A friend says to you, "I just can't take it anymore. I'd be better off dead."
You fear your friend may be considering suicide, but you don't know what to say or do to help.
It's a situation many people will face at some point in their lives, as those contemplating suicide are more likely to reach out to friends or family members than professionals.
Experts in suicide prevention say there are steps the average person can take to save a life.
"The analogy we use is, it's like CPR," says Ben Bryan, a suicide prevention coordinator for Southern Oregon Rehabilitation Center and Clinics in White City who trains average people to recognize the signs of suicidal thinking and intervene.
He notes you don't need to be a heart surgeon to take action when someone suffers a heart attack. Everyday people can perform cardiopulmonary resuscitation to keep the person's blood circulating until paramedics and doctors take over.
"The bare minimum is someone performs life-saving intervention and then links the person up with care," Bryan says.
Locally, more and more people may find themselves faced with a suicidal friend or loved one.
In 2012, the Medford Police Department responded to 346 calls about people planning, attempting or completing suicide. That number rose to 478 calls for help in 2013, then jumped again to 555 calls in 2014, according to department figures.
No one knows why suicide calls are increasing, although theories include drug use, lack of mental health services and economic difficulties, says Medford police Lt. Curtis Whipple.
In 2009, 54 people were known to have died by suicide in Jackson County. That number fell to 34 people in 2010, but has crept up each year to 53 known deaths by suicide in 2013. Numbers for 2014 aren't yet available from the Oregon Health Authority.
The initials S.A.V.E. can serve as a reminder of what to do when faced with a potentially suicidal person. They stand for Signs of suicide, Ask directly, Validate the experience and Encourage treatment/Expedite getting help, Bryan says.
If suicide seems imminent, someone else may be injured or killed, or the person has just attempted suicide, call 911 to get immediate help from police and paramedics. Increasingly, Jackson County Mental Health workers are accompanying police on mental crisis calls.
In less urgent situations where there is more time, follow the S.A.V.E. steps.
Signs of suicide
People considering suicide may make statements such as, "I can't go on," "I wish I'd never been born," "Everyone will be better off without me," "I can't take it anymore," "I'm just a burden to everybody" or "I'd be better off dead," according to experts.
The verbal warning signs may come during a face-to-face talk, over the phone, via text, on a Facebook page or through other methods.
"Sometimes the person will text a friend and say, 'I'm going to end it all,'" says Medford police Lt. Mike Budreau.
Bryan says it's a myth that someone who is suicidal can't be helped. Suicidal feelings are usually temporary and people who have survived suicide attempts are usually alive decades later. Making suicidal statements is a cry for help.
"There's a part of them that wants to live. There's a part of them that wants help," he says.
In additional to making statements, suicidal people may withdraw from others, exhibit hopelessness or rage, pay visits to say goodbye or give away possessions, engage in risky behavior such as reckless driving or drug use, neglect personal hygiene and seek out lethal means such as guns, knives and pills. A sudden sense of calm after a period of depression or agitation may signal the person has decided to commit suicide, experts say.
Women have the highest number of suicide attempts, while men kill themselves more often because they tend to use guns, Bryan says.
Although most people think teens and young adults are most at risk, the elderly have the highest suicide rate per capita, says Jackson County Mental Health Children's Services Manager Amy Buehler, who also trains people to prevent suicide.
Senior citizens may exhibit different warning signs of suicidal thinking, including not following through with medical care, Bryan says.
The recent loss of a loved one, divorce, bullying, stress, retirement or a job loss, debt and other events can put people at greater risk of suicide, experts say.
Budreau says average people are on the front lines because they often see signs of suicidal thinking long before police and paramedics are involved.
During the past year, three armed men suffering mental health crises have died during confrontations with Medford police.
"The bottom line is we need to get intervention before it reaches the critical level and spirals out of control and the person is not thinking clearly and may be armed," Budreau says. "Then it becomes very difficult to deal with, as in officer-involved shootings of people who unraveled. It was not a normal day for them and then five minutes later they are shooting at people. Usually there is a downward spiral friends and family see. That's where intervention needs to happen. Often we're called when things are completely out of hand."
When police are called during emergency situations, they can take people suffering mental health crises to places such as the Asante Rogue Regional Medical Center's psychiatric unit.
"It can be difficult to take people into protective custody while they're in crisis," Budreau says. "Each time, there's a potential for a violent encounter. We want intervention before it reaches that level."
If you see or hear warning signs, ask the person directly, "Are you thinking of killing yourself?" or "Are you having thoughts about suicide?"
This is not the time to beat around the bush with vague questions like, "Are you thinking of hurting yourself?"
Don't phrase the question as, "You're not thinking of killing yourself, are you?" That sounds judgmental, and implies you don't want to hear the answer if the person is considering suicide, experts say.
"Usually people are relieved when you ask the question directly," Buehler says.
It's a myth that asking about suicide will cause someone to commit suicide, Bryan says.
"A lot of people are worried if you ask about suicide you will plant the idea in their mind," he says. "If you ask a friend who's blowing his nose if he has a cold, you haven't given him a runny nose. Asking doesn't create suicidal thoughts. It creates a safe environment to share those thoughts."
Validate the experience
When people say they are having thoughts of suicide, don't jump into problem-solving mode with advice and quick-fix solutions, experts say.
"Our human nature is to fix the problem," Buehler says. "Sometimes we need to just let them talk. Be willing to listen and hear their story."
Although a problem may seem trivial or temporary, the issue is how badly the person is hurting emotionally, not the significance of the problem, experts say.
Be sympathetic, non-judgmental, patient, calm and accepting. Don't tell the person to think positive or look on the bright side.
Take suicidal thoughts seriously and don't assume the person is just trying to get attention, Buehler says.
"I hear that a lot because I work with youth," she says. "People say they are just seeking attention. It's never normal to talk about taking your life."
Even if it turns out the person is not planning to commit suicide, try to get at the root of the problem, Buehler says.
"The person may need professional help if they keep making statements like they don't want to live anymore," she says.
While talking with a suicidal person, ask whether he or she has picked a method and time for committing suicide — then take steps to disable the plan if possible, Bryan advises.
That could mean removing guns, knives, drugs and medication. Use a gun lock and give the key to someone else, store ammunition separately from weapons or take other steps to prevent access to lethal means. However, call 911 if doing so would endanger you or the person, Bryan says.
The key is to take steps to keep the person safe for now and to get help, he says.
Never promise to keep their thoughts of suicide a secret. You will need to reach out to others to get help.
Encourage treatment and expedite getting help
Encourage the person to call the National Suicide Prevention Lifeline at 1-800-273-8255, or do it yourself. Press extension 1 to reach the veterans' crisis line.
Locally, call the Jackson County Mental Health crisis line at 541-774-8201.
Jackson County mental health professionals can help people access community resources and discuss options. They may encourage the suicidal person to come in person to the Jackson County Health and Human Services building at 140 S. Holly St. in Medford.
Anyone can get mental crisis services from Jackson County Mental Health.
People who are indigent or on the Oregon Health Plan are eligible for longer term follow-up mental health services through the county.
Those with private or employer-provided health insurance are usually eligible for mental health care with counselors and other mental health professionals. The 2010 Affordable Care Act requires insurers to cover mental health care on par with physical health care.
Physical health care providers can provide referrals to mental health professionals.
Since suicidal people are often depressed, don't assume they will make phone calls themselves or follow up on treatment. Help them take those steps or find someone else to help.
Buehler advises aiming for the "warm hand-off," in which you take the person to an expert.
The whole community has a role in preventing suicide, Whipple says.
"The most important piece for a citizen who is concerned is to talk to them, listen to them, and if you have any belief they are going to commit suicide, reach out to law enforcement, a suicide hot line or a mental health worker," he says. "Suicide is often a thing people will think about. It's a permanent solution to a temporary problem. There's nothing that can't be overcome with the help of family, friends and mental health professionals."