• Dealing with Depression / Suicide Using Steps to LAST®

    Cincinnati Children’s provides tips − Steps to LAST® − to help those who are feeling troubled, or for talking to a depressed or suicidal teen. Developed by Cathy Strunk, MSN, RN, suicide prevention expert and liaison, these Steps to LAST® tips are taught as part of our Surviving the Teens / Suicide Prevention Program.

  • Tips for Talking to a Depressed and/or Suicidal Teen Using Steps to LAST®

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    Listen and look for signs of depression and warning signs of suicide

    • Listen without showing shock or surprise or expressing judgment. Accept feelings without shaming the person.
    • Listen without interrupting and allow the person to talk.
    • Listen to the person’s feelings and encourage him to express those feelings. This will help him process his thoughts. Imagine how the teen feels to say what he’s saying, or to have gone through what she has gone through, and speak to the teen about those feelings (e.g., “You seem upset,” or, “You look so sad,” or, “You sound angry about that,” or, “That must have really hurt,” or, “I can imagine you are very frustrated about that.”).
    • Look for symptoms of depression and warning signs of suicide
    • Warning signs of suicide
    • Warning signs of depression
    • Look for signs of depression and suicide in written messages, such as on Facebook, emails, letters, etc. If unable to make personal contact with the person when following Steps to LAST®, however, go directly to the last step and tell an adult who can help. This may involve calling the police or 911, which can respond immediately to the crisis situation.

    Ask constructive questions and specific questions about suicide

    • If the person is just being negative or complaining about things, ask questions such as, “What makes you feel this way?” or, “What is the problem?” Of course, the problem may be depression that is contributing to the person’s pessimism and difficulty in dealing with things. If she can identify a problem, ask what was done about it. Perhaps offer positive ways to cope or remind the person of positive ways she has coped in the past.
    • Ask about alternatives if the person identifies negative ways of coping. For instance, ask, “What else do you think you can do about this?”
    • Ask about meaning of vague statements. Don’t assume what the person means or let it go when she says things such as, “You won’t have to worry about me much longer,” “I doubt if I’m going to live that long,” “I don’t want to be here anymore,” “I’m done; I can’t take it anymore,” “I’m going away and you won’t see me again,” “I wish I could just go away and never come back.”
    • Specific questions about suicide: If the person is making vague statements or seems very depressed or is experiencing stressful life events and you think he may be suicidal, ask, “Have you been having thoughts of wanting to die?” or, “Do you want to die?” or, “Are you telling me you don’t want to live anymore?” or, “Have you ever felt so bad that you wished you could just end it all?” Don’t be afraid you will give the person the idea to commit suicide. Instead, you’re giving him permission to talk about it.
    • It is important to ask questions in a positive manner. Don’t ask, “You don’t won’t to kill yourself, do you?” or, “You’re not suicidal are you?” This gives the impression that you don’t want to hear that she is actually having these thoughts, which will discourage her from opening up to you.
    • Ask about a plan if the person tells you he does want to die, i.e., “Have you thought it out?” or, “Do you have a plan to die?” or “Have you ever tried to hurt yourself?” If the answer is yes to any of these questions, the situation is serious and needs to be addressed immediately. Any talk of suicide needs to be taken seriously.

    Support the person by:

    • Being calm and accepting when thoughts and feelings are shared. It’s important to affirm her feelings so that she feels safe sharing those feelings and innermost thoughts with you. Never tell the person that she shouldn’t feel this way.
    • Identifying the problem as depression and telling him how it causes a person to think, feel and act this way. Let the person know that it’s not a sign of weakness or a character flaw. Identify people who can help, such as a trusted adult.
    • Telling the person how much you care (they often feel no one cares) and remind her that suicide is something permanent while the problem is something temporary.
    • Not agreeing to keep this a secret. You can agree to keep it confidential and not to gossip about it, but tell the person you need to tell someone who can help. If you did agree to keep this a secret, then break it! It’s better to have a mad friend then a dead friend.
    • Not using reverse psychology, such as saying, “OK, go ahead and kill yourself if that’s what you want to do.” This will not make the person snap out of it. Instead, it will challenge him to prove to you that he is serious. It also may show the person that you don’t really care.
    • Offering hope instead of minimizing the problem. Instead of saying, “You don’t have it all that bad. There are a lot of other people who have it worse,” say instead, “No matter what you’ve been through, things can get better with help,” or, “Things will seem better once you get help” or, “We will find a way to work this out.” The big hope is that there is help for depression.
    • Focusing on getting help as the solution to the problem.
    • Acting immediately if the person has a plan, especially if the plan is a gun. Guns increase the risk of suicide 20 times. However, many other plans are lethal. It’s important not to leave the person alone if there is a plan and to persuade her to get help.
    • Going with the person to get help instead of telling him to go talk to someone about it.

    Tell an adult who can help

    • Take the person to see a counselor, school nurse, a teacher, parent, or other trusted adult or call a crisis line volunteer (1-800-273-TALK (8255) or 1-800-SUICIDE). If the person refuses to go for help, then go yourself to one of these people. Saying things to the person such as “No one else has to know,” “Please do this for me” or, “I can’t leave you alone until I’m sure you’ll be safe,” or “You’ll make a bigger deal out of this if you don’t do something now” may persuade the person to seek help with you. Nevertheless, you need to take steps to make sure she doesn’t carry out the plan or have access to the plan.
    • Call the police or 911 if you’re unable to be with the person during a crisis or if the person is in imminent danger.
    • Tell one of these professionals if you are the parent or legal guardian: Family doctor or pediatrician, or mental health professional, such as a psychiatrist, psychologist, or psychotherapist.
    • You can call Cincinnati Children’s Psychiatric Intake Response Center (PIRC) for a referral at 513-636-4124.

    Get help for the person

    • Even if he doesn’t have a plan to commit suicide. Having thoughts of suicide is a sign of depression and makes the person at risk for suicide. Offer to go with the person to get help. Contact the crisis line at 1-800-SUICIDE.
    • Read more about related resources and recommended reading.
  • Tips for Helping Yourself When Feeling Depressed

    It’s not fair to you or to others to keep your troubles a secret. It’s also nothing to be ashamed about. Everyone has struggles. If you’re unable to let the person know face to face or verbally, however, then tell her in writing. Also, if it would be easier to talk like you are your friend or someone else, then talk about yourself in the third person. You can then let the person know later that it was you whom you were describing.

  • Let someone know what’s troubling you, such as a trusted friend or family member

    It’s important to tell someone when:

    • You’re hurting inside or having emotional pain.
    • You’re having thoughts of suicide, wanting to die or not wanting to live anymore, escaping your problems or running away, hurting yourself, giving up on things, or hurting someone else.
    • You have a drug or alcohol problem.
    • You’re having difficulty dealing with family problems, fitting in with your peers, school / academic issues, a loss of a friend or family member, sexual identity / orientation, a medical or psychiatric illness, or other stress in your life.
    • You’re having low self-esteem and think you’re no good, fat, ugly, stupid, a burden to others, incompetent, all alone, that no one cares or other negative thoughts about yourself.
    • You’ve been physically or sexually abused, teased, bullied, harassed, gossiped about or ostracized.
    • You’re having relationship problems or conflicts with family, friends or others.
    • You have difficulty looking at the bright side of things or being optimistic and have a lot of negative thoughts about things going on in your life.

    Ask for and accept support

    It is not a sign of weakness to ask for or accept help from others; it is actually a strength and can be very difficult to do. However, it is very important to tell others when you need help and what help you need from them. For example, you may just need them to listen to you without judging, interrupting, or “fixing” it for you. You may also need them to stand by you or go with you to tell an adult who can help. You may also need your friend to tell for you.

    It may help to let others, such as parents, know what isn’t helpful, For instance, it may not help if they yell or get upset when you tell them things. You can let them know, then, that it would help you if they remain calm when you share things with them.

    Share your feelings

    It’s important to tell someone when you feel depressed, hopeless, helpless, worthless, or upset. It’s also important to share when you feel all alone, angry, anxious, afraid, ashamed or guilty. Identifying your feelings can be empowering. Sharing feelings will also help the person better listen to you and to gauge the seriousness of the problem.

    Tell an adult who can help

    A parent or other family member, teacher, coach, school nurse, counselor, pastor / rabbi, doctor or crisis line volunteer (e.g., 1-800-273-TALK).

  • We provide tips for talking to a depressed and/or suicidal teenager.

    We provide tips for talking to a depressed or suicidal teenager.

  • Steps to LAST® Crisis Card

    To help you listen and look for signs of depression and warning signs of suicide, please download the Steps to LAST® Crisis card in portable document format (PDF).
  • Surviving the Teens® Program Helps Teen Do the Right Thing

    Read a true story from a local teenager who used lessons learned from Steps to LAST® to help save her friend's life.

    Read More