Ten Most Common Ten Most Common Errors During A Suicide Errors During A Suicide InterventionInterventionBased on research of 215 Based on research of 215 medical students, master level medical students, master level counselors, addiction counselors, addiction counselors, and crisis line staff counselors, and crisis line staff byby

Robert A. NeimeyerRobert A. Neimeyer

Angela M. PfeifferAngela M. Pfeiffer

Based on research of 215 Based on research of 215 medical students, master level medical students, master level counselors, addiction counselors, addiction counselors, and crisis line staff counselors, and crisis line staff byby

Robert A. NeimeyerRobert A. Neimeyer

Angela M. PfeifferAngela M. Pfeiffer

#1: Superficial #1: Superficial ReassuranceReassurance““You’re so young You’re so young

and have so much and have so much to live for! How to live for! How can you think of can you think of killing yourself?”killing yourself?”

““Come on now. Come on now. Things can’t be Things can’t be that bad.”that bad.”

• Make sure responses Make sure responses don’t come across as don’t come across as trivial or superficial.trivial or superficial.

• Rather than being Rather than being reassuring a teen reassuring a teen may feel even more may feel even more isolated and isolated and misunderstood. misunderstood.

#2: Avoidance of Strong #2: Avoidance of Strong FeelingsFeelings

• When faced with intense When faced with intense depression, grief, or fear depression, grief, or fear don’t retreat into don’t retreat into professionalism, advice professionalism, advice giving, or passivity. giving, or passivity.

• Do not move into an Do not move into an analytical discussion of why analytical discussion of why they feel that way.they feel that way.

• Do use empathy skills by Do use empathy skills by putting expressed feelings putting expressed feelings into words. into words.

“ “With all the hurt With all the hurt you’ve been you’ve been experiencing it experiencing it must be must be impossible to impossible to hold those tears hold those tears in.”in.”

#3: Professionalism#3: Professionalism

““You can tell me. You can tell me. I’ve been trained I’ve been trained to be objective.”to be objective.”

• Intended to put a Intended to put a person at ease this person at ease this can come across can come across as disinterest or as disinterest or hierarchical.hierarchical.

• Be empathetic.Be empathetic.

#4: Inadequate #4: Inadequate Assessment of Suicidal Assessment of Suicidal IntentIntent

“ “You say you’re You say you’re suicidal, but suicidal, but what’s really what’s really bothering you?”bothering you?”

• Most common among Most common among physicians and master physicians and master level counselors. level counselors.

• Time pressures, Time pressures, personal theories, or personal theories, or discomfort with intense discomfort with intense feelings.feelings.

• Find out what they have Find out what they have been thinking, for how been thinking, for how long, specific plans, and long, specific plans, and previous attempts. previous attempts.

#5: Failure to Identify the #5: Failure to Identify the Precipitating EventPrecipitating Event

““It sounds like It sounds like everything collapsed everything collapsed when your brother when your brother died three years ago, died three years ago, but what has but what has happened recently happened recently to make you feel to make you feel even worse? That even worse? That dying is the only way dying is the only way out?” out?”

• Ask about any Ask about any recent key recent key incidents or events.incidents or events.

• This can help move This can help move interventions interventions toward necessary toward necessary action steps. action steps.

#6: Passivity#6: Passivity

““Go on. I’m here to Go on. I’m here to listen.”listen.”

“ “Call back some other Call back some other time when you can time when you can talk more easily.”talk more easily.”

• 25% of counselors 25% of counselors and helpers took a and helpers took a passive clinical passive clinical stance.stance.

• Early stages of suicide Early stages of suicide interventions need to interventions need to be active, engaging, be active, engaging, empathetic, with the empathetic, with the helper structuring the helper structuring the interaction. interaction.

#7: Insufficient Directness#7: Insufficient Directness

““If you keep feeling If you keep feeling suicidal remember suicidal remember you can call back.”you can call back.”

• At a minimum, a At a minimum, a verbal “no suicide verbal “no suicide contract” should be contract” should be obtained.obtained.

• ““Ok we have an Ok we have an appointment set up for appointment set up for you, you have my you, you have my phone # for tonight, phone # for tonight, and I’ll stop by the and I’ll stop by the school to see how it’s school to see how it’s going tomorrow.”going tomorrow.”

#8: Advice Giving#8: Advice Giving

““Just ignore the person Just ignore the person bothering you.” bothering you.”

““Try not to worry about Try not to worry about it.”it.”

““Remember, focus on Remember, focus on the positive.”the positive.”

• Concrete action ideas Concrete action ideas are helpful, but are helpful, but after after trust has been trust has been established.established.

• An action plan should An action plan should come from their come from their tentative ideas, rather tentative ideas, rather than from the than from the authoritative advice of authoritative advice of the helper.the helper.

#9: Stereotypic Response#9: Stereotypic Response

““She’s a borderline, She’s a borderline, attention getting attention getting female.”female.”

• Focus on the Focus on the individuality of individuality of each person.each person.

• During a crisis an During a crisis an attempt to use attempt to use shortcuts can lead shortcuts can lead toward stereotypic toward stereotypic assumptions.assumptions.

#10: Defensiveness#10: Defensiveness

““How could you ever How could you ever help me, have you help me, have you ever tried to kill ever tried to kill yourself?”yourself?”

• Anger or rejection is Anger or rejection is common during common during intense crisis.intense crisis.

• Don’t engage in Don’t engage in power plays, quick power plays, quick witted sarcasm, or witted sarcasm, or put downs. put downs.

• Maintain a caring Maintain a caring stance.stance.