The subject of suicide reappeared in the news again and I found myself wondering what we can offer people to keep them from drowning from despair. Something they could use before the despair or pain gets so big and suicide seems to be the only way out.

One of the most difficult things about deaths of despair or impulsivity is that the ability to predict suicide is really poor and the research shows that it is incredibly difficult to assess who will make an attempt. When people endorse suicidal thinking in mental health intake information—less than 10% engaged in suicidal behavior in the following year[1]. And more than half the people who died by suicide denied suicidal thinking beforehand[2].

So, perhaps by trying to target specific people about specific problems we have it all wrong. We need less of a mental health stance about suicide and more of a lifeguard stance. In thinking about the recent suicide I’d heard about, I began thinking about my summers working as a waterfront director. All of the kids at the waterfront of this camp were learning to swim at different ability levels—so not all kids could swim well. But all of the kids, regardless of ability level, were taught how to survival float or what’s now known as drownproofing.

The basics of survival float is to take a deep breath and put your face in the water, your body vertical, and your arms hanging down. The principle is that you are using the least amount of energy possible. When you need to breathe again, you push down with your hands gently, lift your head, breathe and put your head back down. No big motions, no big use of energy. This relaxed movement can be sustained for a really long time. The goal of drownproofing isn’t to make you able to swim. The goal is to keep you alive if you find yourself in danger in the water. It is just meant to keep you afloat, alive, and as safe as possible until help can arrive. You don’t need to know how to swim well, but you need to be familiar with the motions and familiar enough with water (and not fear water) that you can do the survival float. It’s the fact that you practiced it, and that you know what it feels like to be in the water—to feel the water on your face. It’s something you should know before you need it.

We need to think of suicide prevention less like mental health treatment and more like drownproofing. Yes, I am all for mental health. But when we put suicide prevention in the mental health category lots of people think “I don’t need that kind of help “ or they think, “I can’t get that kind of help.” Despair, pain and the things that trigger suicide aren’t mental health issues per se: they are human issues. We need everyone to understand that the undertow or riptide of life can happen to anyone—painful emotions of grief, loss, disappointment, shame, rage, hurt. These feelings don’t just happen if you have a mental health diagnosis—they happen to everyone at some time. And because it’s hard to predict how big the tidal wave of feelings will be---and how different people will experience these emotions at different points in their life—everyone has to learn how to survival float in these emotions. We need everyone to know how to ride out the feeling of drowning in despair--just the way everyone needs to know how to do the survival float because if your boat capsizes far from shore, even excellent swimmers are at risk of drowning.

The principles of drownproofing for despair aren’t that different than drownproofing in water: you need activities or actions that keep you alive, require as little effort as possible, and that are sustainable long enough to get help. And you need to know what the actions are, have the information easily available and practice them if you can. Here are 3 C’s of drownproofing for despair everyone should learn beginning in middle school and update as you get older or circumstances change. The three C’s of drownproofing for despair are: Comfort/Distract, Connect, and Counsel.

Comfort or distract:

When massive despair hits, comfort the pain. Wrap yourself in a blanket, nap, watch your favorite movie or TV show, read your favorite book, sit on your porch. Fill your birdfeeder and watch them. People watch. Eat your favorite snack. Drink something soothing. Listen to something soothing. Take a hot shower or bath. Sometimes distracting yourself with tasks works, or helping others. Do any or all of these as often as you need to. [Make your own list of what works to help you feel soothed or comforted, and what distractions are good ones for you.]

Connect:

Find other people who you feel safe around. You can tell them your level of despair if you are up to it, or you can just lean into the connection. You can hang out and be with them, or you can tell them you need someone to be with you—even if you can’t tell them why. But give it a shot if you can. Find the words if you can. Or just ask for company while you get comfort or distract yourself.

You can also connect with something bigger than yourself. In Buddhist teachings they talk about how a tablespoon of salt in glass of water makes it undrinkable, but a tablespoon of salt in vast lake dissipates and is unnoticeable. This is where mindfulness training, values, purpose, or faith may come in. Why it’s important to have routines and practices in your life that can hold you when you need it.

Counsel:

Know of some places to go if despair hits. Have those places identified. Is there a clinic, school or hospital? Counseling Center? A house of worship that you can walk into and sit down and seek counsel? A sacred space that you feel connected to and brings out the best in you? Are there people who you can identify who can be of good counsel when things get bad. Have a list of at least 5 people or places. Have the list somewhere you can find it. This list is like a life preserver—you don’t want to be hunting for it when you really need it. The national suicide helpline in the US is 988.

And there’s probably a 4th C that is ongoing which is to Cultivate a relationship with emotion. Get to know your emotions. Get to know the names of them. Get to know their impact on you and what works to help you feel better when you experience them. Cultivate the ability to communicate them as best you can. Normalize emotions, difficult emotions and the practice of sharing them.

[1] Simon, G., et al., Psychiatric Services, Vol. 64, No. 12, 2013

[2] McHugh, C. M., et al., BJPsych Open, Vol. 5, No. 2, 2019