How do I support a friend in crisis when we’re long distance?

Dear Reader, 

Helping a friend to find their way out of suicide ideation and recover from a previous suicide attempt can feel like a never-ending journey, but it's a journey you don't need to take alone. The added complexity of isolation due to a pandemic, or even just a long-distance friendship, can also be frustrating. The COVID-19 pandemic and the mandated quarantines and closures that came with it contributed to a decline in mental health for many people globally. It certainly made feelings of anxiety and depression worse for many people who struggled with their mental health even before the pandemic. These symptoms aren't exclusive to pandemic isolation, in fact, any type of isolation or loneliness can be damaging to mental health and result in suicidal feelings. Despite any type of distance between you and your friend, there are still ways to help someone who is struggling, whether it be by creating space for open and continued communication or simply helping them identify more external resources. 

When you can't physically be there to comfort and support someone, often your words and actions can be an invaluable asset. There are strategies for communicating and showing support for someone who may be suicidal, even if you are far away: 

1. Ask: Asking someone about suicide may feel counterintuitive, but research has actually shown that asking about suicide-related thoughts and intentions won't actually increase a person's risk. Asking direct questions like "are you thinking about suicide?" can be more helpful in offering an avenue for a person to confide in you. Despite physical distance, more frequent check-ins via phone or computer may be appropriate. It can be helpful to remember that you don't have to wait for them to talk to you first. 
2. Be present: Although being physically with the person may be your first inclination, it's not always possible. However, there are still ways to be emotionally present. High-quality conversation and connection can still happen through regular communication, whether it be through message, call, or video chat. Part of having a high-quality conversation can mean you’re being mindful about limiting or avoiding multitasking altogether when you're speaking to your friend. This way you can ensure you're focused on the conversation and able to response more thoughtfully if they choose to disclose something to you. 
3. Help keep them safe: Trying to get a better understanding of their immediate risk can help you to understand the urgency of the situation. To do so, you might consider reflecting on questions like: Have they attempted recently? Do they have any current plans? Do they possess the means to act on a plan? Having information around these questions, even when far away, can help support a discussion about these details in order to help your friend create distance between themselves and any immediate risks. 
4. Help them connect: You might find it helpful to have a conversation with your friend about what support they currently have, what is available where they are, and what additional support options they're comfortable with. This may mean connecting them to helplines or mental health support, including options for telehealth appointments if needed. You may also offer to create a safety plan together for when thoughts of suicide are at their highest. 
5. Follow up: Following through on any commitments you make to them can help to build a strong bond and line of trust between the two of you. This could mean continuing to have a conversation with them about other ways you can help and check in regularly to provide support and understand further how they’re feeling. 

List adapted from #BeThe1To 

Even though it may not always feel like it, simply maintaining an open line of communication truly can be lifesaving and shouldn't be overlooked. Building off the five steps from #BeThe1To, you might consider being cautious when it comes to giving advice if not invited to do so. Offering unsolicited guidance may be taken as condescending or invalidating. Someone who may be feeling suicidal is often looking for a trustworthy and caring person to speak openly to. Taking the time to understand their perspective and experiences first before jumping into discussions about external support can be helpful in relaying to them your concern for their wellbeing. 

You mentioned that you used to speak to your friend daily but recently she hasn't been responding as much. Considering all that's been discussed so far, what next steps may you want to take to re-establish regular communication? Since you can't be there to physically hug her right now, what would an emotional hug look like? How do you let her know that you love her and want to continue to be there for her? Perhaps your bond may not feel as tight as it once was, but your continued support may be just the kind of reassurance she needs right now. 

If your friend decides she’d like help in identifying additional support, there are several options you can discuss together. The 988 Suicide and Crisis Lifeline and Crisis Text Line are two options for support that can be accessed 24 hours a day seven days a week. If she expresses interest in more long-term support for mental health or any of the physical symptoms you've named, you may also help her get connected with the appropriate health care provider(s). That said, being there for someone in this way can also be stressful and overwhelming for you. If you begin to feel this way, you might consider ways in which you can support yourself during this time, whether it's maintaining a self-care routine, talking with other friends or family, or speaking with a mental health professional yourself. 

Although you may not be able to solve every problem, you do have the ability to help guide your friend through this period either through your continual support or through helping to get her connected to more long-term professional help.