September 24, 2020

At UCF RESTORES®, we not only strongly believe in the power of peer support, we’ve witnessed it firsthand. Through REACT, our peer support training program, we’ve worked with thousands of first responders to help our front-line heroes learn how to recognize signs of emotional distress in others, offer peer-level support and effectively coordinate follow up when clinical assistance is warranted.

Though it’s never a sign of weakness to talk about what you’ve seen, unfortunately, we are still battling a universal stigma that can deter someone struggling from reaching out for support, even to their closest friends, colleagues and loved ones. But, especially amid COVID-19 – an unprecedented traumatic event that has heightened stress and challenges for people of all walks of life – talking about trauma, its effects and how we can cope is more important than ever.

In this series, “The Power of Peer Support,” UCF RESTORES’ Suicide Prevention Expert David Rozek, Ph.D., breaks down the concept, why it’s so important, its role in suicide awareness and prevention, and effective tools we can use to support one another – not only as we continue to weather the storm of this pandemic together, but long after we’ve surpassed it. The final installment in this series is developed for everyone and anyone, regardless of professional background, seeking to amplify their support of friends, colleagues and loved ones.

If you or someone you know is struggling with their mental health and would like to request an appointment or consultation with UCF RESTORES, please contact us here or by phone at (407) 823-3910.

What are the signs of someone suffering with suicidal ideation?

There is no single or exact grouping of warning signs that predict suicide, though many suicide attempts are related to some sort of vulnerable period or perceived loss and the stress that started it. (For example, the loss of a job or relationship.) That being said, there are some warning signs that we can look for, many of which our medical providers, first responders and front-line workers are trained to identify. And, perhaps most importantly, we want to have a plan in place for what to do if or when we start noticing signs of distress in others.

The most commonly thought-of warning signs are noticeable changes in mental health. Many people focus on depression, which is a good indicator and can often spark suicidal thoughts. However, newer research suggests that anxiety, trauma exposure and posttraumatic stress disorder are linked to suicidal behavior, so if we start to see people becoming more anxious or “on edge,” it would be helpful to check in with them. Changes in behavior – like an increase in substance use, trouble sleeping or “stress eating” – or mood and emotions (anger, apathy, guilt or shame) can be important indicators that we can both hear and see.

Especially in a work environment, paying attention to the effect environmental factors are having on your colleagues is important, as well. Work-related stressors – more work than normal, heightened pressure, unsafe work environments, arguments with team members and bullying – can enhance the risk of suicidal ideation or behavior.

I believe it’s really important that we approach the concept of “warning signs” more holistically. Often, we hear or send the message, “If you’re in distress – call me!” But, realistically, this is not the best model for providing effective support and working to prevent death by suicide. Rather than hoping that someone reaches out, I’d encourage everyone to take a proactive approach – reach out and listen.

Many times, people who are at risk for suicide may not show “warning signs” outwardly, but are struggling internally. We do not always know what someone is going through; taking the time to reach out to our friends and family to check in on them can be such a powerful moment (for both of you!). By initiating this contact and checking in on someone, you are showing your support and that you care. It also gives the person some time and space to talk. Take the time to listen to what is going on (about whatever they want to talk about) and really be there for them.

Now, there will be times when you notice a change in your friends or family when it comes to what’s “normal” behavior and what’s not. We’ve all had those times where we’ve noticed something different in someone close to us. Something changed and it’s reflecting in their behavior. Perhaps they’re withdrawing from us, avoiding other people or are less active than normal. Perhaps they’re just communicating with you differently or their mood seems “off.” These are additional times when we want to reach out.

Suicide prevention often focuses on not-so-subtle changes in mental health. Having knowledge of these potential changes and looking out for them is a great start, but there are many more areas in which we really want to invest in order to help prevent death by suicide. A first step to having an impact and helping prevent suicide is being supportive of your friends and family – again, reaching out and listening – even when there aren’t any noticeable warning signs, to let the people you love know you are there for them.

How can I approach someone who is showing signs of suicidal ideation? Is there a “right” time or place to broach the topic?

We need to ensure we approach these situations thoughtfully and intentionally. Make sure to express that you care about them and validate their feelings. You might say, “I’m concerned about you. It seems like there has been a lot going on right now.” Or, in some cases, asking, “Are you having thoughts of hurting or killing yourself?”

These might sound direct, and that’s okay! People are often anxious about bringing up this topic due to its sensitive nature. However, there are data points suggesting a very direct approach can be really helpful, not harmful. Sometimes, someone struggling may actually be hoping someone will ask these types of straight-forward questions.

However, as I mentioned, you need to be intentional when going into the situation. Have a plan in place beforehand on how you are going to be able to support them if needed.

When it comes to what not to do, threatening hospitalization or calling 911 as a first approach is not always effective; this carries the possibility to escalate a situation and make matters worse, especially if the person is not showing signs of imminent risk. This is not to say that hospitalization is not an option, but you should go into the conversation prepared for talking about really distressing topics and have some options in mind.

When it comes to starting this type of conversation, timing can be a challenge, especially as you may start to notice signs of an internal struggle during an argument. If that happens, you may want to wait until the end of the conversation, pressing “pause” until the argument has diffused. If you’ve started noticing a build-up of concerning behavior over time, you could incorporate that discussion into a more regular check-in with your partner or person you care about.

What are some phrases I could use to start an inherently difficult conversation? What are some phrases I should avoid (ones that could come across as insensitive, careless or demeaning)?

Regardless of the phrase you use, it’s so important to make sure that your peer or loved one knows that you are coming from a place of love and concern, and that their feelings are valid. As I mentioned before, being direct is not only “okay,” but can also be very beneficial in starting the conversation.

While it’s important to not avoid the topic entirely, it is key to avoid shaming language such as, “So, you aren’t, like, going to try to kill yourself, are you?” Shame-based language perpetuates stigma around the topic and can increase guilt, when it should be something that, as a society, we’re moving toward being more comfortable with discussing. With that said, a specific point I’d like to make is that phrases like “commit suicide” or “complete suicide” can have negative connotations and turn your peer off to opening up about their struggles. Instead, consider using phrases like “death by suicide” or “attempt suicide,” which are more accurate.

Peer supporters should also avoid ultimatums and threats. Those that are struggling are likely to already be under a lot of stress and pressure, and the fear of someone imposing these threats may have kept them from reaching out for help to begin with. Threats and ultimatums may increase their stress levels, upset them or, even worse, cause them to close up or internalize the situation even more. You want your peers and loved ones to know you are here to support them, not to judge, threaten, or punish.

So, while specific phrases will vary based on the person and your relationship with them, it’s important to start with verbalizing or illustrating that you’re coming from a place of care and compassion, and to avoid language that could come off as threatening to the struggling individual.

What do I do if someone is showing clear signs of suicidal ideation, but continues to deny they’re facing challenges, even after I’ve directly approached them to start the conversation?

Continued follow-ups and check-ins are key to getting through to your peers and helping to assure their safety. You must be the one to initiate these touch points because, often times, people who are struggling find it hard to want to reach out or open up. It can also be helpful to have resources to direct them, including therapists in the area, the National Suicide Prevention Lifeline (which is open to personal calls and text-based, virtual chats), and any local resources that might be available. (More on this below!)

It’s important to be patient but persistent – just because you do not get a response right away does not mean that they don’t need your support or don’t value your connection. If you feel like you’re running into a wall, try to think outside the box and be creative in how you communicate. We have so many ways to interact with one another in this digital world, so don’t be afraid to try new methods in your outreach.

How should I continue tracking my peer or loved one’s progress over time without being too invasive?

I cannot stress this enough: following up and checking in is key. To that point, planning regular check-ins that fit into your peer’s schedule is a really good way to continue tracking their progress over time. Also, it is important to note that this conversation does not need to be one focused solely on suicide or suicidal ideation. It can simply be a moment for two friends catch up, vent, and socialize! But, by scheduling these conversations on a regular, recurring basis, you can show someone you’re invested in their mental well-being and set the stage for them to open up when they feel comfortable doing so.

What can I do if I know my loved one is suffering in a way that is beyond my capability to directly and effectively provide personal support? If they refuse to seek help from medical professionals, what can I do then?

Often, people who are struggling might not be in the mental place to do their own research and find a professional to help them. This is where you, as their peer, can come in and help with some of that legwork, within your capabilities and skill set. For example, you might look into organizations and professionals that are available in their area and might be a good fit for them. This also ties back to the importance of having a plan in mind before reaching out to offer help.

Even if they do end up seeking professional help, you want to keep reminding them of your support so they do not feel like they have “lost” you. (Especially in our current world, where so many continue to self-quarantine and isolate, it can be easy to feel this way if communication isn’t consistent.) A few actionable ways to do this:

  • Continue to bring up ideas and provide resources that might help them.

  • Encourage them to reach out to other friends or family that may be able to offer additional or more in-depth support.

  • Talk about some of your best memories with them.

  • Help identify and reduce any barriers that would prevent them from going into see help.

  • Consider small steps to get them comfortable with the idea of getting help, such as a one-time consultation. (At UCF RESTORES, we offer a no-cost, single-session consultation program for essential workers, though we welcome anyone struggling to reach out for our support.)

Any help you are able to provide – no matter how “small” – will make an impact on restoring their mental health, both now and in the long term.

I want to help my peer or loved one, but I am also feeling heightened stress and emotions myself. How can I take care of myself, maintaining healthy boundaries, while still helping others in need?

You cannot pour from an empty cup, so you need to take care of yourself first. Making yourself a top priority – ensuring you’re in the right headspace and have supportive care from others – is so important before you work on providing support to others. Limiting and scheduling social interactions with struggling individuals will allow you to maintain boundaries, provide and receive social support, and help you keep time to focus on yourself. Finding a mental healthcare provider is also always an option that may serve as a jumpstart when you are feeling stressed.

If you don’t start by taking care of yourself, it could be detrimental to your own well-being to lend yourself to others. And, ultimately, you’ll be the best peer supporter you can be by ensuring starting with yourself.