'Man goes to doctor. Says he's depressed. Says life is harsh and cruel. Says he feels all alone in a threatening world. Doctor says, "Treatment is simple. The great clown Pagliacci is in town tonight. Go see him. That should pick you up." Man bursts into tears. Says, "But doctor... I am Pagliacci."

-'Watchmen' excerpt via Patton Oswalt

I want to talk frankly about how to support people who are suicidal, from the position of someone who has been suicidal at times herself in her teenage and adult life. It can be incredibly difficult to be a support person for someone struggling with these issues, and I get asked a lot what to say or what to do. I'd also like to create a basic support guide for someone with daily mental health issues like depression or anxiety, but that's another post (and there's some resources out there).

I'm someone who has often been told that I'm just so strong and so many people look up to me and I shouldn't ever consider suicide because people need me etc etc etc. I know it's all meant well, but it makes me feel like an animal in a cage, unable to express how I feel because I'm constrained by other people's opinions of me and my own reputation. It's not healthy for me, or for anyone. It's ok to break down sometimes. It's ok to reach the end of your rope.

And we need a community to help prevent this from happening over and over again.

I might be especially sensitive to this because  I live in the Bay Area, right by San Francisco, the home of many beautiful things like the Musee Mechanique, the Bring Your Own Big Wheel Race, the Sutro Baths, Emperor Norton and queer porn. It's also the home of the Golden Gate Bridge, the #1 place in the world to kill yourself, with 1,600 confirmed suicides. They've just approved funding for a net to try and prevent suicides in the future, but I know I've considered it, and have multiple friends who have been apprehended on that windy sidewalk.

And yet this is also a city where I have felt more isolated than anywhere else, where "radical self reliance" is the justification for selfishness.

I hope that by penning a guide of what people could actually do, that we can work together as a community of people who give a shit about each other to be there for those in our lives who are struggling to stay alive.

Now, I've done some research to try to make this as general as possible, but also please understand that this is a guide around what I've found useful with people I know, and found useful as support for myself. If things on this list don't speak to you, or are contrary to what works for you, that's a-ok!

THE GUIDE

-Know your own limits. Before anything else, figure out where you're at, and  put your oxygen mask on first. Supporting people who struggle with mental health issues can be exhausting and draining, so be sure to implement self care and don't overextend yourself.

-Don't make idle promises. Connected to the first tip, don't tell people struggling with mental health issues to contact you anytime unless you mean it- it may sound reassuring to you, but it really sucks to reach out and then hear nothing back. Of course you have your own life- I'm not saying you nee to drop everything But maybe rather than saying "call me anytime", give realistic expectations for when are good times to get in contact, and which methods are best. Maybe come up with a code phrase to communicate if it's head weasels or a full blown emergency. Even better, if someone you know if struggling says "do you have a minute?" and you don't right now, but you will in 30 minutes, or two hours, or tomorrow, tell them that. Give them a time you'll be back in touch, and then follow through.

-Don't call the police. Most people with mental health issues find the police to be terrifying, and for good reason- you've seen what's happening in Ferguson, right? Or read about the police when dealing with rape cases? The police are not often allies or friends, and while yes, they may temporarily prevent your friend from killing themselves, the cops often create more trauma than they resolve. This is probably controversial advice, as usually you're told to call 911, but seriously, having the cops being called as a threat over my head has made me more determined to take fatal risks to avoid them and/or made me not want to tell anyone I'm feeling that bad in the first place.

-Don't say any of the following: "But you have so much to live for!" "But you'd hurt so many people!" "Suicide is a permanent solution to a temporary problem!" "You don't have THAT many problems." "But you're so STRONG." "Have you thought about getting help?" "Your whole life is ahead of you!" "You're being melodramatic/just want attention". All of these are incredibly dismissive and/or make the feelings we're having suddenly about you. It's selfish, and counterproductive, and often digs the hole of desperation deeper. We already feel by living we're hurting everyone around us, that it's not going to get better (often, it hasn't), and that we've tried everything we have access to to no avail. Here's a great post that breaks down why these things are all bad ideas.

For me, the kindest thing someone said was "I trust you to do what's right for you." It acknowledged my pain, gave me agency, and centered my feelings, which is exactly what I needed. Let them feel suicidal. I know for me when it's been ok for me to feel like giving up, I've felt less trapped and less desperate.

-Give your loved one options. Ask them if they want advice, or sympathy, or for you just to listen. Stick to what you say you're going to do. If they want advice or help, offer them options there too- "would you like to get some food, or go for a walk, or go to a mental health clinic, or play video games?" or whatever is appropriate for your situation. Knowing that you're not going to drag them kicking and screaming to the ER is huge.

-Be an advocate if you go to the hospital or clinic with them. People who are dealing with suicidal feelings  can feel easily overwhelmed, isolated, and helpless when confronted with mental health care as it stands. Having someone to hold their hand, advocate on their behalf with overeager clinicians, and make sure we're not locked up against our will makes us feel a lot safer getting this kind of help when we need it. Without an advocate, it can be easy for a suicidal person's desires and agency to be shoved aside, which doesn't help when you're already feeling out of control. Ask the clinic if they do involuntary hospitalization, and advocate against that so your loved one can walk out if they need to. Their safety is the top concern, and forcing them to stay somewhere they don't want to be likely isn't going to help.

-Check in on them.  Even (and especially) when you think the crisis has passed. When I expressed my desire to kill myself, I was overwhelmed with offers from people who wanted to spend time with me. Two weeks later, though, I couldn't get any of them to pick up the phone. It made recovery really difficult because it communicated that people only really cared when I was in crisis. Hotlines may be helpful for some, but there's really nothing like someone close to you being present for you. Whether you send a Twitter DM, a text message with a silly photo, an email, or make plans to spend time together, check in on the suicidal person. Once when I was helping someone else suicidal I gathered some friends to make sure we contacted them even just to say hi every 30 minutes or so. We made up a spreadsheet! You don't necessarily have to go to that extreme, but it definitely helped.

-Volunteer practical (and specific) help. When suicidal or seriously anxious/depressed, it can be incredibly difficult to manage daily tasks. The more they get away from us, the more overwhelming they become. While distracting suicidal people is fun for a moment, we often appreciate a helping hand with the house, feeding ourselves, sometimes even doing paperwork or showing. When these things pile up, the temptation to run away increases even more.

-With the suicidal person's permission, talk to other friends about the situation. It's a lot easier and more sustainable to make a care plan when you have multiple people  to pitch in. This care calendar can help a community band together to help with the mundane tasks- tidying a flat, running a bath, making some food, having a cup of tea and a chat.

-Take care of yourself! Give yourself a nice bubblebath, or a fancy meal, or a mini spa day. Somethng that helps you feel taken care of and revitalized. Self care is taking care of someone in need too!

I hope this is useful for people who are dealing with this situation. I'd love to hear comments about what's been useful for you, or what hasn't been. Consider this a living document.