It is very important that family and friends know what to do and what to be alert for after someone they care about has had a suicide attempt. It is a very scary time for both the person and those who care for the person. I receive a lot of calls from people asking me how to help the person who may have just been released from the hospital or how to help their teenager cope with a recent attempt by one of their friends. Research shows that in the days, weeks and months immediately following an attempt is the time when the person needs a lot of support and that is a time that he is most at risk of suicide. Below please find some helpful links for family and friends. Only 10% of the people who attempt suicide will go on to complete and die by suicide. But 80% of those who die by suicide have made a previous attempt. So while chances are that this person won't attempt again, he or she is also at an increased risk for dying by suicide. The first six months after a hospitalization are especially critical to the suicide attempt survivor, and the person remains at an elevated risk for the entire first year. Also know that research shows that 90% of those who die by suicide had a diagnosable mental illness at the time of death. (depression, bipolar disorder, anxiety, substance abuse, eating disorders, yet most people with a mental illness do not die by suicide). Try not to focus only on the act itself. What else was going on in the person's life that may have precipitated the attempt? Do they abuse alcohol or drugs? Do they gamble? these are some issues that are often associated with attempts. Support is available for these issues. GO SLOW: Safety and recovery take time. Give them the time they need.

KEEP TO THE PLAN: Check out any changes in the safety and recovery plan with the clinician before enacting them

TAKE ALL PRESCRIBED MEDICINES: Do not keep unused medication. Dispose of them safely.

KEEP A SAFE HOUSE: Secure all firearms, prescriptions medications, car keys, sharp instruments, ropes and poisons. Put up with temporary inconvenience this may bring. Keep the clinician informed of any changes in situations.

DON'T IGNORE CHANGES: Report any signs of depression or of an attempt

BE ALERT: Anticipate and monitor behavior and feelings around stressful events, especially those which involve personal or interpersonal disappointments.

BE LOW KEY: Lower the emotional tone in the house

KNOW HOW TO GET HELP: Keep emergency numbers public and available

BE AVAILABLE TO LISTEN: Be ready to be shut out. Keep communications open. * If you are a school staff member please go to the bottom of page to see how to support a student returning to school. After a Suicide Attempt: What Now? If you are suffering about the suicide attempt of your loved one, no doubt you’re confused as to the best course of action to take. What should you expect? What should you do? In fact, this is the most critical time – immediately after an attempted suicide. But, what, exactly should you do now? Short-Term Planning The first thing to do is to ensure the person is stable. This will most likely require hospitalization, depending on the method of the attempted suicide and how life-threatening the situation is at the present. The suicidal person cannot be left alone during the days immediately following the attempt. They are not rational, and, contrary to popular belief that once they’ve tried to commit suicide and failed, they won’t attempt it again, the truth is that many times they are likely to try it again at some time in the future. For some persons admitted to the hospital following a suicide attempt, the greatest risk is the first few hours after admission. If possible, stay with the person as long as possible during visiting hours while he or she is in the hospital. If you can’t be there for the duration, ask others to help spell you. The idea is to monitor what’s going on with your loved one. This means asking lots of questions of the doctors and nurses, helping to comfort your loved one, and getting help for him or her if needed. Suicide prevention experts caution that the person who has already attempted suicide may try death by suicide while they’re in the hospital. For others, this risk is greatest when they return home from the hospital. Again, make sure that the individual is not left alone nor has access to any means of making good on their intention to do themselves in. This means sweeping the house for any prescription and over-the-counter drugs, poisons, knives and sharp objects, ropes and cords and, especially, firearms. If your loved one has been living alone, it’s best if you take him or her into your own home – or move in with them – to ensure their immediate safety. If medications are prescribed, make sure that the individual takes them as directed. Many of the medications will help to stabilize mood, especially depression. Pay attention to your loved one’s diet. Make it a point that he or she takes vitamins and supplements as recommended by the doctor in order to build up strength that’s probably been depleted. Often times, the suicidal person has neglected themselves to the extent that they are seriously malnourished. Let Them Talk During the time after the suicide attempt is when you want to engage the person in conversation as much as possible. Let him or her talk – as long and as often as they wish. In your comments, it’s important not to be judgmental or critical of the person. That is counter-productive and will discourage any opening up. It’s also very important to show how much you love the person. He or she is most likely devastated, feeling incredibly lost, ashamed, guilty, fearful of the future, and afraid, most of all, that you will withdraw your love. Therapy Should Be First on the List Your loved one needs professional counseling by a licensed and certified therapist. This must be primary on the list of short- and long-term priorities. In addition to individual counseling, group therapy may be recommended. Make sure the person attends every counseling session. Don’t allow them to slack off, since therapy takes time to work – and it’s often difficult and painful for the individual. The tendency is to minimize the risk, saying “I’m okay now. I don’t need any more therapy.” Don’t buy into this. Push, gently, for continued therapy. Regular medical checkups are also a good idea. Following the suicide attempt, physical and/or mental changes occur, and healing takes time. If drugs and alcohol were also part of the individual’s lifestyle, these conditions need treatment as well. Make Important Lifestyle Changes Obviously, things can’t go back to the way they were before. This often means a severe change of lifestyle, but not always. In any case, some things have to change. Where there was no counseling, there now has to be. The suicidal person will not “get better” on their own. The reason they got to the point of despair, enough to want to end their life, won’t just go away. The underlying causes may not even be known or acknowledged by your loved one. All this has to be dealt with, and the best person to help in the recovery is a professional therapist. Through therapy, your loved one will begin to discover the reasons that led him or her to attempt suicide. Depression, anxiety, fear, shame, disgust and other emotions will surface that are very powerful and very difficult and painful to deal with. The therapist will suggest short- and long-term behavioral changes that will help your loved one to better adjust to life. There is no miraculous pill that will quell suicidal thoughts. There isn’t any set time period during which the person will be healed. Every person heals on their own timetable. Healing can’t be forced, no matter how much you or your loved one wants it.

Exercise plays an important part in rebuilding a healthy physical body. You, and other family members and friends, can help by encouraging your loved one to engage in sports, running, hiking, swimming, working out, or any strenuous physical activity. Be sure that this vigorous exercise takes place a minimum of four days a week, and for 30 minutes to an hour each day. Exercise produces endorphins, the body’s natural feel-good chemicals, which help to reduce feelings of depression. Be aware that many persons who attempted suicide become withdrawn. They don’t want to talk. They don’t want any contact with others, including anyone from the outside world. Respect that feeling, but do encourage your loved one to go out and participate in activities again as he or she is ready to. Make sure you’re not too pushy on this point, however, as that can be misconstrued and backfire. When they are ready, take them out to activities and events – but don’t go anywhere that’s too stressful. Your loved one won’t be ready for that for quite a while. Be Alert for Suicide Warning Signs After the suicide attempt, it doesn’t mean you’re home free – no matter how much your loved one tells you not to worry. Although some individuals do not exhibit any warning signs prior to an attempted suicide, about 75 percent do show one or more signs. You do need to be alert for any of the following warning signs of suicide – as they can occur anytime during the days and weeks after the initial attempt: • Depression or sadness all the time – Note that suicide prevention experts say untreated depression is the number one cause of suicide.

• Talking or writing about death or suicide

• Writing a will

• Giving away possessions, especially those the person holds most dear

• Dramatic mood changes

• Change in eating or sleeping habits

• Loss of interest in activities – especially those previously enjoyable

• Poor work or school performance

• Abuse of drugs or alcohol

• Change in personality

• Withdrawal from family members and friends

• Feelings of hopelessness, being helpless or feeling trapped

• Demonstrating strong feelings of anger or rage

• Acting impulsively or recklessly

• Feeling excessive shame and/or guilt If your loved one is in immediate danger, call 911 without delay. Suicide prevention lifelines are available 24/7 – so make use of them if your loved one needs to talk with someone urgently. Call 1-800-SUICIDE (1-800-784-2433) or the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or in Spanish, 1-888-628-9454. Things Not to Do: Let the person, especially adolescents, be in control of their medication upon release from the hospital. Dispense the medication(s) yourself.

Ignore it and hope things just get better.

Tell everyone this is a family business and keep it a shameful secret

Focus all your attention on the suicidal child to the exclusion of the other children.



Hover and monitor every action of the loved one, never allowing him or her a minute to themselves.

Blame, the family member who made the attempt.

Blame yourself.

Think it will never happen again.

Try not to make statements such as "How could you do this to me?" or "What on earth were you thinking?" or "Whatever made you do it?" THINGS TO DO: Remove all guns from the house and restrict access to lethal means as much as possible

Suggest a session with the therapist for them and for the family/caretakers before leaving the hospital.

Get individual and family therapy

Create scales for 3-5 emotions or thoughts such as loneliness, depression, or suicidal thoughts that can help gauge how he or she is doing and whether or not he or she needs your help.

Family members need to be supported to deal with their own feelings/reactions. Reach out to trusted friends for help and encourage the rest of the family to do the same.



Ask your mental health professonal for information on suicide and mental illness.

Be gentle with yourself and remember to take care of yourself also.



Try to make statements such as, "I'm sorry you felt that way and I wish I could have helped you," or "I'm sorry I didn't realize you were in such pain," or" I can't imagine how bad you must have felt," or finally, "I want to help you, tell me what I can do to help you now." Making a Survivor Kit or Box: Consider having your loved one make a survival kit or bos, where they can put music, pictures, poetry, anything that will help comfort them and respresent safety. If the attempt survivor believes it would be helpful, letters and objects to remind them of their value and the negative impact it would have if they killed themselves can be included. Then, whenever they are upset, they can go to the box and begin to focus on the moment and not the future. Hope Cards: Consider making hope cards, which are simply index cards. The attempt survivor and a supportive person sit down and write what causes them to feel suicidal on one side of the card and on the other side, they work together to create a list of things that can challenge or change these thoughts. For example , perhaps someone feels suicidal when they believe nobody cares for or loves them. On one side they may write, "unloved" and on the other side, they can list all the people in their life who do care about them and/or love them, such as parents, spouse, siblings, partner, friends, children, etc. The cards can be carried at all times and when these feelings come up the person can pull them out the stack of cards, read them and manage his or her feelings. Resources and Help: Keep yourself informed about things to do for your loved one. Helpful books and literature are readily available from a number of sources. The Feeling Blue Suicide Prevention Council is a non-profit community service organization serving Pennsylvania and the Tri-State Area. Their website contains a lot of helpful information and links. Here is a link to their booklet, “After an Attempt: The Emotional Impact of a Suicide Attempt on Families.” The booklet covers important Do’s and Don’ts, dealing with a traumatic event, what to say to the attempt survivor, ways the family can communicate their feelings, how an attempt affects spouses, siblings and parents, and additional resources. The U.S. Department of Health and Human Services (HHS) National Suicide Prevention Lifeline has a downloadable booklet, “After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department.” The booklet covers what happens in the emergency department. First, there’s an assessment. The doctors determine any psychiatric or medical conditions present, determines if they are or have been treated, and if the suicidal thoughts or actions are the result of recent change or longstanding behavior. Next, the doctors seek to find out what the person did to harm themselves, and if there were previous attempts. They also ask if there are any current stressors, and/or anger in relationships. Doctors need to know what support systems there are, and who is or will be providing treatment, and what treatment programs are a good match for the individual and the family. The booklet further covers how you can help the emergency department, next steps after the emergency visit, what you need to know following the emergency department visit – how to keep your loved one safe, reduce risks, creating a safety plan, self care, moving forward and phone numbers for support groups. The National Suicide Prevention Lifeline website has links to various suicide prevention organizations and peer support organizations where you can find more resources and help. Many of them have online libraries with downloadable publications, booklets and information to help family members following a suicide attempt by their loved one. The Depression and Bipolar Support Alliance (DBSA) is the leading patient-directed organization in the United States focusing on depression and bipolar disorder. They operate a toll-free referral line 1-800-826-3632 and have a grassroots network of more than 1,000 patient-run support groups across the country. The National Alliance for the Mentally Ill (NAMI), a nonprofit, grassroots, self-help, support and advocacy organization of consumers, family and friends of people with mental illnesses, has information on mental illnesses, programs, support groups, medication and treatment, and more. There are more than a thousand local affiliates in 50 states. The Center for Mental Health Services (CMHS), of the Substance Abuse and Mental Health Services Administration (SAMHSA), maintains a mental health services locator, which you can use to help find services, facilities and resources in your state. Should You Worry? It’s natural to worry that your loved one may try another suicide attempt. But you can’t let this worry define you or derail your efforts to get professional help for him or her. You may also wish to undergo counseling yourself, to be better able to deal with the situation and feel better about helping your loved one on his or her journey to healing. It’s important that you have your own support system in place. You can’t always be watching over your loved one, fearful that another attempt is imminent. This will just add to your stress level and make it impossible to maintain a serene environment. Get help around the house – whether that entails a friend or other family member coming over to be present while you take some needed away time, or while you work, or to transport your loved one to and from treatment or group meetings, or some other reason. Remember that one of the most powerful emotions is love. The more you can show how much you love your family member that you nearly lost to suicide, the better off you both will be. Encourage other family members to be understanding, nonjudgmental and patient as well. It won’t be easy, and sometimes it may seem next to impossible. But your love and understanding will go a long way toward helping your loved one on the road to recovery. (the above is from the website: www.everythingaddiction.com)

After an Attempt: The Emotional Impact of a Suicide Attempt on Families Where to turn The best predictor of a future suicide attempt is a previous attempt. This is why it is important to get help, design a plan of action, and increase communication with your loved one immediately after an attempt. You may be feeling confused and unsure how to talk to your loved one who attempted suicide. Feeling Blue SPC has recently published a helpful resource for people who have experienced a suicide attempt in their family called, After An Attempt: The Emotional Impact of a Suicide Attempt on Families. This booklet includes information, including: Important dos and don'ts

Dealing with a traumatic event

What to say to the attempt survivor

Ways the family can communicate their feelings

How an attempt affects spouses, siblings and parents

Additional resources Just click here to download a copy. Or go to http://www.sprc.org/library_resources/items/after-attempt-emotional-impact-suicide-attempt-families If the link doesn't work, please click here: www.feelingblue.org

Helpful Resources Suicide Prevention Lifeline: www.suicidepreventionlifeline.org



Suicide Prevention Resource Center: www.sprc.org

Society for the Prevention of Teen Suicide: www.sptsusa.org For Schools:

Students Returning to School After a Suicide Attempt: Students who have felt so helpless and hopeless to have made a suicide attempt have many challenges to face. The problems that led to their suicide attempt are still there, and now on top of that they have to deal with having been hospitalized for the attempt. Peers are not often kind to those who return to school following a psychiatric hospitalization. Although we are trying hard to reduce the stigma around mental illness, it is still a stigma for many who get admitted into a psychiatric hospital as opposed to a drug or alcohol rehab. The school faculty and staff may also not know how to be supportive to the returning student. Many staff can be insensitive and say thoughtless things that other students may overhear in the office or hallways. Many staff hold outdated beliefs about mental health treatment which may not lead to the most positive climate for the student. Still other staff, who are knowledgeable about mental health issues and who themselves may have or know others in their own life with mental illness, may be the most compassionate. How school staff can help: Coming back to school after a traumatic absence is difficult for students, but returning after a suicide attempt is quiet challenging, especially if everyone knows. Try to give the student as much control as possible over the situation. Meet with the student before her return to school, plan together what she does and doesn't want you to say and to whom. Practicing role playing so that she can try out different responses to different situations that may arise will help lower her anxiety. Teaching her to say, "I don't want to talk about it" gives the student permission to be as private as she would like to be about the circumstances regarding her absence as needed. You may want to ask the student (and parents) for permission to let some of her teachers and some students (that may be in clubs or sports )with her, to know how she wants to be treated. It is also important that the student's counselor gets consent to read the student's discharge plan and recommendations as well as to speak with the outside therapist. This helps the student by building a safety net for her. The return to school requires individualized attention and regular follow up. If the attempt isn't public knowledge, not everyone in the school needs to know the details around the student's absence. Faculty and staff who have direct contact with the student, should be part of her safety net that monitors continuing risk. Giving instructions to those members of the staff about how they can be most helpful to the student will benefit both the student and staff. Here are some ideas: Treat the student's return to school as you would had the student been out sick for a few days.

Let the student know you are glad they are back, "Good to see you".

Please respect the student's wishes for the way in which his absence is discussed. If the attempt is common knowledge, help the student prepare by role-playing comments and questions from peers or faculty or staff. If no one is really aware, help the student create a short response to explain her absence. Being prepared helps greatly reduce anxiety and helps the student feel more in control.

Discuss missed classwork and homework and make arrangements for completion. Adjust expectations for the first days and weeks. Let her know that she can come to you for help with the work or assign a student to help her catch up. Some teachers will give a project or a take home assignment for the student to do instead of trying to make up all of the missed homework.

Keep an eye on the student's academic performance as well as her social interactions. If you see that she is isolating or being shunned by peers or is falling further behind in assignments you can follow up with the students and other teachers as well.

Pay close attention to further absences, lateness and requests to be excused during classes. If you are concerned please alert the appropriate staff resource at your school.

Encourage the student to use the school resources for additional support (school counselor).

Always provide regular feedback to school resource staff. Some schools actually have a written policy for students who return to school following an attempt. Often this requires a meeting at the school with the student, parents, or caregivers, and selected school staff before the student is allowed to return to school. At this meeting, adjustments that may be necessary to the student's routine or class schedule may be discussed. Some school will implement a 504 plan if the student is adjusting to psychotropic medication. This written plan will specify the ways the student's assignments, schedule and test taking might be adjusted until the student is stabilized and can once again participate fully again in school routines. A 504 Plan refers to section 504 of the Rehabilitation Act and the American Disabilities Act, which specifies that no one with a disability can be excluded from participating in federally funded programs or activities, including elementary, secondary, or postsecondary schooling. "Disability" in this context refers to a "physical or mental impairment that substantially limits one or more major life activities." A 504 plan spells out the modifications and accommodations that will be needed for these students to have an opportunity to perform at the same level as thier peers. Great resource for schools: Lifelines: A Suicide Prevention Program, Lifelines Intevention: Helping Students At Risk for Suicide and Lifelines Postvention: Responding to a Suicide or Other Traumatic Death. Contact Hazelden Publications: www.hazelden.org/bookstore