Module 3: Talking about suicide Risk: How you ask makes a difference

Opening the Door, Establishing Rapport

So, how do you lead into a discussion of suicide related issues? The previous general guidelines may seem simple enough but what happens when you really have to talk about suicide?

You probably won’t ever lead with, “so, are you thinking of killing yourself?” How to start will depend in large part on your pre-existing relationship with the person and about how you ended up at the point of talking to them about suicide. Do you know a lot about the person? Regularly speak to them? Did he or she come to you or are you initiating the conversation based on something that has been brought to your attention? Will the discussion happen at the church, at the person’s home, or somewhere else?
reaching out
You are likely to encounter two types of situations:

  1. Someone will come to you to talk about suicidal thoughts.
  2. You have a concern about someone and you need to approach him or her.

For the former, when someone approaches you, you will be looking for ways to approach the question of suicide and suicide risk. The place of the first discussion will be determined by the other person. They likely won’t start off talking about suicidal ideation or related risk factors and unless you had concerns prior to the meeting, you won’t initially be thinking in terms of suicide and suicide risk. In this case, the important thing is to be mindful of the possibility that your discussion may need to go in the direction of understanding possible suicidal thoughts or mental health issues. If so, you can segue into talking about risk, as is discussed later in this module.

“Doorknob” questions

Doctors often refer to the underlying issue that a patient really wants to discuss but which the patient doesn’t bring up immediately as a “doorknob” question. “Doorknob” because the patient will often wait until the visit is almost done and you are reaching for the doorknob before they raise the ‘real’ problem. Faith members who approach you first are quite likely to mimic this behavior. Putting off what they really want to talk about until you help them open up.

On the other hand, when you need to approach someone, your first decision is likely to be where and how you approach the person about whom you have concerns. Many times the easiest ways to do this are in passing during a service or other faith function; however, sometimes a phone call is the most private and least intrusive way of first connecting with the faith member. During this initial contact, you are simply opening the door to a conversation. Depending on where the contact occurs, you will likely continue it in the privacy of your office, or set a time to meet at the person’s home, your office, or a different location.

Seeing It in Action

Establishing Rapport: Case Videos

Reverend Molock with Allie

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Father Certain with Jasper

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Bishop Young with Nathan

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For both cases, a key initial issue is how to establish rapport. The establishing rapport stage of a discussion will likely not have anything to do with suicide. Here is where you open the door, you talk about things you share, you ask about kids, family, friends, anything you happen to know regarding the faith member. Establishing rapport may seem like banter, and it is, but it is also essential for enabling a conversation to enter into deeper topics. Without rapport, people will be far less likely to open up about more intimate topics.

We establish rapport to put people at ease. Does this person trust you? What do they perceive your motivations to be in asking about suicide?

What do they feel you will do with the information if they do disclose suicidal thoughts, feelings, and behaviors? What do they think you will think of them (how will you “judge” them – particularly relevant for faith leaders)? What is the history of the relationship between the faith leader and the member? All of these factors influence when and how a person might disclose, and may require patient, gentle support for the disclosure to emerge.

Let’s take a look at three examples of opening the door and establishing rapport. Ask yourself how the faith leaders initiated the meetings? How did they establish rapport? How are the 3 cases similar and how are they different? Under what conditions might you be able to use the strategies depicted and how might you do it differently?