INDIANAPOLIS -- Since Sunday, Indianapolis police have been called to help suicidal persons 17 times. One of those calls came too late. Another ended with a man shot after he threatened himself, his family and officers.
All Indianapolis police officers now receive mental health crisis training, and the department says many have had crisis intervention training and even more advanced training including Mental Health First Aid.
In the vast majority of IMPD calls involving a personal in a mental health crisis, things resolve peacefully. But police intervention in a mental health crisis is far from ideal – and could potentially be avoided altogether, according to Dr. Shannon Woller, if people were more willing to talk about suicide openly and honestly.
Woller knows something about suicidality. As the chief psychologist and director of the mental health clinic at Richard A. Roudebush VA Hospital, Woller works with a population that is more prone to mental illness, substance abuse disorders and suicidal thoughts than the general population.
Woller says she recommends people adopt the same approach she uses with her patients at the VA: Be direct.
“Sometimes we have to ask, ‘What’s going on? What is really going on? Are you thinking about hurting yourself?’” Woller said. “People don’t like to say those words. They’re not comfortable words to say. But most people who commit suicide have told somebody and have talked about their thoughts about death and dying, and giving someone a non-judgmental forum to talk about suicide can be all it takes to get them connected with the help they need, as opposed to continuing to walk down the hopeless path of suicide.”
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Far from making things worse – a common belief about bringing up suicide, Woller said – talking about those thoughts and feelings can be the key to addressing them.
“That’s one of the myths about suicide, that if you ask about it, you’ll trigger it in somebody. What we find is that if you ask somebody who’s not suicidal if they are suicidal, they’ll just tell you, ‘No, I haven’t had thoughts like that.’ You’re not going to trigger that reaction. People are so afraid to talk about it that it feels shameful or like the person needs to hide it, because no one’s willing to communicate about it.”
Reducing the Risk
As part of her job at the VA, Woller also does risk reduction for patients who are considered at high-risk for suicide. That means things like removing alcohol from their homes and encouraging them to stay sober, asking them to make more times for friends and family, and issuing gun locks. That last point is an important one.
“I work with veterans and as a rule, veterans like guns,” Woller said. “What I talk about with my veterans is the pros and the cons of certain things they have in their home, the pros and cons of alcohol consumption when they’re in this state of mind. Of course, my preference as a psychologist, if someone if is acutely suicidal, if someone is depressed, if someone is suffering from significant PTSD symptoms, we do want the weapons out of the house. I’ve had people give them to their brother, give them to another trusted gun owner and just say, hey, hold on to these.”
Here too, police have a role. IMPD’s mental writs policy allows them to place someone in immediate detention for up to 24 hours if officers have reasonable grounds to believe they are an imminent danger to themselves or others and are in need of hospitalization and treatment.
And under the Jake Laird Law – named for an IMPD officer who was fatally shot by a man suffering from mental illness – police are empowered to seize and hold firearms from people deemed to be dangerous or mentally ill.
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In April, a 21-year-old man called 911 saying he was having suicidal thoughts. Officers arrived to find him visibly upset. Inside the house was a gun, which officers transported to the IMPD property room for safekeeping.
A better option, though, is voluntary surrender. In July, a woman flagged IMPD officers down, saying she wanted to surrender her gun for destruction because she was suicidal. Officers took the gun, and ultimately also transported her to receive medical attention as well.
IMPD says anyone who wants to surrender a gun for any reason can call 911 and an officer will come out to document the need and then take the firearm, if appropriate.
Woller says all of this is important because, while the walk toward suicide is usually an extended process, the decision to actually take the action can be very impulsive.
Psychologists determine a patient’s risk for suicide in part based on whether they have three things: intent, a plan and the means.
The time between intent and plan can often be significant – but once people are in the planning stage, Woller said, things have gotten very serious.
“We get into trouble when we’ve come into the plan,” she said. “And when the plan is something very, very lethal like opioids, weapons, hanging … if somebody makes a split decision once it gets to that level, it can happen very fast.”
In a 2001, the Centers for Disease Control released a study by Drs. Thomas R. Simon and Alan C. Swann that looked at 153 people ages 13-34 years old in the Houston, Texas, area who had attempted suicide and lived.
Of the people they interviewed, 24 percent of survivors of nearly lethal suicide attempts said they had “spent less than 5 minutes between the decision to attempt suicide and the actual attempt.”
For respondents who had used a violent means, such as a firearm, even more – 35 percent – said they had gone less than 5 minutes between the decision to take their own life and the attempt.
Other studies of larger populations have found that as much as 50 percent or more of all suicide attempts may occur within less than an hour of the decision to do so.
Having immediate access to a gun, Woller said, can make the difference between whether a suicidal person survives that hour.
“We do need to reduce the risk by not having things in the house that could potentially, if somebody gets into a bad state of mind, help them carry out something that, a few hours later, a day later, they would not carry out,” Woller said.
At the end of the day, though, Woller says the greatest tool for preventing suicide is still just asking about it. That’s why every patient at the VA is asked if they are having suicidal thoughts on every single visit.
“We ask everybody every time we see them here if they have suicidal ideation or not,” Woller said. “And that’s because you never know when you’re going to catch the one who you don’t expect. People don’t expect 16-year-olds to kill themselves. People don’t expect people in college, who have bright futures, to kill themselves. Don’t trust your judgment – just ask.”
For veterans, a mental health hotline is available 24 hours a day, seven days a week by phone at 888-777-4433 or online here. The Roudebush VA also staffs its ER 24/7 with social workers trained specifically to help patients considering suicide.
If you’re not a veteran, help is available through the National Suicide Prevention Lifeline 24 hours a day online at http://suicidepreventionlifeline.org or over the phone at 1-800-273-8255.
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