Content warning: This article contains many references to suicide. Please take care when reading. If you need mental health support, call or text the national suicide and crisis lifeline — 988 — or check out our mental health resource page.
By Taylor Knopf
Twenty-seven years ago on Valentine’s Day, Fonda Bryant had decided to kill herself. She credits a perceptive relative for stepping in and saving her life. Today, Bryant is a certified suicide prevention instructor and begins each hour and a half training by sharing her own story of living with clinical depression as a suicide attempt survivor.
Leading up to that day in February, Bryant had been going to school part-time, working full-time as a pharmacy technician in Charlotte and taking care of her then-12-year-old son. One of the first signs of depression for her was extreme fatigue. She said she was “debilitatingly tired” and every movement felt like walking through molasses.
She said her appearance changed. She stopped wearing makeup and doing her hair. She wasn’t eating regularly and would fall asleep as soon as she got home, sometimes without taking off her coat or work clothes. Bryant described her depression at the time as being a constant unbearable pain that she just wanted to end.
As Bryant planned her suicide, she called her aunt and told her she could have all of her shoes. Everyone in Bryant’s life knew how much she loved shoes, including her aunt, who then asked Bryant if she was planning to kill herself. Bryant replied “yes.”
Bryant’s plans were interrupted by a law enforcement officer at her door with an order to take her to the hospital against her will for a psychiatric evaluation. Bryant’s aunt had called 911. At the time, Bryant said she was angry with her aunt, but now she credits the woman with saving her life.
“Every time I share my story, a little piece of me goes away. But if it saves someone, I will share,” she said.
Her personal experience led her to becoming a certified suicide prevention instructor with the QPR Institute, a national organization offering suicide prevention trainings. QPR stands for Question, Persuade, Refer. The theory is that learning these three steps will make people more perceptive of those around them struggling with suicidal thoughts and give them some tools to step in with the right questions and help someone seek help.
Bryant likes to say, “suicide is everybody’s business” and “anyone can save a life.”
By training community members to recognize the signs, she’s hoping to turn the tide of a growing problem. In North Carolina, there were 1,436 confirmed suicide deaths in 2020. The suicide rate in the state increased from 13.8 per 100,000 people in 2004 to 15.3 in 2020, the latest year of available data.
In the United States, 45,979 people died by suicide in 2020, according to the Centers for Disease Control and Prevention. That averages out to one suicide death every 11 minutes.
Know the warning signs
The first part of suicide prevention training is learning the warning signs — both direct and indirect — that someone could be struggling with suicidal thoughts.
“Take all signs seriously,” Bryant said before listing the various verbal and situational clues that are warning signs.
Someone might use very direct verbal indicators, such as “I’ve decided to kill myself” or “I wish I were dead” or “I’m going to end it all.”
Sometimes people may use more indirect verbal clues, such as “I’m tired of life and I just can’t go on,” or “My family would be better off without me,” or “Pretty soon you won’t have to worry about me.”
Behavioral signs that someone could be at risk for suicide:
- Any previous suicide attempt
- Co-occurring depression, moodiness or hopelessness
- Sudden interest or disinterest in religion
- Excessive drug or alcohol use
- Unexplained anger, aggression or irritability
- Acquiring a gun or stockpiling pills. In 2020, 60 percent of suicide deaths in North Carolina involved a firearm and 12 percent involved a substance.
- Putting personal affairs in order. Bryant explained that this doesn’t always mean going to an attorney and creating a will. This could mean someone tying up loose ends in their relationships, buying a cemetery plot or giving away prized possessions (like Bryant tried to do with her shoe collection.)
There are situational risk factors for suicide to keep in mind, particularly if someone is displaying additional verbal or behavioral warning signs. Bryant outlined the following:
- Being fired from a job or expelled from school
- Recent unwanted move (This could be someone forced to downsize or move in with someone else due to unfortunate circumstances, she explained.)
- Loss of any major relationship
- Loved one dies by suicide
- Diagnosis of a serious or terminal illness
- Sudden unexpected loss of freedom or fear of punishment
- Anticipated loss of financial security
- Fear of becoming a burden to others (This can become a risk factor as people age or receive a serious medical diagnosis and must depend on others.)
Ask the question
If you’re seeing some of the warning signs, Bryant encouraged those in her suicide prevention training to “ask a question and save a life.”
She shared specific ways to ask someone if they’re considering suicide, ranging from indirect to direct approaches. She also referred her trainees to a resource called “Seize the Awkward” which gives suggestions and specific phrases to start a conversation with someone, including some of the following:
- “I’ve noticed you’ve been down lately. What’s going on?”
- “Are you OK? You don’t seem like yourself lately.”
- “Have you been unhappy lately?”
- “You don’t look like yourself. You’re not acting like yourself. I’m wondering if you’re thinking about suicide?”
- “Are you thinking about killing yourself?”
“It’s uncomfortable,” Bryant said. “It’s not a warm and fuzzy topic, but we have to have these conversations.”
There are also wrong ways to ask the question, such as the following:
- “You’re not thinking of killing yourself, are you?”
- “You wouldn’t do anything stupid, would you?”
- “Suicide is a dumb idea. Surely you’re not thinking about suicide?”
All of these introduce judgment into the conversation, she said. Instead, the goal is to invite a conversation by being positive and encouraging.
Bryant added some people have said they’re hesitant to get involved because they don’t want to be responsible for what happens.
“People think, ‘if I help someone and they die, then it’s my fault,’” she said. “Not true! At the end of the day, they have to want to live.”
Research proves Bryant’s point. Interview studies done with people who have survived suicide attempts show that many suicides can be averted if there’s a delay between the decision and the act. A growing body of studies done worldwide has found that many suicide attempts are not planned, but instead are decisions hastily made in the midst of a crisis that became more deadly depending on the means at hand.
For instance, one study published in JAMA Pediatrics found that 90 percent of those who attempt suicide and survive do not go on to die by suicide later.
Bryant compared these conversations to performing CPR chest compressions on someone who later dies at the hospital. No one would blame the person who tried to help with CPR.
Bryant also gave tips for asking the suicide question:
- If in doubt, don’t wait. Ask the question.
- If the person is reluctant, be persistent. Follow up.
- Talk to the person alone in a private setting. This is not a conversation to have in front of others.
- Allow the person to talk freely. Sometimes they don’t need or want you to fix their problem. Just listen first.
- Give yourself plenty of time for the conversation and give them your full attention.
- Have your resources handy. Know the crisis numbers, warm line contacts, local behavioral health urgent care or the number to the local mobile crisis unit.
Persuade and refer
“The best way to save someone’s life is simply caring and checking in on them,” Bryant said.
The second step in QPR suicide prevention is persuade. After asking the question and openly listening to the person, Bryant said it’s an opportunity to persuade someone to stay alive.
“Offer hope in any form,” she said. “Let them know you care and others care and the things they have to look forward to.
“And don’t remind them of the people they will hurt if they kill themselves,” Bryant said, adding that people already think about that and don’t need to feel guilt at that moment.
Helpful things to say include, “I want you to live. I’m on your side. We’ll get through this. You’re not alone,” she said.
You can also ask the person who else in their life would be helpful to get involved. Bryant warned that you should not just assume a certain person in their life — such as a partner or parent — would be helpful. Always ask.
The final step is to refer them to someone who can help. You could ask:
- “Will you go with me to get help?”
- “Will you let me help you get help?”
- “What can we do to keep you safe?”
- “Will you promise me you will not hurt yourself before we’re able to get you help?”
“Your willingness to help can give them hope,” she said.
Bryant encouraged the group to follow up with people with a phone call, visit or even a card. Treat them like any other person recovering from any other illness.
“Don’t treat them as fragile. Don’t walk on eggshells around them,” she said. “Let them know you care about what happens. Ask them how they are.”