Someone you love attempted suicide. Where do you go from here?

By Madeline Holcombe, CNN

(CNN) — What if talking about it brings it back up? What if I get uncomfortable and say the wrong thing? What does this mean about me? What if it happens again?

It can be difficult to know how to move forward when someone we love attempts suicide.

The problem is when fear leads loved ones to avoid a survivor of a suicide attempt, said Dr. Christine Yu Moutier, chief medical officer at the American Foundation for Suicide Prevention. Learning what you can do to provide a support system can help.

“At its core, a suicide attempt is a life-threatening health crisis, and gestures of support that you would use for other types of health crises can be appropriate here too,” Moutier said in an email.

Suicide is one of the leading causes of death in the United States, with nearly 50,000 deaths in 2021, according to the US Centers for Disease Control and Prevention.

The rate of attempts is many times higher, said Dr. Ken Duckworth, chief medical officer of the National Alliance on Mental Illness.

In the wake of an attempt, it is particularly important that a person get support, Moutier said.

“The first six months after an attempt or hospitalization are especially critical to a person’s recovery, and the risk for suicide remains elevated for the entire first year,” she added.

It may feel like an impossible situation, but there are resources and support available, Moutier said.

“During their mental health crisis, (a survivor) may have perceived themselves as being completely alone, or a burden on those who love them, so one of the most powerful gestures at this time is your ongoing presence and support,” she said.

Feelings of shame

A survivor once told Duckworth that she felt like an “emotional burn victim” and every part of her was tender and exposed.

“What do you do with that person? You want them to feel better, but it’s going to be very difficult,” he said.

One thing that makes the aftermath particularly hard is the feeling of shame that often accompanies surviving a suicide attempt, Duckworth said.

“If you’ve ever felt shame, you know how tender your emotions are,” he added.

That is why it is important to approach conversations around suicide without judgment, said Dr. Anita Everett, director of the Center for Mental Health Services for the Substance Abuse and Mental Health Services Administration. For example, Instead of chastising loved ones for missing therapy, ask if they need help with transportation.

And if you have a stigma about suicide, investigate that feeling and find a way to resolve it, she added.

Even without any stigma, there might be strong feelings around a suicide attempt such as anger, fear, sadness or confusion, Duckworth said.

While feeling those things are natural, try to avoid going to a survivor with questions such as “Didn’t you love me enough?” or “Aren’t I good enough to stick around for?” he said.

“It’s not a commentary on the strength of your relationship,” Duckworth said. Rather, try to “stay grounded, not get into advice and not be hurt.”

Talk about how you talk about it

Afraid that you will sweep the conversations under the rug? Or that you will talk about it too much? It can be helpful to have direct conversations with the survivor about how to move forward and follow that person’s lead, Everett said.

“Open the door to talk about what happened but don’t push them through it,” she added. “Don’t force them to talk about it unless and until the person who’s thought about suicide is ready to think about it.”

When it is time to start talking, you and the survivor can set expectations together — either one-on-one or with a therapist, Duckworth said.

Questions that can help include: How would you like me to approach this? What’s the best way I can be helpful? Do you want me to identify when you look like you are struggling?

The person may not know the answers right away, but it is important to communicate that you trust that person to take charge of healing and that you are there to provide support, Duckworth said.

“Do exactly what he or she wants,” he said. “Bring me Band-Aids, bring me Vaseline. Don’t talk about it. Stay away from me for three days.”

It might be hard to give this person space when you feel so uncertain and anxious about the future, he acknowledged.

“The idea is these are people who feel somewhat helpless,” Duckworth said. “You have to remind them that you want to support them in the way they want to be supported.”

As important as it is to keep the dialogue open, it is also key not to let suicide be the only thing you discuss.

“Make sure that simple healthy activities, such as going on walks, playing games, watching television together or partaking in any shared hobby, are part of the routine,” Moutier said.

She recommends resources such as the American Foundation for Suicide Prevention’s #RealConvo guide or its Talk Away the Dark campaign if you want more specific guidelines to these conversations.

Walk alongside the recovery

Of course, in hard times, people usually want to be helpful, Everett said.

And while you shouldn’t just jump to solutions, there are ways to “be in there with the person opening up opportunities for them,” she added.

Duckworth recommended taking steps to help expand the survivor’s view of available resources.

For example, 988 has shown to be a helpful resource as an emergency hotline for people with suicidal thoughts, he said. Support groups may be available to allow a person to talk about experiences with those who share similar ones.

Therapy, particularly dialectical behavioral therapy, a kind of cognitive behavioral therapy that focuses on acceptance of experiences, has been shown to reduce the risk of suicide, Duckworth said. With the survivor’s permission, you can offer to engage in any part of a treatment plan that would be helpful, he said.

There are medications and other treatments that may help as well, he said.

You can also help with a suicide safety plan, Everett said. It is usually a one-page document that people can go over with therapists or family members to list what they can do and what resources they can reach out for when suicidal thoughts come up, she added.

“What I love about it is it does have a pretty good evidence base behind it, and it also starts with a one-pager so it’s simple for families to fill out,” she added.

Take care of yourself, too

As much as you may want to be there to support the survivor of a suicide attempt, that person is not the only one who needs care, Moutier said.

“When someone you love attempts suicide, it may feel as though you have also experienced a trauma,” she added. “It is imperative that you take care of yourself physically, emotionally and spiritually, and seek support in taking those steps if you need it.”

You may feel angry or sad — or even surprised at the depth of your loved one’s struggles, Everett said.

And even though you may feel like it, the attempt is not a failure of your love and support, Duckworth said.

If the anger or fear of another attempt is overwhelming, know that loved ones can also use 988 for support. And the National Alliance on Mental Illness offers Family to Family education courses, he said.

But first and foremost, it is important to know you are not alone, Moutier said.

“Remember, you may not be the best person (and don’t need to be) for every single part of their recovery. Lean on others who have a positive impact on their mental health,” she said. “No matter how you process these complex emotions, you should not have to cope alone so be open to letting others help you navigate this experience.”

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