What to Do in an Emotional Crisis

Research has shown that about 90% of those who die by suicide had an underlying mental health or substance abuse problem at the time of death. Said another way, about 9 of ten suicide deaths could be prevented through timely recognition and treatment of the underlying mental illness or substance abuse. Quite frequently those who die by suicide had struggled with depression.

Those health care professionals who are licensed and qualified to diagnose and treat mental health conditions such as depression are only part of the suicide prevention team. They can do a much better job of halting the progression of depression toward suicide with the help of those who recognize the symptoms and take action.

It’s normal to feel blue from time to time, but feeling sluggish, lonely, sad, withdrawn, “different,” empty, anxious, fearful, or restless for more than a couple of weeks may be due to depression or another depressive illness. Depression screening tests and checklists are available online and can be found using a search engine such as Google or Yahoo. They can help identify symptoms of depression well enough that an individual can recognize themselves or their loved one in the screening questions. However, only a professional health care provider can provide an accurate diagnosis of depression. Such checklists and screening tests are only tools to help approach and talk with a doctor, who is key successful recovery from depression.

Prompt recognition and action saves lives. It is critical to not wait to seek help until depression progresses to a state of crisis, when the symptoms are so severe that the individual feels driven to consider suicide. Early recognition buys time for helpful anti-depressant medications to take effect before the wave of depression crests into crisis. But again, only a health care professional can prescribe these life-saving medications.

As the holiday season approaches, individuals struggling with depression may find that their symptoms become more severe and even unbearable. Depression often follows a sudden loss, significant anniversary, or traumatic life change. Significantly, consumption of alcoholic beverages increases during the holiday season. Alcohol aggravates symptoms of depression. Alcohol and the “holiday blues” can be a dangerous and even life-threatening combination. Holiday blues and booze are bad news.

Service members and veterans may be reluctant to consider that they may be struggling with the holiday blues or even full scale depression. Worse, they may feel peer pressure to consume alcohol, shrug off feelings of sadness and play along that they are enjoying the party. It is therefore critical for veteran and active duty service members, friends and family to avoid pressing alcohol on anyone during the holiday season.

Now is therefore an especially appropriate time to review signs of depression and watch out for one another. Typically, service members are stationed far from home and isolated from the loved ones who might most quickly recognize depression signs. Thus, the service member may be isolated from those who would otherwise be his lifeline in a time of crisis. It takes the strength of a soldier to recognize and act on signs of depression in time to save his or her own life or the life of a buddy in his unit. Just as important is to appreciate the added stress on spouses who are likewise far from home while coping with the unique challenges of military life.

A depressed person whose symptoms escalate may leave a trail of warning signs along the road toward suicide. He or she may do things such as:

  • Talk or write about death, dying or suicide.
  • Use the Internet to find ways to die, for example guns, pills, and other methods.
  • Feel trapped, like there is no way out of a distressing situation.
  • Give away prized possessions or find a new home for a beloved pet.
  • Express feelings of hopelessness, detachment from loved ones.
  • Withdraw from friends, family and society.
  • Drink more, drink more frequently, or change to a stronger alcoholic beverage.
  • Use street drugs.
  • Use inhalants to “huff.”
  • Abuse sleep aid or pain medications.
  • Have difficulty sleeping or sleep excessively.
  • Show little emotion in their speech or facial expressions.
  • Have ongoing aches and pains that don’t go away even with medical treatment.
  • Feel an uncontrollable rage or anger.


These are only a few examples of warning signs to watch for. More can be found at suicide awareness web sites such as:

http://www.suicidepreventionlifeline.org/media/pdf/NSPL_WalletCard_AssessingRisk_GREEN.pdf

http://www.suicidepreventionlifeline.org/help/default.aspx

http://www.save.org/index.cfm?fuseaction=home.viewPage&page_ID=705F4071-99A7-F3F5-E2A64A5A8BEAADD8

http://www.nimh.nih.gov/health/topics/depression/index.shtml

However, immediate help is just a quick phone call away 24 hours and seven days a week. The National Suicide Prevention Hotline number is 1-800-273-TALK (8255) and can easily be programmed into phones, scribbled on telephone book covers and stuck to the refrigerator door. Moreover, the National Suicide Hotline has partnered with the Veterans Administration (VA) and Vet Centers to provide the specialized services veterans need.

Individuals thinking of suicide, struggling with depression, anxiety or feelings of despair can find reassurance by talking with someone trained to listen to those in distress. Family, friends, unit members or co-workers concerned about someone who is showing one or more of the warning signs of suicide can make a toll-free call to the Lifeline’s trained counselors for assistance. The National Suicide Prevention Lifeline is completely confidential.

For those calling for themselves, the Crisis center staff will listen and talk with them. If needed, they can give information about local community resources or services to help after the call is over. Everyone is always free to call 1-800-273-TALK again for followup or to check in.

Those calling for someone they are concerned about can get tips and ideas on how to approach the person and successfully encourage them to seek help. In some cases, the crisis team can conference the caller together with the person they are concerned about. Some communities even have mobile crisis outreach teams that can make home visits.

In addition, the National Suicide Prevention Hotline can answer general questions about mental health, suicide, depression, local suicide prevention activities, community health resources, and more. One need not be in suicide crisis to dial 1-800-273-TALK (8255). Many calls to the National Suicide Prevention Hotline are made by individuals seeking to become more aware of the warning signs of suicide.
One of the most valuable resources at the National Suicide Prevention Hotline website is the printable wallet card at

http://www.suicidepreventionlifeline.org/media/pdf/NSPL_WalletCard_AssessingRisk_GREEN.pdf

It can be downloaded and printed for free use. The Wallet Card shows in an instant what a concerned person should do when faced with someone talking about ending their own life. This card can be carried in wallets, purses, fastened to the refrigerator door, used as a bookmark, kept beside the telephone both at home and in the workplace, bookmarked as a favorite web page and more.

Nobody can predict death by suicide, but nearly everyone can obtain and become familiar with the life-saving instructions on the Wallet Card and keep the card handy for an emergency. Few situations are as stressful as hearing someone say they are thinking of killing themselves. The instructions on the wallet card are designed to help minimize the feelings of panic and direct everyone involved to take appropriate action.

Suicide threats and attempts are life and death emergencies and should therefore be taken seriously. When faced with such a situation, one should ask the person directly if he or she is having suicidal thoughts or ideas, if they have a plan to do so, and if they have access to the means to do so. The wallet card contains a few quick example questions, such as

“Are you thinking about hurting yourself today?”
“Are you thinking about killing yourself?”
“Have you thought of ways you might hurt yourself?”
“Do you have pills or weapons in the house?”

Then take action. Do not leave the person alone if they indicate they are thinking of harming themselves. Say to the person “I am going to get you some help right away.” Then call the Suicide Prevention Hotline at 1-800-273-TALK (8255).

Sources consulted:

Suicide Awareness Voices of Education (SAVE), “The Link Between Depression and Suicide.”
http://www.save.org/index.cfm?fuseaction=home.viewPage&page_id=70489B01-CDA6-EC10-E40B95178144A08F

Merck Pharmaceuticals, “Depression.”
http://www.merck.com/mmhe/sec07/ch101/ch101b.html

National Institute for Mental Health “Depression Symptoms”
http://www.nimh.nih.gov/health/publications/depression/symptoms.shtml

Suicide Awareness Voices of Education (SAVE), “Symptoms and Danger Signs of Suicide.” http://www.save.org/index.cfm?fuseaction=home.viewPage&page_ID=705F4071-99A7-F3F5-E2A64A5A8BEAADD8

National Suicide Prevention Lifeline, “What are the Warning Signs for Suicide?”
http://www.suicidepreventionlifeline.org/help/warning_signs.aspx

National Suicide Prevention Lifeline, “What to Do if You Think a Person is Having Suicidal Thoughts.”
http://www.suicidepreventionlifeline.org/media/pdf/NSPL_WalletCard_AssessingRisk_GREEN.pdf

National Suicide Prevention Lifeline “Get Help,”
http://www.suicidepreventionlifeline.org/help/warning_signs.aspx

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