Please remember that if you or a loved one are experiencing thoughts of suicide or experiencing a mental health emergency, please call 911 or contact one of the 24/7 helplines:
Suicide & Crisis Lifeline: Dial 988 or visit 988lifeline.org
Crisis Text Line: Text HOME to 741741
National Domestic Violence Hotline: Call 800-799-7233
Additional Resources
Please take care of yourself. You are not alone.
We’re progressing slowly though the month of September and addressing how to understand suicide risks, how to have a compassionate discussion on the topic of suicide, and the importance of connection. Now we’re going deeper. It’s one thing to understand the warning signs and how to start the conversation of concern towards a loved one, but what are you meant to do when it’s a friend who is struggling with suicidal thoughts?
If you’re already asking, then you’re a good friend. You know them well enough to notice that they may need some extra help. You’re well versed in their moods, you know when they’re struggling, you know when they’re not themselves. But navigating and supporting a friend through suicidal ideation is not the same as when you helped them through a bad break-up or the worst week at work. This requires you to be locked in as a friend and it requires a specific set of skills and the boundaries of a saint.
Throughout this post, we’ll review how to show up for your friend in a way that matters, how to recognize your own limits (you aren’t their therapist), and how to set boundaries that will preserve your friendship (and your own mental health), in addition to how to guide your friend towards getting professional help. You’re a good friend, but you’re not their therapist.
What Your Friend Actually Needs From You
I will say this until the day that I die, but if someone is struggling with suicide/depression/any other mental health distress, it is NOT your job to fix them. Suicidal thoughts are a normal, but extremely uncomfortable part of life. Approaching suicidal thoughts as a ‘problem’ to fix places the concept that what your friend is going through is ‘wrong’ and that the emotions that they’re trying to process in the first place, they shouldn’t be experiencing.
It’s normal to experience suicidal thoughts, it’s not normal for you to become your friend’s savior. Your friend just wants you to be their friend and to be able to sit with them as they explore what they’re experiencing. You don’t have to be perfect, you just need to be you.
What To Do: A Helpful Guide
Presence over Perfection
Perfection is a mask that the most anxious of people wear in order to protect themselves from perceived harms and failures. It is entirely focused on how you present to the world and how others see you. The mask of perfection is not needed here. No one wants someone who is so seemingly perfect to descend from on high to mingle while they are in the ditch.
Validation, Not Advice
USE YOUR OARS. Advice is great when requested, but it’s not when your friend is struggling. Advice can feel dismissive, micromanaging, and again, like your friend’s emotions are just another problem to be solved.
Consistency, Consistency, and Consistency
Grand displays of affection are best left to Hallmark movies. People don’t need an entire emotional parade of how you’re their ride or die. The best friendships steady, predictable, and have a clear expectation of what the friendship consists of. You send the memes that remind you of an in joke, you call often, and hold the door open when they aren’t likely to need to walk through it.
Authenticity is the best
Putting on a brave face is great when you’re facing your fears. But this is your friend. You know them, you love them and this is where you need to be able to hold nuance and accept that life is messy, scary, sometimes depressing and exhausting as hell. When you’re able to be authentic, you’re able to support.
What to Avoid:
Toxic Positivity
Toxic positivity is the worst. Full stop. It doesn’t do anything, it doesn’t address the concerns and puts a smiley face sticker over serious concerns.
Guilt Tripping
“How could you do this to me?!” Spoiler alert. Your friend’s emotional distress and suicidal ideation is not about you. It’s about them and their emotions and thoughts and feelings. Making your friend’s distress about yourself via guilt tripping is not the way to go and sends a fairly clear message to say ‘I’m not interested in what you’re going through'. I’m interested in how it affects me’.
Comparison
It could be worse, you could be like Nancy who had (insert tragic life experience). It’s not a competition who has it worse. Comparing your friend’s life against someone who is going through other difficult circumstances doesn’t help. All it actually does is reinforce the idea that in order for suffering to be valid, you have to be going through hell. You can’t just be having a hard time, you have to nearly be dying for people to see that what you’re going through is a serious issue.
Solution Bombing
There’s a way to offer a solution and then there’s carpet bombing a friend with endless solutions in the hopes that maybe, just maybe, one of them will stick.
Showing up like a Friend
Create a safe space
For the love that is good mental health care, do not have this conversation during a rave, or a tense moment. Give your friend the space and confidentiality to be able to discuss their suicidality without feeling like there’s a spotlight on them.
Be Direct
It can be uncomfortable, but being direct is honestly the best way to address concern regarding your friend and their safety.
“Are you okay?”
“Have you been thinking about ending your life?”
“Have you been hurting yourself?”
Use Active Listening
Using your active listening skills are the best way to demonstrate that you are actively paying attention to your friend’s concerns. Don’t be afraid to ask clarifying questions when you feel that you’re lost in the conversation. Be able to sit in the usually uncomfortable silence without needing to fill it with talk.
Offer Gentle Support
Once you’ve established that you’re in your friend’s corner, discuss next steps. This is a collaborative effort. Both of you sitting together and exploring what would be helpful for your friend. Sometimes, it’s helping them find a therapist. Other it’s calling the crisis hotline or setting up a safety plan.
Recognizing Your Limits
How to Set Boundaries
There is a need to want to be there for your friend through thick and thin. While it is an admirable position to take, it’s not a realistic one. You will be impacted by your friend’s issues. It’s not a negative thing, it’s merely a fact of life. To protect yourself, you will need to set firm boundaries with your friend. This means that you’ll need to recognize your own limits. Here are a few signs that you are reaching your limits and your boundaries are being burned.
You physically cringe when you see their phone calls
You feel exhausted after spending time with them. You may also feel resentful which can cause you to act out passive aggressively.
Your own basic needs (sleep, exercise, social life, personal time) are getting neglected.
You can’t stop thinking or worrying if they’re safe.
You feel like you are the only person keeping them alive.
Here are some helpful ways to establish a firm boundary with your friend. These are clear scripts of what your friend can expect from you and your boundaries.
Name Your Limits: I’m here for you, but I’m feeling overwhelmed. Can we schedule a time to talk tomorrow?
Limit Access: If you are becoming sleep deprived then you need to prioritize your sleep. That means no more late night phone calls that go on for hours until the sun rises. “At 10PM, my phone is shut off. If you’re needing support or someone to talk to, the Crisis Text Line is available.”
Share the Emotional Load: You aren’t the only friend in their life. There are other people available. Your friend needs to be able to reach out to other people within their support network. Remind your friend of the other people within their life who can support them through their hardship.
Clarify Your Role: You are not a therapist. You are not a therapist. I repeat you are not a therapist. Make it clear that your friend will need to seek out professional assistance in their corner.
Friend Versus Therapist
You are not your friend’s therapist. It is not your job nor should it ever be your job to manage your friend’s emotions for them. They need to be able to manage their emotions and their life without interference. You may be there to guide and support them, but you cannot live their life for them. That’s why there should be a plan in place in case things escalate. This is known as safety planning. It is designed to be a structured plan that everyone knows what will happen when items escalate.
The Non-Immediate Crisis Scenario
If your friend begins to show signs of suicide, but lacks intent or a specific plan (hoarding medication, gathering guns, etc) then this is known as a non-immediate crisis. Here are some ways to support your friend during this time
Call the suicide hotline together. The 988 Crisis Suicide and Hotline is available 24/7. The counselor on the other end can provide guidance and aid in assessing risk.
Text the Crisis Text Line (741741). Sometimes talking about the emotions that your friend is experiencing can be too much to speak. Texting is an option.
Help them find a therapist. After speaking to your friend and seeing where they’re at emotionally, it might be time to help them find a therapist. You can find a therapist via Psychology Today’s therapist finder or use ZocDoc or check with their insurance plan to find a list of in-network therapists. If you’re comfortable, sit with them while they make first contact as this can often be the hardest step.
Create a Crisis plan.
Explore triggers (items, sounds, environments that make things worse)
Coping strategies (what has helped in the past)
A list of trusted contacts (family, friends, and professionals)
Emergency numbers to call (988, 911, etc)
How to remove lethal means.
The Immediate Crisis Scenario
If you’re talking to your friend and they have informed you that they have a specific plan, how they would carry it out, and the intent to act, then things have officially escalated to an emergency. This is out of your wheel house and you will need to contact help.
Stay with your friend unless it becomes harmful to your safety
Call 911 or your local emergency number. When you call, be clear and concise “I am with (insert friend’s name) at (insert address). They’re having a mental health crisis and are at immediate risk of suicide. Request a Crisis Intervention Team if available. These are officers who are trained in mental health issues and can assist in de-escalation.
If it is safe, take them to the nearest emergency room. Tell the intake nurse that your friend is having suicidal thoughts with a plan.
Finally, if it is safe to do so, remove any weapons, pills or other lethal means from the immediate environment. Remember that your safety is the most important thing as is your friend’s. It is far better to have an angry friend who is alive rather than a dead friend. Erring on the side of caution is always the right call.
When They Refuse Help
There is an uncomfortable truth that not everyone is ready for mental health help. You can see it as clear as day, but if they’re unable to take that step forward, then you have to respect their decision. This is in my humble opinion, one of the most painful positions that you’ll ever experience as a friend. There’s nothing worse than seeing someone actively drowning in their own personal Hell and to hear them tell you that ‘they’re fine’ or to ‘stay out of it’.
You cannot force someone to get help unless they are in immediate danger to themselves or to someone else. Involuntary hospitalizations requires an imminent risk to self or others ie your friend has taken a large numbers of pills, your friend says that they have a gun and are going to shoot themselves, or that they plan to kill others.
You set the boundary. You can love them, you can still want the best for them, but you aren’t their therapist and you are not equipped to navigate a position like this. The best path moving forward is to reiterate that to your friend. If they will not seek help, you need to be able to protect yourself. Taking a step back is that protection. It’s not abandonment or a threat, but it’s setting a clear boundary that can’t be bypassed. This is your limit and it needs to be respected just like your friend’s decision to not seek out additional assistance.
Involve their family. If this is a step that you’re comfortable taking, let a member of their family know or speak to a trusted adult to take over. This isn’t a betrayal of a confidence or telling someone’s business. This is taking the necessary step to ensure that your friend stays safe and that you stay safe.
Caring for Yourself, Your Mental Health, and Your Boundaries
So, you’ve done it. You’ve had a hard conversation with your friend. You’ve sat with them as they’ve cried, you’ve removed knives, flushed pills, and maybe you’ve had to call 911 or the Suicide Hotline number when things have gotten too intense. Either way, you’ve done a momentous thing of being there for someone when they were at their lowest.
Now, let’s talk about you.
What are you doing to take care of yourself and to recover from the emotionally intense conversation you’ve just had? Are you relying on your support network to process what you’ve experienced? Have you scheduled a mental health check-in session with your therapist? If not, there’s a chance that you' might be at risk for experiencing compassion fatigue. You’ve done a lot of caring which ironically can leave you feeling numb, exhausted, and cynical. If you begin to experience these emotions, then it’s time to take a step back from the caring position and focus on yourself for a while.
Conclusion
It’s not an easy thing to sit with someone when they are experiencing some of the most challenging thoughts and ideas that their mind can whip up. Being there for a friend can be incredibly rewarding, but emotionally exhausting. This is a reminder for as much as you are there for other people, check in with yourself.
Please remember that if you or a loved one are experiencing thoughts of suicide or experiencing a mental health emergency, please call 911 or contact one of the 24/7 helplines:
Suicide & Crisis Lifeline: Dial 988 or visit 988lifeline.org
Crisis Text Line: Text HOME to 741741
National Domestic Violence Hotline: Call 800-799-7233
Additional Resources
Please take care of yourself. You are not alone.
