  Information is also available in Spanish.

The National Center for PTSD also offers information on “Coping with Traumatic Stress Reactions.” Active coping, defined as taking direct action to cope with your normal stress reactions, means accepting the impact of potential trauma on your life and taking direct action to improve things.  Recommended steps include talking to others for support, distracting yourself with positive activities, learning about trauma, and engaging in relaxing activities such as muscle relaxation exercises, breathing exercises, meditation, swimming, stretching, yoga, and/or spending time in nature.

If you are caring for others, please remember to take care of yourself as well.  For helpful tips, review the recommendations at the National Center for PTSD on Self-Care After Disasters.

If you are interested in my upcoming trainings or my new online suicide prevention training format, or want to review my CV, please visit my website at

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are returning to the final step, Reducing the Potential for Use of Lethal Means, to review some practical steps, especially for firearm use.

Remember that I mentioned in my last post that means restriction is not fool proof or guaranteed, but it is a useful intervention step, especially in the short term.  Once people select a method to end their life, they are unlikely to switch to another method.  Please note I did not say they will not switch – I said they are unlikely to switch.

Firearms are used in half of completed suicides.  If the person considering suicide is planning to use a firearm to complete their suicide, how can we provide means restriction?  See if there is someone who can temporarily store any firearms for that individual.  Sometimes, local law enforcement can assist with this.  If the individual owns a firearm safe, consider placing the firearms in the safe and having them give you the key or change the combination.  Another option, which requires some knowledge of firearm mechanics, is to remove the firing pin.

If medications are the selected method, consider having a family member or friend control the medications, ensuring the individual receives their daily dose but restricting access to large amounts of the medication.  Also consider working with the individual to speak to their prescribing physician about changing the medication (especially opioids and benzodiazepines) to a less lethal option.

The key to means restriction is determining the method the individual is planning on using, and restricting that access.  You cannot eliminate access to lethal means but you can restrict access to lethal means. For more information, see the Means Matter website.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are ready to explore the final step, Reducing the Potential for Use of Lethal Means.

This final step in the Safety Plan is particularly important when someone considering suicide has developed a plan.  Once someone has selected a method – gunshot, hanging, cutting, etc. – the probability of suicide increases the more they refine their plan – when, where, how, etc.

Thus an important follow-up question to “Have you been thinking of hurting or killing yourself?” is “Have you developed a plan for how you will end your life?”  A broader question would be, “Which means to end your life are available to you and would you consider using during a suicidal crisis?”

We ask the question as part of the ongoing assessment process (Is their plan available, lethal, and accessible?), but we also ask it as an intervention tool as well.  Namely, can we eliminate or limit their access to those named lethal means for a temporary time?

This is based on the belief that once people select a method to end their life, they are unlikely to switch to another method.  Please note I did not say they will not switch – I said they are unlikely to switch.  Means restriction is not fool proof or guaranteed, but it is a useful intervention step, especially in the short term.

Barber & Miller (2014), in their article on reducing access to lethal means, suggest several potential avenues of approach: 1) physically impeding access (e.g., gun locks, bridge barriers, restricting access to car keys); 2) reducing the lethality or toxicity of a given method (e.g., reducing carbon monoxide content of motor vehicle exhaust); or 3) reducing “cognitive access,” that is, reducing a particular method’s appeal (e.g., discouraging media coverage of an emerging suicide method).

In my next post, we’ll look at practical ways to implement reducing access to lethal means.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at