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This article is about suicide. If you or someone you know is having thoughts about ending their life, you can call 911 or access the resources in the table below. Each resource will connect you with confidential, qualified crisis counseling 24/7. Organization Phone Text Live Web Chat Military/Veteran Crisis Line Call 1-800-273-8255, Press 1 Text 838255 https://www.veteranscrisisline.net/get-help/chat National Suicide Hotline Call 1-800-273-TALK (8255) - https://suicidepreventionlifeline.org/chat/ National Alliance on Mental Health Call 1-800-950-NAMI (6264) Text NAMI to 741741 - Crisis Text Line - Text HOME to 741741 - September has been named National Suicide Prevention month because suicide is sadly a pervasive issue throughout the country. Below you will find guidance about language, risk factors, and warning signs related to suicide. Next, and more importantly, you will find actions you can take in response to a crisis suicide situation, as well as steps you can take in your everyday life to prevent this growing problem. Use Words Carefully Be thoughtful about the language you use when discussing suicide. A common, problematic term that is used is “commit.” People commit crimes and sins, and these describe actions that are willful acts against society and religious beliefs. If we use the same word to describe the actions of a person who feels they have no viable alternatives, it will only be more difficult for that person to seek help. To learn more about this idea, read the thoughtful article on Dictionary.com, “Why the phrase “commit suicide” isn’t the right way to talk about suicide” or the reader-friendly research summary from the National Elf Service, “Language matters: How should we talk about suicide”, which notes alternate wording you can try out, such as “died by suicide.” Understand the Facts In the United States (according to the CDC and the National Alliance on Mental Illness or NAMI): ● The rate of deaths by suicide has increased by 31% in the past two decades. ● Suicide is relevant across ages. “It is the 2nd leading cause of death for people ages 10-34 and the 4th leading cause of death for people 35-54.” (NAMI) ● Suicide is relevant across genders. Women attempt suicide more than men. However, men are around four times more likely to die by suicide (75% of people who die by suicide are men). ● 54% of people who die by suicide do not have a diagnosed mental health condition. However, about 90% of these people still show identifiable symptoms prior to their death (see “Recognize Warning Signs” section below). Specifically in the US military (according to the Department of Defense or DOD suicide event report): ● The most common mechanism for death by suicide among Service members is a personally owned firearm (not a military-issued firearm), accounting for 66% of suicide deaths in this population. ● The most common mechanism for suicide attempts among Service members is alcohol or drug use, accounting for 56% of suicide attempts in this population. ● Similar to the larger US population, 51% of Service members who die by suicide did not have a documented mental health diagnosis (e.g., depression). To truly understand facts, remember to stay abreast of research that continues to examine evolving trends in suicide among Service members and effective treatments. Know the Risk Factors “Risk factors are characteristics that make it more likely that someone will consider, attempt, or die by suicide. They can't cause or predict a suicide attempt, but they're important to be aware of.” (NAMI) Some important risk factors, according to Military One Source and NAMI, include: ● Demographic: being a young and unmarried male ● Military: having recently returned from deployment, or having combat-related injuries (mental & physical) ● Career: job loss, lack of advancement, a sense of a loss or honor, or disciplinary actions ● Social: feeling isolated, lacking social support, relationship problems or ending of a significant relationship, grief from loss of a loved one ● Psychological: lack of access to mental health services, ongoing mental health difficulties (even without an official diagnosis), enduring prolonged stressful experiences, impulsive and/or aggressive tendencies, negative attitudes toward asking for help ● Health: lack of healthcare access, ongoing medical issues, heavy drinking, or other substance use problems ● History: previous suicide attempt(s) or family history of suicide, experiences of trauma or abuse Recognize Warning Signs According to Military One Source, NAMI, and the Suicide Prevention Lifeline, the behaviors, expressions, and emotions below are all possible indicators that a person may be having suicidal thoughts or planning to attempt suicide. ● Behaviors: ○ Isolation: distancing themselves from their loved ones, community, or unit ○ Risk taking: seeking or obtaining means of self-harm (e.g., guns, pills), increasing alcohol or drug use, unusual spending ○ Preparing: drafting a will, giving away possessions, making arrangements for pets ○ Sudden changes in sleep (too little or too much) ● Expression & Emotions: ○ Talking about wanting to die/hurt themselves, having no reason to live or being a burden on others ○ Intense mood swings (e.g., from being more anxious or agitated to being in an extremely good mood) ○ Feeling hopeless, trapped, or like a burden, experiencing unbearable pain, having intense rage or a desire for revenge Plan How You Will React in a Crisis If you suspect that someone you care about is experiencing ongoing thoughts about suicide (aligning with warning signs above, or your own intuition), here are steps you can take. See Suicide Prevention Lifeline for more info. 1. Ask: Directly inquire with the person if they are thinking about suicide. * You may want to remind them that you are a trustworthy person that cares about them and wants to help and is not here to judge them. Asking this question will not increase the chances they will attempt suicide or “give them any ideas.” It will help you detect how risky the situation is and direct the person to appropriate resources. 2. Be There: Respond in a way that clearly shows your support, whether verbally or physically. Don’t shy away from the topic or shame the person for having these thoughts. Listen to what the person believes will be helpful or help them brainstorm here if they are having difficulty. 3. Help Them Connect: You are valuable as a social support, but chances are that you are not a professional. Direct the person to relevant resources that can help them manage these thoughts long term. Resources such as Real Strength, Project R.E.D. Team (through Hope for the Day), and In Transition may also be particularly relevant, as they are designed for Service members and families. *You may want to remind them that you are not recommending services because they are broken or crazy. Rather, they deserve an opportunity to process their experiences in an environment that is safe, productive, and focused on their unique needs. If someone you care about intends to cause themselves immediate harm (according to Military One Source): ● If you’re on the phone, try to keep him or her on the line while you or someone else calls 911 or one of the crisis resources mentioned at the top of the article. Keep talking until help arrives. ● If you are with the person, stay until help arrives. (Never leave a person experiencing suicidal thoughts alone.) Remove any means of self-injury (e.g., weapons, drugs) from the area. ● If the person is unwilling to accept help in either situation, contact emergency services or command, if they are a Service member. If you are interested in additional information on how to be most helpful in a crisis situation surrounding suicide, consider the trainings listed on the Speak Up Reach Out website. Remember that Suicide Doesn’t Just Affect the Person Who Passed Away If someone you care about dies by suicide, there are resources available to help you. Taking active steps in caring for yourself is important, and healing is very much possible. The Tragedy Assistance Program for Survivors (TAPS) provides support services for military-linked survivors of suicide. Read TAPS article “10 things we know to be true” to learn about facts for survivors of suicide loss. Be Preventative! Remember that suicide affects all kinds of people across ages, genders, ethnicities, jobs/ranks, and education levels. What is common across most people when they begin to contemplate suicide is that they are undergoing stressors in their life that deplete their ability to feel hopeful about their own futures. The best way to prevent suicide is to help people address those stressors and maintain their wellbeing far in advance of any suicidal thoughts. Think about the examples below when trying to prevent suicide among people in military families: ● Not being able to access physical and mental health care are significant risk factors for suicide. In addition, finances, housing, and food insecurity are major life stressors. ○ Take note of the needs in your community and find small ways to support those facing challenges. ■ Volunteer your skills as a medical or mental health professional in military communities. ■ Connect with other military families to create a network of social support. ■ Offer to help a fellow military family with transportation to and from healthcare services. ■ Patron businesses that hire veterans and military spouses. ■ Start a community garden in your area to help those who are food insecure to access nutritious fruits and vegetables more easily. ■ Pick up extra supplies on your shopping trip and share them with a fellow military family in a tight financial spot. ○ Be aware of organizations that target these problems, refer families to them, and support them! ■ Donate goods to charities or food banks that serve military communities. Refer military families to Military One Source and Operation We Are Here for financial resources. ■ Encourage engagement with organizations that provide free or low-cost, easily accessible mental health services and resources to military families. Consider supporting these organizations with financial contributions if you are able. Some examples include: ● Treatment Works for Vets ● The Psychological Health Center for Excellence ● In Transition ● Project R.E.D. Team ● Real Strength ○ Support legislation that addresses the financial stability of military families and makes healthcare more accessible to them. Talk with your local representatives about these initiatives and vote in favor of them when the time comes. See our article about voting in the military for more information. ● Loneliness and isolation are highly relevant risk factors. ○ Connect with other military families on a regular basis. Schedule monthly dinners together or participate in mutual activities that can support mental health, such as a group exercise class. ○ Encourage your fellow military families to attend local events. Invite them personally, give them a reminder when the event is approaching, and, if they come, be enthusiastic about them joining! ● Big family transitions are normal sources of significant life stress. ○ Check in with families undergoing transitions such as welcoming a new baby or having a Service member return from deployment. Help them with small everyday stresses by mowing the lawn a few times or making dinner and sending it over. Sometimes it is better to come ready to help, even before it is requested. This article is about suicide. But it is also about the many ways we can create communities that nurture members and provide safety nets for those who may struggle. Together, we can all make small efforts to address suicide in a way that is informed, empathetic, and likely to change our nation for the better. References: Military OneSource. (2019, December 21). Suicide Awareness. Military OneSource. https://www.militaryonesource.mil/health-wellness/mental-health/suicide/suicide-awareness?utm_campaign=mos-enews-sept2020&utm_content=html&utm_medium=email&utm_source=govdelivery&fbclid=IwAR05ph5sngElTInbRHxXAjs1JtGVkRrcg8vshAK2csCOw7u_S24Lmf5DHzI National Alliance on Mental Illness. (n.d.). Risk of Suicide. National Alliance on Mental Illness.https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Risk-of-Suicide National Alliance on Mental Illness. (n.d.). Suicide Prevention Awareness Month. National Alliance on Mental Illness.https://www.nami.org/Get-Involved/Awareness-Events/Suicide-Prevention-Awareness-Month Stayton, L. E., Martin, C. E., Pease, J. L., & Chard, K. M. (2019). Changes in suicidal ideation following cognitive processing therapy in a VA residential treatment program. Military Psychology, 31(4), 326-334. https://doi.org/10.1080/08995605.2019.1630230 Tucker, Jennifer. (2019, July 17) 2017 DoD suicide event report: Key findings about suicidal behaviors among Service members. Psychological Health Center of Excellence. https://www.pdhealth.mil/news/blog/2017-dod-suicide-event-report-key-findings-about-suicidal-behaviors-among-service-members

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