It is very important that family and friends be watchful for signs of suicidal behavior. Suicidal behavior is not always obvious and is seldom predictable. However, there are some signs that can trigger family and friends to ask more direct questions, such as, "Are you feeling suicidal at all?" It is okay to ask people directly whether they are suicidal. There is not any danger that you will "put ideas in their head" as some family members and friends may fear.
A person's risk for committing bipolar suicide may be increased if they display any of the following behaviors:
- talk about feeling suicidal or wanting to die
- express a feeling of hopeless and believe that nothing will ever change or get better
- feel helpless and like nothing that they do will make any difference
- Feel like a burden on family and friends.
- start abusing alcohol or drugs (or abuse drugs and alcohol that much harder)
- begin the process of putting their affairs in order. This could include organizing finances or giving away possessions as a way of preparing for their death
- writing a suicide note
- become impulsive and start taking risks that put them in harm's way, or into situations where there is a danger of being killed
While some suicide attempts are carefully planned over time, others are impulsive acts that have not been terribly well thought out. Because of this, a valuable long-term strategy for helping manage suicide risk is to remove ALL tools and items that might be used to commit suicide from the person with depression's environment. It is impossible to remove all items that can be used to commit suicide though because people get creative about this sort of thing when they are motivated enough. However, doing all you can may be helpful.
If you think someone has become suicidal, it is appropriate to take the following steps to help keep that person safe:
- Call a doctor, emergency room, or 911 (in the United States) right away to get immediate help
- Ask the suicidal person directly if he or she is feeling suicidal. If they respond yes, then ask whether they have developed a suicide plan and if they have gathered together the tools they will use to carry out that plan.
- Eliminate the suicidal person's access to things they might use to commit suicide. (medication, weapons, knives, etc.)
- Stay with the suicidal person until help comes. Make sure the suicidal person is not left alone.
Because it is so difficult to accurately predict when people are actually at risk for committing suicide, it is generally appropriate to treat all instances of suicidality as real and serious threats, and to intervene every time. The risk of intervening every time, however, is that bipolar patients may stop talking about their suicidal thoughts after several false alarms, because they no longer want to be shuffled off to the hospital. Many patients will have ongoing low-level suicidal thoughts for long periods of time and not be in acute danger of acting on them. On the other hand, it is always possible for patients to impulsively act on long-standing suicidal thoughts if they happen to be triggered by particularly disturbing events or at an impulsive point in their mood cycle. The risk for bipolar suicide is highest when patients are in an impulsive state.
Family members and friends have to use careful and conservative judgment when deciding whether to call in the professionals. They will have to balance the person's safety against damage to their relationships with the person if it should turn out to be a false alarm. When there is any doubt as to the seriousness of the suicidal threat, it is best to err on the side of safety and to call in the professionals. Suicidal crises are terribly frightening events for family and friends to endure. It is important that family and friends realize that such crises are a normal (if unfortunate) part of more severe bipolar illnesses. They will generally pass if the person experiencing them can be helped through the crisis period.