Visiting after a suicide attempt
Visiting after a suicide attempt: What friends and relatives should bear in mind on the ward
Visiting after a suicide attempt: What friends and relatives should bear in mind on the ward
DESCRIPTION: What should you say when visiting a psychiatric ward following a suicide attempt? A psychiatric essay on silence, physical contact, secrecy and the promise to return.
What a visit following a suicide attempt entails
Following a suicide attempt, friends and relatives sometimes hesitate to visit the psychiatric ward because they fear saying the wrong thing. Such a visit raises ethical questions: How do you respect the other person’s wishes? When should you seek help despite a wish for privacy? And what can you promise without overcommitting yourself?
At the ward door: How do you begin the visit?
Anyone wishing to visit a friend on a psychiatric ward following a suicide attempt may have prepared a few things to say. But when they meet again, these words no longer seem appropriate. The other person is exhausted, may not want to talk much, or reacts differently than expected.
Some friends and relatives hold back completely out of uncertainty. Their silence can come across as withdrawal or rejection, even if it stems from consideration. That is why you should offer to get in touch and ask whether a visit is welcome: ‘I’d love to visit you. Is that OK with you?’ Anyone who doesn’t want to see anyone at the moment is free to decline without having to justify themselves.
The first ethical consideration centres on the other person’s wishes and on taking them seriously. This includes remaining available if a visit is declined for the time being. You can agree on when to get in touch again.
What a visit can convey
A visit to a psychiatric ward doesn’t require a set programme. You can sit in silence, sit side by side, look out of the window or have a cup of tea. Exhaustion and the effects of medication can make it difficult to follow a conversation. The visitor doesn’t need to fill the silence with questions.
The visitor shows: ‘You’re worth me coming here.’ This doesn’t require a long conversation. Twenty minutes can be enough. If you’re unsure whether the other person is getting tired, you can ask: ‘Would you like me to stay a bit longer, or do you need some rest?’ The visitor is also free to say when they need to leave.
Making specific offers saves the other person the trouble of having to formulate a request themselves: “Shall I bring you anything: some clothes or your charging cable?” Running errands or making an agreed phone call to their employer can also take the pressure off. What someone takes on and what information they pass on should be agreed in advance.
Ask before touching
Psychiatric treatment can involve restrictions on self-determination. In a secure ward, this extends even to the question of whether one is allowed to leave the ward. Following a suicide attempt, examinations and physical treatments may also have been necessary.
A hug may be welcome. However, in this situation, it can also feel intrusive, even if physical closeness is otherwise part of the relationship. “Would you like a hug?” gives the other person the chance to decide for themselves.
A ‘no’ is a complete answer. It requires no explanation and should trigger neither an offended withdrawal nor attempts to persuade the person otherwise.
Saying the word
Out of shyness, relatives sometimes only speak of ‘what happened’. Such euphemisms can make communication more difficult. The phrase ‘suicide attempt’ may be used, calmly and without emphasis. Similarly, the other person may say that they do not wish to talk about it at the moment.
If the attempt was preceded by a loss, the name of the person concerned may also be mentioned. Referring to a deceased person by name creates space for memories. It is up to the bereaved person to decide whether they wish to make use of this space.
There is no need to reconstruct the suicide attempt during the visit. Questions about details should not be asked out of the visitor’s own curiosity. If the other person wishes to talk, you can listen and ask what is on their mind at the moment. Questions necessary to assess a current risk belong in a different context: they serve the purposes of protection and treatment.
The harm that clichéd phrases can cause
‘Everything happens for a reason.’ ‘I know how you feel.’ ‘Just think of your family.’ Such phrases can stem from a sense of helplessness. They either ascribe meaning to the experience – but only for the speaker – or they impose an expectation before the other person has even had a chance to speak.
The reference to family can come across as a reproach and increase the pressure to have to justify oneself. In *Why People Die by Suicide*, Thomas Joiner describes the experience of feeling like a burden to others as part of his theory of suicidal behaviour. Anyone who already thinks of themselves in this way may interpret a moral admonition as confirmation of their self-reproach.
A promise like ‘I’ll always be there for you’ cannot be reliably kept. What can be kept is a specific commitment: ‘You can ring me this evening. If I don’t answer straight away, I’ll ring you back by nine.’ During the conversation, it’s okay to admit that you’re at a loss for words. Listening doesn’t require a ready-made explanation or a suggested solution.
Asking directly about suicidal thoughts
The concern that asking someone about suicidal thoughts might actually put the idea into their head persists. A review by Dazzi and colleagues (2014) found no evidence that questions about suicidality trigger such thoughts. Some of the studies analysed reported a decrease in such thoughts.
If you are concerned about someone, you should therefore ask directly: ‘Are you currently thinking about taking your own life?’ The wording makes it clear what is meant. It spares the person being asked the need to decipher hints or to have to broach the subject themselves.
The question obliges the visitor to take the answer seriously. They do not need to be able to assess the risk themselves from a professional perspective. On the ward, they can consult the treatment team and relay what they have been told or what is causing them concern.
Confidentiality and its limits
A friend says: “I’m going to tell you something, but you mustn’t tell anyone.” Anyone hearing such a request should not promise absolute confidentiality. You can explain in advance: “I’m listening to you. But if I fear you might harm yourself, I’ll have to get help.”
Here, two obligations may come into conflict: respecting the friend’s trust and responding to a potential threat to life. If they express current suicidal thoughts, the treatment team should be involved. Where possible, this step should be taken together: ‘Let’s tell the nurse how you’re feeling right now.’ In the event of immediate danger, the team must be informed straight away, even against the friend’s wishes.
Announcing this step openly maintains the honesty of the relationship, as far as the situation allows. Only the information necessary to ensure their safety is passed on. The fact that the team may not be allowed to provide any information does not prevent relatives from sharing their observations and concerns.
The small promise
When saying goodbye, you can arrange your next visit: “Would you like me to come back on Thursday after work?” If the other person agrees, this becomes a commitment. If you are unable to keep it, you should cancel in good time and suggest another date.
In *Vita Activa*, Hannah Arendt describes the making and keeping of promises as a human response to the unpredictability of the future. A commitment makes a limited part of that future reliable. For a visit, this means that the other person knows what to expect and can prepare for it.
Small agreements are enough to achieve this: a phone call on Sunday, some books on the next visit, a walk together as soon as it is possible and desired. Even after discharge, this reliability deserves attention.
A meta-analysis by Chung and colleagues (2017) shows an increased risk of suicide following stays in psychiatric hospitals. Discharge therefore by no means implies that all danger has passed.
The visitor’s limits
No visit can guarantee that another person will continue to live. Friends and relatives can maintain contact, provide agreed-upon help and call for support in the event of danger. The treatment team is responsible for professional assessment and treatment. A friend does not have to take on the role of constant supervision.
The visitor may also be deeply shaken by the suicide attempt. Some relatives have found the person concerned or administered first aid. Others are grappling with the question of whether they should have noticed something beforehand. Anger, fear and exhaustion also need a space where they can be expressed without the patient having to worry about reassuring the visitor.
A conversation with a trusted person, a support group for relatives or seeking professional help can provide the space for this. Being reliable means knowing your own limits and communicating them. This allows you to make commitments that you can actually keep.
Key points in brief
• Offer to get in touch and ask before visiting whether a visit is welcome. Respect a refusal.
• Allow for silence and agree on the duration and end time of the visit.
• Offer specific help and agree on who will take on which tasks.
• Ask before touching and accept a ‘no’.
• Feel free to bring up the suicide attempt, but do not insist on discussing it.
• Avoid accusations, hasty interpretations and promises that cannot be kept.
• If concerned, ask directly about current suicidal thoughts.
• Do not promise absolute confidentiality. If the person is currently having suicidal thoughts, involve the treatment team; do so immediately if there is an immediate risk.
• Agree on further contact together and keep your commitments.
• Be aware of your own limits and seek support yourself.
Help in crises: emergency helplines and telephone counselling
In the event of immediate danger on the ward, notify the nursing or treatment team straight away.
· Germany: Emergency number 112 · Telephone counselling 0800 111 0 111, 0800 111 0 222 or 116 123, round the clock.
· Austria: Ambulance 144 · Telephone counselling 142, round the clock.
· Switzerland: Ambulance 144 · The Helping Hand 143, 24 hours a day.
Sources
· Joiner, T. (2005). Why People Die by Suicide. Cambridge, MA: Harvard University Press.
· Arendt, H. (1960). Vita activa or On the Active Life. Stuttgart: Kohlhammer.
· Telephone Counselling Service Germany
· Crisis helplines, gesundheit.gv.at
· Die Dargebotene Hand, telephone 143
Related
Suicide prevention: help in life crises for young people and adults
Jacques Lacan, Psychoanalysis and the Subject: Suicide and the Fundamental Ethics of Psychoanalysis
Why does even the deepest grief subside? Psychological and neuroscientific insights
Borderline disorder: psychotherapeutic treatment options and support for relatives
DESCRIPTION: What should you say when visiting a psychiatric ward following a suicide attempt? A psychiatric essay on silence, physical contact, secrecy and the promise to return.
What a visit following a suicide attempt entails
Following a suicide attempt, friends and relatives sometimes hesitate to visit the psychiatric ward because they fear saying the wrong thing. Such a visit raises ethical questions: How do you respect the other person’s wishes? When should you seek help despite a wish for privacy? And what can you promise without overcommitting yourself?
At the ward door: How do you begin the visit?
Anyone wishing to visit a friend on a psychiatric ward following a suicide attempt may have prepared a few things to say. But when they meet again, these words no longer seem appropriate. The other person is exhausted, may not want to talk much, or reacts differently than expected.
Some friends and relatives hold back completely out of uncertainty. Their silence can come across as withdrawal or rejection, even if it stems from consideration. That is why you should offer to get in touch and ask whether a visit is welcome: ‘I’d love to visit you. Is that OK with you?’ Anyone who doesn’t want to see anyone at the moment is free to decline without having to justify themselves.
The first ethical consideration centres on the other person’s wishes and on taking them seriously. This includes remaining available if a visit is declined for the time being. You can agree on when to get in touch again.
What a visit can convey
A visit to a psychiatric ward doesn’t require a set programme. You can sit in silence, sit side by side, look out of the window or have a cup of tea. Exhaustion and the effects of medication can make it difficult to follow a conversation. The visitor doesn’t need to fill the silence with questions.
The visitor shows: ‘You’re worth me coming here.’ This doesn’t require a long conversation. Twenty minutes can be enough. If you’re unsure whether the other person is getting tired, you can ask: ‘Would you like me to stay a bit longer, or do you need some rest?’ The visitor is also free to say when they need to leave.
Making specific offers saves the other person the trouble of having to formulate a request themselves: “Shall I bring you anything: some clothes or your charging cable?” Running errands or making an agreed phone call to their employer can also take the pressure off. What someone takes on and what information they pass on should be agreed in advance.
Ask before touching
Psychiatric treatment can involve restrictions on self-determination. In a secure ward, this extends even to the question of whether one is allowed to leave the ward. Following a suicide attempt, examinations and physical treatments may also have been necessary.
A hug may be welcome. However, in this situation, it can also feel intrusive, even if physical closeness is otherwise part of the relationship. “Would you like a hug?” gives the other person the chance to decide for themselves.
A ‘no’ is a complete answer. It requires no explanation and should trigger neither an offended withdrawal nor attempts to persuade the person otherwise.
Saying the word
Out of shyness, relatives sometimes only speak of ‘what happened’. Such euphemisms can make communication more difficult. The phrase ‘suicide attempt’ may be used, calmly and without emphasis. Similarly, the other person may say that they do not wish to talk about it at the moment.
If the attempt was preceded by a loss, the name of the person concerned may also be mentioned. Referring to a deceased person by name creates space for memories. It is up to the bereaved person to decide whether they wish to make use of this space.
There is no need to reconstruct the suicide attempt during the visit. Questions about details should not be asked out of the visitor’s own curiosity. If the other person wishes to talk, you can listen and ask what is on their mind at the moment. Questions necessary to assess a current risk belong in a different context: they serve the purposes of protection and treatment.
The harm that clichéd phrases can cause
‘Everything happens for a reason.’ ‘I know how you feel.’ ‘Just think of your family.’ Such phrases can stem from a sense of helplessness. They either ascribe meaning to the experience – but only for the speaker – or they impose an expectation before the other person has even had a chance to speak.
The reference to family can come across as a reproach and increase the pressure to have to justify oneself. In *Why People Die by Suicide*, Thomas Joiner describes the experience of feeling like a burden to others as part of his theory of suicidal behaviour. Anyone who already thinks of themselves in this way may interpret a moral admonition as confirmation of their self-reproach.
A promise like ‘I’ll always be there for you’ cannot be reliably kept. What can be kept is a specific commitment: ‘You can ring me this evening. If I don’t answer straight away, I’ll ring you back by nine.’ During the conversation, it’s okay to admit that you’re at a loss for words. Listening doesn’t require a ready-made explanation or a suggested solution.
Asking directly about suicidal thoughts
The concern that asking someone about suicidal thoughts might actually put the idea into their head persists. A review by Dazzi and colleagues (2014) found no evidence that questions about suicidality trigger such thoughts. Some of the studies analysed reported a decrease in such thoughts.
If you are concerned about someone, you should therefore ask directly: ‘Are you currently thinking about taking your own life?’ The wording makes it clear what is meant. It spares the person being asked the need to decipher hints or to have to broach the subject themselves.
The question obliges the visitor to take the answer seriously. They do not need to be able to assess the risk themselves from a professional perspective. On the ward, they can consult the treatment team and relay what they have been told or what is causing them concern.
Confidentiality and its limits
A friend says: “I’m going to tell you something, but you mustn’t tell anyone.” Anyone hearing such a request should not promise absolute confidentiality. You can explain in advance: “I’m listening to you. But if I fear you might harm yourself, I’ll have to get help.”
Here, two obligations may come into conflict: respecting the friend’s trust and responding to a potential threat to life. If they express current suicidal thoughts, the treatment team should be involved. Where possible, this step should be taken together: ‘Let’s tell the nurse how you’re feeling right now.’ In the event of immediate danger, the team must be informed straight away, even against the friend’s wishes.
Announcing this step openly maintains the honesty of the relationship, as far as the situation allows. Only the information necessary to ensure their safety is passed on. The fact that the team may not be allowed to provide any information does not prevent relatives from sharing their observations and concerns.
The small promise
When saying goodbye, you can arrange your next visit: “Would you like me to come back on Thursday after work?” If the other person agrees, this becomes a commitment. If you are unable to keep it, you should cancel in good time and suggest another date.
In *Vita Activa*, Hannah Arendt describes the making and keeping of promises as a human response to the unpredictability of the future. A commitment makes a limited part of that future reliable. For a visit, this means that the other person knows what to expect and can prepare for it.
Small agreements are enough to achieve this: a phone call on Sunday, some books on the next visit, a walk together as soon as it is possible and desired. Even after discharge, this reliability deserves attention.
A meta-analysis by Chung and colleagues (2017) shows an increased risk of suicide following stays in psychiatric hospitals. Discharge therefore by no means implies that all danger has passed.
The visitor’s limits
No visit can guarantee that another person will continue to live. Friends and relatives can maintain contact, provide agreed-upon help and call for support in the event of danger. The treatment team is responsible for professional assessment and treatment. A friend does not have to take on the role of constant supervision.
The visitor may also be deeply shaken by the suicide attempt. Some relatives have found the person concerned or administered first aid. Others are grappling with the question of whether they should have noticed something beforehand. Anger, fear and exhaustion also need a space where they can be expressed without the patient having to worry about reassuring the visitor.
A conversation with a trusted person, a support group for relatives or seeking professional help can provide the space for this. Being reliable means knowing your own limits and communicating them. This allows you to make commitments that you can actually keep.
Key points in brief
• Offer to get in touch and ask before visiting whether a visit is welcome. Respect a refusal.
• Allow for silence and agree on the duration and end time of the visit.
• Offer specific help and agree on who will take on which tasks.
• Ask before touching and accept a ‘no’.
• Feel free to bring up the suicide attempt, but do not insist on discussing it.
• Avoid accusations, hasty interpretations and promises that cannot be kept.
• If concerned, ask directly about current suicidal thoughts.
• Do not promise absolute confidentiality. If the person is currently having suicidal thoughts, involve the treatment team; do so immediately if there is an immediate risk.
• Agree on further contact together and keep your commitments.
• Be aware of your own limits and seek support yourself.
Help in crises: emergency helplines and telephone counselling
In the event of immediate danger on the ward, notify the nursing or treatment team straight away.
· Germany: Emergency number 112 · Telephone counselling 0800 111 0 111, 0800 111 0 222 or 116 123, round the clock.
· Austria: Ambulance 144 · Telephone counselling 142, round the clock.
· Switzerland: Ambulance 144 · The Helping Hand 143, 24 hours a day.
Sources
· Joiner, T. (2005). Why People Die by Suicide. Cambridge, MA: Harvard University Press.
· Arendt, H. (1960). Vita activa or On the Active Life. Stuttgart: Kohlhammer.
· Telephone Counselling Service Germany
· Crisis helplines, gesundheit.gv.at
· Die Dargebotene Hand, telephone 143
Related
Suicide prevention: help in life crises for young people and adults
Jacques Lacan, Psychoanalysis and the Subject: Suicide and the Fundamental Ethics of Psychoanalysis
Why does even the deepest grief subside? Psychological and neuroscientific insights
Borderline disorder: psychotherapeutic treatment options and support for relatives
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