By Chay Tanchanco, PPS, AMFT
A few friends have recently called me, deeply troubled, terrified for someone they cared about and their mental health, unsure what to do. If this were common knowledge and more openly shared, then we would save many more lives than we do today. This can be a really heavy topic, uncomfortable, and scary, but extremely necessary, especially with the rate of suicide steadily rising in the U.S. and the overall prevalence of anxiety and depression, both of which are still widely misunderstood.
As you probably know, a crisis is something life-threatening, something dire, something that qualifies as an emergency. It seems very obvious, but sometimes mental health issues don’t seem as clear cut as “life-threatening” and “not”. If your friend is telling you that they don’t want to live anymore, and you know they’re not joking -- but how serious are they? What if I make a big deal out of “nothing”? If your friend is telling you they’re not safe in their house, what am I supposed to even do?
In therapy world, there are three situations in which we would be required by law to call for outside help, breaking confidentiality:
Threat of harm to self
Threat of harm to a child
Client threatens harm to another person
As a friend, you aren’t under any legal obligation to report as we are for a client, but being a person who cares for their well-being, you’ll want help for your friend as soon as possible.
Here are some suggestions and information I hope are helpful:
This should go without saying, but… if your friend is in immediate physical danger, call 911. If they took pills, overdosed on drugs, harmed themselves significantly, or are putting themselves in any other unsafe position, they need help now.
If your friend is saying that they feel hopeless, that there’s no point in living, that they hate themselves, that there is no reason to even try anymore, that they want everything to stop… etc. These are what therapists call “suicidal ideation” and you can recognize it as different from the conversational “I hate my life” talk by watching their body language, noting changes in their habits or social life.
If your friend is sharing any of this with you, take it seriously. It's common to joke about dying, especially among younger generations; but if you sense something off, then take precaution and look more closely at what they are saying.
People also have this misconception that suicide happens when someone gets "super, ultra-depressed", goes down to the bottom of the depths of sadness and hopelessness and then kills themselves. This is often not true at all; in the deepest wells of depression, there is often a lack of even a will to act. A person is in fact at the highest risk of suicide when they come out of a depressive state, or if something positive happens and their life takes a turn for the better. Often the pressure of things getting better, only to get worse again, is more torturous than being in the depressive state itself. They also have a more active body at that time, which may just enough to put them in danger.
There are crisis hotlines available, the famous 1-800-273-8255 from the song by Logic, and also text lines (which some people find much easier to use), 741741 and their website has some great info as well. There are also hotlines for specific issues, such as LGBTQ+ or rape or domestic violence. Just search, and you will find.
When your friend drops heavy knowledge of trauma / feels on you:
People always jump in and tell you “say this, say that, don’t say this” -- but none of that will matter if you are not grounded. Notice your body, notice your surroundings, notice your breathing and take it slow. This will put you in the present, and it will help you be non-reactive. A good practice I’ve learned is the rule of 5:
Tell them you see them.
This can feel very “fluffy” or like you’re just repeating what they already said, but some of the most badass therapists and helpers and healers I’ve ever met have their own way of saying it without sounding fake or patronizing. My go-to therapy intervention is noting how a person feels, recognizing the weight of such emotions, and letting them know: "I am open to listening."
You can also phrase it like:
“You’re in so much pain; it’s hard to know if anyone understands.”
Or metaphor like:
“It’s like you’re a boat, and you feel helpless like the water is pulling you toward the edge of a waterfall.”
But honestly, saying, "This sucks. And I see you." Or saying nothing at all but being present to their feelings (not yours) can be more powerful than any fancy words.
Think of a time you felt hopeless and alone, and if someone communicated to you somehow that they understood how you felt. More than likely, you felt less alone, and emotional weight can feel like it's being lifted away.
If I had to make a list of “don’t say these things”, it would just include:
Try to avoid saying things that make it about yourself. (Ex: “I can’t believe what you’re saying right now.” or “I wish you would have told me earlier.”) When a person is in emotional crisis, the last thing they need is to take care of someone else.
Watch how you say the word “but”. It can be dismissive and dehumanizing sometimes. (Ex: “I know you’re in pain now… but… look at all the good things you have in your life!” or “It’s gonna be hard for awhile, but you’ll get better.”) It comes from a place of fear, ultimately; it sounds like good intentions, but what it really says is that you can't handle their pain.
Getting caught up on words isn’t what’s important though: your compassion and the ability to walk through this alongside the other person is what matters.
When someone is suicidal, they are in deep. The common misconception that "if I ask if they want to kill themselves, it will give them the idea" is another way we steer away from their vulnerability. You will not be the first to introduce them to this idea; however, you might be the first person who isn't afraid to name it.
If you are not in a safe emotional space yourself, definitely take the next step instead of asking directly. But even if you have emotional space:
No one should ever go through these things alone -- and this includes you, as the helper. Look for close friends, family, and social supports for the person and for yourself. So many people make the mistake of expending all their energy on helping others, saying that they are going through something terrible and comparing that feeling to their own situation.
This serves no one. You and your friend will be better off if you are both supported. Check in with your own friends and family regularly. Some of the hotlines are also designed for “friends and family” of survivors and those who lost their lives. Reach out, find a community.
And yes, your friend may need therapy, sooner rather than later. But before you go into surgery, you have to stop the bleeding first.