When you take a loved one to the ER after a suicide attempt, the visit is extremely stressful but it can also be a relief. As long as you’re at the ER someone else is in charge. While you’re there, once the physical crisis is over, you know that your loved one is safe.
When the ER staff has done all it can, your loved one may be sent elsewhere for long term treatment, such as to a hospital or residential treatment facility. It is possible, however, that he or she will be discharged and sent directly home.
The period immediately after discharge from the ER is particularly dangerous for survivors. One in ten attempts will be repeated within 10 days. Even after the first 10 days, a repeat attempt is more likely to occur within 6 months after an initial attempt. If you are going home to be the patient’s caregiver, it’s vital to be as prepared as possible.
Before Leaving the ER
The role you play after leaving the ER will depend on your relationship to the survivor. Unless the patient is a child and you are the parent or guardian, the hospital can only share information with you if the survivor gives permission.
Ask the ER staff about the safety plan that needs to be put in place at home. Try to identify your role in implementing that plan. The safety plan will be explained below. If you do not believe that this plan will be able to keep your loved one safe, let the ER staff know this before discharge.
Before leaving the ER, find out if the survivor is going to be on medication. If so, decide who will get the prescription filled and who will be in charge of making sure the medication is taken. If the survivor is a teenager, an adult needs to be in charge of managing the medication.
Follow Up Appointment
Find out when a follow-up appointment will take place and where it will take place. It should occur as soon as possible. If you don’t think the appointment is soon enough, ask for an earlier one. If substance abuse was in any way involved in the attempt or its motivation, be sure that a substance abuse expert will be involved in post-discharge treatment.
Support Resources/What to Watch For
You will need to have a phone number to call if help is needed after you get home, along with a list of situations in which you should request outside help. Don’t forget to ask for resources that you can utilize for your own support.
After You Get Home
Implement the Safety Plan
Fulfill your role in implementing the safety plan:
- Remove and/or secure all firearms so that they are completely inaccessible to the survivor.
- Remove and/or secure all medications. If some must be kept available, keep only small amounts.
- Remove and secure alcohol products.
- Identify the triggers that are likely to lead to a follow-up attempt. Help your loved one to avoid those triggers. If they can’t be avoided (such as when the trigger is a particular date), help your loved one anticipate the trigger and plan how to manage it with support.
- Build a support network of professionals, friends and family for both yourself and the survivor. This situation is not something any one person can handle alone. For your own support, it can be very helpful to connect with others who have been affected by suicide. In addition to local mental health providers and support groups, resources are available at:
- The National Alliance of Mental Illness (NAMI) www.nami.org
- The Suicide Prevention Resource Center www.sprc.org
- Remember that regardless of your own feelings, the survivor needs a safe person with whom to share his or her feelings. Don’t try to be a counselor. Just try to be a good, non-judgmental listener at this difficult time. Try to foster open and honest communication.
- Stress to the household the importance of sharing information about the distress or potentially harmful actions of the survivor. Explain that this is more important than keeping a confidence.
- Establish a system for describing the emotional state of your loved one. This can be a one to ten scale, with one being “doing well” and 10 being “on the brink of another attempt”. It can also be a color scale, such as green or blue for “doing well”, yellow for “not doing well”, orange for “I’m in distress” and red for “I’m on the verge of another attempt”. After you identify a system, establish how often you will check in with your loved one to ask about their emotional state. Ask your loved one to commit to letting you know if they are approaching a crisis state. Once you get home, be sure to follow through. If your loved one experiences another crisis, reach out for help immediately.
Acknowledge Your Own Feelings
When first coming home with a survivor, it’s not unusual to be physically exhausted by the combination of intense emotions and lack of sleep. Do whatever you can to cut back on all your other responsibilities so you can rest and recover. Be easy on yourself.
Being angry with the survivor is normal. Acting on that anger by taking it out on the survivor is destructive, however, and can have a negative effect on their recovery. It may help to remember that suicide attempts are frequently the result of severe suffering and/or mental illness. Remember that, although the attempt has affected you and caused you suffering, it wasn’t an attack directed against you.
Feeling guilty for not foreseeing the attempt is also normal. It’s natural to wonder why you “didn’t see it coming” and to believe you could have somehow prevented the attempt. However, it’s not realistic to expect to know another person’s thoughts and foretell, much less control, their actions. Again, your feelings of guilt need to be discussed with someone other than the survivor.
Shock and Hopelessness
Your response to the suicide attempt can vary enormously depending on whether it’s a first attempt or a repeat attempt. A first attempt may be a complete surprise that causes feelings of shock. With a first attempt, it can be comforting to learn that only 10% of people who attempt suicide will eventually die by suicide. However, it can be alarming to learn that 80% of those who die by suicide have made a previous attempt. A survivor is more likely to die by suicide than someone who has never made a suicide attempt. Fortunately, there are treatments available specifically for those who have made multiple attempts. If this is not the first attempt, don’t give up hope.
It can be terrifying to go home with a loved one who has just survived a suicide attempt. We all want to protect those we love, and it’s not possible to completely protect someone from suicide. It is, however, possible to reduce the risk. Improving our communication with the survivor can help us become more familiar with how he or she is feeling, and whether or not thoughts of suicide persist. There is no guarantee of safety, however. For that reason, there is no perfect fix for the fear that you feel. This is one of the reasons why you need your own support network.
Depression and Loss
After a loved one attempt’s suicide, there is a sense of loss for the life that we thought we had, a life without the fear of losing a loved one to suicide. Problems that were hidden may have come to light and they may present difficult challenges. While our days before the attempt may not have been carefree, they were free from this particular “care”. It’s normal to feel depressed over the loss of our “pre-attempt” life.
What Not to Do
Don’t assume another attempt will not occur.
Don’t let your loved one manage his or her own medication.
Don’t leave it completely up to your loved one to keep him or herself safe. Yes, this is their responsibility, but it is unrealistic to think this is something the survivor can do alone. On the other hand:
Don’t hover. It’s not possible to watch someone every minute of every day. Attempting to do so can generate distrust and prevent open and honest communication. Your loved one needs some privacy and time alone. Ask him or her how to strike the balance between watching too much and not watching enough.
Don’t discourage open communication about the attempt. Silence won’t erase what has happened. It will, however, prevent honest communication and healing.
Don’t blame anyone: not yourself, your loved one or any other household or family members.
Don’t ignore other household members. They need you also. In addition, they will need a support network. They are affected by this attempt as well and will need help to work through the trauma.
What to Expect Moving Forward
Life after an attempt is never going to be the same as it was before. A suicide attempt is traumatic and requires long term support for both the survivor and all of those affected by the attempt. However, the issues that led to the attempt were there before the attempt occurred. A suicide attempt sometimes forces secrets into the open and gives the opportunity for healing to take place.