By Justin and Stephanie Pollock
Pastor, I don’t want to live anymore.
Hopefully, you never hear these words spill from the mouth of a congregant. However, Christians aren’t exempt from these conversations.
Suicide represents the tenth leading cause of death in the United States according to the Centers for Disease Control and Prevention.
How can you prepare? What do you do when a congregant wants to talk about suicide? Do they need to go to the hospital? How can you help them as their pastor?
As an experienced and licensed crisis counselor, I (Stephanie) often explain that in order to help, you need to ask the right questions, know what to look for, and think clearly.
Four factors to help gauge a person’s risk of suicide include: thoughts, plans, means, and intent.
First, try to determine what kind of suicidal thoughts they have. Suicidal thoughts come in two categories—passive and active.
A person has passive suicidal thoughts when they wish they didn’t have to live anymore, wish they could go to sleep and not wake up, or wish that they would die in an accident.
Active suicidal thoughts—which have a higher risk of suicide—demonstrate a more intentional desire to die accompanied with a plan for how they’d kill themselves.
Getting this information means asking hard, straight-forward questions. To determine if they have passive suicidal thoughts, ask: “Have you thought that you would be better off dead?” or “Have you wished you could go to sleep and not wake up?”
To determine if they also have active suicidal thoughts, follow up by asking: “Have you thought about killing yourself?”
Active suicidal thoughts come with a plan. Ask, “Have you thought about how you might kill yourself?”
Assumptions and speculations can hinder clarity, so ask directly. You don’t have the luxury to fill in the blanks on your own.
If they seem confused, ask again with a restructured question, such as, “Have you worked out the details for how you would kill yourself?”
Suicide plans come in a broad spectrum ranging from multiple researched methods to a vague consideration with nothing firmly selected.
Planning is a crucial part of assessing suicidality. People sometimes act impulsively, but premeditated planning puts a person at a much higher risk of an attempt.
Identifying access to the means for a suicide attempt can establish a further level of severity. Do they have the means to go through with the plans?
For example, if someone’s specific plan involves shooting themselves, but they don’t have current possession of a firearm, then they don’t have the means.
If they reveal a suicide plan, ask a simple but pointed question aimed at that specific plan and their ability to follow through with it such as, “Do you have access to a gun?”
Some plans, however, may rely on readily available means, like a plan to run into traffic.
To assess for means a person may not have mentioned prior, ask a broader question such as, “Do you have anything you fear you might harm yourself with?”
Individuals who’ve spent time collecting the means and preparing for their use present a higher suicide risk.
Finally, determine their level of intent. The presence of intent indicates a bridge from thought to action.
Asking this can sound like, “Do you intend to go through with killing yourself?” Expect anything from, “I would never actually go through with any of this,” to “I fear what I might do alone.”
You’ve asked the hard questions and heard their answers, hopefully calmly and lovingly. Now comes the most difficult part—discerning if they need immediate intervention.
Someone with active suicidal thoughts, a clear plan, available means, and strong intent obviously needs hospitalization.
But what if they have active thoughts, a plan, but no available means or intent? Err on the side of caution.
Ask yourself some diagnostic questions such as, “Do I fear the individual will hurt themselves if I don’t intervene right now?” or “Do I believe their life is in immediate danger?”
If yes, get them into a hospital as quickly as possible. If a person feels safe to carry on in daily life, has a strong support system, or has committed to safety until getting into treatment, they may not need a hospital at this time.
However, never ignore any form of suicidality—even passive suicidal thoughts. Passive suicidal thoughts can turn suddenly into active suicidal thoughts.
What to do if someone needs hospitalization?
- Go to the local ER.
- Call 911 (or the local non-emergency police number depending upon the circumstances).
- Call your local crisis hotline.
What to do if someone needs help but not immediate hospitalization?
- Refer them to a licensed professional.
- Continue to engage and assess them, especially until they become fully established in treatment.
- Give them the local crisis hotline and the national suicide hotline numbers.
JUSTIN AND STEPHANIE POLLOCK are members of First Baptist Church, Lavon, Texas where Justin is the pastor of students and worship. Stephanie is an LPC-I working in suicide crisis counseling.