1. SUI
CID
E
Kay Sudekum Trotter PhD
“Suicide is a Threat”
September 15, 2011
Lewisivlle ISD “Ask the Doctor”
www.KayTrotter.com

2. Suicidal
acts
are
fran/c
a0empts
at
improving
one’s
life,
not
ending
it.
D.J.
Mayo,
Psychologist
In
most
cases,
suicide
is
a
solitary
event
and
yet
it
has
o<en
far-­‐reaching
repercussions
for
many
others.
It
is
rather
like
throwing
a
stone
into
a
pond;
the
ripples
spread
and
spread.
Alison
Werhteimer
People
choose
suicidal
acts
when
they
see
them
as
the
best
way
of
ending
an
unbearable
situa>on
or
ge?ng
the
changes
they
desire.
World
Health
Organisa>on

4. suicide is a threat
The example I use for this talk
was a male, so these points
are written as ‘he’, but the person
at risk could also be a ‘she’.
The choice of how to kill one-self is
also an example and could easily
be a gun or pills.
 We’re worried - that he’ll follow through on the threat.
 We’re worried - that he’ll feel he has backed himself into a
corner and has to follow through for people to take him
seriously
 We’re worried - that he might not understand that hanging
puts quick, severe pressure on your neck, spine, air and blood
flow in a way that will almost definitely damage the body an
brain.
 We’re worried - that he doesn’t understand how quick it is,
and that hanging doesn’t leave time for people to respond or
rescue, nor does it leave time for him to change his mind.

5.  We’re worried - that the person’s not thinking straight about
how final death really is. Deep down they’re probably acting this
way because they really want some kind of change, but they’ve
lost hope
 We’re worried - that he can’t think straight, because anger,
jealousy, alcohol or some other drug has broken down the
things that normally keep him safe from dangerous impulses
 We’re worried - that he’s not thinking of ways to soothe
himself or calm himself down.
 We’re worried - that he doesn’t have the skills to look inside
himself, to recognize his needs or analyze his thought
processes so that he could make changes to the way he’s doing
things.
 He might have a need he can’t express. He might have pain
he can’t communicate. And if he can’t tell us about it, we can’t
help him. And while we’re dealing with the suicide threat,
energy gets diverted from dealing with the ‘deeper’ needs.
 Underneath all this, there might be poor self-esteem. The
threats might be a reaction to feeling rejected or unloved. It
might be coming out of anger about confusing or unjust
circumstances. It might be an attempt to reach out in the midst
of loneliness.

6.  Maybe he’s doing this because it’s hard to find actions that
seem to have any noticeable affect on the world, and this is one
of the few ways he’s found to make his presence felt, and
because these actions meet this need, it becomes a bit like an
addiction.
 Maybe this ‘flaring up’ is indicative of really low emotional
resources, feeling deeply stressed, tired or drained.
 It’s hard for us to meet these deep needs when he’s doing
things that create so much distress and isolation.
It might come from the limited thought processes of young
minds and experiences: they don’t know that ‘this will pass’.
Maybe it’s part of youth trying to cope when they have been
experiencing big or fast changes on a deep level. Like those that
have taken place since 9/11.
Or changes in the way the family is run and structured.
It might be that these people do not know how to cope if they
don’t get what they want.
Maybe it’s a sort of crazed anxiety of losing love, especially if
important connections are missing or broken, and it feels like
you might be in danger of losing the ones that are left.
Perhaps the threats are violence turned inwards, then radiating
out to those who are closest. 

8.  Talking About Dying — any mention of dying, disappearing,
jumping, shooting oneself, or other types of self-harm.
 Recent Loss — through death, divorce, separation, broken
relationship, loss of job, money, status, self-confidence, self
esteem, loss of religious faith, loss of interest in friends, sex,
hobbies, activities previously enjoyed
 Change in Personality — sad, withdrawn, irritable, anxious,
tired, indecisive, apathetic
 Change in Behavior — can’t concentrate on school, work,
routine tasks
 Change in Sleep Patterns — insomnia, often with early
waking or oversleeping, nightmares
 Change in Eating Habits — loss of appetite and weight, or
overeating
 Fear of losing control — going crazy, harming self or others
 Low self esteem — feeling worthless, shame, overwhelming
guilt, self-hatred, “everyone would be better off without me”
 No hope for the future — believing things will never get
better; that nothing will ever change
Other things to watch for—suicidal impulses, statements, plans;
giving away favorite things; previous suicide attempts,
substance abuse, making out wills, arranging for the care of
pets, extravagant spending, agitation, hyperactivity,
restlessness or lethargy.

9. Often, suicidal thinking comes from a wish to end deep
psychological pain. Death seems like the only way out. But it
isn’t. Acknowledge the feelings they might be having, and that
it’s okay to feel those things, or perhaps acknowledge your
relationship to them, and that you care about them. Let the
person know you really care. Talk about your feelings and ask
about his or hers. Listen carefully to what they have to say.
" “It sounds like you’re angry (or jealous or something
else), and it’s okay to be angry.”
 “I’m worried about you, about how you feel.”
" ”You mean a lot to me. I want to help.”
" ”I’m here, if you need someone to talk to.”
Don’t hesitate to raise the subject. Talking with young people
about suicide won’t put the idea in their heads. Chances are, if
you’ve observed any of the warning signs, they’re already
thinking about it. Be direct in a caring, non-confrontational way.
Get the conversation started.
" “Are you thinking about suicide?”
" ”Do you really want to die?”
" “Do you want your problems to go away?”

10. Challenge thinking is about letting them know that even though
it’s okay to be feeling this way and you still care about them, it’s
not okay to use the violence of threats or death that cause
people so much pain. It’s also about helping them see that
death won’t solve their problem
 ‘It’s okay to feel angry, but it’s not okay to kill yourself.’
 ‘I care about you, but I can’t give in to you when you act this
way, so now I have to call someone here to keep you safe.’
 ‘How are you going to feel the respect and attention you’re
looking for if you are dead? You’ll be gone forever.’
 ‘Do you really want to go away forever? You’ll leave a big
hole of pain in your family and friends, who love you very much.’
The goal is to keep the person safe long enough to get to a time
and place where there can be some good talking.
 Go for a drive. Take them to a place where they might calm
down.
‘Go for a walk or drive him ‘round the community. Only
drop him back home when he’s really tired. But still
watch over him.’
‘Take him away from the thing that was making him
angry.’

11. ‘Go to a coffee shop.’ (laughter)
‘Or the beach.’ (more laughter)
‘Go to a place that’s safe for them but doesn’t facilitate
their suicide fantasy, or give in to what they’re asking
for.’
‘Sometimes the safest place might be the emergency
room.’
 After they calm down and get some sleept, you can make
connections, like with family or support workers. Then you can
talk about it more.
‘Do something that makes him happy. Just ask them
gently. You can listen to them. Get their story.’
‘Remind them about their family. People they care about.
You can ask them, “What are the troubles in your life?”’
‘Ask them simple questions. Get them to think about
what they are doing. Like, “How are you feeling when you
say you want to kill yourself?” or “What are the things
that make you feel this way?’
Help them break it down, so they can see the
process of when they do this, identifying emotional
states and suicidal triggers.’
‘You can help them think about other things they can do
when they feel this way again.’

12. After the crisis has calmed down never talk of suicide as a
secret, even if they ask you to. It’s better to risk a friendship
than a life.
Ideas of what to say:
" " “I know where we can get some help.”
" " ”Let’s talk to someone who can help.”
"  " “I can go with you to get some help.”
" " “Let’s call the crisis line, now.”
Sometimes you can be the most help by referring your friend to
someone with professional skills such as:
 Someone the person already has connections with.
 Trustworthly family member. Someone the young person
has respect for
" Support working together with the family member
“Family is important to provide support. It’s a
partnership: support workering with family and vice
versa.”
 Someone who can help build coping mechanisms and help
them talk about their strengths.
 Connect with a mental health professional or someone who
can follow up separately with the person making the threat.

13.  Someone who can talk to the whole community about
suicide.
 Anyone SAFE
“Sometimes, to keep them safe, there might
be no one left to call but the police.
Here are some things about what would be unhelpful to say to
someone thinking about killing themselves
 ‘Go for it.’
 ‘Make my day.’
 ‘Go ahead.’
 ‘I dare you.’
 ‘Here’s the rope.’
 Giving them a challenge so they feel they have to prove it,
like, ‘You don’t really mean it’ or ‘I don’t believe you.’
 Saying something dismissive, like, ‘It can’t be that bad’ or
‘You always say that.’
 Saying something that might make them feel more angry or
alone, like, ‘Who’s it going to hurt?’ or ‘No one cares.’

14. Do something now: Don’t assume that they will get better
without help or that they will seek help on their own.
Acknowledge your reaction: It’s natural to feel panic and
shock, but take time to listen and think before you act.
Be there for them: Spend time with the person and express
your care and concern.
Ask if they are thinking of suicide: Asking can sometimes
be very hard but it shows that you have noticed things, been
listening, that you care and that theyʼre not alone.
Check out their safety: If a person is considering suicide it is
important to know how much they have thought about it. Do
they have a plan?
Decide what to do: What you decide to do needs to take into
account the safety concerns that you have. Don’t agree to keep
it a secret.
Take action: The person can get help from a range of
professional and supportive people
Ask for a promise: if thoughts of suicide return, it is
important for the person to again reach out and tell someone.
Look after yourself: It is difficult and emotionally draining to
support someone who is suicidal, especially over an extended
period.

15. 

 “Chasing Happiness: One Boy’s Guide to Helping
Other Kids Cope with Divorce, Parental Addictions and
Death” by Chase Block; Foreword by Kay Sudekum
Trotter, PhD - pages 75 – 81 have great suicide advice
 “Helping Your Child Cope with Depression and Suicidal
Thoughts” by Tonia K. Shampoo and Philip G. Patros
 These resouses can also be
found on my blog titled:
“Suicide is a Threat”
“Teen Sucide - There is Hope”
“Childhood and Suicide”
Avivalbe at: http://bit.ly/cbXwh4