According to Mike F. Myers, MD, Professor of Clinical Psychiatry at SUNY-Downstate Medical Center, Brooklyn, NY, 85-90% of the people who kill themselves have been living with some kind of psychiatric illness, whether it is depression, substance abuse, both, or some type of personality disorder, bipolar illness, etc.1 What makes it particularly problematic is that the illness may be unrecognized by others as well as by themselves. However, that person’s associates can often detect behavioral changes. Dr. Myers recommends that if we have a heightened consciousness of a change in someone, we should consider how to approach the individual.
Dr. Myers suggests that before approaching the person you suspect may be ill, you’ll need to do your homework first. Ask yourself what have I noticed? You need to be able to gently say why you’ve approached the subject. You may wish to set up a private chat, a walk, etc. Dr. Myers recommends using tentative language such as “I may be imagining things, but you seem different over the last couple of months.” Mention what you have observed and say “I’m wondering if you’re feeling OK”. Perhaps you’ve been aware of a slow down in the work place, agitation, lateness, changes in grooming habits, inappropriate behavior with staff or patients, or alcohol on the breath. If this person is not the same person behaviorally as she used to be, that gives you a baseline to present. What is called for is reaching out to your colleague. You may wish to role play the discussion ahead of time. Be low key so as not to encourage defensiveness. You’ll need to be very kind, invitational, nonjudgmental, and carefully rehearsed. Say “I’m wondering if I can assist in any way.” If the person responds in a positive way, you should be ready to suggest local resources and next steps.
If, however, they deny any problem, just say “I was concerned, and I just don’t want this to get worse.” You may wish to ask if their health is okay. Does the person have a personal physician? Some may be resentful and if so, apologize, and say you were only concerned. But, don’t stop. Ask colleagues about your concerns. If they confirm your observations, then it needs to go higher, whether that is the Chief of Medical Staff, or the person’s supervisor. It may be appropriate to reach out to family members as well. Dr. Meyers advises when in doubt to always call the state Physician Health Program and talk with one of the experts as to how to proceed.
1 Personal interview with Dr. Mike F. Myers conducted 9/7/11. 2 Ibid.