How to Talk About Suicide

In the world of social media, it seems I can't go more than a few weeks (sometimes a few days) without hearing that another transgender person has committed suicide. As a healthcare professional, and the very concerned mother of a transgender 10-year-old, I want to discuss why and how you should be talking to your transgender child, loved one, patient or student about suicide.

There tends to be a misconception that talking about suicide with someone who has suicidal thoughts may encourage the behavior. However, research suggests that talking about suicide may actually decrease suicidal behavior and improve the likelihood that someone will seek help (Dazzi, Gribble, Wessely, and Fear, 2014).

Within the general population, the attempted suicide rate is 1.6 percent, but in the transgender and gender nonconforming population, the rate of attempted suicide is 41 percent. While the reasons behind suicidal thoughts are many, Trans Lifeline, a crisis and suicide hotline run by transgender individuals, has reported that calls have doubled since the passing of North Carolina's bill, HB2.

In my own Facebook feed, I've seen increasingly that transgender and gender nonconforming friends comment about how hard it is to ignore the comments that go along with the news stories about bathroom bills. I've seen friends talk about feeling helpless, feeling scared and feeling alone. I've done my best to shield my own daughter from the ugly comments of others, but I can't make the negative comments stop. Instead, I find myself posting about how to contact suicide hotlines and encouraging others to have conversations about how to remain safe.

Don't be afraid to talk to your loved one about suicide. Even if they aren't displaying any of the following warning signs, you should still check in and let them know that they are loved and that their life matters to you.

Signs of suicidal thoughts include:
-Talking about wanting to die
-Talking about feeling hopeless
-Talking about how the world would be better without them
-Talking about how they are a burden to others
-Looking for a way to complete their suicide
-Increasing use of alcohol, drugs or reckless behaviors
-Withdrawing from others
-Displaying extreme changes in mood
(Adapted from The Suicide Prevention Lifeline)

If you are the parent or partner of a transgender loved one:
-Talk to your loved one about suicide. Be direct, open and non-judgmental. Be prepared to listen. Don't make false assurances that everything will be okay.
-Make sure you have the phone number for The Trevor Project (1-866-488-7386) and Trans Lifeline (1-877-565-8860 in the US, 1-877-330-6366 in Canada) in a visible place in your home. Make sure your teen or loved one has the number in their phone.
-Ask your loved one if they have thoughts of harming themselves.
-Ask your loved one if they have attempted to harm themselves.
-Ask your loved one if they have a plan in place in case they develop thoughts of harming themselves.
-Help your loved one create a safety plan. The plan should include how to know the warning signs of when a crisis may be developing, identify potentially harmful situations (persons or places that may trigger suicidal thoughts) and the behaviors that may accompany them. The plan should also include coping strategies to help if suicidal thoughts develop, and what to do if the coping strategies don't work such as who they should call and where they could go for help. Make sure the phone numbers are written on the safety plan.

If you are a medical professional:
-Have your transgender/gender nonconforming patient complete a depression and suicide screening at every visit.
-At every visit, ask if they have had suicidal ideation or thoughts of self-harm since their last visit.
-Ask if they have attempted to harm themselves since their last visit.
-Ask if they have a safety plan in place in case they develop suicidal thoughts.
-Provide a safety plan template in the discharge instructions and make sure to include the phone numbers for the Trevor Project, Trans Lifeline or a local resource for crisis intervention.
-If they are depressed, talk about coping mechanisms, review options for medication if appropriate and refer them to a mental health specialist that is familiar with the transgender/gender non-conforming population. Do not assume that it can wait until the next visit.

If you are a school counselor or teacher:
-Have the phone number for the Trevor Project and Trans Lifeline easily available to give to your student. Make sure the student puts the number in their phone.
-Understand that a transgender or gender nonconforming student is at higher risk than their peers for suicidal ideation and check in with them to let them know that you are a safe resource.
-If a student talks about having suicidal ideation, then walk the student to the school mental health professional. Don't assume they will walk there on their own. If there isn't one available, then follow your school policy on getting the student in contact with the proper person. Make sure the student is supervised until they are in a safe place.

If you are having suicidal thoughts, please reach out to the Trevor Project or Trans Lifeline. Please know that you matter and there are friends and allies fighting for you. We care about you and want to see you safe. I know that the visibility has been a double-edged sword and that many of you are feeling the negative effects of the sudden prominence in the news and media. Please know that people care for you and the world is a better place because you are in it.

Dazzi, T., Gribble, R., Wessely, S., & Fear, N.T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine 44, 3361-3363. doi:10.1017/S0033291714001299

If you -- or someone you know -- need help, please call 1-800-273-8255 for the National Suicide Prevention Lifeline. If you are outside of the U.S., please visit the International Association for Suicide Prevention for a database of international resources.