Understanding Suicide: Overcoming Struggles with the Help of Jesus

1. Overview • New Website: https://www.lds.org/get-help/suicide?lang=eng&cid=rdb_v_suicide_eng • 8 Sections • Doctrines & Principles • How to Help • Crisis Help Lines • Video • Loss Survivors • Attempt Survivors • Thoughts of Suicide • FAQ

2. Understanding Suicide - Kenichi Shimokawa • Over 800,000 people end their lives by suicide each year worldwide. This is likely underreported. • Second-leading cause of death among people between 15 and 29 years of age. • In most countries, suicide rates are the highest among people over 70 years of age. • Approximately 40-60% of those who commit suicide do so during a depressive episode or during a recovery phase. • The lifetime risk for someone who suffers from multiple depressive episodes is around 15% and depressed people are 50 times more likely to commit suicide than non-depressed people. • Moving beyond depression, 90% of those who commit suicide have some sort of psychiatric disorder at the time. • Those aged 18-24 are at the highest risk for suicide attempts and women are more likely to attempt suicide than men. • Around 10% of all high school and college students have seriously contemplated or attempted suicide. • Men and those over the age of 65 are more likely to complete their suicide attempts.

3. Understanding Suicide – Clinical Perspectives • Causal Factors • Hopelessness: A belief that one’s future is hopeless is a major predictor of suicide. Death is seen as the only way out of an “unwinnable” game. • Psych ache: The term “psych ache” has been used to refer to a deep sense of uncontrollable and inescapable pain that the individual feels. Suicide is an attempt to escape the pain that the person believes is insurmountable. • Relationship Failure: Failure to establish or the loss of a close-personal relationship is correlated with many suicide attempts. • Unemployment: Researchers have also identified that there is a correlation between men losing their jobs and committing suicide shortly thereafter. For many men their identities are grounded in their work and the loss of a job can be devastating. • Biology- Twin studies reveal that identical twins are 19x more likely to both attempt suicide than fraternal twins are. Researchers believe that there is an independent genetic vulnerability to suicidal behaviors. • Ethnicity: White people have higher rates of suicide than do African-Americans, except among young males where the suicide rates are similar. • Religion: Countries with predominantly Catholic or Islamic populations show much lower suicide rates than other countries. Certain religious beliefs appear to be protective factors against suicidal behaviours.

4. Doctrines and Principles Principle 1: There is no struggle Jesus can’t help you overcome. • No Matter what a person is struggling with, Jesus has experienced it so that He could help them overcome it. (see Alma 7:11–13) • James E. Faust taught: “Since the Savior has suffered anything and everything that we could ever feel or experience, He can help the weak to become stronger” (“The Atonement: Our Greatest Hope,” Ensign, Nov. 2001, 20). • “When ye are weary he waketh morning by morning.” (2 Nephi 7:4) The Lord is there every moment and consecrates your deepest suffering to your gain. (2 Nephi 2:2) • “I, God, have suffered these things for all, that they [and that means you and I and everyone] might not suffer if they would repent.” [D&C 19:16] In our moments of pain and trial, I guess we would shudder to think it could be worse, but the answer to that is clearly that it could be worse and it would be worse. Only through our faith and repentance and obedience to the gospel that provided the sacred Atonement is it kept from being worse. (Jeffrey R. Holland – Lessons from Liberty jail) • “When it is obvious that a little time in Liberty Jail waits before you (spiritually speaking), remember these first two truths taught to Joseph in that prison-temple. First, God has not forgotten you, and second, the Savior has been where you have been, allowing Him to provide for your deliverance and your comfort.” (Jeffrey R. Holland – Lessons from Liberty jail)

5. Doctrines and Principles Principle 1: There is no struggle Jesus can’t help you overcome. • As the prophet Isaiah wrote, the Lord has “graven thee upon the palms of [His] hands” (Isaiah 49:16), permanently written right there in scar tissue with Roman nails as the writing instrument. Having paid that price in the suffering that They have paid for you, the Father and the Son will never forget nor forsake you in your suffering. They have planned, prepared, and guaranteed your victory if you desire it, so be believing and “endure it well” (D&C 121:8). In the end it “shall be for thy good” (D&C 122:7), and you will see “everlasting dominion” flow unto you forever and ever “without compulsory means” (D&C 121:46). • Remaining true to our Christian principles is the only way divine influence can help us. The Spirit has a near-impossible task to get through to a heart that is filled with hate or anger or vengeance or self-pity. Those are all antithetical to the Spirit of the Lord. On the other hand, the Spirit finds instant access to a heart striving to be charitable and forgiving, long-suffering and kind—principles of true discipleship. • Joseph Smith said: “Therefore, dearly beloved brethren, when we are in even the most troubling of times], let us cheerfully do all things that lie in our power; and then may we stand still, with the utmost assurance, to see the salvation of God, and for his arm to be revealed…Joseph says let us do all we can and do it cheerfully. And then we can justifiably turn to the Lord, wait upon His mercy, and see His arm revealed in our behalf. [D&C 123:17; (Jeffrey R. Holland –Lessons from Liberty Jail)

6. Doctrines and Principles Principle 2: Mortal life is a precious gift from God—a gift that should be valued and protected. • President George Q. Cannon of the First Presidency made a clear statement about the seriousness of suicide when he said: “Man did not create himself. He did not furnish his spirit with a human dwelling place. It is God who created man, both body and spirit. Man has no right, therefore, to destroy that which he had no agency in creating. They who do so are guilty of murder, self-murder it is true; but they are no more justified in killing themselves than they are in killing others. What difference of punishment there is for the two crimes, I do not know; but it is clear that no one can destroy so precious a gift as that of life without incurring a severe penalty.” (Gospel Truth, 2 vols., Salt Lake City: Zion’s Book Store, 1957, 1:30; italics added.) • President Spencer W. Kimball made an equally strong statement in 1976. “It is a terrible criminal act for a person to go out and shorten his life by suicide,” he said. (Teachings of Spencer W. Kimball, ed. Edward L. Kimball, Salt Lake City: Bookcraft, 1982, p. 187.) • “Whatever your struggle, my brothers and sisters—mental or emotional or physical or otherwise—do not vote against the preciousness of life by ending it! Trust in God. Hold on in His love.” (Jeffrey R. Holland – Like a Broken Vessel)

7. Doctrines and Principles Principle 3: Suicide is a sin but it is not our place to judge the eternal fate of those who commit suicide. • The late Elder Bruce R. McConkie, formerly of the Quorum of the Twelve, expressed what many Church leaders have taught: “Suicide consists in the voluntary and intentional taking of one’s own life, particularly where the person involved is accountable and has a sound mind. … Persons subject to great stresses may lose control of themselves and become mentally clouded to the point that they are no longer accountable for their acts. Such are not to be condemned for taking their own lives. It should also be remembered that judgment is the Lord’s; he knows the thoughts, intents, and abilities of men; and he in his infinite wisdom will make all things right in due course.” (Mormon Doctrine, Salt Lake City: Bookcraft, 1966, p. 771; some italics added.) • “Suicide is a sin—a very grievous one, yet the Lord will not judge the person who commits that sin strictly by the act itself. The Lord will look at that person’s circumstances and the degree of his accountability at the time of the act. Of course, this gives us no reason to excuse ourselves in committing sins, nor will the Lord excuse us, if I understand correctly.” (M. Russel Ballard – Suicide, what we Know and what we don’t)

8. Doctrines and Principles Principle 4: There is still hope for those who commit suicide • “I have sincerely sought direction from our Father in Heaven to help me understand the nature of suicide. And I have come to know, as well as anything else that I know from God, that these people have a place in the kingdom of our Father, and it is not one of darkness or despair, but one where they can receive comfort and experience serenity.”(M. Russell Ballard- Suicide: What we know) • “They committed a very serious sin, and some consequences of it may remain with them throughout eternity.” (M. Russell Ballard- Suicide: What we know) • Suicide need not be the defining characteristic of an individual’s eternal life.

9. Doctrines and Principles Principle 5 : Most want relief from pain. • Most people who have thought about suicide do not want to die; they simply want to find relief from the physical, mental, emotional, or spiritual pain they are going through. • Even righteous people like Paul have “despaired even of life” (2 Corinthians 1:8) when they felt weighed down and in deep distress (see also Numbers 11:14–15; 1 Kings 19:4; Jeremiah 20:14; Philippians 1:21–24). Principle 6: Acknowledge Mental Health Struggles & Seek Help • “In that spirit I wish to speak to those who suffer from some form of mental illness or emotional disorder, whether those afflictions be slight or severe, of brief duration or persistent over a lifetime. We sense the complexity of such matters when we hear professionals speak of neuroses and psychoses, of genetic predispositions and chromosome defects, of bipolarity, paranoia, and schizophrenia. However bewildering this all may be, these afflictions are some of the realities of mortal life, and there should be no more shame in acknowledging them than in acknowledging a battle with high blood pressure or the sudden appearance of a malignant tumor.” (Jeffrey R. Holland – Like a Broken Vessel) • If things continue to be debilitating, seek the advice of reputable people with certified training, professional skills, and good values. Be honest with them about your history and your struggles. Prayerfully and responsibly consider the counsel they give and the solutions they prescribe. If you had appendicitis, God would expect you to seek a priesthood blessing and get the best medical care available. So too with emotional disorders. Our Father in Heaven expects us to use all of the marvelous gifts He has provided in this glorious dispensation.” (Jeffrey R. Holland – Like a Broken Vessel)

10. Neal A. Maxwell – Enduring Well Principle 6: Learn how to find value in suffering • Everyone faces trials and feels abandoned by God at times. [D&C 121:1–3] • Anne Morrow Lindbergh wisely cautioned: “I do not believe that sheer suffering teaches. If suffering alone taught, all the world would be wise, since everyone suffers. To suffering must be added mourning, understanding, patience, love, openness and the willingness to remain vulnerable” (quoted in “Lindbergh Nightmare,” Time, 5 February 1973, 35). • Certain forms of suffering, endured well, can actually be ennobling. Annie Swetchine said, “Those who have suffered much are like those who know many languages; they have learned to understand and be understood by all” (quoted in Neal A. Maxwell, We Will Prove Them Herewith [1982], 123). • Part of enduring well consists of being meek enough, amid our suffering, to learn from our relevant experiences. • The Lord will turn our suffering into our gain: “My son, peace be unto thy soul; thine adversity and thine afflictions shall be but a small moment; And then, if thou endure it well, God shall exalt thee on high; thou shalt triumph over all thy foes.” [D&C 121:7–8] • Trying to comprehend the trials and meaning of this life without understanding Heavenly Father’s marvellously encompassing plan of salvation is like trying to understand a three-act play while seeing only the second act. • There is another very powerful inducement for us to endure well. President Young said of Jesus, “Why should we imagine for one moment that we can be prepared to enter into the kingdom of rest with him and the Father, without passing through similar ordeals?” (Teachings of Presidents of the Church: Brigham Young [1997], 264). The Apostle Paul noted how this sacred process produces an exclusive cadre—those who have known the “fellowship of [Christ’s] sufferings” (Philip. 3:10). These are they who will have the greatest capacity for endless service, joy, and happiness.

11. Warning Signs of Suicide Q: What are some of the warning signs of suicide? • Listen for statements such as “I don’t care if I die” or “Everyone would be better off without me.” • Talking about feeling hopeless or having no reason to live • Talking about feeling trapped or in unbearable pain • Talking about being a burden to others • Increasing their use of alcohol or drugs • Giving away personal items for no reason • Acting anxious or agitated or behaving recklessly • Withdrawing or isolating themselves from family and friends. • Showing rage or talking about seeking revenge • Displaying extreme mood swings • Previous Attempts: 15-25% of those who attempt suicide do so again within a 1-year period. Those who have attempted suicide at some point in their lives are at a 5x greater risk of committing suicide. Seek Help Immediately If the person is: • Making threats to hurt or kill themselves • Seeking for ways or means to kill themselves • Talking or writing about death, dying, or suicide A single sign may be a poor predictor but multiple signs indicates higher risk.

12. Assessing Risk – Probing Questions Leaders can assess risk through using the following questions: • Intent: Ask the member if she has recently had thoughts of suicide or if she intends to commit suicide. • Plan: Ask the member if she has made a plan to commit suicide. • Means: If the member has had thoughts of suicide, assess for the means to complete the act in terms of access to guns, drugs or other methods. • History: Ask the member if she has previously attempted suicide at any point in her life. • Future events: Probe to determine if the member has made any plans for the future or if she can think beyond the current day. • Affect: Probe for intense changes in mood, hopelessness and despair. • Control: Ask the member if she feels a sense of control over her life or whether she feels she is experiencing inescapable and uncontrollable pain. • Substance abuse: Probe to determine if the member is currently using drugs/alcohol and if there is a risk of overdosing.

13. Assessing Risk – Risk Categories Based on how the member answers these questions, you can determine what level of risk the client is at for attempting suicide. We can break risk down into three different categories that prescribe different solutions: 1. Low Risk: If the member does not have any intent or plan to commit suicide then the situation is not a crisis and counselling may be indicated. 2. Medium Risk: Consult with emergency services immediately if several red flags have been identified. 3. Medium/High Risk: Call the hospital or emergency services to pick up the members if she has disclosed that she has a plan to commit suicide.

14. How to Help Someone in Crisis • Step 1: Ask.Ask the person directly if they are thinking about suicide. You might ask, “Are you thinking about ending your life?” “Do you have a plan to hurt yourself?” If they have a plan, immediately help them get to a hospital or healthcare clinic, or call an emergency service provider or crisis help line in your area. (See suicide.lds.org/crisis for links to help lines around the world.) If they do not have a plan, move to step 2. • Step 2: Care.Show that you care by listening and communicating the other person’s feelings. “I’m sorry you are in so much pain.” If appropriate, help create a suicide-prevention safety plan. (See Next Slide) • Step 3: Tell.Encourage the person to tell someone who can offer more support. Share contact information for helpful resources in your area. Resources may include community hospitals, urgent care clinics, or free crisis helplines. • If they will not seek help, you need to tell someone for them. You may want to say something such as, “I care about you and want you to be safe. I am going to tell someone who can offer you the help you need.” Respect their privacy by telling only someone you think can help, such as a close family member, the person’s bishop, a school counselor, a doctor, or another health care professional. If you are not sure who to tell, talk to your bishop or call a free crisis help line in your area. Remember, you are not expected to support the person on your own. • For further support church leaders can call the welfare hotline: 1-855-LDS-HELP (1-855-537-4357) • Distress Centre (Canada), 403-266-HELP (4357) • Kids Help Phone (Canada), 1-800-668-6868

15. How to Create a Safety Plan • Recognize the warning signs. Identify thoughts, moods and behaviors that indicate you are in crisis such as: “When I cancel all my activities and only want to sleep.” • Try to calm and comfort yourself. Create a list of soothing and relaxing activities that you can do when you have thoughts or urges to harm yourself. Examples may include going for walk, taking a warm bath, exercising, praying, or writing in a journal. • Think about your reasons for living. At times, the pain may swallow up positive feelings. Create a list to remind yourself of the people you love, things you like to do, and blessings you have felt grateful for. • Reach out to others and ask for help. List several people (with phone numbers) you can talk to and who would be willing and available to help you through the rest of your safety plan. • Make sure you are in a safe environment. This may involve asking someone to help remove items that you are likely to use to hurt yourself, or going somewhere else until your feelings shift. Make a list of social settings—such as parks, gyms, movie theaters, and so on—that are safe and distracting. • If you still feel like harming yourself, contact a professional. List names, numbers, and locations of clinicians, emergency rooms, and crisis hotlines. Suicide.org/international-suicide-hotlines.html lists hotlines for dozens of countries. For example, the United States number is 1-800-273-TALK. • After doing all of this, if you still don’t feel safe, call emergency services or go to your nearest hospital and ask for help.

16. How to Help Someone in Crisis 1. Reframing the Problem: Look at the problem as a desire to stop hurting rather than a desire to be dead. This desire can be satisfied through alternative means. 2. Find most distressing problem and solve it: Ask: “If you could solve one problem right now which one would make you feel better?” 3. Look at how the person has tried to cope with the pain: Look for incomplete or ineffective ways the person has tried to cope and then suggest alternatives. 4. Establish Social Supports: Find people to provide support to the person to make resolution feel possible.

17. How to Help Someone in Crisis • Give the person reasons to hope: You can ask some of the following questions: “Are you doing anything differently now that might suggest improvement? Are the problems that bring you down likely to be temporary? Will they resolve themselves with time? Why do others believe there is hope for the future?” Is it possible you haven’t yet given it all your effort? Have you been through times like this before? Have things gotten better with time, effort or patience? • Reasons to live: You can also remind the person to think of reasons to live by making a list that may include: • Reasons why I shouldn’t leave • People to live for • Things I would miss • Experiences I have not yet had • Things that matter to me

18. How to Respond After a Suicide • Despite our best efforts, not all suicides can be prevented. • It is normal for those left behind after a suicide to have feelings of denial, shock, guilt, anger, and confusion. President M. Russell Ballard said, “The act of taking one’s life is truly a tragedy because this single act leaves so many victims: first the one who dies, then the dozens of others—family and friends—who are left behind, some to face years of deep pain and confusion” (“Suicide: Some Things We Know, and Some We Do Not,” Ensign, Oct. 1987, 7). • Professional resources and counseling may also be necessary. Questions for ward leaders to counsel together about may include the following: • How can the teachings and Atonement of Jesus Christ bring healing to the individual or family? • What needs have ministering brothers and sisters observed in the person or family? What service have they given? • What ongoing emotional or spiritual support will the person or family need? Who can offer this support? • Does the person or family have temporal needs, such as transportation or meals? • How can ward auxiliary leaders support children and youth who have lost a loved one? Note: Don’t talk about how the person took his life in too much detail to avoid copycat behaviors.

19. Advice for Loss Survivors Normalize Your Experience • The unanswered questions of Why? What did I miss? Why didn’t I receive a prompting? How will this affect eternal rewards? etc., can cause tremendous turmoil as well as thoughts that perhaps they were somehow responsible for their loved one’s death. • You are not responsible for someone else’s choice to end their life. • There is a tendency for survivors to withdraw from others in shame because of fears of blame, judgment, and stigma. Allow yourself to Grieve • What is Grief? Grief is the emotional, and often physical, response we have when we experience loss. • Grief Is Painful, but Do Not Avoid It: Grief hurts, but it can be the salve that helps us heal when it is allowed to do its work appropriately. • Feeling Sorrow Does Not Show a Lack of Faith • The Savior has said, “Thou shalt live together in love, insomuch that thou shalt weep for the loss of them that die” (D&C 42:45). I have learned that grief is the price we pay for loving someone—and that the price is worth it. • The Atonement applies to Grief: “Just as the lame man at the Pool of Bethesda needed someone stronger than himself to be healed (see John 5:1–9), so we are dependent on the miracles of Christ’s Atonement if our souls are to be made whole from grief, sorrow, and sin.

20. Caring for Loss Survivors To those caring for someone who is grieving • Be compassionate and do not blame or judge. Understand how “the Lord …suit[s] his mercies” (D&C 46:15). • Reach out and ask the survivors how you can help even in simple tasks, or accompany them in activities. • Be patient, listen, and accept the feelings they share at their pace. • Avoid clichés and false assurances such as “It’ll be OK,” “It could be worse,” “I know how you feel,” “I understand,” “It’s God’s will,” “Time heals all wounds,” and so on. • Don’t try to provide answers to their unanswerable questions. • Don’t compare their grief to yours even if it was related to a suicide. • Talk to them about their loved one in similar ways as you would about someone who died in another manner. • Reassure affected children that they are not responsible. • Offer to help them find additional resources for their grieving (counseling, support groups, etc.). • Allow and respect each person’s unique grieving process.

21. Attempt Survivors Change Your Attitude Towards Suffering • Elder Orson F. Whitney taught: “No pain that we suffer, no trial that we experience is wasted. It ministers to our education, to the development of such qualities as patience, faith, fortitude and humility. All that we suffer and all that we endure, especially when we endure it patiently, builds up our characters, purifies our hearts, expands our souls, and makes us more tender and charitable, more worthy to be called the children of God … and it is through sorrow and suffering, toil and tribulation, that we gain the education that we come here to acquire and which will make us more like our Father and Mother in heaven” (quoted in Teachings of Presidents of the Church: Spencer W. Kimball [2006], 16). • Ending your life will prevent you from learning what you need to in order to prepare for eternal life. Seek Help • If your challenges feel overwhelming, seek help. Everyone needs help from others, no matter how faithful they are. Even Jesus needed comfort and strength from His Father.

22. Videos • Choose to Stay – A young man was asked by family and friends to choose to stay in this world despite the intense pain he was feeling. The pain doesn’t go away but you can choose to remain hopeful and stay. • Understanding Suicide - “There is an old sectarian notion that someone who commits suicide is banished to hell forever…that is totally false. I believe the vast majority of cases will find that these individuals have lived heroic lives and that suicide will not be a defining characteristic of eternity.” –Dale G. Renlund • Talking About Suicide – It is completely safe to ask somebody if they are having suicidal thoughts. The most important thing is to give the person enough time to listen. Suicidal thoughts are beyond reading scriptures or praying better and requires professional help. The Burden will remain but can feel lighter. • Suicide & Same Sex Attraction – Anyone who bullies someone with same-sex attraction is sinful. These people need more connection and not less and need to be connected with the Savior. • Parents who have lost a child – Sadness, anger and regret are likely to follow as well as “What could I have done differently?” This is not your fault or an indictment of your parenting. It isn’t helpful to judge you or your child but leave that to God. Your child can progress in the Spirit world. • Grieving After a Suicide – Grieving can last for a long time but pain should diminish over time. The Grieving process is aided by focusing on gospel principles such as the plan of salvation, the atonement of Jesus Christ and talking to others about the loss. Take it day by day.

23. Videos 7. Comfort After a Suicide – Important to look to the Savior for comfort after a loss. The Spirit is the comforter that brings peace. 8. Preventing Suicide – We have a covenant responsibility to look out for each other. Assure them you will stand by them until they find the professional help they need. Be willing to walk with them and mourn with them. 9. Members of the Military – On behalf of the Lord and His church thank you for sacrificing to serve your nation, we all owe you a great debt of gratitude. They are a vulnerable group with a higher incidence of PTSD and suicide rates. Reach out and get the treatment you need. 10. Rodolfo’s Story – Son committed suicide. Only thing that helped was faith in Jesus Christ. Advises taking it day by day. Nobody is immune from dealing with suicide. Church needs to be a safe place where people who struggle with mental illness can reach out. 11. Princess’s Story – Most people wouldn’t know she struggled with suicidal thoughts. She felt hopeless and wanted to end life to end the pain. She ended up surviving the attempt and went to the hospital. It feels like there is no way out and you just have tunnel vision on one solution. Healing occurred through seeing the Bishop and then a counsellor. 12. Sitting on the Bench Story – Just sit with me and don’t say a word but spend time with me.

24. Euthanasia Policy LDS Church Official Policy • The Church of Jesus Christ of Latter-day Saints believes in the sanctity of human life, and is therefore opposed to euthanasia. Euthanasia is defined as deliberately putting to death a person who is suffering from an incurable condition or disease. Such a deliberate act ends life immediately through, for example, frequently-termed assisted suicide. Ending a life in such a manner is a violation of the commandments of God. • The Church of Jesus Christ of Latter-day Saints does not believe that allowing a person to die from natural causes by removing a patient from artificial means of life support, as in the case of a long-term illness, falls within the definition of euthanasia. When dying from such an illness or an accident becomes inevitable, it should be seen as a blessing and a purposeful part of eternal existence. Members should not feel obligated to extend mortal life by means that are unreasonable. These judgments are best made by family members after receiving wise and competent medical advice and seeking divine guidance through fasting and prayer. • https://www.mormonnewsroom.org/official-statement/euthanasia-and-prolonging-life