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Identifying Suicide Risk: The Best Ways to Help a Loved One

Suicide is the eleventh leading cause of death in California, with one person successfully taking his or her own life every two hours. In fact, more than twice as many people die by suicide in in our state annually than from homicide.

Kristin Wolcott Farese, a Licensed Clinical Social Worker (LCSW) at MarinHealth Medical Center, has counseled suicidal individuals, survivors of suicide attempts, and heartbroken friends and families who’s loved ones committed suicide. In this podcast, she discusses how to tell whether a person might be at risk and what you could say to help prevent a tragedy.

Identifying Suicide Risk: The Best Ways to Help a Loved One
Kristin Wolcott Farese, LCSW
Kristin Wolcott Farese, LCSW is a Licensed Clinical Social Worker at MarinHealth Medical Center.

Bill Klaproth (Host): New research from the CDC shows that suicide rates are on the rise. So what are the warning signs and what should you do if you think someone you love might be at risk? Here to talk with us about suicide prevention is Kristin Wolcott Farese, a licensed clinical social worker at Marin General Hospital. Kristin, thanks for your time. So what are the factors that contribute to suicide?

Kristin Wolcott Farese (Guest): Well there are many factors to consider regarding suicide, and I think first and foremost it's important to look at how we understand suicidal thinking and behavior. You know, suicidal thinking and actions are- can be both a symptom of depression and a strategy for managing depression. You know, not everybody who's depressed is suicidal, but most people who are suicidal are depressed. And people who are clinically depressed and suicidal are often experiencing significant hopelessness. And many people that I've talked to really liken this to being in a fog where it's difficult to imagine possibilities for coping and getting to the other side of a depression, or depressive episode.

And so one of the things that happens with depression is that thinking gets pretty distorted and people start developing ideas that- for example, that others would be better off without them, or that suicide is the only way to get relief or to communicate their suffering to others.

And when I say that suicidal thinking and behaviors are a strategy for coping, what I mean is that depression and hopelessness are creating kind of a pressure filled environment internally for someone who's suffering with this. And many patients talk about their suicidal thoughts and plans, it's like an escape valve that helps them cope with the pressure they feel to exist.

And this is really obviously a- a dysfunctional strategy, because having that escape valve open usually causes additional emotional distress, you know, both for the person who's suffering and for people who are connected to that person, and then obviously when someone can't commit to safety, they generally feel more vulnerable.

Bill: So what are some of the other factors when considering suicide?

Kristin: Obviously the mental illness such as depression, social isolation, having chronic pain, any substance abuse, people who have any sort of trauma history are also at a significantly higher risk for suicidal thinking and behaviors. And then importantly, any family history of suicide also increases the risk of suicide.

Bill: Kristin, are there certain types of people more prone to committing suicide than others?

Kristin: Men are over three times as likely as women to complete a suicide, and this country, seven out of ten suicides are completed by white men, usually middle-aged, and over half of the suicides in this country completed by guns. And so access to guns is something that needs to be assessed immediately.

And then people who experience suicidal thinking or actions often just have a lot of difficulty regulating their emotions. They may be living with real consuming sense of shame, that something's inherently wrong with them, or bad about them. They're often struggling with emotional intimacy in relationships, and just a sense of being really disconnected from any coherent sense of self or self-worth.

And I think it's also important to think about suicide on a continuum. You know, not everybody who thinks about suicide is at risk of committing suicide. People could have ideation or ideas about suicide, thoughts about suicide with no plan or intention to move forward with that. They can have an intention with no means or knowledge for completing a suicide. No- they don't know how it would actually work.

But people who are at the highest risk of suicide have more than thoughts. They often have the intention, they have a plan, and they have the means to kill themselves. So again, that's where we want to look at things like access to guns, we want to look at access to medications that could be lethal in the con- context of suicidal thinking and depression. We want to look at access to a car that could take them to somewhere where they could complete a suicide.

And so- and I guess the last thing I want to say about that is that the people in the context of depression can often have what we would consider passive suicidality, meaning they may place themselves in situations where they could be harmed or killed, and that's also a major risk factor.

Bill: So what are some of the symptoms to watch out for if someone is depressed?

Kristin: We want to look for changes in mood, in affect, meaning what people are showing, and changes in thinking, the distorted thinking, like I mentioned, and behaviors. But people who are really in the depth of depression often don't have the energy to complete a suicide. People who are really at imminent risk may have some new energy, or maybe a change in their affect. Their affect may brighten, for example, if a plan is in place, and if the depressed person sees a way out, and they may begin to- you might begin to see some more goal-directed behaviors like giving away possessions, or taking care of other unfinished business. And others who are at high risk for suicide won't show those changes in mood or affect, but their behaviors change, they're more impulsive, and as I mentioned earlier, you know, the thinking is distorted, not based on reality.

And people who are always at higher risk when they're socially withdrawn and isolated, and so this is a really important and tricky thing about treating depression. You know, connection is the last thing that a lot of times people want when they're depressed, but it's the thing that's most needed.

Bill: So if you recognize any of these symptoms in a loved one, is it safe to ask? You know? If they are thinking of hurting themselves, what should we do if we see these symptoms in someone we love?

Kristin: It's imperative that we ask, and one of the challenges we have as a society is that we tend to shrink away from these questions of where people are mental health wise, and specifically, uh, whether or not somebody is considering hurting themselves or killing themselves. So we really encourage people to if they're- if that's a- if that's, uh, on your mind, that you go right to that question. "Are you considering hurting yourself or killing yourself?"

Bill: Will they be honest in that moment? Or will they brush it off? "I'm fine. I'm fine. I'm just a little bummed out lately." Or are they looking for somebody to reach out to them, because they- they desperately want to connect with somebody and- and talk to somebody, and share their feelings with somebody. So if somebody says that, "Are you thinking about hurting yourself?" Are they like, "Yes, finally, I- I need somebody to talk to." Are they receptive to that question?

Kristin: You know, you'd be surprised to think most people, when asked that direct question, are receptive to it. Now there are some people who have clearly made up their mind and they're going to do everything possible to hide that reality from- from loved ones and from other concerned parties, but more often when that direct question is asked, there is- uh, people tend to answer.

Bill: So if someone says, "Yes, I am thinking about that," what do we do then?

Kristin: Well that- that's where it's important to- uh, you know, I'm assuming you're talking about as a- as a lay person.

Bill: Right.

Kristin: Uh, it's important for- yeah.

Bill: Right, a parent, uh- a friend, uh- you know, uh- a brother, a sister. "Okay, are you thinking about hurting yourself?" "Yes, I am. I'm struggling." Okay, now what? Now what do I do? Now hearing that from my loved one, what do I do next?

Kristin: Right, so you know, it's really impo- it's really essential that- that um, you not try to take that on yourself as a loved, as a parent. This is a time to, uh, get help. And so you know, it could be that you would give the person a choice about how they would like to get help. It's important that there is some kind of- something negotiated there where that can happen right away. And so, uh, we do have a lot of options. You know, we have several options in this county. You know, the emergency room is- is one option. We also have a- a uh- crisis stabilization unit here through the county that's open twenty-four hours a day, seven days a week. People can call up the- uh, main number for that and problem solve with the crisis specialists that answer. We have a mobile crisis team in this- in this county that can go to people. My understanding is that they operate between 1:00 and 9:00 PM most days of the week. Uh, maybe not on Sunday, I'm actually not sure, but most days of the week they're open from 1:00 to 9:00 and they can actually go to patients where they are and problem solve and potentially bring them in for an evaluation at the crisis stabilization unit. And from there, you know from there, uh, loved ones are having their- their- their loved one’s problems held with somebody else and a decision can be made about what's needed. People can either go home with a safety plan that involves increased contact and accountability with loved ones and follow-up care with a- with a therapist and a psychiatrist, or they may be hospitalized from that point.

Bill: So that's good advice. Don't take this on yourself. Seek help from a crisis specialist. What if your loved one though is reticent to go see a crisis specialist? What do you do then?

Kristin: You can- uh, you can have a mobile crisis team come to you if the- if the- your loved one is not willing or able to respond, or you can just take them to the emergency room.

Bill: And then treatment, you kind of touched on it. Can you go a little bit more in depth on that as far as treatment once that person does see a specialist? Generally what happens at that point?

Kristin: Right, so if people are hospitalized, uh, often on a what we call 5150 in this state which is an involuntary hold for up to seventy-two hours. Um, after that hospitalization, uh people often- what's recommended is people go to a level of care called partial hospitalization, um, and that is- that's a level of care that's offered in this hospital, and that's where I work. Um, we have a step down from that called intensive outpatient, and those are two levels of care that are really designed to help people pace their recovery and, uh, have the structure and support that's needed, start to look at what's occurred, um, either in their minds or actions, um, and start to develop more of a sense of compassion and curiosity towards themselves so that they can start to access skills, um to prevent the need for those strategies- the strategies that's going to suicidality to manage high distress. Um, looking at other ways to cope. Um, we also use that level of care to help people connect, um with, um ongoing support.

Bill: And if you could just wrap this up for us, Kristin. What is most important for us to know about suicide prevention?

Kristin: Well I think it's important for us to really approach rather than avoid, um, the discussion of suicide. Um, because it's a public health issue. Um, this is something that is, um quite treatable, and um, ultimately preventable the more that we can talk about it as a community. Um, but you know, the question about whether or not people can get to the other side and live full lives after either attempting or serious- seriously contemplating suicide, and the answer is absolutely. This is just like any other mental illness, and like most other physical illnesses, this is highly treatable, um, through the DBP, the Dialectical Behavioral Therapy, modalities that we teach here, in addition to trauma informed therapies. Um, the group modality is extremely, extremely powerful as a complement to individual therapy. Um, so the message is that this requires approach, it's very treatable, and um, people need to find- find these areas of connection to get through these difficult times.

Bill: So there is help, there is hope, and that's a great phrase. Approach, don't avoid. Kristin, thank you so much for your time today. We appreciate it. For more information, please visit That's This is The Healing Podcast brought to you by Marin General Hospital. I'm Bill Klaproth, thanks for listening.