Quote:
Originally Posted by robayon
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Is your job directly relating to this subject? I ask because it's pertinent with a friend of mine who I have known for nearly 30 years now. He is in a relationship, if that is pertinent - since you said your clients often are.
Most of the time, if we talk, and he's been drinking (which he does often), he almost always turns the subject to suicide or something that represents the end, doom, gloom, etc. He claims he is beyond help, and that he's given up on psychiatrists, or medicine, or therapists, or whatever - to him, they are all morons, and he's beyond their help. He is constantly worried that his father will die (his dad's like 85 and in poor health) and he suddenly becomes "patriarch" of his family, his brothers & sisters are all younger and generally do not have their shit together, heroin addiction and various problems.
He and I were having some drinks, as we can do, and he asked me kind of flat-out if him mentioning suicide frequently stressed me out. I told him something like "Yes, it does, because I do not want you to do it and I care about you, but I do not know what to tell you that I have not said a whole bunch of times before"
And since then, this is about... four weeks ago, he's been largely silent. He'll talk to me about a video game, or a tv show, but it's always light stuff - he doesn't talk about 'real' stuff.
Did I make a mistake in telling the truth? It does stress me out, I don't know what to tell him. I have tried a lot of things over the years, this isn't exactly new. I have told him I do not know how to make him want to help himself, I can only talk about what helped me or if I don't know to try helping other people. But still the constant low-key threatening of suicide.
I fear one day he's gonna do it, he's been going on about it for like 20 years now, but it's been worse than ever for like the last five or so
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Yea dealt with this stuff for the past 14 years in my job
Suicidal thoughts and behaviors tend to follow a progression. I say tends because this doesn’t mean for everyone. A person is overwhelmed by an amount of situational stress or negative emotions beyond their current mechanisms to cope. If they can’t either lower the stress or negative emotion intensity+frequency, and/or increase their ability to cope, then their brain will start looking for another way out
Usually this starts with what we refer to as hopeless thoughts such as nothing can help me, and a deathwish, such as I wish I could fall asleep and not wake up or I wish something would happen to me like a car accident. If the person continues to decompensate mentally, this can progress to coming up with plans on how to kill self. This can progress to end of life preparations, such as giving away belongings, trying to make arrangements for pets/family, and writing goodbye notes/texts/emails. It sounds like your friend is towards the beginning side of that progression, not the end
However, this being a progression is not true for everyone, and alcohol is a giant monkey wrench in the equation. Not only being a depressant will it make the person feel worse in the long run, heavy use of it can increase impulsivity to the point of making someone skip steps above and impulsively attempt, especially if lethal means are handy. Seeing or thinking about previous plans using lethal means such as seeing a gun or knife or meds when heavily intoxicated can be a trigger to attempt
When we are assessing risk as clinicians we are looking at risk factors versus offsets. Suicidal thoughts are a risk factor, a history of previous attempts is, access to means and the lethality of those means is another, alcohol is another. The last possible risk factor (if it is bad) is their basic functioning, such as how much sleep they are getting and any radical changes to their appetite. Offsets to risk would be motivations to not kill self - can the person think of any (without suggesting these to them), and how involved their support system is. Then we consider their level of future orientation. Future orientation is how much they appear to be thinking about the future, both positively and negatively. A person who says they have no goals and used to care about not being able to pay rent, but lately doesn’t care anymore despite nothing changing for their situation has very limited future orientation. That is a big indicator of risk
So based on those risk factors vs the offsets we create a plan. The higher the risk the more than plan leans towards hospitalization. If the risk is less the plan leads more to getting supports involved, and offering assistance with outpatient formal treatment such as counseling, meds, or support groups
None of this is your job and you will always be seen as a friend first and only, not a counselor. Because you can’t be his counselor you should encourage him to get formal treatment, listen to his barriers and try to reason through breaking them down with him. I only told you about our process in case he continues to be completely resistant to formal treatment. I would encourage sobriety for him, and stop drinking with him, say that you think it is hurting him in the long run and that you don’t want to encourage that anymore. If he has lethal means handy, try as politely and compassionately as you can to temporarily hang onto those. He can always get more but having to go out and buy something gives him time to possibly change his mind, it’s all a stalling game
Let him know you are there for him to talk to. If he brings up suicide, you can try to learn a bit more about those factors I mentioned, trying to fit them into the flow of a conversation. Then reach out to the national suicide hotline and run them by them. They can give you more ideas and let you know about how you could get him treatment against his will. A form of this exists for threats of suicide+high risk in all 50 states