Dr_Tyler_Black

There are grades of suicidal thinking, from the very active (I will die by x method at x time) to the very passive (i'd rather be dead), and whether or not "watch" is necessary depends a lot on the type of watch. Supervision is preferred for more active/pressing suicidal thinking but it doesn't guarantee safety - people can and do hurt themselves with direct 1:1 nursing observation.

I certainly think that in the road to recovery from active suicidal thinking, there should be regular-ish check-ins, hopefully with a trusted and helpful professional, or a family member/friend who is going to be able to be of assistance. the main reason I advocate for this, is because the question "Is there anything right now I need to make my situation better?" is often minimized vs the "things aren't as bad now so don't rock the boat" type of thinking that people have.

I really wish you well on your path; and thank you for asking such an excellent question!

I think its important to do what you can, but people can still make their decisions. Many jurisdictions in the world have mechanisms to trigger mandatory assessments, and often this involves *you* calling a hotline in your area, or *you* calling an emergency service (for example, in Vancouver, there is a police car with plainclothes police officers and social workers that can be specifically called).

The general tips are:

• "what can I do to help?" - they called you for a reason, don't let them go halfway and just make you worry
• distraction often helps in the moment, but it doesn't solve the problem. still, "lets go do something" is an appropriate way to reduce an emergency, and once things are calmer, then maybe direction is more possible
• Offer to see the person or talk to them in person, as its a lot harder to imagine isolation when someone is with you
• direct to care in all your statements - "I know you don't want to talk to a professional, but this sounds like something that needs one."
• There is no confidentiality when safety concerns are emergency. Reach out and get your own help, call that person's parents, do what you need to do, if you think there is serious jeopardy here. The balance of "but I don't want to violate their trust" is never worth it if something bad happens, and most suicidal patients i've talked to very much understand why their friends/family did what they did. it does NOT ruin friendships to ask for help.

Probably the biggest would be that suicide behaviour or thinking is only for people with mental illness. Risk factors and protective factors don't work like that. Just like all humans are at risk for heart attack (some, very very very low compared to most humans, some very very very high), all of us have various risk factors that push us towards suicidal thinking and protective factors that push us away. Mental illnesses add to our suffering but so do physical illnesses, stressors, bad news, poor sleep, etc etc. There are hundreds of risk and protective factors that all work in different directions to influence suicide risk.

The reason I want this misconception to change so much is that:

1. we tend not to think about suicidal risk factors as bad things until they are a crisis
2. we tend to think that we don't need to worry about people until they show significant dysfunction/suffering
3. we minimize our own daily influence on others, forgetting that every moment we're with another human being, if they are struggling with something, we could be helping
4. we overvalue what psychiatrists do in "predicting" suicide risk. Many times, my job is not treating specific mental illnesses, but teaching coping strategies, connecting people to resources, advocating for time off school (because school is a major stress that not every person can handle every day), etc. I am happy to help, but many many other people could be helping more people.

One of my first days as a psychiatric resident included a patient on another ward dying of suicide, and I had the misfortune of watching all of my colleagues (my bosses, my co-residents, the nursing staff) and the persons family get torn apart by the event. Almost everyone had something to say about it, and the things they were saying were not compatible with each other. I dove into the research and found how important a topic suicide is, and it sparked a research passion in me.

I'm busier than I want to be, and despite the wonders of our healthcare system (I truly do love Canadian healthcare), we still have to work on inefficiences. Your 6 months wait is unacceptable to see a psychiatrist if you are struggling with a possible illness, and so you will need to reply on primary care (family doctors, walkin clinics). there are really good volunteer organizations at well which might be a good stepping stone.

in Vancouver specifically, I think about SAFER for adults, Kelty Mental Health for kids, and CrisisCentre.bc.ca and its affiliated programs.

Call your MLA!

Policymakers and advocates need to work hard to improve our system. We need tiers of service that are readily availalble:

a) primary prevention designed to reduce the likelihood of BECOMING suicidal

b) detection pathways (school counselors, teachers, doctors, police, family, etc) and find people who are suicidal and direct them to services

c) non-emergency "urgent" interventions designed to reduce passive suicidal thinking or reducing risk factors that emerge

d) emergency interventions designed to rapidly respond to people who ARE suicidal (where most "resources" currently available apply

e) robust follow-up systems for all people who need it

We need strong leadership, advocates (community, medical, and governmental) to make the bolded items a priority.