Background and tips on handling
calls from suicidal people
Silver Cross EMS 2011
The EMD may feel helpless talking to
suicidal callers. There is no scripted
protocol for how to handle these types
of calls. The dispatcher likes to be in
control of the situation so they can
stay focused on their tasks. It can be
quite frustrating and stressful, not
knowing what to do or to say to the
caller.
All suicidal callers should be taken seriously.
Regardless of the outcome, dealing with the
suicidal caller is often very difficult. The
obvious despair and hopelessness that leads
a person to consider taking their life raises
many highly charged emotions. There are
many ways to provide help. Helping
someone begins with understanding the
problem and trying to offer some solutions.

People that talk about suicide, won’t really do it.
 Not true. Almost all people that commit suicide have given
some warning signs or clues. Don’t ignore them.

If a person is determined to kill themselves, nothing can stop
them.
 Not true. Most suicidal people do not want to die, they just want
their pain to go away. Talking to them will help.

All suicidal people are crazy.
 Not true. Suicidal people are often depressed and in a crisis but
may not have any underlying mental illness .
Suicide takes the lives of nearly 30,000 Americans
every year.
Many who attempt suicide never seek professional
care.
There are twice as many deaths due to suicide than
HIV/AIDS.
Between 1952 and 1995, suicide in young adults nearly
tripled.
Over half of all suicides occur in adult men, ages 25-65.
Suicide rates in the United States are highest in the
spring.
Over half of all suicides are completed with a firearm.
Suicide rates among the elderly are highest for those
who are divorced or widowed.
In the month prior to their suicide, 75% of elderly
persons had visited a physician.
80% of people that seek treatment for depression are
treated successfully.
15% of those who are clinically depressed die by
suicide.
There are an estimated 8 to 25 attempted suicides to 1
completion.
The highest suicide rate is among men over 85 years
old: 65 per 100,000 persons.
1 in 65,000 children ages 10 to 14 commit suicide each
year.
Suicide is the 11th leading cause of death in the U.S.
(homicide is 15th). (CDC)
Suicide is the 3rd leading cause of death for 15- to 24year-old Americans. (CDC)
It is estimated that there are at least 4.5 million
survivors in this country. (AAS)
An average of one person dies by suicide every 16.2
minutes. (CDC, AAS)
There are four male suicides for every female suicide.
(CDC, AAS)
Research has shown medications and therapy to be effective
suicide prevention.
Suicide can be prevented through education and public
awareness.
There are three female suicide attempts for each male
attempt. (CDC, AAS)
According to the Violent Death Reporting System, in 2004
73% of suicides also tested positive for at least one
substance (alcohol, cocaine, heroin or marijuana).
Illinois Region ranks 10.9 per 100,000 population in the
national suicide rate. (AAS)
 Why
do people commit suicide?
They are having intense feelings of helplessness
and hopelessness and don’t see and other way
out. Revenge may also be a motive.
 Is
it true that people attempt suicide as a
cry for help?
Their attempt is often a method for getting
others to recognize just how badly the individual
is feeling.

Does suicide run in families?
 If someone in the family has committed suicide,
other family members may be more tempted
because that behavior has been modeled for them.

Do people ever attempt suicide to get
attention?
 Anyone that does attempt suicide for attention
desperately needs it! It is tragic when a person feels
the need to bargain with their life to have their
problems taken seriously.

If a person attempts and fails, is it likely that
they will try again?
 A history of prior attempts should suggest the
possibility of similar behavior in a subsequent crisis.
They are less likely if they receive concerned help
after an attempt.

Is it true that people who attempt to kill
themselves really don’t want to die?
 Most people want to live and die at the same time
and are undecided right up until the moment of
death.

Will a person that is deeply depressed
always become suicidal?
 Depression is a risk factor for suicide but not all
depressed individuals become suicidal.

Does anyone ever impulsively attempt
suicide and then become sorry for making
such an attempt?
 At the time of the attempt a person may find the
emotional pain intolerable and make an impulsive
decision, later regretting it.

Does drug or alcohol use increase the
chance for suicide?
 These substances can exaggerate the painful
feelings to a point where the feelings are intolerable.
In that state, a person might attempt suicide who
otherwise would not go that far.

Is there a particular time of day that is more
common for suicide attempts?
 Young people tend to make attempts in the morning
or around dinnertime, when they are more likely to
be rescued.

How does talking about a suicide prevent it?
 Talking diffuses some of the intense feelings that a
suicidal person may be feeling. It creates an
environment of caring and helps to break through
the loneliness the person is experiencing. Showing
these individuals some real caring by listening and
being supportive can make them feel life may be
worth living.
IF THEY ARE TALKING TO YOU THEY ARE NOT
COMMITTING THE ACT!
Significant changes in:
• Relationships
• Well‐being of self or family member
• Body image
• Job, school, university, house, locality
• Financial situation
• Environment
Significant losses:
• Death of a loved one
• Loss of a valued relationship
• Loss of self esteem or personal expectations
• Loss of employment
Abuse including:
• Physical
• Emotional/Psychological
• Sexual
• Substance
• Neglect
• Withdrawing from friends and family, lack of
communication or isolation
• Depression
Signs of depression include:
• Loss of interest in usual activities
• Showing signs of sadness, hopelessness,
irritability or helplessness
• Changes in appetite, weight, behavior, level of
activity or sleep patterns
• Loss of energy and difficulty concentrating
• Making negative comments about self
• Recurring suicidal thoughts or fantasies
• Sudden change from extreme depression to
being `at peace' (may indicate that they have
decided to
attempt suicide)
• Talking, Writing or Hinting about suicide
• Previous attempts
• Feelings of worthlessness and guilt,
• Purposefully putting personal affairs in order:
• Giving away possessions
• Sudden intense interest in personal wills or life
insurance
• `Clearing the air' over personal incidents from
the past
 Depression
is the most significant
factor that contributes to suicide.
 It
is a common misconception that
people who threaten suicide never
commit it.
Suicide is a cry for help.
Someone is in a crisis that he or she cannot
handle alone.
If a person is stating they are
suicidal, has formed a lethal
plan and has the means to
carry it out immediately, they
would be considered more
likely to attempt.

DO

DON’T
 Be a GOOD LISTENER
 MINIMIZE their
 Be DIRECT and talk
feelings
 Make moral
JUDGEMENTS
 ABANDON them
 IGNORE the problem
openly
 Show that you CARE
 Get them HELP

Be yourself.

 There are no “right
words” to say. Your voice
and manner are more
important. Show them
that you care.

LISTEN! Let them vent
and unload their
feelings. Talking will
give them relief and a
feeling of being
understood.
Be empathetic.
 Non-judgmental
 Patient, calm

Take them seriously
and keep them on the
line.

Avoid arguments,
belittling, problem
solving or advice
giving.

Try to establish a
bond with the caller

 Let them know that you
are there to help

Try to identify areas
of commonality with
the caller
 Keep them talking
 Take notes
Reassure them and
focus on positive
alternatives
 Their problems are
very real but
temporary. Suicide is a
permanent solution.

Avoid sensitive topics
or things that set the
caller off.

Avoid statements that
are condescending:
 “You have everything
to live for”
 “I know how you feel”
 “There’s light at the
end of the tunnel”

Avoid statements that
will make the caller
feel guilty:
 “Think of how your
family will feel”
 “You will make
everyone feel sad”
Key Questions:
1. What is the patient’s
location? Phone number?
2. What is the suicide
mechanism? How? If drugs,
go to OVERDOSE protocol
3. Are there weapons involved?
Available?
4. Where is the patient now?
5. Is the patient breathing?
YES? Monitor breathing until
help arrives
If difficulty in breathing, go to
DIB protocol
NO? Go to ARREST protocol
per age
6. What is the history of the
incident?
Pre-Arrival Instructions:
1.Send law enforcement to
secure the scene
2. Attempt to calm the patient
3. Remove dangerous objects,
if safe to do, including
weapons
4. If caller is also patient,
attempt to maintain phone
contact. Be careful not to
agitate patient.
5. Call back if patient’s
condition worsens prior to
the arrival of medical
personnel
6.In case of suicide attempt by
hanging, to release patient,
cut ligature above the knot
ADDITIONAL INFORMATION
INQUIRE OF CALLER
1.Does the patient have a history of mental problems?
2. Is the patient under psychiatric care or counseling?
3. Any previous overdoses or suicide attempts?
USEFUL INFORMATION
IN DEALING WITH SUICIDAL CALLERS:
1. Remain calm 2. Instruct caller to stay on line
3. Avoid putting caller on hold
4. Avoid lying to caller
5. Dispatcher who answers call should create a
psychological bond with caller
6. Create an environment of trust
If the victim has ingested
drugs/poisons or has injuries,
refer to the proper protocol for
additional pre-arrival
instructions.
Will County Crisis Line
AAOS Emergency Care and Transportation
of the Sick and Injured 10th Edition
CDC website
SAVE (Suicide Awareness Voices of
Education) website
American Association of Suicidology
website
Will County (Region 7) EMDPRS