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• The Role of Employers in Preventing Suicide
• Recognizing the Warning Signs
• Responding to the Warning Signs
• Seeking Professional Help
• If a Suicide Happens
• Resources
  • Resources for Employers
  • Resources for Locating Mental Health Services
  • General Resources on Suicide and Suicide Prevention

Suspecting that an employee is considering ending his or her life can be frightening and confusing. You may not know when you should become involved in the problems of someone who is not a family member or close friend. You may be unsure of what you can really do to help someone with emotional difficulties or feel uncertain whether that person is actually in serious trouble. Being wrong could be embarrassing. But being right could save a life. These issues are especially complicated if you own a small business which does not have a human resources department or employee assistance program. This publication will help you recognize and assist an employee who may be considering suicide.

Each year, more than 30,000 Americans take their own lives. An additional 500,000 Americans visit emergency rooms for injuries related to suicide attempts. A large number of suicides and suicide attempts are related to treatable emotional conditions including depression and other mood disorders as well as alcohol and drug abuse. People may be embarrassed by those problems or fear that public disclosure will hurt their careers - although the Americans with Disabilities Act (ADA) prohibits discrimination in employment because of mental impairment.

People who are in danger of suicide often display warning signs. You may be in a good position to recognize such signs in your employees - even if they are trying to conceal their problems. You see your employees on a regular basis and know how they talk, act, behave, and react to stress in the workplace. You can recognize changes in their behavior, personality, or mood. Such changes may be the proverbial "cry for help." Signs that a crisis is imminent can include:

• Talking about suicide or death
• Making statements like "I wish I were dead." and "I'm going to end it all."
• Less direct verbal cues, including "What's the point of living?" "Soon you won't have to worry about me" and "Who cares if I'm dead, anyway?"
• Uncharacteristically isolating themselves from others in the workplace
• Expressing feelings that life is meaningless or hopeless
• Giving away cherished possessions
• A sudden and unexplained improvement in mood after being depressed or withdrawn
• Neglect of appearance and hygiene
• Sudden unexplained deterioration of work performance or productivity

You should respond to warning signs that an employee may be thinking of suicide. If you are comfortable speaking with this person, you should ask the difficult questions that can help you understand that person's state-of-mind and intentions. Don't be afraid to approach the issue directly and just ask: "Are you thinking of killing yourself?" or "Do you feel like you want to die?" If their response gives you any indication that they have been considering suicide or having suicidal thoughts, ask them to find help immediately. Offer to accompany them to your company's employee assistance program (EAP) and make an appointment with a counselor. If your company does not have an EAP, offer to help them find another source of mental health counseling. More information on how to find such counseling is provided below. You can also suggest that they call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). The Lifeline provides crisis counseling and referrals 24 hours a day, seven days a week.

Some of your employees may be your personal friends. You may maintain a more professional relationship with others. And some of your work relationships may be strained or even antagonistic. If your relationship with an employee who may be thinking about suicide is such that you do not feel he or she will talk to you about thee issues, express your concern to someone else - perhaps another employee who is friendly with that person or a member of the human resources department or EAP (if you have one). But as an owner or manager, you cannot delegate or assign responsibility to employees to help one another with emotional issues.

If you think a person is in immediate danger, do not leave him or her alone until you have found help. This may require mobilizing other employees or the person's friends or family. If a crisis seems imminent, accompany your employee to an emergency room or community mental health center. If your employee is unwilling to seek help or is uncooperative or combative, call 911 or 1-800-273-TALK (8255). Tell the dispatcher that you are concerned that the person with you "is a danger to themselves," or "they cannot take care of themselves." These phrases will alert the dispatcher that there is an immediate threat. Do not hesitate to make such a call if you suspect someone may be on the verge of harming him or herself.

The emotional problems associated with suicide - including depression, bipolar disorder, and the abuse of alcohol and other drugs - are difficult conditions requiring professional intervention. One of the most important things you can do for an employee who may be considering suicide is help him or her find professional help. This may require overcoming his or her reluctance to go to a mental health professional. Larger companies which have access to a human resources department or an employee assistance program have an advantage in locating such help. The resources included below can help owners and managers of smaller businesses locate professional help in their communities. You do have some control over the work environment. If your employee tells you that conditions in the workplace - perhaps stress or conflicts with other employees - are contributing to their depression or suicidal feelings, take action to fix this problem or relieve this stress -without violating the employees' right of confidentiality regarding his or her mental condition.

The suicide of an employee - even if it does not occur on the job - can have a profound emotional effect on the workplace. Owners, managers, and co-workers may struggle with guilt and unanswered questions. Some people may experience depression or suicidal thoughts after such an experience. Many EAPs or private mental health professionals offer grief counseling or "postvention" services for these situations. For additional information on helping yourself and others recover from such a trauma, see the Survivors publication. (http://www.sprc.org/featured_resources/customized/survivors.asp) in this series.

Americans with Disabilities Act (ADA) Home Page
http://ada.gov/
A U.S. Department of Justice website providing information and technical assistance on the Americans with Disabilities Act (ADA). This website includes guidelines, documents, and other resources concerning compliance with the Americans with Disabilities Act. The U.S. Department of Justice also operates a toll-free ADA Information Line for employers, employees, and others needing information and assistance. It can be reached at 800-514-0301 and 800-514-0383 (TTY)

Guide to Employee Assistance Programs and Services
http://www.eapassn.org/public/providers/
A database of employee assistance program (EAP) service providers which is searchable by state and specialty. This resource is a project of the Employee Assistance Professionals Association.

Handling Traumatic Events: A Manager's Handbook
http://www.opm.gov/Employment_and_Benefits/WorkLife/OfficialDocuments/handbooksguides/Trauma/index.asp
by Mary Tyler. Washington DC: Office of Personnel Management, 2003.
This U.S. Government publication contains guidance on anticipating and reacting to traumatic events in the workplace, including suicides, assaults, and natural disasters. Chapters include "How to Listen to Someone Who is Hurting" and "Supervising an Employee with Suicidal Concerns."

Mind Your Health In the Workplace
http://www.mentalhealthamerica.net/go/information/get-info/workplace
This Mental Health America website provides materials and resources for employers wishing to promote mental health in the workplace. These resources include factsheets such as "What You Need to Know: Returning to Work - Information for Reservists and Members of the National Guard and Their Employers" and “What to Do When You Think an Employee May Need Mental Health Help”.

National Partnership for Workplace Mental Health
http://www.workplacementalhealth.org/
The mission of the National Partnership for Workplace Mental Health is to develop and support educational efforts focusing on better understanding of the benefits of a mentally healthy workforce, early recognition of mental disorders, effective treatment, and appropriate access to quality mental health care. It is a program of the American Psychiatric Foundation in collaboration with the American Psychiatric Association. The National Partnership's website includes resources on workplace stress management programs, depression, dealing with anxiety, post-traumatic stress disorder, and Mental Health Works Online, a free quarterly publication about mental health in the workplace.

ValueOptions Strategic Principles for Suicide Prevention
http://www.valueoptions.com/suicide_prev/html%20pages/Support.htm
This web site was designed by ValueOptions (a managed care provider) to help employers create a comprehensive suicide prevention plan for the workplace. It includes materials for senior management, articles, tip sheets, posters, banner graphics, a self-scoring quiz, and sample public education email messages.

Bureau of Primary Health Care Service Delivery Sites
http://ask.hrsa.gov/pc/
A nationwide directory of free or low-cost mental health services.

Depression and Bipolar Support Alliance (DBSA)
http://www.dbsalliance.org
Patient-directed organization focusing on depression and bipolar disorder. The DBSA website includes resources that can be used to locate professional help or support groups, a wide selection of educational brochures on depression, bipolar disorder, and suicide prevention, and an online bookstore. The DBSA supports more than 1,000 peer-led support groups across the nation. These support groups can be located by using DBSA's website or calling (800) 826-3632.

National Mental Health Information Center
http://mentalhealth.samhsa.gov/cmhs/
Information on mental health and recovery for both professionals and the general public. This website includes:

• a Mental Health Services Locator featuring state directories of mental health and substance abuse treatment facilities and mental health services
• Consumer/Survivor Publications (in the Publications menu at http://store.mentalhealth.org/publications/browse.asp).

NAMI
http://www.nami.org
Non-profit grassroots self-help, support and advocacy organization of consumers, families, and friends of people with severe mental illnesses such as schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic and other severe anxiety disorders, autism and pervasive developmental disorders, and attention deficit/hyperactivity disorder. NAMI has local and state affiliates in every state that can provide support and education. NAMI also provides information and referrals through its Information Helpline which can be reached at (800) 950-NAMI (6264) or (888) 344-6264 (TTY).

National Mental Health Association (NMHA)
http://www.nmha.org/index.cfm
A non-profit organization addressing mental health and mental illness. Information available on the NMHA website includes fact sheets on depression, bipolar disorder, anxiety, substance abuse, and suicide; FAQs for consumers of mental health services; and a list of local affiliates who can be of assistance in finding mental health services in your area.

National Mental Health Consumers' Self-Help Clearinghouse
http://mhselfhelp.org
A consumer-run national technical assistance center serving the mental health consumer movement. Among the resources available on the Clearinghouse website is a directory of mental health services that have significant consumer input (that is, input from people who use mental health services).

Suicide Prevention Resource Center (SPRC)
http://www.sprc.org/
SPRC provides prevention support, training, and materials to strengthen suicide prevention efforts. Among the resources found on its website is the SPRC Library Catalog (http://library.sprc.org/), a searchable database containing a wealth of information on suicide and suicide prevention, including publications, peer-reviewed research studies, curricula, and web-based resources. Many of these items are available online.

American Association of Suicidology (AAS)
http://www.suicidology.org/
The goal of AAS is to understand and prevent suicide. AAS promotes research, public awareness programs, public education and training for professionals and volunteers, and serves as a national clearinghouse for information on suicide. Membership of AAS includes mental health and public health professionals, researchers, suicide prevention and crisis intervention centers, school districts, crisis center volunteers, survivors of suicide and a variety of laypersons who have an interest in suicide prevention.

American Foundation for Suicide Prevention (AFSP)
http://www.afsp.org
AFSP is dedicated to advancing knowledge of suicide and the ability to prevent it. AFSP's activities include: supporting research projects, providing information and education about depression and suicide, promoting professional education for the recognition and treatment of depressed and suicidal individuals, publicizing the magnitude of the problems of depression and suicide and the need for research, prevention and treatment, and supporting programs for suicide survivor treatment, research and education.

National Suicide Prevention Lifeline
http://www.suicidepreventionlifeline.org/
The Lifeline provides immediate assistance to individuals in suicidal crisis by connecting them to the nearest available suicide prevention and mental health service provider through a toll-free telephone number-1-800-273-TALK (8255) that is available 24 hours a day, 7 days a week. Technical assistance, training, and other resources are available to crisis centers and mental health service providers participating in the network of services linked to the National Suicide Prevention Lifeline.

National Center for Injury Prevention and Control (NCIPC)
http://www.cdc.gov/ncipc/
The NCIPC, located at the Centers for Disease Control and Prevention, is a valuable source of information and statistics about suicide, suicide risk, and suicide prevention. To locate information on suicide and suicide prevention, scroll down the left-hand navigation bar on the NCIPC website and click on "Suicide" under the "Violence" heading.

Suicide Prevention Action Network USA (SPAN USA)
http://www.spanusa.org
SPAN USA is the nation's only suicide prevention organization dedicated to leveraging grassroots support among suicide survivors (those who have lost a loved one to suicide) and others to advance public policies that help prevent suicide.

This publication is part of the SPRC Customized Information Series. Find out more at: http://www.sprc.org/featured_resources/customzied/index.asp