Protocol for Threats of Imminent Suicide

bloorrevington.jpgYesterday my Friend insisted I read the web log of a colleague, Molly Holschlag. I don't know Molly aside from hearing about her and her many successes. I've never spoken with her and I'm not in her field. So why the urgency from my friend?

This is why:
"I am sitting in a hotel room in London. I have a minibar full of alcohol, and 80 Lorazepam tablets (2 milligrams each) and 100 friends within a mile radius."

I have had many experiences with depression so I guess my friend figured I might be able to help or at least help him help her.
By the end of her post I was very concerned for Molly.

"If you see me tomorrow, it’s because maybe I can figure out how to help myself instead of destroying myself. But I'm not sure that will happen, and I have only myself to blame. I have waited too long pretending."

There has been a steady outpouring of support for Molly' by her friends in the comments field and even more support behind the scenes to secure her safety I'm told.

But it got me thinking…
I don't muck around when it comes to suicide. ALL threats of suicide should be taken seriously. Statistics back me up on this. There's no question anymore that suicide is a major health problem.

Suicide Deaths, U.S., 2001

Suicide was the 11th leading cause of death in the United States.

It was the eighth leading cause of death for males, and 19th leading cause of death for females.

The total number of suicide deaths was 30,622. * The 2001 age-adjusted rate** was 10.7/100,000 or 0.01 percent.

Suicides outnumbered homicides (20,308) by three to two. * There were twice as many deaths due to suicide than deaths due to HIV/AIDS (14,175).

Yet there' is no consistent and REQUIRED procedure for dealing with a suicidal person, even amongst professionals. There are recommendations, guidelines and certainly protocols for emergency rooms, EMTs and police. But they can vary from place to place and there is certainly is no way to become CERTIFIED in suicide intervention.

For the rest of us lay folks, there's nothing at all.

There should be.

Yes, you can go online and look up what the NIMH recommends or call a hotline on behalf of a friend or loved one. What they will tell you right off the bat is to call 911. That's not the problem. The problem is that we non-professionals really don't know how to identify a threat of suicide or what to do while waiting for an ambulance. Worse is the notion that we can handle our friend's threat ourselves. Reassurance and an open ear are vital, of course, but suicide can be a sly beast. A friend who you helped may seem much better, happy even, after you've talked. But what about the days after?

Suicide has such a devastating effect on family and friends. Too often they feel guilty for missing signs or not knowing what do.

Say your friend, (conscious) is lying on the floor clearly having a heart attack. You wouldn't just reassure them, listen attentively to their concerns and then once the heart attack was over hug them and then pick up leave. Nor would you decide not to call for help because they didn't want you to.

In reality if your loved one was at high risk for a heart attack you may well have learned CPR. In any event you COULD become certified in CPR. Its encouraged even.

So I'm thinking we need to use this model, CPR, and set up a course in suicide intervention. Maybe call it Protocol for Threats of Imminent Suicide. You could go to your local community centre, St John's Ambulance or health clinic and become certified in PTIS and in the event you encounter a suicidal person, you'd know what to do. This has certainly worked wonders for cardiac patients and CPR. Its saved thousands of lives.

I'm not qualified to design such a program. besieds, there are well tested recommendations already in place.

bloorbridge_-_0174.jpg** If someone is threatening to commit suicide, take it seriously. Be calm and follow these steps from ACEP to help you manage the crisis:

Don't try to handle a suicide threat or attempt alone. Involve other people. You don't want to risk your own health and safety.

Call 911 or the local emergency response number, if necessary. Contact the person's doctor, the police, a crisis intervention team, or others who are trained to help.

While waiting for help to arrive, listen closely to the person. Let the person know you are listening by maintaining eye contact, moving close to the person or holding his or her hand, if appropriate.

Ask the person questions. Find out if the person has a specific plan for suicide. Try to determine what method of suicide the person is considering.

Acknowledge the person's feelings. Be understanding, not judgmental or argumentative.

Remind the person help is available and things will get better. Stress to the person that suicide is a permanent solution to a temporary problem.

Don't promise the person threatening suicide that you will keep this confidential. You may need to speak to a physician or mental health professional in order to protect the person from injury.

Don't leave a suicidal person alone until you are sure they are in the hands of competent professionals. If you have to leave, make sure another friend or family member can stay with the person until they can receive professional help.

If a person attempts suicide, immediately call for emergency medical assistance. Administer first aid, if necessary. If you know the person swallowed poison or drugs, call the Poison Control Center. Be prepared with the name of the poison or drug used.


Molly writes today that she is feeling much better now. The overwhelming support of her fiends has helped dodge this bullet. She even spoke at her conference .Even better, she's going to seek out counselling or a psychiatrist. But this brush with suicide, however it is framed, means Molly's at a greater risk now. She needs for the people around her to know what to do should this happen again.

Perhaps Molly's very personal posting may seem a rare thing in the blogosphere (yes, I hate that word too). It prompted immediate and on-going comments of support. At least 50 at last count. But visit an online support group for a mental illness and you'll see many similar stories. The difference is in the comments. People there know that however many times its been said it must be the first thing you say in a reponse: Get professional help as soon as possible.

Photos:Suicide Barrier. Designed by University of Waterloo Prof. Dereck Revington of the School of Architecture and engineer Morden Yolles.

2. Luminous Veil by Jon at groundglass.

* From the National Institute of Mental Health : Suicide facts.
** From The American College of Emergency Physicians " Responding To A Suicide Emergency"

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One Comment on “Protocol for Threats of Imminent Suicide”


  1. I think you’ve written about this in a great way, the tone and the stat’s. Especially what you’re supposed to do. I’ll keep checking your blog.
    My blog if you want to check it: ennazussuzanne.wordpress.com


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