Listener discretion note: this episode contains a discussion of the issue of suicide, specifically in terms of warning signs and risk factors, and the noting of a high-profile loss.

Tragic events this week have put suicide front and center in the headlines once again. We wanted to put together, as immediately as we could, a clear, honest and open discussion about suicide-- its risks, its warning signs, its myths, and what to do when you're concerned about yourself or someone you love.

Shame and stigma lead to silence-- which leads to people not getting the help they need.

You are not alone. And there is help.

If you or someone you know is in crisis, call 988 to reach the Suicide and Crisis Lifeline in the United States. You can also call the network, previously known as the National Suicide Prevention Lifeline, at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.

Hi, all. Uh, this is me, Dr. Andrea Bonior. And this is Baggage Check: Mental Health Talk and Advice. So I put the episode I would have aired today on pause hours before it would have dropped, and I'm sitting here knowing I won't have time to edit this. I'm not writing a script. I won't dub in music or some silly absurdity about what the show isn't about. I may not even be able to post the transcript in time when this is released, though I will work on getting that out soon, because accessibility for the hearing-impaired is important to me. And the episode cover art and show notes might not be as perfect as usual. I hear you. You're saying, uh, they weren't really perfect before, but anyway, I'm flying by the seat of my pants here because I'm just going to talk because I hear so many of you ready to open up and learn about the issue of suicide. We've had a really tragic and high-profile loss. Stephen Boss, aka tWitch, the beloved dancer, the longtime effervescent personality on, The Ellen Show. He has passed away from suicide, and folks are shocked and devastated. By all accounts, he was just so joyous, so kind, so creative, so passionate. He had a spark. He had a twinkle. It seems incomprehensible to folks, and yet it's another reminder that many, many, many people are, uh, walking around this earth with struggles that you can't see. I can't pretend to know anything about his inner story or how to best honor the immense talent that he was. But I feel like we have the opportunity to honor his memory by talking about how to help others who are struggling. Because the headlines will change and his family and loved ones will be left to grieve, their lives torn apart. And then society will start talking about something else. So how do we honor his memory without assuming that we know anything in particular about his unique pain? And how do we honor the struggle of those who are fighting every day with suicidal thoughts and depression and other forms of mental health struggles? There aren't any generalities here, and everyone's own pain and story is unique. But we can use this as a reminder that there are other stories right here with us today. There are other stories to get to know. There are other struggles to not turn our backs on. There are other conversations to have, other pain to bear witness to. Mental health symptomology has been rising so much, so dangerously for years, and silence makes it worse. So we need to talk, we need to notice, we need to listen. We need to ask questions and bear witness and offer hope in the form of professional support. There are so many people fighting this fight, whether to help others or just to stay here on Earth. But neither group should have to do it alone. And so I wanted to use this time today to talk about some risk factors for suicide and some warning signs and finally to break down some myths. Suicide is far more common than homicide in this country. It's a large ratio. And yet there's so much silence and stigma and shame, and it all leads to people not getting help. So let's talk about some statistical risk factors for suicide. Now, none of these are warning signs per se, but you should know that these all do, statistically at least, increase a person's risk. First of all, having any severe psychological disorder. The more severe, the worse. And some disorders are classically associated with suicide risk, like depression and like bipolar disorder. But even disorders that you wouldn't necessarily think of, like some phobias, can be associated with suicide risk if the person is in agony, if it's severe. But here's where you can help. Only a small minority of people who die by suicide were in treatment at the time of their deaths. So that means that there's a big gap that needs to be bridged, that so many people who die by suicide were not receiving treatment. And that's where loved ones and friends and even coworkers and neighbors can come in. Having had a suicide in the family is a risk factor. Having had a recent loss of a significant relationship, whether by death or by breakup or divorce or separation, having a firearm in the home is a statistical risk factor for suicide, and it is unequivocal. And firearms are such a hot button topic that people don't want to talk about this. But two thirds of gun deaths are suicide deaths, and the rate of firearm suicides has gone up in the past decade. Substance abuse is a risk factor. Having had a stressful life event recently, especially involving humiliation. Past suicidal behavior is a statistical risk factor. Impulsive or aggressive tendencies. Violence, whether being the victim or the perpetrator, having had abuse or neglect in your past or other adverse childhood experiences. Job loss, unemployment, academic or disciplinary crises like getting kicked out of school, concerns about sexuality or gender identity, hopefully as a risk factor that's decreasing over time as our world becomes a little bit of a kinder place. But it's nowhere near where it should be. Lack of having achieved a certain goal that was important. Serious illness or chronic pain is a risk factor. Lack of access to health care is a risk factor, as is social isolation. Now, in terms of warning signs, these are things to be taken even more seriously. These are signals. These are red flags. And none of these alone automatically mean that someone, by definition, is suicidal. But they need to be taken seriously. When someone talks about it, talks about suicide, either directly or indirectly. Maybe it's a lot of jokes about it. Maybe it's mentioning it, uh, in an offhanded way to test the waters. Maybe it's mentioning feeling trapped or feeling like things are absolutely unbearable. Another warning sign is increased risk taking and impulsivity, or violence. Increased risk taking and impulsivity can put you more at risk for death, even if you hadn't necessarily been intending it. But it's also a sign that something is going on inside, that maybe that you're not as concerned about dying, so you're not being as careful. Having some sort of a plan, knowing exactly how you’d do it, making a plan, those are all warning signs that someone's suicidal thinking is more than just idle, abstract ideation. Expressing severe hopelessness that things will never get better is another warning sign. Giving away things or tying up loose ends, trying to sort of clean up a mess for other people beforehand can be a warning sign. Expressing severe shame like you can't face the world is a warning sign. Expressing that you feel like you're a burden to other people can be a really critical warning sign. Because not only does it reflect how much pain someone is in, but it also means that maybe they feel like they would be doing someone a favor if they were to no longer be on the earth. Most folks tend to have barriers where they say, I wouldn't do that to my family, or there's no way I would leave my kids without a parent. But when someone expresses that they feel like they're a burden to others, it means that that's no longer a barrier because they actually feel that others might be better off without them. Severe agitation and insomnia can be a really serious warning sign. And again, that can also cause someone to not think as clearly and to be more impulsive. Severe mood swings are another warning sign. Increased substance abuse is a very problematic warning sign. And of course, that's going to increase the risk of accidental death as well. All of these warning signs should be taken seriously. And we'll talk about how to initiate a conversation in just a moment. But if you see these things, please do pay attention and take it seriously. Now, a few myths, and because there's so much silence and stigma and shame about this topic, myths persist because people don't have the facts and they don't get the proper information and they don't get the proper support. Myth number one someone is absolutely at their worst, at their biggest, deepest rock bottom when they die by suicide. Oftentimes this is just not true. And I've worked with so many heartbroken survivors of folks who have died by suicide, their loved ones who say, but I thought they were getting better. They really seem to actually be doing better. I knew they were struggling mightily, but I thought they were on the upswing. Well, there's two reasons why this might be the case. Number one, sometimes when someone is truly at their rock bottom, they might not be functioning at all. They might not have the wherewithal to act on a plan. They might not have the energy to even get out of bed or put together a method to end their life. And so then once they start to feel a little bit better, maybe they go on antidepressants or the seasons change or things get a little bit better and they get a little bit more sleep and they have a little bit more energy. And now they still have the suicidal thoughts, but they have the energy to act on them, whereas they didn't before. The other reason why somebody might not be at rock bottom when they die by suicide is because sometimes, unfortunately, when they've made a suicidal plan, this might come across as a change in mood to them. Um, it might seem like maybe they're a little bit more calm because they've decided they might feel some semblance of relief in their mind because they have decided to end their life. And of course, we wish that this wouldn't feel like a solution to them, but that's what it can seem to an outsider that they've maybe had some stability. Now, another myth is that there's nothing you can do if someone is determined to end their life. And of course, we hear this in reference to firearms all the time, but the research does not bear this out. Yes, lots of people have given warning signs and it's very important that we take them seriously. But that does not mean that suicide isn't sometimes an impulsive act. A lot of times the actual moment can be more impulsive than we want to realize. It's very painful to imagine that we could have stepped in and changed something. It's almost more comforting to imagine that maybe they would have found a way no matter what. And of course, everyone's story is different. But the truth is there are a lot of survivors who intended to end their lives and accidentally did not, and are very glad that they did not and they didn't ever go on to attempt again. And m, this is why having such a fatal and immediate method like a firearm available can truly be the difference between life and death. Something irreversible like a firearm can be all the difference. And then finally, another extremely damaging myth is the idea that if you ask directly about someone having thoughts of suicide, that you'll put the idea in their head-- this is not the case. You should not be afraid to ask directly about whether the person is having thoughts of hurting themselves or ending their life. If you're squeamish about using the word suicide, you can say just that ending your life, dying, hurting yourself. This will not put the idea in their head. I think this confusion comes from the fact that there is damage in how the media covers suicide. Sometimes there is danger in glorifying it-- there can be suicide clusters. When someone's death is glamorized, when it's made to look like a solution, when it's made to look like a strategy-- that is very harmful. But that's not what you're doing when you're asking directly with concern, when you're saying, I, uh, want you here, I'm worried. How bad has it gotten for you? I want to get you help. You're not glamorizing suicide. In that case, you're opening a door. You're allowing them to hear that you care and that you want them here on this earth and that you don't want them to die. So please do not be afraid to ask compassionately and respectfully and directly about thoughts of suicide. Because often times it's not until someone asks that someone feels like they can be honest about it. And they still might not be honest. I realize that. But at least you have planted a seed that you're ready to listen. So what can you do when you're concerned about someone? As mentioned, you start the conversation, you listen, you take notice, you bear witness. You can convey a message of hope and support that there is help, that depression and mental health struggles, they're real. And there's research and those that are trained to help, that we have resources, that we have names for these things, that if one thing doesn't work, there are new treatments coming out all of the time and that it's worth it to try. You can offer to help make them an appointment. Offer to look for mental health professionals online. Offer to drive them somewhere. Offer to reach out to an additional loved one. Offer to listen. Because this is not their burden to carry alone, and it's also not your burden to carry alone either. There's a large weight in worrying about somebody that you love. So remember, caregivers need their own support as well. Remember, if you or someone you know is in crisis in the United States, call 988 worldwide. You can visit Speakingofsuicide.com/resources. We'll have lots more conversations about this in the future. I'll have experts on and planned episodes and survivors and things will be scripted and edited and polished, and I'll say exactly the right thing, or maybe closer to exactly the right thing. And my dear dog Buster won't be barking in the background, and I won't be looking at the time of night saying, oh, this is under the wire, even by my procrastinating standards. But for now, I felt like it was important to get this out there with my hoarse end-of-night voice, just being real. And if there's one person listening today, just one person who does something with this, who checks in on a friend, or who decides to ask for help themselves, or who starts a conversation with their teenage son, or who seeks out a therapist or decides to admit to their partner, maybe, how they're feeling. Well, if that happens just one time, then I am really glad that I did this tonight. Please, let's take care of each other. And we'll be back because breaking the stigma of seeking help for mental health struggles and talking about those struggles, all the struggles that we as humans goes through, we're just getting started with that. So thanks for bearing with me with a very bare bones episode today. But it's from the heart. You're not alone out there. In memory of Stephen Boss, tWitch. Until next time. Take good care.