3.06 | Suicide ideation in others

[JoannaK]

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

[JoannaK]

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.

[Skip]

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:

[GradStudent]

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

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.

[blackandwhite]

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!

[blameme]

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?

[pallavirajsinghani]

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.

[OverBoard]

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.

[thimble]

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.

[Zaza42]

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!

[Skip]

As recommended by board members, I called 911 and described my situation... .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... .This a huge blow for us.

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.

[LoveNotWar]

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.

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.

[Steph]

 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

[thimble]

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.

[sotiredtoonice]

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.

[Auspicious]

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.

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 ... .

[Goldenchris]

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.

[TryingtobeReal]

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.    

[MarshaDole]

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.

[Suzn]

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.  

[Carri1]

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.

[MarshaDole]

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.

[Suzn]

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

[Auspicious]

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.

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.)

[mimitray]

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?

[mimitray]

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?

[Want2know]

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.  

[Auspicious]

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?

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

[selk]

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. 

[bumble bee]

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?