Suicide intervention: Not just a checklist of "to-dos"

Reprinted with permission with names respectfully omitted, the following note was written by a participant of Applied Suicide Intervention Skills Training (ASIST) to her trainer just two weeks after the workshop. Heartfelt and sincere, this story is a detailed account of the suicide intervention and one testament of how ASIST training can save lives.

Thursday, September 14, 2006

Dear <ASIST trainer>,

It was probably two weeks after our training. I was talking on the phone with my sister, who lost her 26-year-old son this past February to suicide. She had just returned home for a counseling session with her therapist and was very upset. She was angry, frustrated and crying. I asked her what was going on and she told me life was not worth living, there was no reason for her to continue living.

I asked her directly if she was thinking about killing herself. With a burst of emotion, she said, "Yes, I want to die." I said that I could hear she was very upset and I cared very much about what is going on with her and asked her to tell me why she wanted to die. She gave me her reasons and we talked about her reasons. I was able to determine her husband and stepson were home. She told me they could probably hear her conversation with me. She told me she doesn’t drink because it makes her feel like killing herself even more. I asked about medications. Her doctor had been weaning her from Prozac because it made her feel worse. She told me she would be starting on a new medication that week. We talked about the doctor’s treatment plan with her.

I went on to ask her if she had a plan on how she was going to kill herself and fortunately she did not. I used the language from our training and brought it to her attention that part of her must want to live because she is still here. I asked her specifically about her reasons for living. I needed to prompt her and ask her about the grandchildren and her son living in Texas. I asked her if she felt she had the support and sincere caring from her sisters. She said yes, but when she talked about suicide with our other sisters they became angry with her. It was then I shared some of the experience of our training and gave her some reasons why people react that way. She told me her therapist made her sign a paper that if she spoke of suicide the therapist would immediately call the police. She had not talked about her desperate feelings during her appointments with the therapist.

She was calmer by the time we were at this point of the conversation. I asked her if she would agree to make a plan with me about things that can happen that would help. She told me she was not in any immediate danger of killing herself and that as soon as those feelings returned she would call me right away, regardless of the time of day. We made sure we had the correct cell phone numbers for each other. She also promised to take her new medication and to take the sleeping aid medication her doctor had prescribed for her that she had also stopped taking. We talked about her concern about drug addiction and her confidence in her doctor. We discussed her changing therapists and joining a survivor support group. She agreed to go to a support group. I promised to find one and we would go together. I told her I would be calling her in two days with the support group options and would purchase and mail her a book for her to begin reading. She sounded relieved and agreeable.

I’ve followed through as promised. We attended our first support group. It is a distance for both of us, however I’ve promised to pick her up so we can go together. At first she resisted my driving an hour to pick her up then another 40 minutes to the location. She proposed reasons why I shouldn’t do it and I was able to make her feel comfortable about it. I told her I wanted to be with her as she moved through this difficult time in her life and that she wasn’t alone. I reminded her it was safe to talk to me about anything.

I think by telling her about this training, it gave her more confidence in me and what I was proposing to her. After the first support group, I went into her house for tea and we talked for a long time until I felt she was grounded again. She has been given resource information for selecting a new therapist. I will be following up with her on how that is going and we have agreed to continue attending this group on a regular basis.

It isn’t enough to just guide someone to what they can do for themselves at a time like this and then call them back and review a checklist of "to dos." The time we spent talking after the group session was probably even more important than the first support group session itself. Allowing her to talk openly about her desire to die opened her heart and mind to talk about and find hope for living.

Thank you <name omitted>, thank you to the wonderful trainers we had and the group of people we learned these new skills with. Have a great day!

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