BPDFamily.com

This Workshop will discuss the problem of threats of suicide, suicide ideation and attempts in those with BPD.
 
The bpdfamily protocol for suicidal ideation is outlined here:
 https://bpdfamily.com/discussions/search-info3.htm
 
How To Be Helpful to Someone Who Is Threatening Suicide
 

• Be direct. Talk openly and matter-of-factly about suicide.

• Be willing to listen. Allow expressions of feelings. Accept the feelings.

• Be non-judgmental. Don't debate whether suicide is right or wrong, or whether feelings are good or bad. Don't lecture on the value of life.

• Get involved. Become available. Show interest and support.

• Don't dare him or her to do it.

• Don't act shocked. This will put distance between you.

• Don't be sworn to secrecy. Seek support.

• Offer hope that alternatives are available but do not offer glib reassurance.

• Take action. Remove means, such as guns or stockpiled pills.

• Get help from persons or agencies specializing in crisis intervention and suicide prevention.

www.suicidepreventionlifeline.org (https://suicidepreventionlifeline.org/#)

MYTH: You have to be mentally ill to even think about suicide.

FACT: Most people have thought of suicide from time to time and not all people who die by suicide have mental health problems at the time of death. However, the majority of people who kill themselves do have such problems, typically to a serious degree.  Sometimes this has been recognised before the person’s death and sometimes not.

MYTH: People who talk about suicide aren’t really serious and not likely to actually kill themselves.

FACT:  People who kill themselves have often told someone that they do not feel life is worth living or that they have no future. Some may have actually said they want to die. Whilst it may be the case that some people talk about suicide as a way of getting the attention they need, it is very important that everyone who says they feel suicidal be treated seriously.

MYTH: Once a person has made a serious suicide attempt, that person is unlikely to make another.

FACT: People who have attempted to kill themselves are significantly more likely to eventually die by suicide than the rest of the population.

MYTH: If a person is serious about killing themselves then there is nothing you can do.

FACT: Feeling suicidal is often a temporary state of mind. Whilst someone may feel low or distressed for a sustained period the actual suicidal crisis can be relatively short term. This is what makes timely emotional support so important.

MYTH: Talking about suicide is a bad idea as it may give someone the idea to try it.

FACT: When someone feels suicidal they often do not want to worry or frighten others and so do not talk about the way they feel. By asking directly about suicide you give them permission to tell you how they feel. People who have been through such a crisis will often say that it was a huge relief to be able to talk about their suicidal thoughts. Once someone starts talking they have a greater chance of discovering other options to suicide.

MYTH: Most suicides happen in the winter months.

FACT: Suicide is more common in the spring and summer months.

MYTH: People who threaten suicide are just attention seeking and shouldn’t be taken seriously.

FACT: People may well  talk about their feelings because they want support in dealing with them. In this sense it may be that they do indeed want attention in which case  giving that attention may save their life.

MYTH: People who are suicidal want to die.

FACT: The majority of people who feel suicidal do not actually want to die; they do not want to live the life they have. The distinction may seem small but is in fact very important and is why talking through other options at the right time is so vital.

Here is the site protocol. We worked this up in conjunction with 2 directors of National Hotlines.  It's an interesting topic area - there are many papers on the psychology an methods for attending to the suicidal ideation of others (which is very different than attending to ourselves).

I had the misfortune of experiencing a suicide in my life. When you do you realize that all the logic that you used to characterize it as idle manipulation or impulsive seem pretty meaningless after the fact.

Anyway, our protocol... .

1. Take it seriously.

Myth: “The people who talk about it don't do it.” Studies have found that more than 75% of all completed suicides did things in the few weeks or months prior to their deaths to indicate to others that they were in deep despair. Anyone expressing suicidal feelings needs immediate attention.

Myth: “Anyone who tries to kill himself has got to be crazy.” Perhaps 10% of all suicidal people are psychotic or have delusional beliefs about reality. Most suicidal people suffer from the recognized mental illness of depression; but many depressed people adequately manage their daily affairs. The absence of “craziness” does not mean the absence of suicide risk.

“Those problems weren't enough to commit suicide over,” is often said by people who knew a completed suicide. You cannot assume that because you feel something is not worth being suicidal about, that the person you are with feels the same way. It is not how bad the problem is, but how badly it's hurting the person who has it.

2. Remember: suicidal behavior is a cry for help.

Myth: “If a someone is going to kill himself, nothing can stop him.” The fact that a person is still alive is sufficient proof that part of him wants to remain alive. The suicidal person is ambivalent - part of him wants to live and part of him wants not so much death as he wants the pain to end. It is the part that wants to live that tells another “I feel suicidal.” If a suicidal person turns to you it is likely that he believes that you are more caring, more informed about coping with misfortune, and more willing to protect his confidentiality. No matter how negative the manner and content of his talk, he is doing a positive thing and has a positive view of you.

3. Be willing to give and get help sooner rather than later.

Suicide prevention is not a last minute activity. All textbooks on depression say it should be reached as soon as possible. Unfortunately, suicidal people are afraid that trying to get help may bring them more pain: being told they are stupid, foolish, sinful, or manipulative; rejection; punishment; suspension from school or job; written records of their condition; or involuntary commitment. You need to do everything you can to reduce pain, rather than increase or prolong it. Constructively involving yourself on the side of life as early as possible will reduce the risk of suicide.

4. Listen.

Give the person every opportunity to unburden his troubles and ventilate his feelings. You don't need to say much and there are no magic words. If you are concerned, your voice and manner will show it. Give him relief from being alone with his pain; let him know you are glad he turned to you. Patience, sympathy, acceptance. Avoid arguments and advice giving.

5. ASK: “Are you having thoughts of suicide?”

Myth: “Talking about it may give someone the idea.” People already have the idea; suicide is constantly in the news media. If you ask a despairing person this question you are doing a good thing for them: you are showing him that you care about him, that you take him seriously, and that you are willing to let him share his pain with you. You are giving him further opportunity to discharge pent up and painful feelings. If the person is having thoughts of suicide, find out how far along his ideation has progressed.

6. If the person is acutely suicidal, do not leave him alone.

If the person is acutely suicidal, do not leave them alone - drive the person to the nearest emergency department or other service facility. They may be hesitant - that is normal. The local suicide hotlines can advise you of the best facility.

If the situation is life threatening, or the person refuses to go for care, or you are unable to transport them, call 911.

Please do not use emergency medical services to teach anyone a lesson.

.

If the means are present, try to get rid of them. Detoxify the home.



7. Urge professional help.

If someone is acting suicidal or talking of suicide, it is vitally important to get them into professional care at the first signs. Like many disorders, early detection and treatment yields better outcomes. Persistence and patience may be needed to seek, engage and continue with as many options as possible. In any referral situation, let the person know you care and want to maintain contact.

8. From crisis to recovery.

Most people have suicidal thoughts or feelings at some point in their lives; yet less than 2% of all deaths are suicides. Nearly all suicidal people suffer from conditions that will pass with time or with the assistance of a recovery program. There are hundreds of modest steps we can take to improve our response to the suicidal and to make it easier for them to seek help. Taking these modest steps can save many lives and reduce a great deal of human suffering.

https://bpdfamily.com/discussions/search-info3.htm:

I don't know if anyone else would find them helpful (and I certainily wouldn't recommend them as a stand alone measure for handling suicidal ideations, gestures, or attempts... .) but SAMHSA offers FREE wallet cards for how to handle suicide/self-injury situations.

Here is a link to their page for the National Society of Suicide Prevention.  www.mentalhealth.samhsa.gov/suicideprevention/fivews.asp (http://www.mentalhealth.samhsa.gov/suicideprevention/fivews.asp)

To find the wallet cards, you go to publications, and search "suicide."  They are still in stock, I just ordered another 45 last week.  They serve as a tangible reminder to think and act as a process rather than a reflex.

SAMHSA is the United States Substance Abuse and Mental Health Services Administration and they run a clearinghouse for publications.  Some are available online.  Most are geared toward professionals in the field and I'd say that a good 75% are focused on substance abuse issues.  However, some are easily understood by people outside of the field and they even offer some self-help publications.

To answer the validation question, I think that the answer would vary depending on the person you are intending to calm.  Some people would respond well to, "I hear you saying that you are angry/scared/sad, what can I do to help?"   Others would rage even more that you presumed to "know" their feelings.

It's my personal opinion that if someone is in the mood to rage, they will find something to rage about regardless of any attempts to de-escalate the situation.  If there's a contentious relationship and the non-suicidal individual is typically a trigger for the suicidal individual, I don't know that attempts at validation would make the situation improve.  I am a fan of 3rd party intervention.  Not even necessarily emergency personnel, but just someone less evocative to try and better assess the situation.

I think it's fair to mention, too, for anyone new to this world, that 911 will not always provide the response you anticipate.  There will be times when callers will be referred to the local mental health crisis number.  There will be times when that crisis number will be of zero assistance.  There will be times when the first available appointment from the crisis number to meet with a mental health professional will be weeks away.  Even individuals with regular professionals on their treatment team might not receive immediate attention of they are known to make threats.  

If all of these options are not responding and people feel that their loved ones are not safe, I'd recommend calling the sherriff to have them removed and trotting myself to the Magistrate's office (or the procedure in your state) to begin the process of involuntary committment.

We have and emergency link at the bottom of every thread.  Please remember this - it has the site protocol for how to deal with a member that is having suicidal ideation and how to deal with a person in your life that is suicidal (very different).

Click it - check it out!

(https://bpdfamily.com/message_board/images/mb/messageboard-footer.jpg) (https://bpdfamily.com/discussions/search-info3.htm)

I have looked on the board for this a bit but can't find an answer so if this is on here somewhere could someone point me to it? I made the mistake of breaking the NC rule with my pwBPD thinking that months of time would have ended the drama. So wrong. So he's back to the suicide threats.

Here's the dilemma: Next suicide threat and/or attempt if I WALK away and do not call 911 could I be considered legally responsible? I have contacted his parents and told them that I simply cannot put myself in danger again to keep him from killing himself and would walk away. They were furious and say that he would be fine but claims that I am the problem.  I know I should call 911 but last attempt he swore to God he: "would make [me] pay" if I called 911. He is extremely vindictive and my guess is that the consequences and rage would be out of control high if I call the cops. I suspect he and his family might even figure out some way of taking legal action against me.

Summary: If he says he's going to jump off a cliff and I drive away and discover a day later that he did am I responsible legally despite having notified his friends and family he is suicidal?

Your responsibility (ethical or otherwise), begins and ends with the 911 call.

They are trained. You are not.

They have the authority to take him to the hospital for observation.  You do not have that authority.

Enough 911 calls due to suicide threats = possible court mandated therapy.

911 call is your absolution and your salvation and your safety.

Not always... .mine was in ICU 5 days without insurance. Released... no observation or therapy. Since we were not married and she did not have health insurance... .they just let her go once she got her bearings... .and then all hell broke loose again.

But, yes... .they are prepared to handled it.

My significant other had a serious breakdown and started saying she "wants to end her life" or "doesn't want to live anymore" and banging on the walls, etc. Probably the worst and most terrible situation you can be in.

As recommended by board members, I called 911 and described my situation. She continued to be out of control for some time, until the police arrived.

But after talking to them and describing her feelings, she calmed down, and was at her normal capacity.

An officer still recommended her for an emergency committal, which I expressed wasn't necessary, as did she. Still he persisted and requested an ambulance to come and pick her up and drive her eleven miles to the nearest hospital.

We just received the bill, which is over $700. We're 23 and 21 and are just getting by paying our rent. This a huge blow for us.

She will be checking in with her insurance tomorrow morning. But I'm hoping somebody might have some experience with this sort of thing and what we can do to avoid paying out of pocket for services we DID NOT want.

*The officer also told us "we shouldn't have to pay" for the ambulance.

If it's volunteer you can call and state your situation. As an EMT, we don't make an evaluation, we have to push you to come.  I'm not sure if it's for a medical reason or $$$.

If you say 'no' three times we'll leave you alone about it.

Volunteer should let you off the hook, no insurance? If you call the corps, they'll usually reduce it to circumstances, let me know how it goes!

Getting someone to professional help is important and there are many ways to do that.  Suicides tend to occur impulsively so how you deal with the immediate situation is important.  911 is one way, but there are other less dramatic ways, too.

1) Trying to get the person on a local Hotline number would be my first line of attack.  A local Crisis Hotline (not the National organizations) will have the ability to remotely trigger the police or ambulance while on the call.  These volunteers are trained to assess the situation and will dispatch if they think there is danger.  Most of the time, they will recommend an ER that sees suicidal ideation.

2) Another option is to call the Hotline and get the information and drive the person to the ER or have someone else drive them like a friend.

3) If either if 1-2 fail, if someone else is potentially in danger, or the situation includes a plan and a means, call 911.  It's pricey and dramatic - but at times, most prudent.

If you can't be there, getting someone else to be with the distressed person is important - a family member, friend, neighbor.  Making the ideation visible to others helps too - it brings focus, aid, accountability, and other resources to help out.

Not all suicidal ideation is equal and we need to make some judgments.  We often know the person intimately and while we what to be very conservative, we can't pretend that all suicidal ideation should be treated with a one size fits all response. We won't follow that when the time comes - so its better to think practically - know how to triage.  

I would never ignore, taunt a personal, or do anything to increase the crisis. This may mean getting manipulated a bit in the moment, but when the crisis clears, you lay the ground rules for handling the next crisis. For example, you could say that you are very concerned and encourage that next time that the person needs to call X for support, or that if they don't go to the ER, you may need to call 911 to be safe.   Making the ideation visible to others helps too - it brings focus and other resources to help.

And lastly, I also might suggest making a plan in times of calm so that you will know what to do when it happens - these can be highly emotionally charged events and it hard to think clearly in those situations. Learn your options and tipping points in times of calm so that you will be ready in times of crisis.

Suicidal threats are very scary! I am sure the situation was horrible and i am sorry you had to cope with that. You did what you thought was right to help your partner.

What if you hadn't taken action and she hurt or killed herself?

You did the right thing.

I know the bill is hard to swallow but if you can't get it reduced or get the insurance to pay for it you might be able to make nominal monthly payments.

 What happened after she was taken to the hospital?

These trips in can be a real asset to recovery... .the reality of a psych unit, diagnosis, etc... really an excellent intervention.

Taking her in was the right thing to do... it kept her safe and it brought her to the attention of professionals. It also lets her know that 911 will be called when she is out of control emotionally, as she was.

The bill can be negotiated... .had she taken her life, it could not have been.

Having lost a close friend to suicide last September, I can tell you that it is a terrible, horrible way to lose someone. ALWAYS call 911 when suicide is threatened. Alternatively, you can drive her in to a hospital ER yourself, if she will go. In ANY case, one or the other needs  to be done.

Steph

I strongly agree that it has ultimately helped her realize that she needs help and that her condition is serious. She was at the hospital most of the day, and talked to several different doctors. According to her, they said that her condition wasn't really suicidal and just that she was really stressed. Her argument to me and against the situation in general is that "it's just something she says" and not something that she plans on actually doing.

So we actually had a quite a good conversation once the shock of the bill settled down... .On her perspectives on suffering and escape. Her feelings are that suffering in life is inescapable, and this contributes to her logic that screaming "i want to end my life" is just a cathartic expression of that frustration. She said she sees death as the only release.

I described to her that the way I see my life is almost the opposite, that I've learned to find release in living, and that this is possibly the goal of living.

Anyways, back to the hospital day. After the whole ordeal she actually expressed that she was happy that all of it had happened, because she had the experience of talking to professionals that validated her need for help. Before, she has felt selfish or childish is seeking therapeutic help, but she is now much closer to recognizing it as a necessity, and a good thing. She has had one appointment and does plan to continue seeing someone.

Ultimately, everything worked out for the best. I am just still shocked at the bill and we will probably be receiving one from the hospital for their services as well. So I recognize that there is a certain quality to the experience that is priceless, but at the same time, the actual logistics of getting her to a hospital to talk to someone theoretically could have only involved a car ride and $5.00 worth of gas.


I really must thank you all for your support. It is quite a stressful thing I had to do, and to have you folks re-affirm that it was the right thing to do is really comforting. I don't really have anyone else to go to.

I'm sure we'll get the financial situation straightened out, and in the meantime, I must continue to encourage her to continue her therapy.

Just giving input here... .ambulance billing is my thing. $700.00 bill is correct, they are pricey, but thats because they are on call 24/7 to help people in need. If you have insurance it should pay at least SOME of it, rarely all of it. Most ambulance companies should work with you to make monthly payments to pay the bill off. Ask about a prompt payment discount. Sometimes if you are willing to pay a big chunk, they will take off a big chunk.

My wife used to use that argument a lot.

The fact is, though, that if you live in a family or a community, then there are things that simply can't be things that you "just say". (Or rather you can, of course, but people are going to take action based on what you are actually saying.)

I can't "just say" my little bank robbery joke to the bank teller, ya know ... .

My ex attempted suicide on multiple occasions, but all but 1 were cries for help. Admittedly she did hospitalise herself for 10 days the time she DID do it, but I had already rang 911 and sent an ambulance round as soon as I got a text telling me she had slit her wrists (which she hadn't actually done, and instead had injected herself with as much of my insulin as she could find - so even then, it wasn't all truth)

If your ex says "I've done it" or similar, just phone the professionals and keep your distance. If they had/ have actually done harm to themselves, then you would need to call for an ambulance either way. If its a cry for help (which it probably is).

Its quite embarrassing to have to explain to the people called out it wasn't serious.

I cannot begin to tell you how many times my ex uBPDbf threatened suicide... ."I just don't belong on this earth"  "Will you come over and be with me... .I don't want anyone else to find me."  



Oh and then there was the time a girl he was having an affair with (behind my back of course) called me on my cell, asked me my address because he had just texted her he was "ending it all."  She wanted to come to my house (!) to beg him to "not go through with it."   No idea how she got my name or number!   Quite the shock... .I let her know he was actually sitting at my kitchen table, on his computer, drinking a cup of coffee... .

I know not all BPD's are the same, but over the 5 yrs I was with my ex, it just became a standard conversation we had almost every month.   I think he was feeling bad about himself, wanted attention and was manipulating me.  Of course, I panicked almost every time, that sick pit in my stomach of "oh no, is he really going to do it this time?"  

Afterwards when I wanted to talk about it, he would minimize it and say he was just in a bad place.   He was pulling me along on his rollercoaster ride.

Please take care of you.  The advice everyone has given you seems to be on target but don't forget about you in all of this drama.    

My BPD exBF was serious. He had pills purchased over a period of a couple of weeks. He had a note written to his family and friends and a will. The threat was very real.

I called a medical friend to come and meet me after persuading my BF to meet us both. Together we got him into the hospital, where he said all the same stuff all over again and was then hospitalized against his will. He got the help he needed while there and was diagnosed and put on medication that does stabilize his mood swings.

I don't agree with those here who say people don't give a warning.

My exBPD bf definitely did. And he later told me it saved his life. He told me that AFTER he had left me to return to a previous GF, so I definitely believe he was going to do it.

I think we should all remember that about one out of ten pwDPD actually DOES commit suicide, not just talk about it. It's a very high percentage compared to some other mental health conditions.

My exBPD bf told me something in his head was telling him to do it, and he said, "You wouldn't believe how compelling it is." I believed him then and I still do.

It is quite possible to reinforce suicidal behavior unknowingly.

Meaning... .a person who is suicidal may feel they get more attention or a temporary relief from demands made on them... even small demands. He may not even be aware that the attention he's getting is reinforcing his suicide threats. Once that idea is there for his relief of his own anxiety it's there for good. In other words it's always going to be an option for his relief. Changing your behavior when he does this is reinforcing his behavior... ie calling more often, spending more time with him than you normally would an such...

Regulating your emotions is first an formost. These threats are extremely stressful for you and that's not at all healthy. Have you thought of speaking with a T to help you with these situations? It would be very valuable to help you through your own enabling of his behavior.  

I recently read that if you call 911 and tell them what's going on (suicide) ... .if he/she has a cell phone ... .Emergency Services can find out exactly where he/she is by the cell phone number.  It tracks it somehow and very quickly.  It's a good thing because they don't have to be at their own houses.

Carri 1, that is such valuable information and it could save lives. I hope one of our senior members or board moderators will see to it that this info is put somewhere very prominent on the home page and kept there indefinitely. I seem to remember reading this info somewhere before, but I had kind of forgotten it. My exBPD bf was in his car once threatening to kill himself by having a one-car head-on accident. I talked him out of it, or he said I did, but many hours passed before he finally came home. I could have called 911 on my land line and given them his cell phone number even as I was talking to him. This could be crucial info for anyone whose loved one has a suicidal crisis.

Great idea Marsha... .we'll see what we can do.  |iiii

Cell phone tracking literally saved my wife's life. Twice. (And she wasn't the one who called - one of those times I called 911, and the other time, her therapist did.)

One caveat that I have experienced with calling 911 is that if the police do make contact with the person, at least for me in the area where I live, the police themselves carry out an evaluation (I forget what it was called exactly) that is a set of questions that determines criteria for whether they need to involuntarily bring the person in for help or not. My sister had been threatening suicide repeatedly day after day but at the time the police made contact with her, she was able to answer all of their questions correctly so they had to let her go.

And now she has made the threat that if we were to call the cops again, she would kill herself.

So personally, I am at a loss at what to do. I feel like I can't even do what people and professionals tell me to do (call the cops if I am worried about her safety).

I fear that if the cops made contact with my sister again prematurely a second time, then it would cause her emotions to escalate further and push her to actually carry out her threat to kill herself.

I am just wondering what are some different opinions on a situation like this, where the individual with BPD is able to "work the system" (as much as I hate to say it that way) and uses my contacting authorities as a part of her threat to kill herself?

Hi,

I'm not sure if this is the proper forum to post this question in - I apologize if it is not. My older sister has BPD and has been making constant suicide threats every day for the past four weeks. I only just found this forum and learned of "emotional blackmailing", which is what it sounds like she is doing to me. An example of the things she'll say to me is:

"Tell [ex-bf] or I'll kill myself."

"No one wants to help me, all I'm asking for you to do is email him for me and you won't because you'd rather see me die."

"You want me to die."

"Tell him or I die."

She has told me multiple times that she has a plan,  and has picked a time, place and method to kill herself but she won't tell me the details. She's tried to kill herself twice in the past, so she knows that if she told me then I would call the cops.

She's also very fixated on the idea that the police or therapists are going to "lock her away". She has been in a short-term facility previously but was allowed to leave after about 2 weeks.

I'm having trouble understanding the balance between dealing with emotional blackmail and dealing with a "crisis situation". Almost each night for the past four weeks, she will threaten that she will kill herself because I am not helping her or that she will kill herself because I won't contact the ex-bf for her.

I have been calling the police to find her (she is currently living out of her car, and not returning home so I don't know where she is) every time she makes the threat to kill herself. However, the police have yet to locate her.

I am a little confused as to what to do once the "crisis situation" is "over" - in the mornings when I (or other people) hear from her, she does not seem "acutely suicidal" anymore. Do I keep the missing person report when she does not appear acutely suicidal at the moment?

I know that when a person makes a suicide threat, I am supposed to call the police. But what if this threat isn't acted on the next day? Is it still appropriate to get the police involved if the threat was made days ago?

95% of suicides happen during a depressive episode.  

In an out of control situation like this, calling 911 during the crisis period effectively puts the person in protective custody until the episode passes.  Most jurisdictions have a law that limits involuntary commitment to 72 hour (e.g.Baker Act).

After the depressive period,  the police don't really have a role.

With two attempts behind her, there is a high likelihood that your sister will try again and even if its drama  - many people die unintentionally during half hearted attempts.

The thing that would help your sister is admission to a inpatient program in a specialized mental hospital - these programs have a high success rate in remitting people with chronic suicidal ideation.

I feel for your situation, mimitray, and hope that this information helps.  

The answer is one that you are not going to like: you can't let yourself be controlled by her threats.

I've been controlled by those same threats. "If you call the police I'll REALLY kill myself".  I don't even know what that means... .when she's rational, we discuss the threats and she is logical about them.  When she's in a rage, those conversations never existed.  I have told her that if she lays out a threat to kill herself I will call 911... .but I never have had to do it, and the thought of it makes my stomach turn.  911, means police, then ambulance then trip to local ER, waiting for hours to find a psych unit, then ambulance ride 3 hours to that.  3 days there, then find your own way home or I go get her.  Is all of this better than her dying?  OF COURSE.  Is my own ego and humiliation what is stopping me from calling?  YOU BET.  Small town and all.  Are those feelings real although often misunderstood?  Yes.  If you live this life with a person with BPD, then you know this can end as suddenly as it starts... ."if I just wait a little bit, this will pass, then I can go back to my own private self torture and denial."

So, I guess what I am trying to say... .is I totally understand that calling 911 isn't easy.  And, I also know that the results of calling aren't always great or even all that helpful.  But, I agree with everyone who states the obvious... .it's better than dealing with a followed through threat.  None of this was any help, but I did just want to say that I know how you feel. 

Your local Mental Health Center will be able to help you to fill out committment  papers on her. They'll of course need an address. Is there a way you can find out her exact location?

My STBXw swallowed a handful of pills right in front of me a couple of months before my kids & I GTFO. Right after she had thrown an entire room of crap at me, & scratched the s__t out of my neck & tore my shirt, all while she was screaming at the top of her lungs, “SAVE ME! SOMEBODY SAVE ME!”…... I did call 911, police & EMT’s arrived at house. As soon as they got there, CB took one of the officers aside to “Talk” where she accused me of beating her up & she was deathly afraid of me and wanted me arrested. Luckily for me, the officer was smarter than that. He came out, told me of the accusations & said, “But I don’t see any marks on her” so he did not believe it was true. He paid no attention at all to my torn shirt or bloody neck. I can only guess it is because I am a man... .She refused treatment or to go with the EMT’s… He asked her to leave for the night & she just said in her most afraid & frail voice, “But I don’t have any place to go, It’s just me & this house, I have nothing else”… (hilarious because she has over a dozen family members within 5 miles of the house). The officer looked at me & said, “You’ve gotta go”. (all of my family is over 1500 miles away!). I left & stayed with her brother for the night. He thinks she is a CB too…...

Being “Compassionate”  & calling 911 could have easily got me arrested if a different officer had showed up.  BTW… Now she gets to tell everyone (and has) that the police ORDERED ME OUT OF THE HOUSE for the night.

If there is ever another situation like this again, I will probably just “Get out of the car”

Peoples idea of compassion can mean different things to different people. In my case, the person who threatened me with this and I know he's bluffing because he's done it multilple times and never even attempted suicide. I don't call the police in this case because I know. Calling the police would end up with this person being taken to the hospital and grilled by multiple psychiatrists and doctors and being labled a suicidal on his medical records which will follow him for life! With insurance companies and whoever else needs that information,  being dischared on multiple medications, possibly put on some sort of compliance agreement which requires them to "take their medicine" or be re admitted and commited. No thanks. I don't do that. And my person is glad I don't and so am I. Calling the police on him to put him through that, I do not see as compassionate. My life my choice.

I am NOT a professional or have done a ton of research, so this is purely my personal opinion. Here is my take:

A BPD informs you of an intent to harm themselves, usually implying that your actions will help determine his decision/actions. You have now been informed of a threat to the health/life of a person you know. It is possible that you are the only one who has this information - if this is the case, it places an enormous potential responsibility on your shoulders as you weigh your options of "dealing with it yourself" vs. "calling the professionals".

Let's take an analogous setting: You and your SO are out camping. She gets bitten by a snake. You believe that the snake is "most likely" harmless, but you are not in a position to determine with certainty if it is. Do you "deal with it yourself" because you feel it is "most likely" harmless or do you "call the professionals"?

This is a 2x2 outcome matrix. On the one dimension you have the BPD SO actually intending to kill or seriously harm (S) vs. not kill or seriously harm (NOT S) themselves. On the other dimension is your choice of getting immediate help or not. Let's go through the 4 potential outcomes (focusing on the BPD - of course with a BPD you always have to be prepared to deal with accusations of domestic violence against a BPD's SO, especially if you are male):

S and 911 - if they are in time, you helped save a life and may have contributed to the BPD getting professional help for his disorder. Of course they can still decide to kill themselves later, but for now they get to live another day. (++)

NOT S and NOT 911 - while there is not actual threat to their lives, you are possibly still the only person that knows about their threat. There is also a risk if the BPD feels you are not "taking them seriously enough" that they may escalate the threat level to get a reaction (such as full compliance) out of you by actually starting to (non-lethally) harm themselves. (0 / -)

NOT S and 911 - while there is no actual threat to their lives, they are now in contact with professionals who can help make that determination and potentially facilitate the BPD getting the medical attention they need. Also the BPD now knows that trying to use threats of suicide to control you can have a cost attached: Having to deal with emergency responders. This may discourage them from using threats of suicide to emotionally control you again. (0 / +)

S and NOT 911 - here the BPD may die or be seriously injured, causing follow-on emotional trauma to family / kids - and you would have to live with the guilt of not having decided not to act on the information you had. While you may be able to "logically" tell yourself that it was not your fault, I'm not sure your conscience will be so rational. ( -- )

The problem with the decision matrix is of course that you do not know whether the BPDs intention is suicide or not, so you have to make a decision under this uncertainty. "I don't think they will do it" is not a solid base to make what might literally be a life-and-death decision.

In my view,

911 comes with ( ++ ) and (0 / + ) outcome

NOT 911 comes with ( -- ) and (0 / - ) outcome.

I would call the professionals. That does not mean that your personal decision to handle it yourself is necessarily "wrong", but you would be taking a risky gamble that I would not be prepared to take and would not recommend others take.

When someone is using suicidal threats to meet their emotional needs they are in need of professional help.  When professionals step in an opportunity exists for them to get that professional help.  If professionals are not brought in and there is no accountability for these threats the behaviors will most likely continue.  Repeated behaviors have a pay off somewhere or they wouldn't be repeated.

I think it is important for all of us to explore this in depth and get clarity so that if or when the times comes we can make a well informed decision.  :)uring times of crisis it is difficult to think clearly and time may be of the essence.  

And, yes, I have had to call 911 several times for my own daughter when she was raging a threatening to jumop out of a window.

Thank you Alvino for that very good explanation that you took the time to post!

lbjnltx

Keeping it all in perspective  :)  Don't wait for a distressed call to act.

1) 95% of suicidal ideation is related to chronic or ongoing depression - it's not a isolated event - its an impulsive reaction to ongoing depression.

2) Suicidal ideation needs professional treatment. Early treatment is important.

3) People will be most responsive to treatment that they buy into and that is safe and comfortable - and most importantly have a supportive family (studies have shown the family role as very significant).  All clinicians agree about getting a person to professional help in the most cooperative way as possible.  All clinicians stress the importance of involving family - bringing it out in the open and helping.

4) 911 primarily serves to physically disrupt an act.  It is force and it can save lives to stop aggression and should be used in situation where a reasonable person perceives a threat. But it is not a substitute for treatment and support and it has downsides.  

We often know the person is distress and the history of prior suicide attempts, the severity of acute depressive incidents or compounding depressive incidents, changes in behavior, etc.  We may not make a perfect decision, but we can do better than the person who is distressed. We want to make a wisemind decision and error on the side of taking action in ambiguous situations.

5) Compassion and support during and after the 911 call is extremely important to recovery.

6) Calling a 911 and cutting off communication - going NC or changing a phone number - will likely cause the depressed person to experience a major depressive event (the 911 episode with rejection) that may be  greater than the what spurred the initial plea for help - especially if it was a benign plea.  This could make the person more acutely depressed in the period after release.  It could shame the person into withdrawal and reluctance to seek treatment or  share the expression of future feelings of despair.  Remember, depression is a more chronic problem (weeks) and commitment laws limit the government from forcibly holding anyone for more than 72 hours.

7) Using 911 to enforce no contact or send a rejection message is abusive.

8) Our role as members is not to prescribe to members which actions to take, but to communicate a perspective and balance so that they can make informed wisemind decisions.  It would be nice if there was a one size fits all, 15 word answer - but this topic is far more complicated.

9)  A lot of members of Leaving and Undecided, over the years, have approached this topic as manipulation and made recommendation on how to stop manipulation.  Yes, this is a effective way to get a faker to stop faking it.  But is it responsible way to act?

~ A pwBPD is 400% more likely to commit suicide that they average American,

~ Only 1 in 25 suicide attempts is successful. Having a previous suicide attempt is not an indication of faking, is is considered by professions to be a significant risk factor to suicide death,

~ 95% of suicides are with people that have had suicidal thoughts - Having a previous suicide thoughts is not an indication of faking, is is considered by professions to be a significant risk factor to suicide death,

~ Not all suicidal ideation is equal - the severity and duration of depression, the severity of acute depressive incidents or compounding depressive incidents (e.g., family death, loss of job, relationship failure), changes in behavior, etc. - the availability of a means and a plan -  all must be considered when making decisions on how to respond and act.

What is a suicide threat?

We reviewed the last 20 times members recommended 911 for "suicide threat" and none of the situations were actionable calls. In one case, a member was concerned that her ex boyfriend may be depressed and possibly suicidal (in general). There were no words or actions.  She was advised to call 911 and simultaneously go no contact.  Can you imagine a full emergency contingent just showing up one day?  And the person that called them not taking calls?  Frankly, the caller would probably at risk for making a malicious false alarm if she did this.  

In 18 more cases where the situations did not rise to the level of suicide threat all were told to call 911... .mostly to shut the person up. In 14 of the cases, it was also recommended that the caller go no contact after making the call. This is not responsible.

In the remaining case an estranged husband was clearly getting his affairs in order over a 4 month time frame and has not mentioned suicide. He seemed seriously suicidal. Members again recommended 911. Clearly this man needs help, but this isn't going to help.   EMTs can't transport someone for cashing in a 401 K and transferring the money to a daughter.

There is a difference in general depression and a suicide threat

It's really important to separate out general depression which requires one type of response (not 911) and a suicide threat - a risk event.  911 calls are good for:

1) A true in-the-moment threat event - not just casual or past musings

2) Only if the person refuses to go to talk to a HOTLINE and follow their advice or is too emotional/unstable to make the trip in a car.

When a person is making the genuine actionable suicide threat they are effectively saying "I cannot safely cope with this situation - I need serious intervention to protect my life and health."  And if the person is not amenable to less forceful treatment and support, you need to take action.


It's precisely for these reasons that if my wife ever makes another suicide threat (she has a history), then I will (unless she immediately calms down and agrees to go straight to her therapist or to a hospital) call 911.

I would just like to clarify and add to my previous comment about not calling 911. In this case, I describe above and my decision in not callling 911, the person I am speaking of is not BPD and also does not have mental illness. It's basically a threat I get when in arguments. Similar to someone who says... .if you don't shut up... I'm going to jump off a cliff, jump in front of a bus, shoot myself... .or whatever. He does it to make me angry and shut me up and it works because it does scare me and it usually ends the arguement. Latter when we discuss he assures me, he's never going to do that and just says it to shut me up. In this case, in my opinion this is not an "acute suicidal ideation." Obviously, as he's never attempted suicide in his life and this has been going on for years.

Having said that, if I knew someone who had BPD and threatend suicide, I would take that seriously. I may or may not call 911, depending.  However, I may call the hotline, encourage them to call the hotline and also encourage outpatient mental health suicidal ideation evaluation by a professional.

These are just my opinions, not to be taken as a "protocol" for anyone to follow. Just my experiences and what I think I would do in the situation. Each and every one of us has glean from all the info, decide what they want to use or not use and make their best decision in how they will proceed.

What about the situation where a person says 'I feel f suicidal every day' in angry response to you saying you felt down?

When I asked further if she were okay she laughed and said 'don't worry dear, I've not slit my wrists yet have I'. She has said other similar things often in anger or as a response if you ever say you're upset or down.

But when asked about it not in a rage or not in that sort of response she refuse to discuss it and say she is 'okay'.

So she is not saying she s thinking about doing it just that she feels it?

I would definitely be concerned ... .the question is whether that is something you would call emergency services for.


One thing you might do is to call a community mental health center in your area, or the psychiatric ward of a local hospital. Describe your situation, say that you are concerned, and ask for advice on what to do. Those local resources should be familiar with your local laws and available services.

Linusham building on what Auspicious is saying this is a moment where you can address the topic of suicide with the person.  And stay on this topic not letting the person minimize the severity of it or your concern.  If you call the local hospital/hotline and they say to bring the person in because its not an immediate threat qualifying for 911 then you can suggest to the person let's go down to doctor and address these feelings.

If the person is yanking you around emotionally playing at suicide, staying on point addressing the issue with concern with love they will see you aren't playing around.  If they are seriously depressed and need support you are there.

Here is our Safety first protocal with good information on resources and steps we can take: https://bpdfamily.com/discussions/search-info3.htm  (https://bpdfamily.com/discussions/search-info3.htm)

Have you had a chance to talk to someone about it?  These situations can be stressful.

My BPD spouse began obsessing over the Sandy Hook tragedy on the day after it occurred.  I was also very upset.  We have a very large home and live on opposite ends, as our contact is quite limited.  I was doing laundry and she initiated a rant about Sandy Hook that went to a rant about people calling her daughter a whore to a rant about people calling her a whore and eventually to me being some kind of pervert and how I didn't realize how close she was to killing herself.  

Naturally, I freaked out.  She has always engaged in self-mutilation, but never vocalized suicide.  

I had already contacted MHMR authorities (Mental Health & Mental Retardation Centralized Intake) and got a "hotline" card from them.  

Calling MHMR was pointless.  They asked if she was armed or taking pills.  If not, then there was no "emergency".  

I called the County Judge and with his help got them to respond two days later.  The Sherrif's Dept responded and picked her up only to return her two hours later without advising me.  I found out when she surprized me in the kitchen with "I'm going to kill you."  She laughed and added, ":)on't you think I know how to escape?"  I didn't think it was funny, but did not react openly.  

I then called the MHMR people and it took 4 hours for them to give me a response... ."She doesn't appear to be a threat to herself and others now.  She just feels guilty about letting you molest her daughter."  

You can only imagined how I freaked.  

I demanded a meeting and they made a home visit that night.  They said that they could not force her to seek help and would run a 7 day evaluation and report.  No offer to clue me in on the results of the report.  No offer of support to me.  As they were leaving my home, my BPD spouse told them that I was "punishing her" (for what I don't know).  As the MHMR people drove away my BPD spouse lit up a joint she had squirreled away.

Needless to say, they have not contacted me.  7 days have come and gone.  So much for caring.  

It is easy to say that the mental health care system is bad, but I imagine that's only because I actually expected something.  

Tomorrow may be New Year's eve, but I'm going to see my attorney, the County Judge, and whomever else necessary to put an end to this lunacy.

H56

It is ironic that the title of the workshop popped up, when I was grappling with the suicidal issue for the entire weekend.  My d25 has several times taken too much prescribed medicine and ended up down at the hospital ER.  One time she took excessive medication and then tried to hang herself.  I have been working with my therapist on breaking the rescue role and setting boundaries.

    Friday night she took took much medication (not to my knowledge).  Saturday night she does it again (and tells me).  Sunday night she repeats it and calls me. I ask her to call the crisis center, but she would not.  I read several postings when I logged on Sunday night.

   Auspicous said
   Since she is an adult, I am not allowed to be with her in counselling nor have I met her counselor.  I did call the agency and request that I leave important information.  I did and the counselor did call my D telling her either she goes down herself or the police would be there. When I went to her house, it was full of knives, screw drivers, etc all over the place.  Her cutting had escalated also.

   Like Hunter 56, I have experienced the nightmare of dealing with the current mental health situation. But this time it worked (she is currently hospitalized).

   As Green Mango stated
I thought this time she met No. 1 and No. 2.  Thanks to the workshop.

                                                                                                 Tightrope Walker

                               

                         

This is an interesting thread for me.  Here are some of my feelings on the subject:

My BPDh has threatened suicide many times, and I have watched him try.  He even overdosed on pills one time when I wouldn't stay with him, going ahead with it when I had given my firm "no," and then threw them up to save himself soon after. 

Most of the time his threatens are his way of ordering me to give into whatever his needs/wishes are, over-riding my own.  I haven't allowed it to change my behavior, and have looked at it as just another way of him abusing me. 

I think every time is different though, and I remain on guard.

There have been times where I have felt very envious of his freedom to threaten suicide, of his freedom to express his sadness and anger.  Every one feels overwhelmed at times, and as much as I value my life and would never seriously consider suicide, I could imagine how fulfilling it would feel just to express the general feeling of "misery" and "helplessness" to him when I was hurt. 

this is a good thread.  I am not sure how I feel.  My dd 38, has 3 children has continued to threaten to kill herself off and on throughout the past 20 some years.  We never take it lightly but, scary to say it seems to be like the "little boy who cried wolf".  I agree with some posters that in our dd's case sometimes it is a, I just can't handle things, don't want to deal with things, way to pull our strings.  It is very destressing for us.  She sometimes text, like a bomb shell,  better make arrangments to get the kids I love, cause I am going to kill myself tonight.  Or we get the ,  I wish I had the guts to just shoot myself in the head.  I am dead inside so who cares. 

I worry that, because I am not valadating her feelings nor is her bf, when she says this. 

I am kind of confused as on one hand we are suppose to valadate, not tell them they have issues, mentally problems, I am using the words in general terms, and yet we will take them to mental health, dr.s or call 911 .  That is a huge statement telling them we think something is wrong.  Which it is and if they say these things they are accountable for their actions.

My fear in calling ( which probably is wrong) is that she will go to ER, maybe be kept for a little while, then released with not really any follow up, someone had to pick up her children,  bf family and or friends would probably know, because we are 6 hrs. by plane to get there.  She would be devistated, and it may drive her over the edge.   HOW DO WE WEIGHT THIS OUT?  CALL 911 or not.  When you think this may be just, I am really made and i can't deal anymore. 

There are no perfect answers. In the end you just do your best and hope for the best. It is not your fault that she has this mental illness.

She's the one making the threats. She's the one telling you that she is putting her children at risk. Whether she understands it or not, there are natural consequences that flow from doing that.

Mutt I totally get where you are coming from and agree with your pragmatism... .I wouldn't usually interject on a topic of such seriousness... .but with such personal experience... .and also as wishfulthinking has suggested (please correct me if I'm wrong)... .this is behaviour that has been exhibited before by him... .without consequence rather than an impending emergency right now?... .

In the UK 999 calls to suggest suicide threat invoke a rather tame disinterested response from emergency services... .litigation isn't such an issue yet, most police don't have guns (things are changing though)... .

I fully appreciate a phonecall could escalate events to a situation that caused more harm than good... .but I have made a personal decision that when someone threatens such a violent act (and it is that)... .it is not my responsibility to assume responsibility... .for them.

Imo if we consistently react to such threats with that call (in my country of origin)... .it lessens the frequency of that behaviour over time... .or appropriate care responds every time... .win-win  |iiii

Thanks Newton. This info should be helpful.  

Thanks for the article Mutt... .|iiii... .hopefully thought provoking to members... .

I read similar as part of ambie training here... .seen similar in my security role... .I think personal interpretation of the information is the 'right' thing to do here... .we only have so much influence/control in any given situation we didn't instigate... .we all choose our own paths.

A seemingly relevant example (I hope it isn't considered a 'hijack' by the thread host... .I'd like to hear back from wishfulthinking) ... .was a frantic 'suicide threat' from a BPD ex approx 2 years ago... .I had a call at midnite from an unknown number... .recognised the voice as my ex (separated 1 year approx)... .threatening suicide... .then a guy came on the phone suggesting ... ."everything was ok... .don't phone the police or anything like that"... .

I hung up... .phoned the police and ambulance.  I received a txt from him 2 days later saying... ."Well done fella... .she put all the phones in the house in the bath she was in... .she is fine".  I was glad for them, what if she wasn't?... .I don't want that 'on' me.  I appreciate this isn't the same dynamic as being in a rs, I have similar stories to share from those another day... .I chose to do the same then too (after time and reading)... .their behaviour changed, that is my experience... .I don't want that responsibility... .I am not omnipotent... .this is the ultimate threat other than intended violence expressed against us.

Imo people can act out 'kicking off' to their hearts desire... .I can cope with that or choose to walk away.  Someone who is threatening to take my life... .or their own... .changes the game.

Hi all  

I've posted in a thread before about my experience advocating for a sexual assault survivor who also happens to have BPD, and I wanted to ask a question here - why do people with BPD make suicide threats that they have no intention acting out on?

Within two weeks of me being called into the case, she was asking me "how do I go to the hospital?" but when I asked her when she wanted to go, she said 'maybe' during spring break when she had more time. It turns out she was making these kinds of threats for months with the crisis center - she would constantly talk about "wanting to go to the hospital" and then when the crisis counselor asked her when she wanted to go, she replied "one day."

We finally sat down with her and told her the next time she would make those threats, we would call the hospital. She then immediately stopped, and later told us she had set a 'date' (two years out) which was her way i guess of letting us know we wouldn't have to worry in the immediate future while still maintaining some control of the situation.

Apparently she does this with other people too, like her friend. Her friend told her she was having ideations about jumping off a roof/ledge before she went mountain climbing, but then went mountain climbing and according to everyone there, appeared happy/had a great time.

My question is... .why do some BPDs do this? I understand many don't want to feel abandoned. Maybe she was doign that to me and the crisis center woman so we would feel more invested. Maybe she really does feel some deep inner pain. Could it also be that some BPDs (especially if they cross-over into narcissism/sociopathic traits) enjoy the manipulation and power play of having someone worry about them?

Her friend told her she was having ideations about jumping off a roof/ledge before she went mountain climbing, but then went mountain climbing and according to everyone there, appeared happy/had a great time."

Correction: her friend told ME the girl was having ideations... .