(gentle ethereal music)
- It's so important that you guys, the viewers,
understand that the steps Dr. Judy is explaining
have to be done a certain way.
It has to come from this calm,
simple, patient, nonjudgmental space.
(gentle solemn music)
There's someone in your life,
you think they're experiencing suicidal ideation,
how do you approach them to start to have
this difficult conversation?
- Well, it's gonna be a tough conversation
because when they're in that mindset,
they're not necessarily gonna be open
to talking to you about it really
and they're going to maybe be even agitated
and push you away and this is something
that sometimes depressed people do anyway,
even without the suicidal ideation,
'cause they're just feeling so down
and there's so much self-loathing
and just self dislike that any kind of positive attention,
they just wanna push away and they don't even
wanna recognize it and so it's similar
when somebody is in a state
where they've been contemplating suicide.
In some ways they do want you to pay attention to them
but in other ways, they almost don't want you to,
it's almost like just leave me alone
so I can just do what I want already and maybe carry it out.
And so, I think you have to approach 'em somewhat gingerly,
but not with such kitty gloves
I think sometimes people are afraid to talk to people
when they think that this might be part of the picture,
like, oh, I don't wanna disturb them
and possibly veer them into more stress
and then they're gonna kill themselves
and it's gonna be my fault, don't ever think that because,
by you being there, you might be saving their life.
And so, it does require a lot of patience,
it requires a lot of open-mindedness,
but it does require assertiveness as well.
So, you may just begin the conversation with,
I have noticed that you've been
and enlist off the behavioral characteristics
that you've been noticing
and when I say behavioral characteristics,
I mean, things that are more factual,
that you can see, that anybody can see,
like, you've been hiding in your room a lot more,
when we try to talk to you, you yell at us,
you know, you've been talking about how the world
would be better if you weren't in it,
say the things that actually reflect back to the person,
the things that you've observed,
rather than trying to make a statement
about what you think they're thinking about.
But list those behaviors, list those observations and say,
I'm really concerned about you, what's going on?
Leave the question open-ended
so that they can fill in the blanks and reply to that,
and if they're not giving you much back,
if they're being very short where their answers,
oh, don't bother me, I'm fine,
that's when I think you really have to go in and say,
I'm concerned that you might be thinking about
hurting yourself, are you thinking about that?
And let them respond to that particular question.
If they're still not giving you anything,
but you're still concerned and they haven't convinced you
that they're being safe,
I think that's when you have to step in and say,
I am very concerned and I don't feel safe leaving you
by yourself today and I'm gonna stay here
until so-and-so comes home,
or I'm gonna stay here until maybe we can go
to your therapist together to talk about this,
or, I'm gonna stay here and if you're saying
that this is not an issue for you,
then hopefully you won't mind that I'm going to call
the suicide hotline while you're here,
because I'm worried about you and even if you say
that that's not what you're thinking, I'm not convinced,
and I'm gonna call them in your presence.
So, you do have to sort of wedge yourself
in there a little bit, and you should expect a pushback
'cause they're not necessarily gonna be welcoming you
with open arms.
- That's good for people to realize
because I think the thought process would be
that if I'm doing my job correctly,
they should be responding positively.
But in actuality, a negative response
may just be indicative of the situation
and not necessarily your approach.
- Right, absolutely.
And I think there, of course, is a subset of people
who the suicidal ideation that they've been experiencing
is kind of a cry for help
and then when you start to probe them more,
they might actually look very relieved,
like, oh, thank goodness 'cause I was thinking
about doing it yesterday, but then I actually
really didn't want to, like, now that we're talking about it
I'm realizing I didn't want to, yeah,
you're going to get that subset of individuals too,
but I don't think you would expect that,
you shouldn't expect that in fact because,
the person who is thinking about suicidal ideation,
they're not necessarily in their most logical mind,
so they're not gonna respond in a logical fashion
and you do have to be aware of that
and sort of be prepared for any kind of response
under the sun.
Children and teenagers have a really hard time
thinking ahead, they don't have that executive function
development yet, it's not fully complete.
And so, for them, it's important to let them know
that it's not always gonna be this way,
and for them, that's still a vague idea,
so you're not really necessarily gonna tell them,
well, when you're 18, this won't matter
'cause they're like, 18 sounds like, yeah,
you're a dinosaur because you're my mom
and you're 40, right?
I mean, so it's like this idea that like,
they can't think that hard in that far ahead,
but, you can just tell them,
it's not always gonna be this way, sweetie,
it might be a different day tomorrow
and it might be a different day the day after that.
But that's really kind of the level
in which you should be talking to them is like,
don't just think that you're gonna get stuck here,
but you don't wanna use too much future talk with them
that's too lengthy because they won't understand
that conceptualization, they will only think about
the pain that they're in now and think that that's just how
it's always gonna be in their life.
- Can a parent ask a 10-year-old,
are you thinking about killing yourself?
- Yes, and they should, because again,
children are much more concrete,
they're not quite as abstract
and so if you say something like
you're not gonna do something stupid, will you?
That's an abstract question that could mean
a bunch of things.
Anything being stupid could be you going skateboarding
at night, I mean, it could be so many things
and also when somebody is in the mindset
of wanting to hurt themselves, they may not think
that that's a stupid idea.
And furthermore, once they figure out
that you were referring to hurting themselves
as a stupid idea, they feel even more judged
and that could actually increase their feelings
of hopelessness.
- It's so important that you guys, the viewers,
understand that the steps Dr. Judy is explaining
have to be done a certain way.
And what I mean by that is, you can't just go in and say,
hey, Timmy, are you thinking about killing yourself?
They're gonna be like, no, sorry,
like they don't wanna get in trouble,
it has to come from this calm,
simple, patient, non-judgemental space.
So, parents especially have to get themselves together
before they go in and have these conversations
because, the doctors are so good, right?
You and Dr. Myers and Dr. Dom and Dr. Robby,
you guys are so good at explaining how to do it
because you've done it 100 times in therapy,
but for parents, it might be their first time ever
having those conversations.
So I even say to a few friends who would call me, I go,
you've got to practice this,
this is almost like a script and you're in a movie
and you've gotta deliver this a certain way,
'cause if you don't, you're not gonna get the same results.
- I'm so glad that you're bringing up these points
because those are great tips
that parents should get themselves together
a little bit more emotionally before they go
and you can't just be charging in, the tears down your eyes,
I mean, if you cry naturally when you learn
that your child is thinking about it, fine,
but you should not be going in emotionally charged.
You should be going in prepared and you should be going in
knowing that you can be authentic once you're there
so that when they say, yeah,
I am thinking about killing myself and look,
I even bought a noose.
Wow!
I mean, when you see that,
as a parent, you're probably going to cry,
you're gonna have an emotional reaction and that's fine,
but again, as a parent, even in that moment,
it's important that you tell the child why that's happening.
Like, I'm not crying because I'm mad at you,
I'm just crying 'cause I'm so, so sad
and this is not a judgment and I'm sorry, you know,
that you feel this way and I'm just deeply sad for you
and which is why I'm crying, right,
as opposed to whoa, why is my mom and dad
out of sorts right now?
And, I do think that practice does make perfect
and that it is a good idea to maybe even jot down
the main things you wanna get across.
Like, boom, step one, here's the question I wanna ask.
Step two, like if they do admit to it,
here's what I wanna convey,
it's not silly to like bring in a little card
to make sure that you've actually covered
the things that you think are the most important to cover,
your child's not even gonna remember that
about that moment a year or two from now,
they're just gonna remember what you said
to make them feel better, they're gonna remember
the feeling and that's what people don't realize,
like the parents, like, you know,
we can make all these kinds of mistakes,
but your children will remember the times in which
you were there for them and the emotions
that they felt when they felt safe.
So, that's really, I think the key,
so I'm so glad that you brought that up.
- Absolutely.
What should people not do?
- Well, people definitely should not
make them feel like they're not being appreciative
or grateful.
Like, how could you kill yourself,
you have so much going for you.
That's awful, because the person probably thought of that
and they already feel bad about themselves.
Like, man, I should be more grateful,
but instead I just want to end my life,
what's wrong with me, you know?
And so if you bring that up,
they're going to feel even worse,
but sometimes people think that's gonna motivate them
somehow, but that they haven't somehow thought about
the fact that maybe their lives aren't really that bad.
And I think that that is not a motivating factor.
I also don't think it's a motivating factor
to try to scold them and scare them into not doing it,
like sometimes I will see people or hear people
do things like, oh, do you know how much
that's gonna hurt?
How stupid are you to like try to do this method?
Like that's gonna hurt so bad,
they don't care about that in that moment,
they're not thinking about that because guess what?
The pain that they're feeling in that moment
where they want to take their life
is so much more than what you're describing,
so you're just not gonna move them that way, and finally,
I think it's important that people don't then sort of
put their own issues on that person in that moment.
I think that sometimes people make it about themselves
and they will say, well, if you killed yourself,
what would I do?
Like, again, that individual likely has thought about that,
you're a loved one, you're some concerned person
that's an important part of their life
and they've already thought about that
and the more that you do that, the more selfish they feel,
the more it increases their self-loathing
and self-loathing can be another risk factor
to increase suicidality, so, let's let those ideas go
and just, that's not the moment to make it about yourself,
you can decompress later with a friend
or with your therapist, you can deal with that
in another time, right now you're in crisis mode
and you need to be there for that person.
- That is right.
If it is an emergency, what is this action to take?
- If it is an emergency, then you will, first,
you can ask the individual, if you would be okay
taking them to the hospital,
that maybe it's time for us to go to the emergency room
for an evaluation.
And sometimes the person will go willingly,
if they do not go willingly,
then you call 911 and you ask for a pet team,
a pet team has a psychiatric evaluation unit,
it's psychiatric evaluation team.
And these are law enforcement individuals
who are trained in how to assess somebody
for eminent safety and eminent risk for suicide
and they will come out and they will assess the individual
and if they find that the individual is at eminent risk,
they will take that individual and transport them
in an ambulance to the ER.
And so I think when things get that dire, you can't wait,
you're gonna have to pick up that phone
and call 911 if the individual
will not go to the emergency room with you.
- Yeah, Dr. Judy, is there anything else
that viewers should know when it comes to talking
to somebody who has suicidal ideation?
- Well, I would say that, although not everything
is going to be a state of emergency,
if you notice any signs, don't wait, have the conversation.
The worst thing that could happen
is a person gets a little annoyed with you
or laughs at you and says, no, don't worry about that,
but the best thing that could happen
is that you could save that person's life
and you could put them on a better mental health trajectory,
so, just talk to them about it.
(gentle music)