Staying safe with suicidal thoughts
So for starters, the necessary opener is that if you are having serious thoughts of hurting yourself or dying by suicide, seek treatment. There are many, many competent therapists out there who can help you manage intense emotions and stay safe. Also feel free to check the resources page for crisis phone lines and other help. This blog post is intended to be informational, not instructional. This is more of an educational, “here's what I would discuss with you in session,” regarding suicidal thinking. If you are concerned enough about dying by suicide that you are reading this like “okay I should do this to stay safe right now,” you need to get into therapy for assessment and intervention. There's no shame in that.
Additionally, if you have a plan, and you have intent to act on the plan, you need to go to the hospital right now. Full stop. If you're currently able to maintain safety, by all means keep reading.
Steps to take:
Limit substance use. What I really mean here is decrease opportunity for impulsivity. Drinking and using drugs vastly increases risk for suicide and self-harm because it decreases impulse control and inhibition. What you're willing to do in wise mind sober in the morning can be leagues away from what you may do when you are in emotion mind, intoxicated, at night. So, wise mind sober you in the morning needs to ensure that you never get to the version of you that is alone and emotional and intoxicated at night. Emotion mind might still come—and your impulse control doesn't need to be absent when emotion mind arrives.
Decrease lethal means. Lock dangerous stuff away or get it out of your hands.
I don't know anything about guns, and I do know they are extremely lethal—so any weapons need to be secured, preferably with a number code you don't know, or with a key you can't access. If you are suicidal, I promise you you do not need to have a gun in your home that you can access. If you are the family member of someone suicidal and you have guns in the home, consider a number code (not an obvious one like a birthday) or make really, really sure a key cannot be found to access weapons.
If your lethal means is medication, that presents a problem, right? Because you need to be able to take your medication. My first recommendation is for if you have a companion or a person you can trust. If this is a spouse or parent or someone you live with, you can have them keep a hold of your medication and just give you what you need for the day.
Get a medication lockbox from your local drug store.
Place all pill jars and boxes in that.
Get a small pill organizer (one of those morning, noon, afternoon, night ones) and have your trusted person put just enough for today.
If your trustworthy person is someone outside the home, it may be possible for you to meet up every few days and grab only the amount you need until the next time you meet. The key is to decrease quantity available. I've had folks who don't have local support leave their medications locked up in another location (so for example a safety deposit box). The emphasis here is to create time and space between emotion mind urges and you being able to actually access means.
Seek company. Easier said than done a lot of the time, I know. And if you are concerned about safety, it may be beneficial to stick around someone close to you—a friend, or a family member. Usually this is effective when the suicidal thinking is a passing storm, not when it is constant, as it is really difficult to ensure you're not alone every hour of every day.
Ask what the suicidal thinking is really for. Some suicidal thinking is about punishing ourselves, some is about punishing others, some is about relieving pain, some is about wanting to be with someone who died, some is about communicating our pain to others—and all of it has some kind of reason for existing. We don't wake up suicidal just because of a whim or a fancy. Suicide is an ineffective solution to a problem. So it's important to figure out what the problem actually is, and how the suicidal part of our brain thinks suicide will help. Because then we can decide on alternate paths. If suicide is about relieving pain, we need to engage in treatment planning and building hope that we can decrease the pain we're in. If it's about punishing ourselves, we need to challenge our negative self judgments (and also release punishment as the useless behavioral technique that it is). If it's about revenge, we need to figure out how to make needs known or get closure with others. If it's about communicating our pain, we similarly need to figure out how to make needs known and communicate directly. As you can see, there are many, many, many other solutions to explore for all these diverse problems. (And as an aside—exploring these topics and changing the problem-solving is part of why therapy is so important in addition to medication.)
Compile reasons to stay. Some people have you create hope boxes—pictures of loved ones that make you smile, letters or notes you've received, music you enjoy (in the 00's this was easier because you could put a burned CD in there, now you could likely do some of this electronically and build a playlist), self-soothe items like a stuffed animal or a favorite smell, a book you love dearly. You name it. It just needs to be a bunch of stuff that you can offer your emotion mind that shows why this life is sometimes redeemable.
It's also a great idea to make plans you don't want to wiggle out of, or start activities you want to see to completion. Buy concert tickets. Wait on a release date for a video game or movie. Book a hotel room for a vacation. (“All this stuff costs money, Allison!”) Fair point—start crocheting or knitting a blanket, rehab a clearance plant (I'm not kidding), or make a sourdough starter. Anything to give you a reason to keep going while you're building mastery and building a life worth living in the long term. I'm not saying a blanket or a concert will create meaning in your life and banish all your suffering—and if those things help keep you here while you continue to do that work of building a life worth living—then that's the purpose.
If you are unable to stay safe, please go to a hospital for care. If you are currently safe, and if you'd like to keep exploring ways to manage suicidal thoughts and urges, I offer in-person therapy in Huntersville, NC, and online therapy in NC and SC. Thank you for the time you invested reading this.
