Taking Proactive Steps When Silence Feels Safer: Thoughts about Suicide Prevention

September is National Suicide Prevention Awareness Month. It’s a painful subject. And as happens too often, when a situation or interaction feels painful or hurtful, it can feel safer to avoid it altogether. Fight, flight, freeze – our rapid survival responses to what seems dangerous can save our necks. Or it can become a maladaptive way of coping with ongoing situations that require a more proactive approach to immediate, and causative, factors on the troubling path to suicide.

The positive focus of this month is prevention. Things need to change. Campaigns advocate moving past the shame and silence surrounding emotional and mental well-being. Many conversations appropriately discuss mitigating risk factors, strengthening social supports, and recognizing behavioral cues earlier. That’s the big picture.

An already overwhelmed care team member, working in a pressured situation, sees a co-worker head in hands, weeping. He feels uneasy, not sure what to do. His brain is chattering, “Maybe I shouldn’t get involved.” “If I speak up, it might make things worse.” He nervously walks away.

In the morning huddle, the unit manager rails at the team for a medication error. One nurse notices another member of the team, his non-verbal expressions conveying fear. No one else seems to notice, as they too are lost in thoughts about what this might mean for them, the patient. Or a lawsuit.

When we observe another person suffering or in distress, it stirs up thoughts and feelings. We develop ways of coping, and these can be helpful or unhelpful. In recent months, I have written about “avoidance” as a stress response that many health professionals participating in our program report seeing frequently in the workplace.

Is silence an avoidant behavior? It can be.

Change at the individual and social support level starts to happen when we increase our capacity for awareness and self-assessment. As well as increasing our willingness to flexibly act on a different, potentially more workable, strategy.

A change might look something like this.

We can self-reflect in such moments, “Is my avoiding speaking up in this situation helpful to them? To me?” And if not, then take a moment to ponder, “Am I willing to flexibly change how I respond? What might I do differently?”

In the one scenario, the care team member turns around and walks back towards his co-worker, weeping against the wall. “How are you doing?” he asks, without judgment or criticism.

The nurse reflects on what she just saw in the meeting with the upset unit manager. It has been in the back of her mind all morning. At lunch, she approaches the distraught co-worker. “That was kind of rough in there. How are you doing?” she asks, and simply listens. She suggests a support resource that may be a fit. The co-worker says, “Thanks for noticing. I’ll be okay.”

There’s no simple answer to how we respond when we see a co-worker or a friend in distress. We have no crystal ball to know what will happen next. Mental health professionals play a valuable role.

One thing we can do to mitigate emotional distress is to renew a commitment to intentionally acquire practical cognitive and behavioral strategies and competencies in how we respond to stress.

Learning these evidence-based strategies, as developed in the StressPal Frontline program, means cultivating our own capacity to navigate stressful thoughts, feelings, and behaviors, even in pressured situations, and to choose more workable responses.

In turn, these capacities can improve our ability to be better able to compassionately observe stressors in others and take a step.