Suicidality: How to Support Someone in a Crisis (Part 1)

CONTENT WARNING: This episode discusses suicide and suicidal ideation, which may be difficult for some listeners; if you or someone you know is struggling, please reach out to a mental health professional or a crisis hotline like 988.

"When you are suicidal, it is an incredibly isolating feeling. It’s feeling like nobody really understands." In this episode of RECOVER, host Terry McGuire sits down with Dr. Sara Kohlbeck, PhD, a distinguished suicidologist and public health researcher, to peel back the layers of a topic often kept in the shadows. Dr. Kohlbeck shares her profound insights into the "suicide spectrum" and the reality of being high-functioning while struggling with thoughts of ending one's life.

Find mental health and addiction treatment near you: https://recovery.com/

This conversation is designed to normalize the human experience of suicidal ideation and provide practical, research-backed tools for intervention. Whether you are currently struggling, a loss survivor, or someone worried about a friend, this episode offers a roadmap for connection. Dr. Kohlbeck explains the "Suicide Thermometer," why sadness isn't always the primary symptom, and how to navigate the fear of "saying the wrong thing."
Dr. Sara Kohlbeck, PhD, is a leading expert in suicide research, focusing on the complex socio-economic factors that contribute to suicidal behavior. Her work emphasizes that connection is prevention.

If you or someone you know is in crisis, please call or text 988, the Suicide & Crisis Lifeline, or reach out to local mobile crisis teams. You are not a burden, and there is hope for recovery.

⏱️ Chapters:
00:00 – Intro: Breaking the Silence on Suicide
01:31 – Normalizing Thoughts of Suicide
03:05 – The Suicide Thermometer: Understanding the Spectrum
05:58 – The Reality of High-Functioning Suicidality
06:36 – Critical Messages for Those Currently Struggling
13:47 – Why It Happens: The Complex Risk Factors
15:55 – What to Say to Someone Who is Suicidal
22:22 – The Myth: Does Asking About Suicide Plant the Idea?
24:03 – Crisis Response: When to Call 988 vs. 911
47:24 – How to Tell a Partner or Parent You’re Struggling

❓ Questions the Video Answers:
How do I talk to someone who is suicidal?
Does asking someone about suicide put the idea in their head?
What is the difference between passive and active suicidal thoughts?
Can you be high-functioning and suicidal at the same time?
What happens when you call or text 988?
What should I do if someone gets angry when I ask if they are suicidal?
Why do I want to die if I don't feel sad?
What are the subtle warning signs of suicide?
How do I tell my parents I’m struggling if they don’t believe in therapy?
Is suicidal ideation a normal part of the human experience?
What is the "Suicide Thermometer" concept?
When should I call 911 for a mental health crisis?
How can I support a suicide loss survivor?
What are "Warm Lines" and how do they differ from crisis lines?
How do I help someone who feels like a burden?
#suicideprevention #mentalhealth #988lifeline

Transcript

SPEAKER_01 0:00

When you are suicidal, it is an incredibly isolating feeling. Sarah Kolbeck is a public health researcher specializing in suicide. It's feeling like nobody really understands. It's feeling like I don't want to burden the people that I love.

SPEAKER_02 0:14

How do I tell someone, my parent or my partner, that I'm really struggling and thinking of ending my life? Welcome to Recoverable. I'm your host, Terry McGuire. Today we will be talking extensively about suicide. It'll be a conversation you have likely not had or heard, and it might bring up a lot of things for you. So we are going to encourage you to exercise self-care as you listen. That might look like taking this episode and next week's in chunks instead of listening all at once. It might mean skipping it, coming back in two weeks when we're doing another topic that isn't as difficult. It might also mean calling 988 if things come up for you. That is the suicide and crisis lifeline. So we will proceed with this with that understanding that you need to take care of yourself while you listen. Joining us today is Dr. Sarah Kolbeck, who is, I now learned a new word, a suicidologist and a suicide researcher and the perfect person to have this discussion with. Thank you so much, Sarah.

SPEAKER_01 1:16

Yeah, thanks for having me.

SPEAKER_02 1:17

So and she told me to call her Sarah, not Dr. Sarah. So, what have you learned about suicide in your life experience, your research, that as we begin this conversation, you want to make sure people understand.

SPEAKER_01 1:31

Yeah. Um, I have learned a lot, as you can imagine, in my my own lived experience and through the work that I've done, the research that I've done. But I think the thing that I want people to know sort of if there's one thing to take away from this conversation today, is that it is not uncommon to have thoughts of suicide. I really believe this is part of our human experience. And the more that we sort of normalize that thought, that it's not uncommon to have these thoughts, and we can do something about these thoughts. There is a way to prevent suicide. And in most cases, I think the more that we normalize that conversation, normalize that fact that this is not uncommon, the more that we open the door for conversations to happen that can lead to that healing, that can lead to recovery, that can lead to prevention. If we keep talking about it as if it's in the shadows and it only happens to those people, and in those cases, we're going to continue to have the stigma that we have seen for so many years in our communities. And so I think that's the thing that I want people to know. This is not uncommon. This is part of our experience. So let's talk about it.

SPEAKER_02 2:39

Let's talk about it. Yeah. So when you say those thoughts, there's a range of those thoughts. Yes. And and we'll get to the internet questions, but I think it's important. There's the, you know, I'm just done. This this life thing is not any fun. It's too much work. It's too hard. It's all the things it can be. Two imminent danger. So let's talk a bit about that spectrum when you say people or that it's common to have those thoughts. What kind of thoughts do people have?

SPEAKER_01 3:05

And I love the way that you conceptualize this or frame this as a spectrum because it really is a spectrum. There's a really wonderful artist. Her name is Elise Rourianni. Anyone who's interested in learning more about this, I would suggest checking out her Instagram and her website. Um, but the way that she conceptualizes suicidal thoughts is on a thermometer. And I think it's a really cool way to sort of think of this in a really, I think way that people can sort of grasp what this looks like. Everyone knows what a thermometer looks like. We start down at the bottom where it's cold and then up at the top, it's really hot. And that's kind of how suicidal thoughts can happen. Sort of you can have, you know, this experience of no thoughts of suicide, or you might have thoughts that are kind of passing thoughts of maybe morbidity, like, you know, what would it be like if this were the end or if this could be the end? And then you have sort of passive thoughts, but you don't have any real intent, you don't have a plan, or you may have thoughts where there is maybe you've thought about a plan and you have intent to carry out those thoughts. And then at the top of that thermometer are is when someone is actually attempting suicide. And I think it's important for us to understand as sort of a place to start this conversation, that thoughts happen along that spectrum for an individual person throughout the course of their life. Some people may have one passing thought at one point in their life and never again. But all of the thoughts that are along that thermometer or along that spectrum are reasonable. They're all valid experiences, and they all sort of count in that conversation about suicidal thoughts. Um, and so when we talk about thoughts, um, again, somebody might have a passing thought, somebody might have a thought with a plan, an intent, somebody might attempt. And when I talk about those thoughts, that's really what I'm talking about is that spectrum, that thermometer of suicidality that, again, is I think so important to understand and center in this conversation.

SPEAKER_02 5:05

And we will get into it later as we have this discussion, but there are different responses for each level. You know, you have to do a very different intervention or response if somebody is in imminent danger than if they're having the thought. And some people live with this chronically. And that's a you know, that's a very different thing if somebody's always thinking about it.

SPEAKER_01 5:24

Yeah.

SPEAKER_02 5:25

Wake up thinking about it, go to bed thinking about it. Yep.

SPEAKER_01 5:28

And I think people tend to think of suicide and suicidal thoughts as sort of it happens or it doesn't happen. It's yeah, it's a yes or no. And it's not. I know this through my own experience, it can last months. And you can wake up every day thinking about this. It can last years. You can wake up every day thinking about this, and then it might be gone and it might come back at some point. So I think again, just thinking about this in that nuanced way and talking about this in that nuanced way uh is really important. I think to honor all the experiences that folks have.

SPEAKER_02 5:58

Because before learning that, it's easy to think if someone were to say, I'm thinking of ending my life, which I don't know how often someone actually comes out and says that, but let's say to not be like five alarm fire, right? I'm running to the phone to dial 911. I've got to save this person's life. And that's often not the situation, which I look forward to exploring. Yes. So before we dive in further, I would like you to directly address sort of the groups of people who might tune into a suicide podcast, an episode about suicide. First of all, for anybody who might be suicidal right now, what do you know they need to hear?

SPEAKER_01 6:36

You are not alone. Um, you are not a burden. Um, and there is hope out there for recovery. Um, the feeling that you're feeling right now is going to pass. And uh there are people out there who want to help you. And how would they get that help? So you mentioned one earlier in the episode. 988 is a great place to call. Um, oftentimes um counties have mobile crisis lines uh that you can call that are often staffed by therapists. I think one of the fears that people have when they're suicidal is I don't want to call a number because police are gonna come. Um, 988, again, a great resource to call. Mobile County Crisis, great resource to call. There are also um resources called warm lines. Um, these are organizations that are staffed by people like you that have lived experience who are there to just listen and talk to you. Um, another option could be an alternatives to suicide group that meets regularly. Um, oftentimes they meet virtually. There are alternatives to suicide group across Wisconsin. So just Googling that um and looking for that uh could be really helpful.

SPEAKER_02 7:45

Yeah, it's it would be nice to feel safe describing what you think and feel to other people who have that same experience versus who are going to look at you like, what's wrong with you?

SPEAKER_01 7:56

Well, and sometimes I found that just having space to talk about those feelings is can be enough to sort of decrease that feeling of suicidality because again, it helps a person feel less alone.

SPEAKER_02 8:07

So for someone listening who's really worried about someone in their life who they fear might be suicidal, yeah, what is your message to them before we jump in?

SPEAKER_01 8:15

My message is that if you are worried that somebody is suicidal, it's really important to ask them directly about that suicidality. Um, there's often a fear that if you ask somebody directly, you're gonna put the thought into their head. We know from research that's not how that works. In fact, if you ask somebody who is suicidal directly, often you're making that space for them to feel better. You're letting them know that uh you're somebody that is safe, somebody that they can come to, someone that's not gonna judge them. So ask the question if you're concerned, hold space for that conversation and then listen a little further because we're gonna talk about how we can support folks uh who are in that space.

SPEAKER_02 8:55

Some of the people watching today have lost someone by suicide. What do they need to hear? And I think a lot of it might just be validating whatever it is they're feeling. Yeah. But what is your message for lost survivors?

SPEAKER_01 9:07

Yeah, we do a lot of work with lost survivors. And I think, yes, validating what they're feeling, what you are feeling in this really complicated, traumatic experience is normal. Um, it is not your fault. Um, and there again are people out there who have the same experience you've had. You're not alone. Um, and connecting with people that have had this similar experience really can be helpful. And so that would be my encouragement. Um, experiencing suicide loss can bring its own level of stigma, but I think knowing that, again, you're not alone, there are people out there that have experienced this. There are people willing to talk about this can really help.

SPEAKER_02 9:46

And then for people who are not actively suicidal, but who are just kind of done with life, who are listening, who are just like, I just what's the point? People who are at that point.

SPEAKER_01 9:56

Yeah. I would say the world is hard right now. Uh, things are difficult right now. Um, but I think, you know, thinking about the next thing to kind of kind of put one foot in front of the other. I think thinking about what's going to get me through until tomorrow or next week or next month can seem like an awful lot. So think about what's going to help you get through to, okay, an hour from now, what's going to help to get you through to tomorrow and kind of searching out those sources of of hope and strength and those reasons for living. Um, reach out to others. I think, you know, feeling like you're done can be very isolating. And connection is prevention. And so connecting with others in that time can be really helpful as well.

SPEAKER_02 10:40

How do you describe the difference between what suicide looks like from the outside and what it feels like from the inside?

SPEAKER_01 10:46

Yeah, that's such a good question. I think from the outside, suicide and suicidal thoughts, we may not see them. Um, we may not, you know, sort of overtly notice someone who is thinking about suicide. When we do see signs, it can often look like things like increasing substance use. It can look like hopelessness, despair, anxiety. It can look like anger. Um, it can look like impulsivity and doing things that are really out of character for the person. But again, I think it's important to know that oftentimes we we won't be able to see signs outwardly of someone who might be thinking about suicide. Um, sometimes those signs are really subtle. And sometimes someone who is suicidal will actively hide signs from people that they care about because they don't want to be a burden. They don't want you to worry about them. Um, but when you do see signs, you might see some of the things that I mentioned earlier. When you are suicidal, um, and again, I'm drawing on my experience here of when I've had suicidal thoughts in my life, it is an incredibly isolating feeling. It's feeling like nobody really understands. It's feeling like I don't want to burden the people that I love. In my case, my I think kind of tipping point came when I felt like my mental illness was preventing me from becoming from being a good mother. And so I felt like my purpose was sort of gone. Um, you kind of feel like you're in a tunnel. And not necessarily in the sense that you have tunnel vision, but everything is kind of black around you. And it's really hard to see the light at the end of that tunnel. And again, nobody is going to know or see that unless they're in that tunnel with you. And so I think suicide can look very different. But in my experience, it really is about that isolation and that sense of burdensomeness and that sense of I the world will be better off without me. Um, I can't fulfill my purpose here anymore. That that's kind of what that feels like.

SPEAKER_02 12:51

Lest you think you're the only one at the table who has had those thoughts, I will share that I have as well. And when you first said hide, I thought you were gonna say hide, just hide, withdraw, but you said hide the hide what's going on. Yeah. Also, as you say, isolation, yeah. Right. It's hard to for someone else to notice a warning sign if they don't see you.

SPEAKER_00 13:10

Yeah.

SPEAKER_02 13:11

Because you're hiding. You know, you have shut down or shut out.

SPEAKER_01 13:15

So yeah. Yeah. I when I was at, you know, a particularly low point, I remember physically sort of withdrawing into my couch. Like I would get home after work and I would shrink myself into the corner of my couch. Um, to and in in that attempt to withdraw. And so that is, I think, a big part of it.

SPEAKER_02 13:34

Are there common risk factors or reasons? You know, we're gonna, I'm gonna ask you a whole lot of questions, but the one that certainly lost survivors, you know, it's why? Why would someone do this?

SPEAKER_01 13:47

Yeah. It's such a good question. And I think the message that I want to send is that suicide is not the result of one factor. It is complex. That doesn't mean that we can't prevent it because there are evidence-based strategies for suicide prevention. However, it is very complex. Um, a person who has, you know, depression, for example, or anxiety, that does not mean that that person is going to die by suicide. Conversely, there are people who don't have depression or anxiety who do die by suicide. So we know that there's complexity to this. When we think about risk factors, I like to invite folks to think kind of outside the individual. We know that things like having a mental health condition, um, having experienced a suicide loss at the individual level do increase risk for suicide. But there is a lot going on outside the individual that contributes to suicide and suicidal behavior. I think we have to look at our organizations and our communities and how we are or are not supporting people in those spaces. For example, when we look at some of the research literature, things like lack of access to mental health insurance, lack of access to basic needs contribute to suicidal thoughts and behaviors. We also know that big things like policies influence suicide and suicidal behaviors. One of the studies that I did looked at kind of the effect of big sort of macroeconomic policies and how those policies might correlate with suicidal thoughts and behaviors among farmers. So we know that it's not just about what's happening inside an individual. It's about the things that are happening to an individual, often from the outside, and sort of the confluence of those factors coming together in a person's life that really result in this feeling of intense pain, intense distress, feeling like there's not a way out of this that really ends up uh resulting in suicidal behavior.

SPEAKER_02 15:44

Yeah, no way out is hopeless. Yeah. Yeah, exactly. Okay. Top internet searches. The most searched question on the internet is what do I say to someone who is suicidal?

SPEAKER_01 15:55

If you start to get kind of that gut feeling in a conversation with somebody that uh they might be thinking about suicide, asking them very directly, are you thinking about killing yourself? Using those words, or are you thinking about taking your own life? Using those words, are you thinking about suicide? Is suicide what we're talking about here? Using those words is really important. Um, and then I think if a person is suicidal and they have told you that they are suicidal, another really powerful thing that you can say is, you know, wow, I really appreciate you telling me that. Thank you for telling me that I'm here to listen. And then actually doing that, listening. Um, and then through that conversation, trying to listen for things that give you clues where a person is at on that spectrum that we talked about earlier. But really, that person needs to know that they're not alone, that they're not a burden, and that you're here to listen.

SPEAKER_02 16:46

It is, I have interviewed dozens of attempt survivors and asked them what would have helped. Yeah. Is there anything, you know, at that stage just before that would have made it not happen or perhaps it made change something? And it's always if someone had listened to me, if someone had known, if someone had made me feel like I wasn't a burden, if someone had said, what your feelings real.

SPEAKER_01 17:10

Yeah.

SPEAKER_02 17:10

And I will sit with you.

SPEAKER_01 17:12

Yeah. Yeah. I think it's true. And, you know, for many people, that that talking and that that being heard is is treatment. That is the treatment that they need in that moment.

SPEAKER_02 17:22

I think there's a fear of saying the wrong thing. And I think that that stops a lot of people from saying anything.

SPEAKER_00 17:28

Yeah.

SPEAKER_02 17:29

Which is worse? Not saying anything if you think someone might be struggling or suicidal, or saying what's the wrong thing.

SPEAKER_01 17:37

One of my favorite colleagues has said, and I'm gonna misquote him, but he said something like, an imperfect intervention is better than no intervention. And I think that's so true. We're all human, and I think acknowledging that humanness and that humanity is part of that conversation can be great. Like saying, I'm worried about you. I'm feeling sad that you're feeling this way. I don't know exactly the right words to say to you right now. I just want to keep listening, is so much better than ignoring it or not saying anything at all. And I think by acknowledging that humanness, this person is scared. They're in distress. I'm also scared that creates that connection. Um, and just that humanity, I think, is so important in that conversation.

SPEAKER_02 18:25

You know, I have a depression podcast and I interviewed two men, one of whom was literally over the rails on a bridge.

SPEAKER_00 18:32

Yeah.

SPEAKER_02 18:32

And the second was walking, approaching that bridge to cross over it, and saw just all these people walking past him, saying nothing, probably afraid to say anything or get involved. He walked up, and the the magic words, you know, hardly somebody who had studied it and, you know, had his script, even knowing what you just said would be a good thing to say. And he just said, What's going on, dude? Yeah. And they ended up having a conversation. He did, in fact, come back over the bridge. He had left a psychiatric hospital and went back, finished treatment. They're friends, and and he's still alive and they're still connected. And what's going on, dude, is probably not what would come to mind to someone thinking in a really scary situation, these are the perfect words.

SPEAKER_01 19:15

Yeah. Yeah. So an open-ended question. What's going on? How are you feeling? Right. What started this? Um, can again invite that conversation in a way that can be really healing. And I love that story. Yeah, it's a it's a cool story.

SPEAKER_02 19:31

So a follow-up question also from the internet. What should I do if I ask someone if they're suicidal and they get angry or defensive? Should I back down or press harder?

SPEAKER_01 19:42

So um, we talked about stigma around mental health and suicide. There is a lot of stigma around this issue. And when we do suicide prevention trainings, we tend to, and when we talk about this conversation, we tend to frame it in a way that it's gonna go from step A to step B to step C to step D. You get them to help. And that's very rarely how these conversations happen in the real world. And that is a possibility. Somebody's gonna get really ticked off at you or they're gonna get angry or defensive. And that could be for a number of reasons. I think it's important for you to not take that personally and say something like, it sounds like you don't want to have this conversation right now. That's fine. Just know that I'm always gonna be here for you if you need to talk. You're leaving that door open. Um, continuing to push a person further might continue to kind of amp up the situation in a way that is not going to be helpful for anybody. And so again, just saying, okay, I recognize that you're uh this is not a conversation that you want to have right now. Um, just know that I'm here for you. Maybe I'll text you in a couple hours to see how you're doing and kind of leave it at that.

SPEAKER_02 20:46

One last question from the internet under this category. Are there things we should never say to someone who's suicidal?

SPEAKER_01 20:52

Yeah, there are some kind of guidelines for things we shouldn't say. Um, one example is to not give advice. Um, it can be, I think, human nature for us to want to fix somebody that's feeling just distress. We want to help. And in that quest to help someone, we might say things like, Oh, you should try yoga or you should try meditation. I like to frame this similar to how we would approach someone who's having a heart attack. You wouldn't tell somebody who's having a heart attack to start exercising, right? So avoiding advice in this situation. I think saying things like, I can't believe you'd be so selfish. Um, that person's so much to be grateful. So much to be grateful for. Again, when you're in that tunnel, um, it can be really hard to think about those things that you're grateful for. And the you're so selfish piece, people are feeling the opposite of selfish in that situation. We often feel like a burden and we feel like removing ourselves is going to be helpful. So it's sort of the opposite of selfish. So kind of those judgment statements, I think, are really important to avoid. And I think the other thing I would say is avoid minimizing. I think this can be tempting, especially with. Youthful people that maybe have gone through like a breakup, then we feel as adults like there's so much more for you to live for. There's more fish in the sea. I think avoiding minimizing things, like, wow, this sounds like this is really difficult for you. And sort of validating that experience, no matter how minor we perceive that to be, um, avoiding that minimization is also really important.

SPEAKER_02 22:22

Good advice. So you addressed this earlier in an answer, but I want to ask it separately because it's the second most asked question on the internet about suicide. Well, asking someone about suicide put the idea in their head.

SPEAKER_01 22:33

Yeah, it's a really common uh fear. And I think, you know, again, that fear rooted in wanting to make sure that people stay safe and caring about people. Research has actually shown that asking people about suicide does not plant the thought in their head. It doesn't increase their risk for suicide. In fact, it's the opposite. If somebody is thinking about suicide, you've opened that conversation, you've let that person know that you're safe. And if a person, if you ask that question and a person isn't thinking about suicide, you have also let them know that you are a person that's willing to kind of ask that difficult question. Um, and that if they're ever thinking about that in the future, you're somebody that is going to be a safe person to come to. So you're not gonna plant that thought in their head. But that is a very common miscon uh kind of misconception around this. Yeah.

SPEAKER_02 23:20

I think the way it's asked too is you've been saying, because before I learned better, I can imagine a phrase like, you're not thinking of doing anything stupid, are you? Yeah. Or even of hurting yourself because they're not thinking about hurting themselves and might not even be thinking it will hurt.

SPEAKER_01 23:34

Yeah. Yeah, absolutely. Hurting yourself or harming yourself is very different. And I think when we ask those questions, people's response is naturally gonna be, well, of course I'm not thinking about hurting myself, you know. And I as as askers, we're kind of hedging a little bit. We need to be really direct. Yeah. And you're not thinking about doing anything stupid.

SPEAKER_02 23:52

And who's gonna answer that? Yes. Right, right. To them, it is not stupid. Right. It is essential or whatever it is that they have convinced themselves. Yeah.

SPEAKER_01 23:59

Yeah.

SPEAKER_02 23:59

What do we do if we ask someone if they're suicidal and they say yes?

SPEAKER_01 24:03

Acknowledging sort of the bigness of that is really important. So wow, that must have been really hard for you to share. Thank you so much for trusting me and um sharing that with me. And then we come right back to listening because again, as I said earlier, it's not uncommon to think about suicide and suicidal thoughts exist along a spectrum. And so, really, our job in this situation is to sort of do our best to kind of figure out where somebody is on that spectrum because that is going to inform our response to that person. Um, so asking questions like, when did this start? Um, open-ended questions, how does that feel for you? Making space for that conversation is really important. I think where some of our suicide prevention trainings sometimes fall short is we tell people to ask the question. And then we are told to ask people, do you have a plan? And I think we need to sort of hit pause after we ask the question. The first question, are you thinking about killing yourself? Make space for more conversation to happen before we start to ask about planning. Um, because within that conversation, you might start to hear sort of answers to that, that planning question and things like that. If you're having a conversation with somebody and you're really concerned about them, you've been talking to them for a bit, you can't ask about planning. You know, have you made a plan for how you might do this? Have you started looking for ways to attempt suicide? If they say yes to that question, planning is kind of what I would consider a tipping point between more passive thoughts of suicide and more active thoughts of suicide. If somebody doesn't have a plan and they say something like, I've never really, I'm not actually going to do it. I haven't really thought about it. I'm just feeling bad right now. Continuing to have a conversation about those bad feelings, helping them get connected with, you know, a support group or a therapist or a counselor or a pastor or whomever can help them further is great. When somebody says yes to planning, again, that's higher up on that spectrum. And that's time to think about okay, how can we connect you with 988? Do you have a mental health therapist that we can reach out to? Um, that's a situation where we need a little bit more immediate support. Um, and us as community members, we're not therapists. It's not our job to diagnose and treat this person. It's our job to kind of help get that person to the next step that's going to provide them that treatment.

SPEAKER_02 26:32

So when is that next step driving them to the hospital or dialing 911? I mean, where when you say escalation, I don't want to sit down and have a lovely conversation with someone and then leave and find out that they went through with it.

SPEAKER_01 26:45

Yeah. Yeah. Typically we uh suggest calling 911 if there's a medical emergency, if there's an attempt in progress, for example, and the person really needs medical attention immediately, um, that is your time to call 911. It is perfectly acceptable and encouraged to call 911 at that point because that person needs medical attention. In a situation where there's not, you know, kind of immediate physical harm that's been done. Maybe the person doesn't have immediate access to lethal means or a way to take their own life, a call to 988 might be a better choice in that situation, or your county mobile crisis team might be a better call in that situation. There have been scenarios where calling law enforcement can make a situation worse if a person is not in immediate medical danger. And so if that's the case, a person's not in immediate medical danger, seeking out some of those other options, 988, County Mobile Crisis.

SPEAKER_02 27:42

So can you ask for a crisis response team? Can you call 911 and say, could you please send someone who's familiar with mental health crises as opposed to uh, you know, law enforcement response?

SPEAKER_01 27:56

Yeah, you can. Um, and um not every county has these resources, certainly, but when you call 911, you can absolutely request um an either an officer that's been mental health trained. Another training that officers sometimes receive is crisis intervention training or CIT or a crisis response team. You can absolutely ask for that. Give the 911 operator as much information as you have. This person is suicidal. Um, maybe they've harmed themselves. It would be great if you could send someone who's trained in crisis response. And um, you may or may not get that response, but you can certainly ask for it. And what difference would it make if you did get it? So typically, crisis response teams uh typically there's a law enforcement officer involved, but in most cases, there's also a therapist who accompanies that law enforcement. So law enforcement often will come in first. They will make sure the scene is secure, and then they will step away and allow that therapist to come in and assess the situation, help the person. And in some cases, again, just that intervention of that therapist is going to be enough to de-escalate that situation to the point where the person doesn't necessarily need to go to the emergency room or to uh inpatient hospitalization. So leveraging those resources that we have, even though it can be scary to make that call, can be really important and can help a person from progressing to the point where they really do need to go to the emergency department.

SPEAKER_02 29:22

It sounds like if available, when available, that would be a, I don't know, the word softer is coming to mind.

SPEAKER_01 29:30

I think it's a a slightly less threatening approach for folks. Again, when you're in that space of being in a suicidal crisis, you're scared in a lot of cases. And so how can we make the situation a little bit less threatening, if at all possible?

SPEAKER_02 29:45

So the third most asked question on the internet about suicide is why do I feel like I want to die if I'm not sad? Oh, that's such a good question. Interesting.

SPEAKER_01 29:55

Such an interesting question. I think we have, as a society, kind of put suicide in this box of like sadness and hopelessness. And it doesn't feel like that all the time. Sometimes it can be really, really extreme anxiety or anger or kind of all of these pressures pushing in on a person to the point where they're feeling so overwhelmed that they don't see a way out. Sadness is not always part of that equation. Oftentimes it's anxiety and anger. Um, and so sometimes people who are suicidal feel sad, but that is not the universal experience. And so I think acknowledging and making space for all of those feelings that are involved in that suicidal experience is really important.

SPEAKER_02 30:34

So you brought up anger and anxiety, but sometimes there's also just numbness.

SPEAKER_01 30:39

Yeah, absolutely. Absolutely. And kind of that just I don't really feel anything.

SPEAKER_02 30:44

Yeah. Is that more dangerous in some ways than somebody who might be visibly sad and weeping and despondent?

SPEAKER_01 30:53

I think it can be more dangerous in a way because again, you're not seeing, people aren't necessarily seeing numbness unless you really know a person. Um, numbness can just look like, oh, maybe this person's tired today, or maybe they're just having a bad day. Um, and you might not tend to ask a person or approach a person um as readily as you would someone who's really outwardly weeping or outwardly anxious. Um, yeah.

SPEAKER_02 31:17

Another question online is it possible to be high functioning and suicidal at the same time? And how does that look to the outside world?

SPEAKER_01 31:24

Oh my gosh, so many good questions for online folks. Yeah, I would say absolutely yes. And again, I'm gonna draw on my own lived experience here. So I went through uh an extended period of suicidal ideation right before I turned 40. And that's a whole other conversation I want to have about women's health.

SPEAKER_02 31:42

We should talk about there could be a hormonal factor. There could be, yes.

SPEAKER_01 31:45

Um, I was going to work every day. I had two kids, have two kids that I was caring for every single day. I did not take time off work uh when I was going through this crisis, despite the fact that my doctor was encouraging me to take, like, take a week off. I didn't do it. I was going to work, making sure my kids were getting to all of their activities, um, performing well at work. And then at the end of the day, I talked earlier about sinking back into the couch, was all I could do. So there are people out there, absolutely, who are going about their lives and putting on the mask, right? And and keeping people out of that tunnel who are thinking about suicide. And so it is absolutely possible to be what we might call high functioning and still have these suicidal thoughts. And again, I think that can be a function of that anxiety and not wanting to be a burden and wanting to keep showing up for people when even when you're not willing to show up for yourself in that space. Um, so I think again, what we think of as somebody who looks suicidal, we need to set those uh stereotypes aside because we really don't know. It could look like somebody walking down the street going to their job every day. Yeah.

SPEAKER_02 33:01

So you go to work, you take care of your kids, you come home, you recede on the couch. What are you thinking? I mean, is it active like when someone's suicidal? Are you thinking, I want to kill myself right now? Are you just thinking I can't do this anymore? What are the thoughts?

SPEAKER_01 33:19

Yeah. I think it's a lot of the latter, what you to what you talked about. Like I think one I a thought that I remember thinking often is I can't believe this is gonna be the rest of my life. Like if this is gonna be the rest of my life, I don't know if I can do this. This is so hard. Um, it wasn't like actively like I want to kill myself right now. It was more like that again, that tunnel with not being able to see a way out and seeing how this was affecting my husband, for example, who I was very honest with about my thoughts and him having to cancel plans and stay home with me and things like that, and feeling like a burden, feeling like you can't do the things that you want to do for people, um, and thinking that it's never going to get better, that kind of hopelessness that this is the rest of my life and this really sucks. Um, I think that was a much more prevalent thought than I have this plan that I'm gonna take, that I'm gonna go through with. I remember that.

SPEAKER_02 34:17

Yes. I remember I say with a smile, but I was not smiling. It was waking up and just thinking, oh my God, not again. Yeah. This again. Yeah. You knew what was gonna happen. You knew what you're gonna think, you knew how you're gonna, it's like walking through molasses and it's just everything was, I don't know, slow and robotic and distanced. Yeah. Um, it was and it was a long time. Yeah.

SPEAKER_01 34:39

It's it's not fun. And like I'm I'm smiling and laughing about it now. Um, and I think there's always a part of me that's worried that that's gonna come back.

SPEAKER_02 34:49

Oh gosh, yes. I I refer to it as Jaws music. It's like dun dun dun. I just, you know, I am very, very on alert for it to come back.

SPEAKER_01 34:59

Yeah. So I think it's something that again, acknowledging that it's there. Mine is a bear. Uh, we talk about my anxiety bear. Um, sometimes my bear is really friendly and it's laying next to me in a sunny meadow. And sometimes my bear is hiding ready to jump out from a cave at me. Um and so I think it's important for folks who love us and care for us to know that.

SPEAKER_02 35:23

So what can we say? What can you say to somebody who's currently in that space? Because we wouldn't have believed it if we saw two people sitting at a table going, oh, it passes. You know, it would have been like, yeah, well, it hasn't yet.

SPEAKER_01 35:36

Again, I think when I was in that space, I would not have believed someone who told me in six months or in a year or next week, you're gonna feel better. Um, I think what would have helped me most in that space is I'm not gonna let you sit through this alone. Like I'm gonna be with you in this muck for as long as this muck is gonna last. And we're gonna work hard to help get you through this. And I think that would have taken that, that would have put someone in that tunnel with me.

SPEAKER_02 36:03

And taken away the no one cares. Yeah. Yeah. I'm all alone in this. So, what did help you get out of it?

SPEAKER_01 36:09

Um, a very, very astute and understanding healthcare provider who I went into the doctor and I was like, I I can't, I can't do this. I'm too anxious, I can't function. And instead of sort of what you said, far five alarm fire jumping off her chair and worrying was able to get me connected that day with a therapist. And then I was in therapy for many, many months. Um, medication also helped me. And I will say coming back to therapy and medication in the eight or so years since that happened has been a constant process. But I think that initial intervention of someone showing me, I care about you. I am not going to punish you for this. I'm gonna get you the help that you need. When I didn't, I work in this field. I've been working in this field for 15 years, right? I didn't know what to do with myself. And so somebody who is willing to say to me, I'm gonna take care of you through this. We're gonna get you through to what this, whatever this next step looks like, is really what saved me. And then therapy, off and on over the past eight years and really through my whole life since I was in my late teens, medication, paying attention to medication has sustained me in this recovery uh for the past several years. Um, and I think surrounding myself with people who are supportive and not being afraid to talk about it, because I find the more that I talk about this, the more conversations like this happen. I'm feeling less alone in this moment because you shared your experience with me. And so it's a lot of things therapy, medication, certainly, connecting with people, even when I really don't want to, trying to maintain physical health too is really important. Like diet and exercise. I feel better when I'm exercising. And so just really taking time to care for yourself and making it okay to care for yourself, I think is really important.

SPEAKER_02 38:06

How different our lives could be if you could pick up the phone and say to somebody, I just think about dying all the time. Yeah. I because I've always said if I limped for those two years, people would have told me to get an x-ray.

SPEAKER_00 38:19

Yeah.

SPEAKER_02 38:19

How did I actually articulate? I can't come, I don't even want to get out of bed. Yeah. Yeah. And people were like, Well, okay, catch you next time. It's shocking. Yeah. And again, not everybody is equipped or has the heart to say, talk to me. You know, I can hold space for you. But to just say, you should see a doctor, you should call a therapist. Yeah. Even if that's all you can do. If someone said that, I might have done it way before I did.

SPEAKER_01 38:45

Yeah. I mean, and I think it can be as simple as that. Or like, I'm going to check in on you. You don't sound like yourself. I'm going to check on you in a couple hours. I'm just going to send you a text. No pressure. You don't have to text me back. But just to let someone know that you're thinking about them. Yeah. Can be really powerful.

SPEAKER_02 39:01

So we tell people all the time, we did at the beginning of this episode to call or text 988. What happens when you call 988?

SPEAKER_01 39:09

Yeah. So when you call 988 or text 988, you are connected with a crisis counselor. Um, typically it's somebody in your own state. Um, unless for some reason the lines are full in your state, then you might be kicked to somebody in another state, but you will be connected with a crisis counselor who is going to sort of help you kind of triage your situation, what's going on. I think one of the things uh that I want to share about calling 988 is it's about having that conversation to help figure out what a person needs in that moment and what's going to sort of help them get through this terrible moment to the next thing that's going to be helpful to them. 99% of calls that go to 988 in Wisconsin don't result in a call to law enforcement. A vast majority are a conversation that is had and a connection to resources in many cases. And so that's really what it is. It's someone who's trained to hear you and understand what's going on in this situation and to help you figure out what's next.

SPEAKER_02 40:07

I was surprised to learn, having worked at a crisis line, that, well, first of all, we define crisis, right? It doesn't have to be I am actively suicidal. I never spoke to someone who is actively suicidal. And I was so afraid to pick up that first phone call after my training. I was like, oh, what if they say, you know, I don't want to get this wrong. The stakes are so high. Most people just needed to connect and talk and say what's going on in their head, what's going on in their life.

SPEAKER_00 40:31

Yeah.

SPEAKER_02 40:31

And, you know, it asked first question, you know, are you suicidal? One woman would just say, not today, darling. Every time, every time she called, which was frequently. But that was part of what kept her from crossing that line.

SPEAKER_01 40:47

Yeah. Exactly. Yeah. And I think if people are curious, give it a call and you will see what is like to call 988. You don't have to be in crisis to call. Um, I hate talking on the phone. And so texting, I love that that option is available.

SPEAKER_02 41:01

So you brought up that in Wisconsin anyway, you know, it's very rare the police would be dispatched, but that is the number one fear. Yeah. I'm not going to call 988. I don't want the police knocking my door down.

SPEAKER_01 41:13

Yeah. Yeah. I think it's real. And I think that's a totally valid fear. But again, a vast majority do not result in that call to law enforcement. So I think it's important that people are informed that that's a possibility when you call 988, but just know that that almost never happens.

SPEAKER_02 41:30

And that under what circumstances would it?

SPEAKER_01 41:33

I would imagine if someone uh is saying something like, I have a gun in my hand, I'm gonna pull the trigger. Yeah. Um, but if someone is calling like, I'm super anxious, I don't know what to do, um, that's gonna be a conversation. I think if there's again that threat of or something that's already happened of sort of that physical harm that would result in that call to law enforcement. Right. Yeah.

SPEAKER_02 41:54

Um, let's talk more about the spectrum of suicidal thoughts and what the responsible reaction to each would be. So if someone just tells you more along the lines of hours, you know, that like I just like I don't, I don't get it. I just like why would I want to do this again tomorrow and the day after and the day after and the day after? We've talked about listening, being there for the person. Let's talk about as it goes up.

SPEAKER_01 42:17

Yeah. So you're having a conversation with someone, you've asked the question. Um, you maybe have talked to them a little bit about planning. I think an appropriate thing to say in that situation is, you know, again, thank you for telling me that. I am really concerned about you in this moment. Um, I think that we need to see about getting you some extra help. And sometimes that can, again, if a person already has a mental health professional, include calling that professional. It might include um reaching out to 988. Um, I think an important thing to say to that person is, I'm, I'm going to, I'm going to be here with you if you want me to be here with you as we're doing this. I can call 988 for you. I can make a call to your mental health provider for you. And I think another thing that we, that we don't talk about as much is that sometimes, especially if somebody has been in this situation before, they may have sort of existing strategies that have worked well for them in the past. That can be another question that you ask, or you ask that person, what's helped you in the past? Kind of who have you called in the past that's helped you. One of the questions that I've learned in a training that I've done is what can we do to keep you safe for now? Um, tomorrow might be too much to think about. So what can we do to keep you safe for now?

SPEAKER_02 43:29

That was literally what we were trained at the end of the crisis call. It was like, what are you gonna do tonight? Yeah. And and the answers were shocking to somebody who didn't didn't know a whole lot. And I put myself in that category that, you know, when someone says I'm gonna watch a favorite movie, I'm gonna take a bath, I'm gonna dance in the kitchen to some music, I'm gonna play with my dog, watch cat videos on YouTube. So many people were gonna watch cat videos on YouTube. And I was thinking, like, really? You know, but it's whatever, whatever distracts you, whatever brings you just this much joy. Yeah. You thought there was none. It doesn't have to be a big thing. That's so interesting to me. So when you we talked earlier, and I'm really grateful for you emphasizing because I wasn't taught this, you know, that the pause between the are you suicidal and the do you have a plan?

SPEAKER_00 44:14

Yeah.

SPEAKER_02 44:15

On a crisis line, it was the next question. And the third was uh the timing of of that plan. Yeah. And Dr. Stacy Friedenthal, another researcher who we both know, told me a great story about uh, you know, she asked someone, Are you suicidal? Yes. Do you have a plan? Yes. And that it's ratcheting up now. It's I might have to do something, you know, I might have to get involved more than just say, let's talk. After listening to him and and kind of getting really activated about like, okay, this is this is a situation. She asked him his timing. And his timing was as soon as his little brother went to college. Okay. And she was like, oh key next question. How old's your little brother? He was in fifth grade. Okay. So now it's not a 911 situation. It's not an I'm outside my I'm gonna get you in my car and we're gonna go to the emergency room. So there it it is so when you said complex from the very, you know, first words out of your mouth in this episode, it is. It is and it's so much different than people who have I was gonna say the luxury, but there's probably a lot of words I could put there of not ever having to consider how they would handle the situation.

SPEAKER_01 45:20

Yeah, I I love that story. And I think what what I'm hearing in that story is that person's reason for reason for living in that moment was getting to see their brother graduate. And so I think it's continuing to have that conversation to cultivate those small reasons for living that are going to get us to that point. We don't need to necessarily worry right now what's beyond that point. Uh, could be years down the road. Um, but helping that person get the support that they need between now and then to get them to see a little bit beyond that, I think can be really helpful.

SPEAKER_02 45:53

Are there ways that people indirectly communicate that they might be thinking of ending their life?

SPEAKER_01 46:01

Oftentimes it is indirect. Um, like you said earlier, people typically don't come out and say, I'm thinking about killing myself. They don't typically offer that information. So we can see uh subtle signs. People might say things like, I just, I feel like I'm such a burden to everybody, or I can't see a way out of this, or this is just all way too much for me. I don't know if I can handle this. Um, you might notice people kind of giving things away, sort of making kind of preparations maybe in the background, um, you know, that again are a little bit more subtle or indirect. Um, so things like that, again, sort of everyone's experience is different and there's no hard and fast role. But I think if you're seeing sort of maybe vague or indirect things that just seem kind like they're kind of out of character for the person, just kind of make that spidey sense tingle or give you that feeling in your gut, like there's something going on here. Trust that intuition and follow up with that person.

SPEAKER_02 47:00

I don't see a way out of this is huge. Yeah. That's a really good um alarm to have set in the back of our minds.

SPEAKER_01 47:08

Yeah. Yeah, because that that is that hopelessness talking.

SPEAKER_02 47:13

We are on to the fifth. And then next episode we'll do six through ten. The fifth most asked question on the internet about suicide. How do I tell someone, my parent or my partner, that I'm really struggling and thinking of ending my life?

SPEAKER_01 47:24

Yeah. Uh, it can be so scary to say those words. But I think, you know, asking to maybe have a conversation with them in private. Um, and, you know, I think being as direct as you can be in that conversation, um, you know, again, using kind of indirect words, um, things like that might not be picked up by somebody who doesn't, you know, really understand kind of this spectrum. And so being as direct as you can, I think is is really important. Again, that can be really scary. I think, you know, letting the person know that you, you trust them and that you're coming to them with something that you that's really important to you to talk about, you know, can kind of help broach that conversation as well. Um, I know that I had trouble having that conversation with people, um, but just I think recognizing that this is the first step toward caring for yourself in that space and and being direct is really important.

SPEAKER_02 48:22

Follow up in the same idea. What if my parents don't believe in therapy or mental health? How can I tell them I'm thinking about suicide so they will actually listen?

SPEAKER_01 48:31

That is such a good question. I know. I'm so glad we're looking for it. Such a great question. Yeah. I think um, you know, again, kind of taking suicide out of that box of mental health. It's not just about mental health. Um, and maybe talking about some of the other things that are going on in your life that are making you feel like you're in this tunnel can be really helpful. Um, you know, again, not everyone who's thinking about suicide uh has a mental health condition. And so if that's not part of your experience, or maybe if the people that you were going to rely on for support that's not in their vocabulary or in their experience, talking about some of the other things that are going on. I think, you know, and kind of we tend to put suicide in this mental health box and we know it doesn't just exist there. So sort of taking it out of that box, I think can be helpful.

SPEAKER_02 49:18

And a backup plan if they do not respond appropriately when you actually do reach out for help. When I say reach out for help, tell somebody. Right. Doesn't mean they're gonna respond appropriately.

SPEAKER_01 49:29

Doesn't mean they're gonna respond appropriately. Yeah. So you can certainly go to if you have, you know, a close group of friends, you can talk to a friend. Um, maybe it's a teacher or a coach or a pastor or um a colleague at work or a neighbor. And at the very least, if there's not anyone that you feel like you can trust, you can call 988. Um, I think, you know, if if um there's one thing that I would that I would want people to take away is that resource is always gonna be there for you.

SPEAKER_02 49:59

That's where we're gonna end today's episode. Thank you for listening. If you're still here, come back next week. We will continue our conversation with Dr. Sarah Kolbeck. We're going to look into more of the questions that you have asked on the internet about suicide and hopefully help you protect not only yourself, but other people in your life. Thanks for joining us.