Suicide Prevention: Presence in showing up for others
You Don’t Need the Perfect Words…
Paul Frehner, Psychologist at Stillpoint Psychological Services in Peterborough, NH, specializes in trauma work in young adults, adults, and seniors. In his words, “We don’t talk about death, money, sex, or religion in our culture. There are so many topics essential for life that we, as a society, have difficulty talking about.”
The discomfort we feel about a subject can keep us from doing the one thing that helps most: talking about it.
Talking About Suicide Does Not Plant the Idea
At Trauma Responsive Monadnock, we’re working as a community to break this unspoken contract of silence. To raise awareness on the important topic of Suicide Awareness & Prevention, we sat down with Paul Frehner and Gina Pasquale, Executive Director and Licensed Clinical Psychologist at Maps Counseling Services, to help us better support those in our lives who are in need.
It’s normal to feel discomfort and even fear when raising the conversation with someone around suicide. Many people are concerned they’ll put the thought into a loved one’s head by saying the wrong thing or planting an idea that wasn’t actually there.
“What we do know for sure is that talking about suicide helps prevent suicide. Talking about suicide does not cause or catalyze suicidal thoughts or actions. Open and honest conversation is imperative for prevention. Appropriate services, access to resources, systemic societal changes, and continued efforts to center the mental health of our citizens as crucial to overall healthcare are all also necessary pieces of the prevention puzzle.” -Gina Pasquale
The conversation is where most of us need to begin with those we’re concerned about and care about. And it starts by moving through our own hesitation and discomfort.
Don’t Let Fear Freeze You in Place
The fear of saying the wrong thing freezes a lot of good people in place.
“The key ingredients to making sure we aren’t saying something unhelpful are kindness, emotional validation, actively listening, taking the person seriously, and demonstrating an accepting, non-judgmental attitude,” Gina says. “If our words meet those criteria, we are on safe ground, even if we stammer and stumble, and say imperfect words.”
Similarly, Paul frames it as presence over performance, “Relating is an intervention in and of itself. Even if you don’t have the conversation yet, just showing your interest and being present is vital.” People want to be noticed and seen, and suicidal thinking usually travels with a deep sense of isolation. Simply saying “I see what’s going on with you, I’m concerned about you, I’d like to talk to you” can matter more than we realize.
There’s inner work in this too, and it happens before we even open our mouths to show care and concern. “If we’re anxious, we can recognize we’re anxious, take a few deep breaths, and acknowledge we’re afraid of this, but it’s important and so we’re going to move forward in having the conversation, ” Paul shares. Part of showing up is tolerating the discomfort of being near someone else’s pain without rushing to fix it.
Signs to Notice, In Others and In Ourselves
Watching for warning signs isn’t only something we do for other people, Gina shares, “When we acknowledge that mental health is not separate from physical health, we can then also pay attention to when these signs and symptoms might be cropping up in us too.”
She groups the signs into three areas:
- Language: someone talking about wanting to die, expressing guilt or shame, or describing themselves as a burden.
- Feelings: emptiness, hopelessness, a sense of being trapped, agitation, rage, or unbearable emotional or physical pain.
- Behavior: withdrawal from friends, giving away important belongings, seeming to say goodbye, increased risk-taking, severe mood swings, changes in eating and sleeping, and increased use of substances to self-medicate.
Paul adds that certain moments and circumstances raise risk: a sudden loss, an accident, a history of trauma. He also names groups that tend to be more vulnerable, including middle-aged men and, increasingly, adolescent boys, often because they carry fewer or shallower community connections.
How to Start the Conversation
Avoidance of the conversation is usually what loved ones end up regretting.
Paul suggests opening with permission, sharing honestly your care for the other person. As an example:
“I’m really concerned about you. I’ve seen you change over the last few weeks, I’d like to have a conversation with you about your safety. Is that okay?”
Leading with a personal statement of concern conveys compassion before it asks anything of the other person. If you’re ever truly worried for someone’s immediate safety, welfare checks are also an option. You can call local police and ask them to check on someone you believe is at risk of harming themselves.
Why Trauma and Suicidal Thinking Are Connected
“The big component of suicide is hopelessness,” Paul says. “Hopelessness combined with pain.” When someone carries unresolved trauma and never receives the right support, they can be left with recurrent flashbacks, nightmares, and reactions they don’t feel in control of, and no sense that things could ever be different. That combination, pain plus the belief that nothing will change, is where risk lives.
Gina describes the toll trauma has on individuals by sharing, “The intensity and the toll that chronic emotional and psychological pain from trauma leaves in its wake is monumentally larger than having a rough day. The body-mind-spirit experiences the aftermath of trauma as if it is still happening, and it leaves a burning residue in the psyche that literally can alter our nervous systems. Thoughts of wanting to die are a normal response to that extraordinary amount of suffering.”
When we reframe suicide through this lens and see it as a normal response to abnormal suffering rather than a personal failing, it changes how we respond.
“It is incumbent upon all of us,” Gina says, “to double down on trauma and violence prevention efforts, investment in access to trauma treatment, and cultivating trauma-informed schools, workplaces, and communities.”
If You’re the One in Pain Right Now
If you’re reading this and you’re the one struggling, it’s no accident you’re reading this article. Both Paul and Gina have something they want you to hear today.
“In the darkest of times we can sometimes convince ourselves that people would be better off without us, but that is a trick of the mind and never true. Please reach out.” – Gina
Paul points to his research from grad school, “People who survived serious suicide attempts, by and large, were relieved afterward that they had lived.”
This all to say, the pain can feel permanent in the moment. It is not.
Talking alone doesn’t always lift someone out, but small, concrete actions can shift things: Asking someone to go for a walk with you, go swimming, watch a movie together, have a coffee, etc. Doing something that has a positive quality to it, along with professional support can help us get through.
And remember, crisis lines aren’t only for people in crisis, “Hotlines and resources are not just for folks who are themselves experiencing suicidal thoughts. They are also for people who are concerned about a friend or loved one.” – Gina
What Mental Health Really Asks of Us
Near the end of our conversation, Paul offered a powerful definition of mental health, “The way I see mental health is the ability to be present and to show up in your own life and with somebody else. Showing up, and actually being present with somebody who’s deeply in pain, that is an intervention in itself. And it takes courage and skill.”
When we get scared and lose that presence, we can get caught up in finding the right thing to say that we stop seeing the person in front of us. When we simply name what’s real and true right now, and see the person in front of us, it becomes easier for them to name what they’re feeling and for us to sit with them. That in itself is healing and relaxing for the nervous system.
The invitation is not to fix anyone, not to have perfect words. But, to stay present, notice, reach out if you’re concerned about someone, and start the conversation.
Being seen is the beginning of finding a way through.
What Mental Health Really Asks of Us
If You or Someone You Know Needs Support
These lines are for anyone in crisis and those worried about a friend or loved one. All are free and available 24 hours a day, 7 days a week:
- 988 Suicide and Crisis Lifeline: call or text 988
- NH Rapid Response Access Point: call or text 1-833-710-6477, or chat at nh988.com
- Crisis Text Line: text HOME to 741741
Locally, the Monadnock Region has independent psychotherapists, group practices, mental health agencies, and peer support options, including programs for people who are uninsured.
This article is for educational purposes and is not a substitute for professional medical or psychological advice, diagnosis, or treatment. With gratitude to Paul Frehner and Gina Pasquale for sharing their time and expertise.
Stillpoint Psychology Website: https://stillpoint.us.com/
Maps Website: https://mapsnh.org/
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