Suicide Warning Signs and Prevention | Line One

CDC data shows that in 2022, there was one death by suicide for every 11 minutes. While the stigma around mental health has begun to fade, this is a reminder that many struggles are still hidden. The signs of suicidal thoughts are not always obvious and recognizing them in yourself and loved ones is vitally important. On this Line One, host Dr. Jillian Woodruff and her guest discuss those signs and share resources for suicide prevention.

HOST: Dr. Jillian Woodruff

GUEST: Dr. Seth Bricklin of Psychology Services of Alaska

Click Play below to listen to the audio from the live show. Please continue below for a transcript.

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Transcript:

Dr. Jillian Woodruff: Hello and welcome to Line One, Your Health Connection. I’m your host, Dr. Jillian Woodruff.

Introduction: Suicide is a profound and complex issue that affects individuals, families, communities across the world. In fact, in the US, suicide ranks as the 11th leading cause of death across all age groups. What’s even more alarming is that among individuals age 10 to 34, suicide is the second leading cause of death. A heartbreaking reality that underscores the need for greater understanding and awareness. For many, the warning signs of suicidal thoughts and intentions are not always obvious. They can manifest as changes in mood or behavior like withdrawing from loved ones, sudden irritability or even a sense of calm after a long period of deep distress.

These are often misunderstood or overlooked making it crucial for all of us to be vigilant and informed. Today, we’ll be talking about recognizing the red flags if someone you care about might be considering taking their own life, how to support a loved one in crisis, and understanding the reasons that may drive someone to feel like death is their only option. We’ll also address how people dealing with depression can recognize these signs in themselves and seek help before reaching a crisis point. Most importantly, if you or someone you know is experiencing thoughts of suicide, resources are available.

Call 988, this is the Suicide and Crisis Lifeline. It’s a national confidential 24/7, support line that anyone can call or text to connect with a trained counselor. Help is just a call away.

Joining us today is Dr. Seth Bricklin, a highly respected licensed clinical psychologist. Dr. Bricklin brings a wealth of expertise in mental health care with a focus on depression, anxiety, post traumatic stress disorder and suicide prevention, making him an invaluable voice in today’s conversation on suicide awareness and intervention. Dr. Bricklin provides care here in Anchorage at Psychology Services of Alaska, and can be reached at 907-290-7250 or by visiting www.psychak.com.

Dr. Jillian Woodruff: Welcome. Dr Bricklin.

Dr. Seth Bricklin: Thank you so much for having me.

Dr. Jillian Woodruff: Well, thank you again. Dr Bricklin, and I think before we dive into this immense topic today, let’s just learn a little bit more about you and what led you to this field.

Dr. Seth Bricklin: Sure. Well, how I got into psychology probably started when I was in middle school. My mom went back to school to get her Masters in Counseling, and I just became interested in hearing her talk about what she was learning, and that got me interested in psychology. And then when I was in high school, I actually had the opportunity to take a psychology class. Then it just started to make sense. I just really felt like I understood it well – helping understand people and it really seemed very interesting. And then, we actually saw a movie in that class called Ordinary People. It’s an old movie. It’s like 1980. It’s like Timothy Hutton’s first movie. He actually won an Oscar. He’s like one of the youngest people to win an Oscar, and that’s about him. So he survives a boating accident where his brother died, and then he struggles with depression, PTSD. The movie starts as he’s coming out of a residential facility after attempting suicide. So, the movie is all about his recovery, and a lot of the movie scenes are with his therapist. I just remember watching it saying, that’s what I want to do. Yeah. I really wanted to do that. And, you know, I remember talking to my folks, and they reminded me, you know, your aunt and uncle are both psychologists. So I had a lot of support also, as I got into the field. I went to college and just started in psychology and it took off from there. So a lot of people are supporting me, helping me, which is something that I have always been interested in.

Dr. Jillian Woodruff: Do you think psychologists are masters of communication? Do you think that’s something that we all struggle with, communication, whether that’s at work or with colleagues, with our family members, we’re all trying to, like, reach the other person, are these just strategies that you learn from training?

Dr. Seth Bricklin: I think it sort of depends – what kind of communication, but hopefully, I think as a psychologist, the thing you have to be really good at is listening, hearing what other people are really saying, and being able to communicate with them. But a lot of times it’s listening, letting the person know that you’re listening to them, how to reflect back to them. It’s really the best tool is what we call active listening. Somebody says something, you reflect back what they’re saying. Let them know that you’ve heard them ask open-ended questions, continue to help them talk and really doing things to let the person know that you’re really interested and hearing what they’re saying.

Dr. Jillian Woodruff: That’s a great point you bring up. I think in my research and studying for this program, I did come across that a lot – listening. I think we want to share our point and get our point across, we all want to be understood. And so I guess showing that you’re understanding that other person by listening is very important and critical.

Dr. Seth Bricklin: The term we love to use as psychologists and therapists is validation. You want to really validate what the other person is saying that often gets confused with agreeing. Validating somebody doesn’t mean you agree with them. It really just means that you’re saying to them, hey, I hear what you’re saying. Your feelings make sense to me. They’re reasonable or understandable, and they matter to me. Even if I disagree with you, I can still validate and that’s really what it comes down to. I think that is really important.

And that’s really what I would say is sort of the underlying theme for this is you have loved ones, children, other people in your lives that are struggling. The main thing is, you know, all the recommendations and things I might suggest you say to people, the underlying theme is you want to validate them. That you care about them, you hear what they have to say. Their feelings matter to you, you’re not trying to talk them out of those feelings, you’re not trying to minimize them, but you’re giving them the time and consideration and telling them that it’s valuable, it matters to you.

Dr. Jillian Woodruff: So if they’re saying to you that their life is difficult or that they’re struggling or they feel bad about themselves, they’re coming from a difficult situation, our job is not to tell them, No, your situation is good, better than others.

Dr. Seth Bricklin: Correct. In fact, that would be one of the don’ts. Often, people say what are the dos and don’ts if somebody’s expressing to you suicidal thoughts or concerning kinds of thoughts? We don’t want to do pep talks or try to cheer them up, necessarily. The reason being is that it feels invalidating. Imagine, think of times you’ve come home or you talk to somebody “I’m so upset that this person did this to me, can you believe what they said?” and I’m like, “Oh, calm down, it’s no big deal. Just relax.” Most of us don’t like to be told to relax when we’re upset because it’s invalidating.

Dr. Jillian Woodruff: Or saying others have it worse than you.

Dr. Seth Bricklin: That’s another one. “Look, there was a hurricane the other day in Florida, at least you don’t have that happening.” Because then what the person feels is you don’t understand. They feel patronized. They’re not feeling heard or understood, and then they’re just going to say, well, this person just doesn’t get it and they’ll just shut down.

Dr. Jillian Woodruff: Given the range of mental health issues that you address, how frequently do you encounter concerns about suicide?

Dr. Seth Bricklin: It’s such a broad topic, right, because people can talk about suicide or say things sort of even “ugh, I’m so mad I could kill myself.” Often, they may not really be suicidal and not necessarily a concern in terms of, hey, this person needs immediate intervention.

So, I would say the majority of patients I see don’t struggle with suicidal thoughts on a regular basis. I think many people have them from time to time and it’s certainly a normal occurrence in my practice helping people deal with struggles. It’s a common thing where people may have what we call fleeting thoughts where they think about suicide, but it’s not something they dwell on or actually consider doing. You may have somebody who is having more serious thoughts. I think people who are having more serious thoughts or more persistent kinds of thoughts, I probably see that in a given month a few times. Usually, the way I work is I will have a case load of patients that I’m working with, so at any given time I may have 2 or 3 or 4 that are struggling with this as an ongoing issue.

Dr. Jillian Woodruff: Maybe you can give us an overview of suicide in general and the many facets of it.

Dr. Seth Bricklin: It’s a broad topic. There’s different ways to talk about sort of like we already but I said this like it ranges from people who are actively suicidal, so we say were they really seriously considering it. But I guess we’ve looked at it like the CDC, let’s say, would define suicide as death caused by injuring oneself with the intent to die. It’s the intent. When we talk about suicide, one thing we want to distinguish are – there’s suicidal thoughts, which might be actual thoughts of killing oneself. There might be thoughts about death, where it might be, something might be thinking, “Gee, I’m just tired of living. I wish I just wouldn’t wake up tomorrow. That might be what we call more passive, so somebody’s not actively thinking about taking action to harm themselves, but feels like they would rather be dead.

Dr. Jillian Woodruff: So it’s suicidal thoughts without the intent?

Dr. Seth Bricklin: Correct.

Dr. Jillian Woodruff: So people can have that? Think maybe this would be a better way to go, but do not have any intention of…

Dr. Seth Bricklin: Correct. That is probably the most common form/type of suicidal thoughts that I see in practice. People who are thinking about it, who are feeling very depressed or distressed about some type of crisis but may not actually be actively suicidal. That’s something that we assess, as a professional.

For folks who have people in their lives that they’re concerned about, the bottom line is, if you’re not sure, try to get them help so they get them somewhere. Call that hotline, take them to their primary care doctor. If it’s your child, go to a pediatrician and let them do that assessment to try to distinguish what might be going on. The majority of people I see will have those kinds of thoughts without any act of intention.

Dr. Jillian Woodruff: I think that some people may be a little concerned even to bring this to their primary care doctor, maybe thinking “are they going to call the police on me because I’m actively trying to die.” So maybe that could leave people to not want care.

Dr. Seth Bricklin: That’s true. People are very concerned about that, and I will say to patients frequently…They say, I don’t want to be taken away. I don’t want to be put in a hospital. I tell them, the only reason people are put in hospitals is because they’re a danger to themselves or others and have some kind of mental illness perhaps. But if somebody says they’re having thoughts of suicide, but they have no intention of doing it, they’re not going to get put into a hospital. Now, that might be recommended as a form treatment long term, because if somebody’s chronically having that kind of thought, that’s obviously not a good place to
be. If you’re feeling that way long enough, then those thoughts may become suicidal. But there is that distinction and the other important distinction to make especially with teenagers because it’s becoming more common is the topic of self harm.

So we often talk about self harm like cutting behaviors and it’s important to distinguish that most often, people who are engaged in those behaviors are not suicidal. Things like self harm and cutting generally is a way to cope. It’s a coping mechanism.

Dr. Jillian Woodruff: So they’re not trying to die by suicide? Just dealing with intense emotions?

Dr. Seth Bricklin: Yes, but that’s often very shameful, and so they cover it up and they don’t talk about it because they’re afraid that people will think that they’re suicidal. But very often, if you ask them, were you trying to kill yourself? Very often they will say no. I was feeling so stressed that doing that is a stress relief. They feel empty and it’s a way to feel something.

Dr. Jillian Woodruff: So they definitely need help, but a different sort of help for that situation?

Dr. Seth Bricklin: Yes a different help, and also again sometimes people can be seriously injured or die accidentally. People will be engaging in those behaviors, but their intention is not to kill themselves, but things can happen so obviously these are things you might want to take seriously.

Dr. Jillian Woodruff: So is there a way to distinguish between self harm and somebody who is trying to die by suicide? Is it basically just what you mentioned, just asking them?

Dr. Seth Bricklin: Yes. Certainly as a parent, you may feel more comfortable to just ask that direct question, but in all honesty, asking directly cuts through all of the stigma and actually help somebody talk about it and it takes a lot of the pressure off. Sometimes you can just say, are you thinking about killing yourself? I saw that you cut yourself. What’s going on? Tell me about that. Tell me what happened. Were you trying to kill yourself? Sometimes asking a direct question can be the best. What I would say to family members, people who have loved ones, people in their lives who are struggling, you want to make sure you get help from a professional. You don’t want to feel like it’s up to you to decide – is this serious? What do I need to do? The bottom line is encourage them to get into treatment, talk to their pediatrician, have them see a counselor or call a hotline. You don’t want to feel like it’s up to you to decide it. Having said that, it is okay to ask those questions.

Dr. Jillian Woodruff: I hear you with these questions that are open-ended questions which is exactly what you said to do so that would encourage the person to listen to that response. I think when we talked previously we were talking about that by asking these questions, you’re not putting thoughts into someone’s head.

Dr. Seth Bricklin: Right. That’s another myth about about suicide. That if you mention suicide, you’re going to give them the idea. It’s not like it’s a new concept. It’s not like they haven’t heard of that before. Think of it yourself. If you’re having such a bad day and somebody said “are you thinking about killing yourself?” You would say no, I’m not. It’s not as if that plants the seed. There are some things like certain media coverage and there’s really good work now being done with the media in covering suicide in a way that doesn’t encourage other people. You know, sensationalizing it, things like that can lead to suicide clusters and things of that notion. But when you’re talking about just talking to an individual or asking them that question is not going to put them more at risk of suicide.

Dr. Jillian Woodruff: Dr. Bricklin, I want to make sure were using correct terms when we’re talking about suicide. There’s been this shift in language and they’ve eliminated “commit suicide” and now discuss “death by suicide” or they’re utilizing that term. Are there other terms and are these to reduce stigma around it at all?

Dr. Seth Bricklin: Yes. The reason the language is so important is because we would encourage people struggling with suicidal thoughts to talk about it. So, language that stigmatizes or shames suicidal thoughts and behaviors is going to discourage people from seeking help. So the bottom line is we want to change that language to encourage people to talk about it and the term “committed suicide” goes back to when suicide was illegal, so you were committing a crime. That’s one of the reasons why we changed that language. If somebody dies from cancer, you don’t say they committed cancer. They die from cancer. So now we’re saying, the person died from suicide or died of suicide, because you want to equate it more with other kinds of medical conditions that could be fatal.

Dr. Jillian Woodruff: Now, I was also somewhat surprised to hear that death by suicide is not necessarily associated with mental illness.

Dr. Seth Bricklin: Well, it frequently is, but it’s not a guarantee that the person may not always be mentally ill. More importantly, they may not have any history of it. So the question of, well, were they mentally ill at the time they actually committed suicide? That’s a little bit maybe more of a difficult question to answer with any certainty, but it is true that people can die by suicide may have no history of mental illness. People may think about suicide or attempt suicide for other reasons. It could be an acute crisis. They could have a devastating diagnosis, a death of a loved one, somebody close to them committed suicide. They’re struggling with addiction, which that, in of itself, could be considered a mental illness, but, you know, it’s a little bit different than what we’re thinking of like somebody who is depressed.

People make mistakes, they’re about to get arrested, they know they’ve done something, and they really have a lot of shame. They could also be the victim of violence or abuse, and maybe again, you know that’s like, well, if they’re struggling with abuse, they must have PTSD. I mean, maybe. We don’t know. But they may not have any history of mental illness.

Dr. Jillian Woodruff: I think you just shared some of the risk factors. Are there other risk factors for dying by suicide that predispose someone to be more likely to have suicidal thoughts?

Dr. Seth Bricklin: There are certainly risk factors. When you’re dealing with an individual person, those aren’t really as important, but things that you would think about are what we would call… The CDC sort of identifies different categories of risks. So, one would be individual characteristics, and that would be things like previous suicide attempts, history of depression, mental illness. I mean, it is a risk factor, but serious illness, chronic pain, is a big one. People struggling with chronic pain, especially idiopathic pain, like they don’t know where it’s coming from, they just have this pain, but it could be a specific injury, criminal justice, legal problems, financial problems, impulsive aggressive tendencies, substance use, history of trauma. They’re feeling a sense of hopelessness, violence, victim of violence, or even perpetrators of violence.

So these are sort of, you know, they’re all risk factors. None of those are guarantees, but if you see that…Then we also talk about relationship risk factors, bullying, someone struggling with that. A family or loved one has a history of suicide, loss of relationships. They’re in high conflict or violent relationships.

Dr. Jillian Woodruff: So a suicide in your family can increase your risk?

Dr. Seth Bricklin: Statistically speaking. People who have a history of suicide – parents, if someone has a parent or a close relative or a loved one who has committed suicide, it just statistically puts them at greater risk.

Dr. Jillian Woodruff: Well, in Alaska, we have a lot of people who participate in high risk activities or even sports that have increased risk of concussions or brain injuries. How do these injuries affect suicide risk? Just seeing a lot more about that, especially in the professional sports world, what are the signs or what should family members or those who have had concussions, are there things they should look out for or do?

Dr. Seth Bricklin: The best advice is always get help. You know, if somebody has a concussion, especially in Alaska, we’re kind of rough and tumble folks up here, if they get a concussion, they bump their head, they rub some dirt on it, they go home. When it comes to head injuries, you really want to make sure you’re getting assessed. If they tell you, oh, you had a mild concussion, you should go see your doctor, you should go see your doctor. Very often patients will “Oh, yeah, I went home and I felt fine.” So anytime you’re dealing with head injuries, you really do want to get assessed. You want to be mindful. Most people with a concussion, usually one to two weeks, their symptoms are going to get better, and they usually recover. You know, 99% of people who suffer a concussion do not have any kind of suicide related behavior after that. So, it’s not a common thing, but your risk does increase after a concussion.

Dr. Jillian Woodruff: Is that for everyone, or for people that have had a history of suicidal thoughts?

Dr. Seth Bricklin: That would just add to it, you know, so somebody with a history of it and then has a concussion, yes, they would certainly be at a higher risk. You want to look for signs of post-concussion syndrome – headaches, dizziness, nausea, fatigue, loss of balance, light and noise sensitivity, ringing in the ears, confusion, concentration, memory problems, and then anxiety, irritability, and depression. Irritability is a big one with post-concussion syndrome. You often will see a lot of irritability, and it often gets missed a lot in kids.

Dr. Jillian Woodruff: Because kids are irritable.

Dr. Seth Bricklin: Yes. Kids can be moody, kids can be irritable, but they fall. They have a fall on their skateboard or their bike, they hit their head. You know, they’re at school, they don’t really tell anybody, they get up, they shake it off and meanwhile nobody knows.

Dr. Jillian Woodruff: And you may just think it’s kids being kids.

Dr. Seth Bricklin: Yes, I mean that is part of my assessment. I will always ask my patients, have you ever had any head injury, any seizures? Things like that, we always want to know.

Dr. Jillian Woodruff: Do you know how long after you’ve had an event where you would start to have these changes in your mood?

Dr. Seth Bricklin: It’s not something I would say specifically, when you would see that. Like I said, if the symptoms go on more than a couple weeks after the concussion, you would want to get that looked at. And then, from my experience, it can come up months later, a year later
and oftentimes people don’t realize that. If you really start to ask them more specifically, they’ll realize, hey, this has been going on for a few years. Oh, and you know, a few years ago I had that head injury. I bumped my head and had that concussion. It’s a little bit hard to gauge, because sometimes people don’t recognize it. You may not see it until 2 or 3 years later, but when you ask them, they’re like, the signs have actually been there that whole time, just nobody picked up on it.

Dr. Jillian Woodruff: So then when you’ve had a head injury, being proactive and making sure you’re following up, but then afterwards, now you’ve helped a lot of people to maybe connect things that they’ve been seeing looking back. “Oh, this happened to me” and this could be really good.

Dr. Bricklin, we’re going to take our first break. You are listening to Line One, Your Health Connection. After this short break, we will continue our discussion of how loved ones can help someone with suicidal thoughts with Dr. Seth Bricklin as Line One continues statewide.

Welcome back to Line One, Your Health Connection on Alaska Public Media. I’m your host, Dr. Jillian Woodruff. I’m joined by guest, Dr. Seth Bricklin, who holds a doctorate in clinical psychology and a master’s in business administration from Widener University. Dr. Bricklin has experience treating a wide range of mental health issues and integrate science-based practices, including cognitive behavioral therapy, psychodynamic, mindfulness and client-based therapies to treat anxiety, depression and post-traumatic stress disorder.

We are here speaking on the important topic of how to support a friend or loved one who may be thinking about taking their own life and the red flags that they may display. If you, yourself are personally struggling with suicidal thoughts or recognizing that you may be on a path leading to suicidal behaviors, please know there’s help. Call 988, a national helpline where trained counselors are ready to connect you to the support and the resources that you need.

Dr. Bricklin, I think we should get into beginning that conversation with a loved one that we may suspect is having suicidal thoughts and what are some ways to start that conversation effectively?

Dr. Seth Bricklin: Great question. Again, one of the things I learned in graduate school is you can answer every question in this field with an “it depends.” So it depends on your relationship to the person. I think some general tips, you really just want to let the person know that you’re there and that you’re listening. And so you might say something, you might just look at them and say, “hey…” I guess I’d say it depends on what’s causing your concern. If it’s like this person doesn’t seem themselves, they seem down, they seem depressed. They haven’t really said anything specific, but something in your gut is telling you something is wrong. You know, something that just says you care and you’re listening. So you might say something like, “You know, I’m really grateful for your friendship, and I’m so glad you’re my friend. I noticed you haven’t been yourself lately, and I’m worried about you. Is there anything going that you need to talk about?” It could be just that simple. Just letting them know that you’re there.

Dr. Jillian Woodruff: Just being there.

Dr. Seth Bricklin: I think, as parents, you know your kids, I mean, so some of that is, you know, depends to some degree on your relationship with them.

Dr. Jillian Woodruff: So they’re a little different when you’re talking to an adult versus a child or adolescent?

Dr. Seth Bricklin: Yeah. I mean, it can be, in all honesty, a lot of the interventions are pretty similar. You might see some differences in how they manifest to some degree, like some of the warning signs you might see. From peers, they tend to be isolated from their friends. They’re having a lot of peer conflicts.

Dr. Jillian Woodruff: So younger people?

Dr. Seth Bricklin: So, younger people. Like a lot of adults were dealing with stress at work and there’s office politics or gossip. Most adults manage that okay. For younger folks, if they’re dealing with a lot of gossip at school or that sort of thing at their level, that might be a little bit more of a concern. So, if they’re struggling with their peer group, that could be a big risk factor. So it’s something to be aware of. Those are times when you might say something, “How’s it going with your friends? Are you struggling? What’s been happening?”

And so then, if somebody actually starts to say things that cause you more concern, that are more direct, more specific – “I feel like I’m a burden to everybody.” “I’d rather not be here.” The first thing you want to do is make that validating statement – “Wow, I hear what you’re saying. I’m so sorry you’re struggling with that. I can’t imagine how you might be feeling, but I’d like to try to understand.”

Dr. Jillian Woodruff: I think that’s very difficult, Dr. Bricklin because instinctively, we’re going to want to negate that feeling. Of course, you’re not a burden. Of course, we want you to be here. So I think that is something that definitely takes practice.

Dr. Seth Bricklin: Yeah, it does. The other thing I would say is, if you’re not sure, you yourself can seek help. Talk to a counselor, talk to a therapist, you know, reach out. I very often work with patients on this very thing. How do I talk to my son, my daughter? They’re really struggling. I’m not sure what to say, so I will talk to them about ways to do it.

Dr. Jillian Woodruff: So they can contact you as well. So let’s say they’re struggling with their family member and they want to get help and that family member may not be at that place, do you have people that are seeing you and talking to you as patients, in that situation, to help other people?

Dr. Seth Bricklin: Yes. What I will help them with is their own anxiety, and that’s really what I’m technically treating in a sense. But often, in order to help them, I’m teaching them communication skills, tools and how to express their feelings and then talk to their loved one. So if somebody does share more suicidal statements, you can say something like, “I’m so glad that you’re able to share that with me. I’m here for you. I would be devastated if something happened to you.” Letting them know that you care about them.

One question that people are often surprised when I tell them, especially if I’m training interns, is that you can ask people this question, or if I tell somebody this question, they’re sort of surprised. But sometimes I will say, Well, what’s kept you going? What’s kept you from hurting yourself or killing yourself until now?

The reason you do that is you want to get people thinking about what are the reasons for living? They often will say, “Well, it’s my parents I wouldn’t want to do that to them.” “I really want to graduate high school.” “I really want to finish this project. So, you want to get them thinking about the things that they have to live for. So, asking that question directly, it’s again another example of “just ask them”. Sometimes I might say, well what stopped you from killing yourself until now? What stopped you? It’s something that I would say sometimes to patients. What that does is, because it’s validating, I’m not telling them not to do it, but they’re actually feeling “Okay, I can open up to this person…”

Dr. Jillian Woodruff: Because you’re listening.

Dr. Seth Bricklin: I’m listening and I’m saying that – I’m not trying to say that their pain is not important. It’s letting them know that I hear what they’re saying. I’m understanding how they’re feeling. There’s a saying we have in the field, “Don’t just do something, sit there.”

Dr. Jillian Woodruff: Interesting. That’s powerful.

Dr. Seth Bricklin: That really is important, and especially as a parent, your immediate reaction is – I got to do something. “No, no, you’re fine. No, it’s okay.” And really, just resist that impulse and just sit there, just listen. Nothing’s going to happen in the next 20 minutes. If you take that 20 minutes to just listen, let them talk about it, it’s going to be hard sometimes to hear what they have to say. That’s often the best thing we can do.

Dr. Jillian Woodruff: Tell us some more about the warning signs that we may see. So in an adult, what are some of the warning signs and how do those warning signs differ between I have depression or major depression, versus I’m having suicidal thoughts with intention?

Dr. Seth Bricklin: Well, some of that’s based on what they say. And as I said, if you have somebody who’s really struggling with depression, the main thing is that they’re getting treatment. You know, if they have depression, they’ve been diagnosed with it, are they keeping up with their treatment? If they have prescribed medication, are they keeping up with their medication?

Dr. Jillian Woodruff: So start there, the warning sign. What’s the warning sign for depression because we know they could be at risk or they’re more at risk?

Dr. Seth Bricklin: The warning signs for depression – there is some overlap here. There’s changes in mood. Then the symptoms of depression that are observable might be the person is having trouble sleeping, they’re certainly expressing those kinds of suicidal thoughts, trouble concentrating, trouble focusing. But the risk factors we see when someone may be really more at risk for suicide are things like preoccupied with death, dying or violence. They seem to talk about it a lot. They watch a lot of movies about it.

Dr. Jillian Woodruff: This is adult?

Dr. Seth Bricklin: And kids. I mean, these are the same for adults and teens. I’ll talk about some of the things you may be more likely to see in teens, personality changes, severe anxiety or agitation, risky self-destructive things – they start using drugs or they’re driving faster, they’re engaging in just kind of more risky sorts of behaviors.

An individual, you know, you mentioned at the top of the show, what are some warning signs you might see within yourself – feeling trapped, feeling hopeless… So, somebody expressing feelings of hopelessness, you know that their situation is bad and doesn’t think it can be changed. Acquiring the means to take your life – somebody suddenly buys a gun, you find out they’re stockpiling medications. Things like that are certainly a warning sign – giving away belongings, getting their affairs in order for no apparent reason. If you say goodbye to them, and it’s like they’re saying goodbye to you for the last time. As I say, trust your gut. Increased alcohol, drug use, mood swings, talking about suicide, and then withdrawal, isolation. Those are all certainly signs of depression and if you know somebody who’s already depressed, and then these start to happen, those would all be risk factors. They’re the same in teens. It may manifest slightly differently and so you have to sort of know your teen a little bit to understand it. But as I said, romantic breakups are much more traumatic for teenagers. We often think, “Oh, they’re young. This is no big deal. But to them, this is supremely important. It’s very important when you’re talking to teens not to be dismissive of their problems and go, “oh, you’re young, it’s fine, you have plenty of time,” because they don’t see it that way. They don’t have that perspective. So certain things like that, I think, you might be more concerned about a teen going through a breakup than you might be, like an adult or somebody in their 20s or 30s. Now, if somebody is going through a divorce and custody battle, those kinds of things, that certainly could be an issue.

The other risk factor for somebody to actually be dying by suicide would be things like firearms in the house. I think we live up here in Alaska, and you know, a lot of firearms. The most important thing is making sure they’re safe and secure if they are in the home. But if you have somebody in the home who has expressed suicidal thoughts, and you know is suicidal, the best recommendation is to at least temporarily get them out of the house. Store them elsewhere in a storage unit, with a friend, with a neighbor.

Dr. Jillian Woodruff: So it’s safer. The home, it’s not ever secure.

Dr. Seth Bricklin: It’s safer. I mean the lowest risk is in homes where there are no firearms, and then in homes where there are firearms, the risk is much more reduced obviously if they are stored unloaded and locked. One of the myths is, “Well, what’s the difference? They’ll find a way to do it if they want to do it.” That’s actually not true.

Dr. Jillian Woodruff: Interesting.

Dr. Seth Bricklin: I mean, sometimes it is, but there are many suicides that can be prevented if we remove or put barriers between the person and the means.

Dr. Jillian Woodruff: Make it more difficult.

Dr. Seth Bricklin: Make it more difficult, because a lot of times people who are depressed and maybe feeling suicidal, they lack volition, they don’t have the energy. So, taking that extra step like, gosh, I don’t know. I don’t want to get in the car and go to the storage unit where the gun safe is and get them out there. I can’t manage that.

Dr. Jillian Woodruff: Lack of volition, okay.

Dr. Seth Bricklin: There’s good research to say that these methods work. I mean, the statistics are pretty clear. One thing that is striking is a lot of parents who own guns, and they feel like, oh, yeah, my child has never handled a firearm that’s in our house. Well, they did some research, and in those cases, about 22% of kids who were then interviewed separately said that they actually had. So even when parents think that their kids have not accessed the firearms, there’s about a quarter of them that actually can access them. They know the code to the safe. They figured something out. So all I would say is, if you have somebody who you’re concerned about just kind of double, triple check that everything in the home is safe.

Dr. Jillian Woodruff: Kids are smart. They’re intuitive. They’re always listening.

Dr. Seth Bricklin: So they know more than we think. That is one thing I would say that really does help.

Dr. Jillian Woodruff: Before we go to a caller, you did mention teens having conflict with others, and so this could be a warning sign. What about adults who suddenly enter into having conflict with multiple people who would typically be getting along?

Dr. Seth Bricklin: One of the things that we say typically is like a behavior change. So something that seems to be a pretty significant, noticeable change in the person’s behavior. This used to be the calmest, nicest person, and all of a sudden they’re fighting with everybody. That would certainly be something I would be concerned about.

Dr. Jillian Woodruff: It’s a warning of something. It’s a change.

Dr. Seth Bricklin: It’s a warning of something. It’s a change. Especially with parents and their kids, but even with friends, if you see a sudden behavior change, they’re not themselves, you know, if you see something, say something. The other thing too is, if you’re worried about somebody, you’re not sure what to say, you’re not sure how to talk to them, talk to somebody. If it’s a friend, maybe try to talk to their family or talk to your own doctor – like I said, talk to your own therapist.

Dr. Jillian Woodruff: If you have concerns that there are suicidal thoughts, or intentions, you can call that national hotline 988.

Before we actually go to that caller, we have to take another break. Let’s take this short break for the stations down the line. We’ll continue our discussion of providing support to loved ones at a time of mental health crisis when we return. You’re listening to Line One, Your Health Connection on Alaska Public Media.

Welcome back to Line One. I’m your host, Dr. Jillian Woodruff. Our guest today is Dr. Seth Bricklin, who provides specialized psychology services to address mental health concerns and life challenges here in Anchorage.

Dr. Bricklin, we’ve got a caller. We have Deborah from Eagle River who is going to ask us some questions or tell us something about concussions. Deborah, welcome to Line One. You’re on air, Deborah? Okay, we’ll come back to her. We have some difficulties, so let me go through an email that came in please. They are asking for some clarification.

We have a Judy that has emailed us about preteens. Preteens that may become friendless and may shut down. So if they are depressed, do you ask directly about suicide with a validation statement if they express suicidal tendencies? If they express maybe that they want to
hurt themselves or die, what is that? What does that question look like that comes from you and how do you make that validating?

Dr. Seth Bricklin: Well, I think the first thing is, whatever their statement is, make a reflective statement. So what is that? You can repeat back what they said to you. “My life is so bad I just want to kill myself.” “Gosh, you’re feeling so bad that you’re actually thinking of killing yourself?” That reflective statement – I hear what you’re saying. I can help. What can I do? What is it that you need? That would be a validating, reflective statement.

Again, as I would say, if you have a preteen who is saying things like that, the most important thing is trying to get them help. Now, that doesn’t happen overnight. So in the meantime, how do you help them stay safe? Again, I would ask directly, were you thinking about hurting yourself or killing yourself? And there’s one thing I would say, it’s really important to actually say “killing yourself” and not just “hurting yourself” because to somebody who is suicidal, in their mind, suicide may not be harming themselves. They might be ending their pain. So they might see it very differently – “hurting myself? No.” So I will usually say, are you really thinking about hurting yourself or killing yourself? It’s important to say both.

I think I would just say that directly. “You know, I’ve been hearing what you’re saying and it sounds like you’re really struggling and you’re in a lot of pain. Are you thinking about hurting yourself or killing yourself? And then if they say, “well, yeah, I don’t know….”

One way that we assess it as professionals and as a parent, you can do this too. There’s an acronym, and it’s actually SLAP.

SERIOUSNESS – What’s the seriousness of their thoughts? Do you have intention or is it like “I thought about it, but I would never do it” or “I’m actually thinking about doing it.”

LETHALITY – What’s your plan? How would you do it?

Dr. Jillian Woodruff: And you’d ask them?

Dr. Seth Bricklin: Yes. Are you having thoughts? Do you want to hurt yourself or kill yourself? “Well, yeah I think about it” Ask, well have you thought about how you would do it?

[LETHALITY] – How lethal? “Well, I don’t know. I would just take some aspirin. I have my Prozac and I would just take that.” Well, that’s not as lethal as “I would shoot myself.” The next question now is access to means.

ACCESS – Do you have access? You would shoot yourself, but do you have a gun? “Well no, I don’t know where I would get one.”

PROXIMITY OF SUPPORT – Loved ones, do you have friends, family? I think in the email it said the person suddenly doesn’t have a lot of friends. Do they have other support? So as a parent or even as a friend, that is something you can do. You can try to assess how serious is this right now. If it’s a friend who is an adult where I can’t just go to their house and take them somewhere, maybe I can ask them those questions and then what I’m thinking is am I calling 911 or not? If I’m really concerned that somebody’s in immediate danger, then it’s not 988, it’s 911.

Dr. Jillian Woodruff: I think that’s scary too, especially if you’re thinking about doing that for an adult, that can be very scary. Add to the trauma for that person. It would be very difficult to determine, like, this person’s going to be mad at me, but at least they will be alive. But then, if you think about minority communities and calling 911, the police coming, that could certainly…

Dr. Seth Bricklin: It might be while you’re thinking about hurting yourself or killing yourself, yes, I’m going to do it. Well, I would be devastated. I don’t want you to do that. What can we do to get you help? “I don’t know”, say, “look, if you’re telling me that you’re gonna go and do it, then what kind of friend would I be if I just let that happen? I would have to call 911, or have to call somebody. How about I come and pick you up and we go to the hospital together?” But I think the response is often, you know, people might be concerned but I would generally say, “Well, what kind of friend would I be if I just let you do that? What kind of dad? What kind of mom would I be if I just let that happen? I can’t just let that happen.” Sure, they might be angry at you, but in my experience, having had to hospitalize patients and having had parents do that, in the end, oftentimes the person understands it. They understand.

Dr. Jillian Woodruff: They understand why it was done.

Dr. Seth Bricklin: They understand why it was done.

Dr. Jillian Woodruff: An interesting thing that you taught me about are the different reasons why somebody may have suicidal thoughts. If somebody has not had that, it may be very difficult to understand somebody, but you were saying that some people may think that this is not a bad thing to do. It may be in line with their beliefs. Can you tell us a little more about that?

Dr. Seth Bricklin: Yes, if somebody is really struggling and in a lot of pain, let’s say, in their mind, suicide may be something that’s reasonable and that it makes sense. There’s a term: Ego-syntonic. It means it fits my view of myself, and it seems a reasonable to me versus, you know, I’ve had patients come to me and say, “I’ve been depressed, but I felt like it was okay and then all of a sudden, I started having these thoughts of killing myself, and it really scared me. It freaked me out.” That’s what we would call Ego-dystonic. It’s upsetting to them. It doesn’t fit with their view of things.

And so when they get concerned, that’s a good thing because they’re more likely to bring themselves in for treatment. But sometimes, people won’t say anything because they don’t think of it as a problem. You’ve got to remember too, a lot of times when people are severely psychologically distressed, or if they are mentally ill, they may not be thinking very clearly. Their thinking is kind of clouded, or might be irrational. They’ll struggle with all-or-nothing thinking. They will believe that everybody hates them. There’s plenty of evidence to the contrary, but you know, there’s something called the confirmation bias, which is we tend to focus on evidence that supports our beliefs. So if I believe that nobody loves me, then I’m going to only look for evidence to support that belief, and I’m going to ignore all of the things that are clearly demonstrating that that’s not true.

Dr. Jillian Woodruff: It’s like that in scientific literature. You can always find things to support what you believe and ignore the rest. So when they’re having these thoughts, we may think that these are irrational thoughts too, but we cannot counteract those thoughts with what we think is our logic.

Dr. Seth Bricklin: Yes, you don’t want to try to get into that debate with them. It’s really more what you can at least acknowledge and try to validate the pain. “Gosh, I can’t imagine how that must feel.” And very often, what people will say, and I’ve asked patients this question, you know, it sounds to me, I might say something like, it sounds to me that it’s not so much that you really want to die or want to kill yourself. You just want your pain to stop. And very often, most patients, “Yeah, that’s what it is.” Not always, but very often, that’s what they’re saying. They’re just in a lot of pain and they just want that to stop.

Dr. Jillian Woodruff: They could try to get help for that.

Dr. Seth Bricklin: One of the things that we say as a therapist, one of our primary jobs is instilling hope, which is not always easy. You can say things like, “I know this won’t be easy, this would be difficult, but I’m going to be here with you and I will do what I can to help you. I know what help is available and I will make sure that we will get that for you.”

Dr. Jillian Woodruff: Thank you for that. I think that’s going to speak to a lot of people.

We have an email from Susan, and Susan says that in a class, and in her experience, one of the signs of suicide is the person’s mood seems to be lighter, and they are clear on what they need to do. Can you speak to that?

Dr. Seth Bricklin: It’s what I said a little while ago, because they feel like they have come to the solution of their problem. So they feel like, “Ah, I’ve got it. I’ve solved the problem. I know what I’m going to do.” So, it’s not uncommon that once they have made that decision to end their life, they might suddenly seem better. It’s like, gosh, they seem so down and now suddenly, out of nowhere, they seem better. That actually can be a cause for concern. “I don’t need therapy anymore. I quit therapy. Everything’s great.” I see that as a therapist and I get concerned.

Dr. Jillian Woodruff: Right. Because they’ve figured it out. The way to end that suffering.

Dr. Seth Bricklin: Right. That’s why you sometimes will see that.

Dr. Jillian Woodruff: We have another email. This one is from Doug, and Doug says that this is, of course, a very important topic, and that this tracks with his experience many years ago. His depression reached the stage that if he had had access to a gun, he would have been dead. He lacked the energy to actually figure out a plan to take his life, and he did mention that the 988, national suicide prevention hotline is great and will save thousands of lives.

Dr. Seth Bricklin: Okay, well, thank you for that, Doug. I appreciate you sharing that. It really is true, and I’m glad that he was able to share that with us. You know, it does tell you – very often people have told me that. I’ve heard that from several patients, “If I had had…” Sometimes what I’ll do as a therapist is, I’ll call their family “I’m with your son, I’m with your daughter, they’re telling me they’re suicidal. I know they have a gun in their house” – and this could be an adult.

Dr. Jillian Woodruff: Because they need that support.

Dr. Seth Bricklin: This could be an adult and I say, would you be willing to go over and get their firearm and hold that temporarily? And I’ve had patients tell me that, yeah, if we hadn’t done that, they were pretty sure they would have gone and used it.

Dr. Jillian Woodruff: Here’s another email that has to do with that. This one. This Judy, she wants to know, how do you speak to a person that has a gun in hand?

Dr. Seth Bricklin: We have people who train for years for that kind of work when you’re talking about somebody who is really in imminent danger. That’s a really, sort of a different expertise, you’re talking about, like, hostage negotiators. If you’re really talking about somebody that seriously, but really, like, I’d be on the other line to 911. I’m on the phone, I’m getting help and I’m calling 911. I’m not going to try to talk somebody down just by myself. I mean, I think in general.

Dr. Jillian Woodruff: It would take a professional. It’s scary too because if you have a gun and….

Dr. Seth Bricklin: If you’re in that situation, the guidance I would give is just tell them “I’m here for you. I want to talk to you. Please tell me what’s going on.” Just try to keep the person talking. Don’t try to cheer them up. Just “I hear what you’re saying. I know that you’re hurting.”

Dr. Jillian Woodruff: And you’re calling for help.

Dr. Seth Bricklin: Yes.

Dr. Jillian Woodruff: We have one final email because we’ve run out of time. This is very interesting and I think we probably need to do a whole different show about this, because we didn’t get to this part. But Lindsay from Matsu knows someone who works in mental health, and the stress of this position has led this person to self harm and contemplate suicide. So this is a mental health provider. The person doesn’t have any plans of leaving the behavioral health field, and they don’t reach out to family or friends for help. How do you suggest they combat the stress of the career? But I think you know this is a big one, and our music’s coming up.

Dr. Seth Bricklin: I could do a whole show on caring for caretakers. Yes, that’s the next one.

Dr. Jillian Woodruff: I think we should definitely do that. We will email Lindsay back.

Well, thank you so much for your time with us today. I really appreciate your willingness to share your expertise.

Thanks to our expert, Dr Seth Bricklin, thanks to our audio engineer, Chris Hyde and our producer, Madeline Rose. You can find more information on this and our previous programs on our website at alaskapublic.org. Let us know your thoughts and suggestions by emailing us at LineOne@alaskapublic.org.

This has been Line One, Your Health Connection. I’m your host. Dr Jillian Woodruff.

Line One is a production of Alaska Public Media which is solely responsible for its content. News expressed are those of the host and participants, and not necessarily those of Alaska Public Media, this station or its underwriters, learn more about Line One and listen online at AlaskaPublic.org. This is Alaska Public Media.

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