Working with those at risk is challenging even for the most experienced, but in most situations, the ability to remain calm, empathic, communicate concern, actively listen, without judgement, will be key to creating a safe and supportive environment.

Expressions of suicide and self-harm are different in that self-harm is often a way for people to manage difficult emotions and not necessarily because they want to die.  However, people who self-harm can ‘accidentally’ kill themselves so expressions of both suicide and self-harm should be taken seriously.

When to call emergency services

If the person in crisis is at immediate risk of either, you may be asked by the caller to ring the ambulance or police immediately, if you know where the person is.  Where callers are resistant to this, but the risk remains imminent, you may need to break confidentiality and follow the same procedure.

Questions you could ask

The list of questions below is not exhaustive and they may not always be appropriate or necessary.  They are just examples of responses that may be helpful. 

Remember that you will also have your own style and way of engaging someone, and that asking open and, at times, more direct questions will not lead or encourage someone to take their own life.

• “It sounds as if you have been going through a particularly difficult time recently and that killing yourself or harming yourself is a way of coping with that. Do you feel able to tell me a little bit more about that, and what might have led to this point” (leading into questions around immediate intent and method).

• “Is this a new experience for you, or have you felt like this before?” You are looking for previous history and if the answer is yes, your response might be to validate the caller’s feelings and experiences, then say something like “Can you remember what you did in that situation and what it was that stopped you?” 

• “Was there anything in particular that was helpful at the time?” (You are looking for protective factors, which could be numerous things such as religious beliefs, family, pets).

• Dependant on their response, ask whether the caller has the same support network now.  Are those people still around? Are there other types of support still around that were helpful at the time, such as activities or places that helped them feel calm and connected?
• “And when you think about harming yourself now, is there anything we could think about together, that may be helpful to you”?  If the answer is yes, you could ask the caller to think about how they might reengage with that network again.
• If the answer is “no” you might want to say something like “Would it be okay if we tried to come up with a different plan together that might be helpful?” (You are trying to enable and resource a safety plan for the caller, which, to be effective, needs to be meaningful).
• Then check out what the next step might be in implementing that plan (GP, family friends, details of emergency and hotline numbers, places, activities etc).
• If the caller has engaged in the conversation with you but remains intent on harming themselves, you may still have to consider contacting the emergency services, or if there remains intent but no immediacy, seeking advice from your supervisor, Safeguarding Team etc will be important.
•  If the call has gone okay you might say something like “I really appreciate your call today and I imagine it was not easy to pick up the phone and talk to me in the way that you have, and I wish you all the very best for the future”

Support for you

Responding to someone who self-harms or is suicidal can be very distressing.  Remember to think about what you need during and after such an encounter. During the call, remember to breathe and use grounding techniques).

Your supervisor is also there for you:

1. Call them for support during a call if appropriate
2. Debrief after such an intense experience is important
3. Do allow yourself some space before taking another call.

Suicide awareness training

Speak to your supervisor if you are interested in re-doing suicide awareness training.