There are around 100 suicides in San Francisco every year, according to Eve Meyer, executive director of San Francisco Suicide Prevention. Some of those people may not show a lot of overt warning signs, as was the case with Dylan Yount, the 32-year-old who jumped off the Forever 21 building in February 2010.
This week's feature story, "Public Influence," notes how Dylan's loved ones felt shocked and helpless upon learning of his death. He had no history of depression and he appeared to have a successful life. They wondered, in hindsight, if there was anything they should have seen, anything they could have done.
"There are people who can hide the signs," says Meyer. "How they do it, I have no idea. Suicide is about pain. It would be like walking on a broken leg. But some people do it."
Most, however, do exhibit signs. And the difference between that person's life and death often comes down to whether anybody notices those signs and steps in. That itself can be a challenge because, as Meyers explains, "We're trained not to believe we would kill ourselves."
There is a stigma attached to suicide, many experts observe. Suicide is often seen as a decisive act of escape, rather than as a mental disease that overcomes a person. For those who have never experienced suicidal thoughts, Meyer says, it can be difficult to understand why another person would consider ending his life.
"Any time somebody is exhibiting suicidal behavior or talking about suicide or taking any action, you absolutely need to take it seriously, the same way if you saw someone having a heart attack you need to take it seriously," says Joanne Harpel, senior director of Public Affairs and Postvention at American Foundation for Suicide Prevention. The stigma "just exacerbates the fear that those people who are vulnerable have about taking help."
Yet sometimes all it takes to save the life is a little bit of help.
"People who are suicidal are ambivalent to some degree," says Meyer. "There's a piece of them -- might be small, might be large -- there's a piece of them that wants to live. You gotta grab that piece."
Here is San Francisco Suicide Prevention's "Nine Steps to Help Suicidal Friends and Family Members":
1. Don't be afraid to ask.
Often people who feel suicidal put out clues about their intentions, because they are afraid to talk about their feelings. When no one picks up these clues, it further reinforces the idea that suicide is not a topic they can talk about with friends or family. If you sense that someone is suicidal, you need the courage to start the conversation. People are often afraid to start this conversation because they fear the will say the wrong thing. You can trust yourself. The only wrong answer is ignoring the situation.
2. Let the person talk.
In most cases, talking is good. If the suicidal person is talking out their problems, they are not harming themselves. Listen without judgment and do not try to make the suicidal person feel guilty. Suicide happens when there is too much pain for someone to tolerate. Think of the people you would turn to if you were in a crisis and act as you would want them to act.
3. Safety Comes First.
However in some cases, you may need to assess if the person has completed an act of harm, before talking out problems. For instance, a person may have taken an overdose of pills, and then calls you on the phone to talk. Evaluating suicide risk early in the conversation may be critical to saving a life.
4. Evaluate the Risk.
Ask direct questions about the person's suicide method and plan. The more well-thought-out the method and plan, the more dangerous the situation. (Learn more about the warning signs.) Ask if the person has already completed the act of harm. You may need to call 911 now.
5. Remove the Method of Harm.
In some cases you can reduce the risk of suicide by removing the method of harm (guns, pills, keys to the car, etc.) from the person's immediate surroundings.
Usually, suicide is a solitary act. People tend to do it when they are alone. Sometimes just having people stay with a suicidal person for hours to days, until the crisis passes, can make all the difference. Sometimes family members or groups of friends take shifts to assure 24-hour supervision. Also, it reinforces to the person that someone truly cares.
7. Get Help.
Work with your loved one to get help. There are many mental agencies in your community that can help, Find referrals in San Francisco.
Contract (i.e., make a verbal or written agreement) with the person to contact help whenever they feel in crisis and before they make an act of harm. That helping person could be you, a crisis hotline, or their counselor. Contracting to contact more than one person is better, because a single caregiver might not be always available. Also, honor your end of the contract. If you tell a person in crisis that you will call tomorrow, call the person!
9. Reduce Isolation.
Depressed and suicidal people often feel very alone and isolated. Hang out with friends or family members feeling depressed or alone, even when you feel too busy. It helps them. They may help you someday.
San Francisco Suicide Prevention's crisis number is 781-0500.