BCC Staff Note: The following resources were originally posted at Pastor Paul Tautges’ Counseling One Another website. Paul has given us permission to bundle these resources together as part of our BCC Free Resource Library.
SLAP DIRT Suicide Assessment
What do you do when you fear a friend or family member may be suicidal? How do you assess the seriousness of your suspicion or their ‘suicidal comments’? The following assessment tool is from the mini-book HELP! My Friend Is Suicidal by pastor and police chaplain Bruce Ray.
Listen to Your Suicidal Friend!
Be willing to talk about suicide plainly. Many suicidal people want to voice their thoughts but their family and friends won’t let them! You don’t have to have all the answers; you just need to be willing to listen. Take your friend seriously. Don’t discount her concerns. Don’t say, “It’s not that bad…” To her it is! Don’t tell her what to do, but show her biblically what God wants her to do. Help her to take every out-of-control thought and bring it into submission to Jesus Christ. “We demolish arguments and every pretension that sets itself up against the knowledge of God, and we take captive every thought to make it obedient to Christ” (2 Corinthians 10:5).
When in Doubt, Ask!
If your friend’s intentions are not clear, ask him point blank: Are you thinking about suicide? It seems counter-intuitive, the opposite of what you think you should do, but asking will not push him to act. Talking about his thoughts and feelings may actually serve as a release-valve, thus buying more time. Learn as much as you can about his suicide plan. A suicide threat assessment tool that I find helpful is easily remembered by the acronym SLAP DIRT:
SPECIFIC PLAN – has your friend thought about how, where and when he would commit suicide? A plan that is specific is much closer to being carried out than one that is only general: “I don’t know how, but I’m gonna’ do it.”
LETHALITY – how deadly is the plan? I’m not overly concerned about a plan to overdose on Vitamin C, but if someone says they’re going to shoot themselves or jump from a freeway overpass, they have my full attention.
AVAILABILITY (of means) – does your friend have or can he easily get what he needs to carry out his plan?
PROXIMITY (of help) – How close help is can indicate determination. Fred moved in with his daughter and her family after his wife died. They were glad to have him there and Fred did much of the gardening. One evening he said he was going for a walk. He actually went to a park in a neighboring city. In the gazebo in a remote part of the park, Fred put a handgun to his head and pulled the trigger. He went to an isolated place so that there would be no one nearby who could interrupt what he had decided to do.
If there has been a previous attempt(s), add DIRT to the mix:
DANGEROUSNESS – how dangerous were the previous attempts? Is there is a pattern of para- or pseudo-suicidal attempts that were deliberately unsuccessful, and is your friend more determined now?
IMPRESSION – whatever the actual danger might have been, what is your friend’s impression of how dangerous her previous attempts were?
RESCUE – how did your friend survive previous attempts? Did he use less than lethal means, or were there friends or other people who came to his rescue?
TIMING – some people attempt suicide expecting to be rescued. Linda rigged a vacuum cleaner hose from the tailpipe of her car in the garage into the passenger compartment, expecting her estranged husband to find her (and save her) when he came to pick up their children. She forgot he had a dentist appointment. As a result of that miscalculation, Linda died and almost killed her kids when carbon monoxide filled the house.
When depression is present, suicidal persons can send out conflicting signals. One of the most dangerous periods is on the way down, when they are unhappy with life and close to the bottom but still have enough energy to carry out a plan.
At the bottom of the curve, life is flat and depressed persons have little energy to do anything. This is when they don’t go to school or work, don’t seem to get anything done, and spend a lot of time unable or unwilling to get out of bed or off the couch. When they start to come out of the depression, that’s the next most dangerous period because they are beginning to regain energy and can again carry out a plan. Often friends are misled into thinking that the suicidal person is getting better: “He seemed so much happier the last few days….” That apparent happiness may be because the person has a plan and now has the energy to carry it out.
Don’t Try to Be a Hero
Suicide intervention is risky. It places you in harm’s way, between a suicidal subject and the means of carrying out his plan. Your priority must always be your own personal safety first. Don’t try to be a hero, and don’t become a victim. Call for appropriate help from police, fire, or the local suicide crisis line.
11 Myths and Misperceptions about Suicide
As we focus our attention on the subject of suicide, we will seek to understand this growing, heart-wrenching problem in our fallen world. As we learn to be wise friends and counselors, let’s also pray that we will grow in ministering the grace and truth of Jesus Christ to those who have lost all hope, and the desire to live, as well as those whose lives have been forever changed by the death of another.
Today’s post is written by police and fire chaplain, and pastor, Bruce Ray, author of the new e-Book HELP! My Friend Is Suicidal.
There are many myths and misperceptions about suicide that hinder us from dealing effectively with suicidal persons. Here are some of them, with brief comments:
- Suicide is always caused by depression. Actually, other factors such as anger, revenge, remorse and drug and alcohol abuse may be more dominant influences. Bill and Mary was a young couple who were living together. They went to a bar to celebrate a special occasion. Both had been drinking and Bill accused Mary of flirting with another bar patron. They argued all the way home, where Bill decided to show Mary how upset he was by forcing her to watch him commit suicide in front of her.
- People who talk about suicide won’t really do it – they just want attention. It is true that sometimes suicide “attempts” are cries for help, but remember the boy who cried “Wolf!” One day the wolf actually came, and no one believed him. It is dangerous to assume that a suicide threat is “only” to get attention.
- Thinking about suicide means you will commit suicide. Many people have fleeting occasional suicidal thoughts, but do not act on them. A key concern is when thinking about suicide extends to the point of actually making a plan.
- If you talk about suicide to a suicidal subject, you may encourage her to do it. The fear of pushing someone over the edge leads us to avoid the subject. Actually, talking about her thoughts and feelings to someone who is really listening and interacting may be a release for the suicidal subject that makes it unnecessary for her to act.
- A true believer cannot commit suicide. Samson was chosen by God to be one of the judges who would deliver and protect his people from the Philistines (Judges 13-16). Despite his many faults, Samson seems to have been a true believer who prayed for God to give him the strength to collapse the Philistine temple on his captors even though it meant his own death as well. Samson is named in “the great faith chapter” of the Bible (Hebrews 11) as one of many “who through faith conquered kingdoms, administered justice, and gained what was promised” (Hebrews 11:32-33) [Some question whether Samson’s death was a case of suicide or martyrdom.] Other factors may affect the decisions believers make. Pastor Bob stunned everyone when he put a handgun to his head and pulled the trigger one night. Weeks later, his wife discovered that a new heart medication he was taking listed depression and suicidal ideation as possible side-effects. If they had known, they could have removed all guns from the house as a precaution and discussed changing the medication with his cardiologist.
- Suicide happens without warning. Actually, most people give warning signs that they are considering suicide. The problem is that often we don’t recognize they were warning signs until after the fact.
- Once suicidal, always suicidal. Not true. The primary value of a 72-hour involuntary commitment by a mental health professional is that it puts a suicidal subject in a safe place and enables him or her to get past a critical period and reconsider other options.
- The risk goes down when the mood goes up. Not necessarily true. Actually, the mood may seem to improve because a decision has been made.
- Suicidal people are intent on dying. More often, suicidal persons want to end the pain and think they are out of options and out of hope. Not wanting to go on living as you are is not the same as wanting to die.
- Suicide runs in families. That’s often true, but that doesn’t mean suicide is hereditary. It is more likely that family history provides unhealthy patterns of dealing with issues and “permission” to end life when solutions can’t be easily found.
- Someone who commits suicide must be mentally ill. Nevada’s suicide prevention plan authoritatively declares, “90% of people who die by suicide have a diagnosable mental health and/or substance use disorder at the time of death.” Only four sentences later, however, it acknowledges that “over 90% of the people that died by suicide in Nevada had not been seen by a mental health professional.” [Nevada State Department of Health and Human Services]. Then how were they diagnosed? This sounds like circular reasoning to me: “People who commit suicide must be mentally ill. Jenny committed suicide; Jenny must have been mentally ill.” That argument will quickly discredit you when talking with a suicidal subject.
You Can Help Your Suicidal Friend
In the previous post, Bruce Ray corrected eleven myths and misconceptions commonly believed about suicide. In this post, he introduces us to the horrific reality of how prevalent suicide has become in our fallen world. He also encourages us to get involved by preparing ourselves to help, especially since those who work in the field of crisis intervention tell us, “A significant number of suicides are preventable, provided help is available.” The following words are from the Introduction to his new booklet HELP! My Friend Is Suicidal.
We had responded to our third suicide call in less than a week when one of the detectives working the case, a veteran investigator, looked at me and muttered through clenched teeth, “Too much death!” Then, without another word, he turned and walked off the scene. I should have gone after him, but I didn’t.
The questions that drove my detective friend away that day were also swirling around my own weary mind. What’s going on? Why would Kathy, a friendly and popular employee of a local business, take her life on her lunch hour? Why did Jimmy, barely in his teens, end his life before it had really begun? And how could Matt, a loving husband and father, abandon his young wife and children when they needed him so much?
We understand that people die. They die of old age and cancer. They die in traffic accidents and disasters and wars. We even understand that some people are victims of homicide. But suicide is different. Suicide is self-inflicted. Suicide is a choice. Why? Why do so many people today think suicide is the solution to their difficulties? I’ve had to think a great deal about suicide in the past twenty-plus years, and I’ve learned a great deal about suicidal subjects, too.
Suicide is not new. But its acceptability and even popularity are quite new. Early in the 20th century, Masaryk called suicide “a social ailment peculiar to modern society.” Only fifty years later, Myers labeled depression “the common cold of psychological disorders.” Today there are more than 36,000 confirmed suicides in the US every year (2009=36,909). More than 101 people take their own lives every day; four every hour; one every fifteen minutes. That’s “too much death!”
The actual numbers are under-reported. For every completed suicide there are an estimated 25 attempts. In 2006, there were almost 600,000 hospital Emergency Room visits attributed to suicide attempts. That means there are a lot of friends who are suicidal!
Statistics like these provide useful information, but we must never forget that these numbers represent husbands and wives, mothers and fathers, sons and daughters, friends, neighbors, coworkers and classmates.
Suicide literature often distinguishes between suicide prevention, intervention and postvention. “Vention” comes from the Latin venire (to come) plus pre (to come before), inter (to come between) and post (to come after).
This booklet addresses suicide prevention and intervention. It will help you to recognize the warning signs of suicidal thinking and to be able to defuse a suicidal subject before a suicide takes place. You have a good possibility of being successful.
You Are Qualified to Help
If you know and love the Lord Jesus then you are able to help the suicidal person more than you realize. Bruce Ray writes, “You may not feel prepared, but you have what you need to help. Long before there were professional counselors, people in trouble relied upon family and friends to help them through difficult times. Writing to believers in Rome, the Apostle Paul said to the whole church (not just the church leaders), ‘I myself am convinced, my brothers, that you yourselves are full of goodness, complete in knowledge and competent to instruct one another’ (Romans 15:14).” You possess three very important qualifications:
- You have the character to help others. As a believer redeemed by Jesus Christ and filled with his Spirit, you are “full of goodness.” You care about others and you seek to do them good, not harm.
- You have the knowledge to help others. You may not know everything about the problems your friend is confronting, or be an expert on suicide, but you have access to divine wisdom revealed in the Scriptures.
- You have the motivation to help others. You are “competent to instruct one another.” The word translated “instruct” in the NIV means to put or place into mind and is elsewhere translated “admonish,” “warn,” or “counsel.” It carries the idea of lovingly confronting someone with the purpose of bringing about desirable change in his or her thinking and living. Your motivation for helping others is their welfare, not your own personal gain.
Remember, don’t try to be a hero. If your friend or family member is in imminent danger then you need to employ the civil authorities whom God has provided to protect his or her life (Romans 13:1-7). Once safety is regained, however, don't merely leave your friend “to the professionals.” Even if there is a role they must have at certain points in time you are the person your friend needs right now. Trust the Lord to use you and His Word to direct the mind and heart of your friend to Jesus Christ, the one who came to give not only eternal life, but also the abundant life (John 10:10).
Conducting a Funeral When Suicide Is the Cause of Death
“Nothing jars the mind and emotions like news of a suicide,” writes Brian Croft, pastor of Auburndale Baptist Church in Louisville, Kentucky, and founder of Practical Shepherding. For this series on suicide, Brian has graciously given me permission to reprint a portion from his very practical book, Conduct Gospel-Centered Funerals (co-written with Phil Newton). Brian continues:
I remember the shocking news I received when returning home for a visit during my sophomore year in college. My mother told me that the father of one of my close friends had committed suicide. I asked my dad, ‘Why did he do it?’ His reply has stuck with me, ‘Why does anyone take his own life?’ My dad let me know that we could dredge up ideas but ultimately, no one knows. In such settings, does the gospel minister have anything to say?
1. Realize that no one knows what is going on in the psyche of a person who takes his/her life. So be careful of making quick judgments. Sometime emotional illnesses or physiological conditions contribute to the snap decision to take one’s life. John Newton, the famous Anglican minister and author of “Amazing Grace,” spent years ministering to William Cowper, one of the 18th century’s most beloved hymnists, as he struggled with depression, melancholy, and attempted suicide [Gaius Davies, Genius, Grief and Grace: A Doctor Looks at Suffering and Success].
2. As family members ask why, it is okay to probe with them the rationale of their loved one’s decision, though I would be careful of trying to dig too deeply at that emotionally charged point. The minister’s goal is to help the family deal with the sense of guilt that will inevitably fall upon them. What they are looking for in probing for a rationale is what part they had that led to the suicide. Here, we must assure the family that the decision to take one’s life rested with the deceased alone. Point to this as a time to learn how to improve one’s life and service to others. Above all, point to the peace in the gospel of Jesus Christ.
3. The funeral service is an opportunity to demonstrate biblically how the gospel is an anchor for us in the worst storms of life. The service is really about how the gospel applies in such settings.
Above all, point to Christ. That is the most valuable counsel. There are many times that ministering God's grace and truth to fellow sinners and saints—in this fallen world—means we must choose to focus on what we know is biblically true, while at the same time leave with God that which may always remain unknown to us—the answer to “Why?” Suicide is one of the most horrific manifestations of the pain and sorrow that sin has brought into our world. When we do not possess the knowledge to be perfectly sure of all that may have contributed to a person murdering himself let us be sure of one thing: The only source of true and lasting hope is Jesus Christ, the Son of God, who willingly entered our world so that “through death He might render powerless him who had the power of death, that is, the devil, and might free those who through fear of death were subject to slavery all their lives” (Hebrews 2:14-15). Christ Jesus came into the world to save sinners (1 Timothy 1:15). Let us look to Him, ourselves, and let us faithfully point others to Him as the demonstration of God's love and only hope of our redemption.
Hope for the Suicidal Mind
“There is ultimately only one reason why people commit suicide. Most of them have not lost their minds, but all of them have lost hope. They have developed tunnel vision and cannot see any other workable options. Suicide is the only choice left that makes sense – i.e., the only option that to them seems reasonable” (Bruce Ray, HELP! My Friend Is Suicidal).
Hope, true hope, biblical hope, hope that grows out of that which is eternal—not temporal—is the remedy for the suicidal mind. Hope delivers from death (Psalm 33:19).
There are many definitions of hope that I could mention here, but instead let me offer you mine. Hope is confident expectation in God to be faithful to fulfill each and every one of His promises.
Hope is in God. It is found in no other place. But what exactly does that mean? What mental ‘hooks of hope’ can we hang our thoughts upon? What truths must we continually feed to our idea-voracious minds in order that we might “not lose heart,” but instead ensure that “our inner man is being renewed day by day” (2 Corinthians 4:16)?
- Hope is God-centered. “And now, Lord, for what do I wait? My hope is in You” (Psalm 39:7). Ultimately, hope is not found in anything, or anyone, outside of God.
- Hope is connected to Jesus Christ. “Paul, an apostle of Christ Jesus according to the commandment of God our Savior, and of Christ Jesus, who is our hope” (1 Timothy 1:1). “Hope in God” is not possible unless we have been reconciled to Him through His Son, the one and only Mediator between God and sinners (1 Timothy 2:5). In Christ, we have “a better hope” (Hebrews 7:19).
- Hope is the work of the Holy Spirit. “Now may the God of hope fill you with all joy and peace in believing, so that you will abound in hope by the power of the Holy Spirit” (Romans 15:13).
- Hope is rooted in the resurrection. “If we have hoped in Christ in this life only, we are of all men most to be pitied. But now Christ has been raised from the dead, the first fruits of those who are asleep” (1 Corinthians15:19-20). Through Christ we are “believers in God, who raised Him from the dead and gave Him glory, so that [our] faith and hope are in God” (1 Peter 1:21).
- Hope is not dependent upon hopeful circumstances. “For I consider that the sufferings of this present time are not worthy to be compared with the glory that is to be revealed to us” (Romans 8:18).
- Hope is focused on God’s promises. As believers, we live “in the hope of eternal life, which God, who cannot lie, promised long ages ago” (Titus 1:2).
- Hope is dependent upon God’s goodness and mercy. “Behold, the eye of the LORD is on those who fear Him, on those who hope for His lovingkindness, to deliver their soul from death and to keep them alive in famine” (Psalm 33:18-19). Biblical hope never grows well in the garden of entitlement.
- Hope grows in the mind that intentionally chooses to remember who God is. “This I recall to my mind, therefore I have hope. The LORD’S lovingkindnesses indeed never cease, for His compassions never fail. They are new every morning; great is Your faithfulness” (Lamentations 321-23).
- Hope is found in the encouragement of the Scriptures. “For whatever was written in former days was written for our instruction, that through endurance and through the encouragement of the Scriptures we might have hope” (Romans 15:4). “My soul longs for your salvation; I hope in your word” (Psalm 119:81).
- Hope is found in the saving gospel. “…because of the hope laid up for you in heaven. Of this you have heard before in the word of the truth, the gospel” (Colossians 1:5).
- Hope is laid hold of by faith. “For through the Spirit, by faith, we ourselves eagerly wait for the hope of righteousness” (Galatians 5:5; cf. Romans 5:2).
- Hope grows out of Christ-like character, which can only be produced in the fires of suffering; therefore, a believer should not seek escape from suffering. “More than that, we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope” (Romans 5:3-4).
Finally, brethren, let us listen to and believe God’s benediction of hope that is obtained by grace. “Now may our Lord Jesus Christ Himself and God our Father, who has loved us and given us eternal comfort and good hope by grace, comfort and strengthen your hearts in every good work and word” (2 Thessalonians 2:16-17). Lord, make us people who counsel one another with hope.
A Prayer for Those Left Behind After Suicide
God of all comfort, who comforts your children in times of affliction, comfort those who are grieving in their time of extreme loss. Minister to the indescribable pain that gnaws at their heart every moment of every day; help them to remember Jesus and His indescribable suffering so that they will run to Him as the faithful and compassionate High Priest for every sinner who turns to Him in repentant faith.
God of peace, govern their hearts in this time of great confusion. Help them to take their thousand questions and “what ifs,” which swirl furiously in their minds, to Jesus, the Prince of Peace who has the power to calm the storm. As the Holy Spirit helps them take their anxieties to you in prayer, flood their souls with the peace that passes all understanding. When they cannot pray—when their hearts and minds are so overtaken by grief that they cannot find a word—remind them that the Holy Spirit prays for true believers when they do not know how to pray.
God of justice and righteousness, steady their minds with the understanding that you know all things, which includes the final state of their loved one’s soul. Let them not place blame upon themselves that does not rightfully belong to them. Remind them that the Judge of all the earth always judges righteously. Let them rest in this. Let them now concentrate on the state of their own soul before their holy Creator and quickly run to Christ as the Redeemer who came not to call the righteous, but sinners to repentance. May they find the assurance of their own salvation, and eternal life, which you promise to those who turn to Jesus Christ.
God of mercy and grace, may they know your presence as you walk with them through this valley of death. May they know—in an experiential, not merely intellectual way—the sufficiency of your grace! Help them to rest in the truth that they do not need to try to live off of yesterday’s supply, but instead drink from the fresh stream of your mercies that are new this very morning.
God of truth, gently lead them to the green pastures of your Word where they will feed their hurting, doubting souls upon all your righteous judgments and faithful promises. Lead them to streams of living water, which flow from Christ who said “the water that I will give him shall never thirst; but the water that I will give him will become in him a well of water springing up to eternal life.”
Heavenly Father, knowing that every one of these requests can only be answered in and through and because of Jesus, draw them close to the Savior who invites them to let Him carry their burden. Hold them close in your loving arms. Cause them to know you more deeply as the Father of mercies and God of all comfort so that their every need will be fully met and they—in time—will become ministers of comfort to others.
[Based on 2 Corinthians 1:3-6; Hebrews 4:15; 1 Thessalonians 5:23; Isaiah 9:6; Philippians 4:6-8; Romans 8:26; Mark 7:37; Daniel 4:37; Psalm 67:4; Luke 5:30; ; 1 John 5:11-13; Psalm 23:4; 2 Corinthians 12:9; Lamentations 3:21-23; Psalm 23:2; 119:7; John 4:14; 2 Corinthians 1:20; Matthew 11:28-30.]
Resource Links for Suicide Prevention and Grieving a Suicide
Here are a number of resources that will help us grow in ministering God’s grace and truth related to suicide prevention and grieving a suicide.
Books, Booklets, and Articles
- Assessing and Counseling a Person with Suicidal Thoughts (Aaron Sironi)
- Gaining a Hopeful Spirit (Joni Eareckson Tada)
- Grieving a Suicide (David Powlison)
- HELP! My Friend Is Suicidal (Bruce Ray)
- I Just Want to Die (David Powlison)
- Life After the Suicide of a Loved One (Julie Gossack)
- Making Sense of the Suicide of a Christian (Jeffrey Black, CCEF)
- Right Thinking in a World Gone Wrong (John MacArthur, and GCC Pastoral Staff) – contains one chapter on a pastoral perspective of suicide
- Suicide: Understanding & Intervening (Jeffrey Black)
- When You Can't Fix What's Broken (Mike Emlet)
Free Online Links
- Can One Who Commits Suicide Be Saved? (John MacArthur)
- Do People Who Commit Suicide Go to Heaven? (Ed Welch)
- Funeral Meditation for a Christian Who Committed Suicide (John Piper)
- Suicide Assessment Tool (Bruce Ray)
- Suicide in the Church (Ab Abercrombie)
- Suicide, Salvation, and Eternal Security (Bob Kellemen)
- The Law & Counseling Pt 2 – Legal History and Climate (Bob Kellemen)