In part one of this column, suicide was defined as a conscious act of self-induced annihilation in an individual who sees it as the best possible solution to a defined problem. We discussed that the World Health Organization estimates that over 800,000 individuals die by suicide each year. For each suicide, as many as 20 additional individuals have attempted to kill themselves. Suicide rates vary in different countries, based on several factors. In Canada, the suicide rate is approximately 11 people per 100,000 population, meaning that more than 10 Canadians die by suicide every day.
Communicating with a suicidal subject is challenging, but the basic principles are the same for interacting with anyone who is in crisis.
First, introduce yourself and why you’re there. As negotiators, we don’t use rank as our given name as this can, in many situations, create a barrier. Instead, ask them how they want to be addressed. Can you call them by their first name? Establish a professional, friendly and calm approach based on safety, mutual respect and a desire to assist. Ask how you can help.
Try to protect the person from unnecessary onlookers. All too often I have been on calls where onlookers will say derogatory things to the subject, yell at them to jump and even project laser pointers on them. If possible, have them move to a safe location.
Pose structured and sequential questions that will allow the subject to open up and talk. Reduce the tension by trying to establish a rapport through questions unrelated to their distress. If possible, focus on the positive.
A goal is to assist the individual along the Behavioural Change Stairway Model. This model was developed by the FBI’s Crisis Negotiation Unit and outlines a relationship-building process with the ultimate goal of assisting the suicidal individual overcome their resistance. It involves the negotiator helping the subject achieve a peaceful resolution. The Behavioural Change Stairway Model consists of five stages – active listening, empathy, rapport, influence and behavioural change.
Active listening
Generally, people are poor listeners. They tend to rehearse what their next question will be rather than listen to what the subject has to say. Active listening ensures the subject knows they are being heard and understood. It consists of:
Mirroring consists of repeating the last few words or theme of the subject being discussed. As well as demonstrating to the individual in crisis you are attentive, it also serves as a way of drawing out new material to discuss. The negotiator should not use the exact words as it can be annoying to the individual in crisis. Mirroring is not parroting.
Paraphrasing is putting the content of what the subject said into the negotiator’s own words, thereby demonstrating that the negotiator is trying to understand the individual from a contact perspective.
Emotional labelling refers to identifying the emotions felt by the subject. It can add to clarification because if the negotiator misidentifies the emotion, it still demonstrates to the individual that the negotiator is trying to understand the situation. This shows empathy and can de-escalate volatile emotions.
Summarizing is combining the content of the paraphrase with the emotion identified by the negotiator through emotional labelling. For example, “Let me make sure I understand what you’re saying. You lost your job for no apparent reason,” paraphrasing, “and this makes you angry,” labelled emotion.
An effective pause before or after a meaningful comment by the negotiator can provide the subject with the ability to focus on what the negotiator is saying.
Minimal encouragers are brief, well-timed responses that let the subject know they are being listened to. These are nonverbal and verbal cues to the subject and show the negotiator is being attentive to what they are saying. Verbal minimal encouragers or comments such as ‘yes’, ‘uh-huh’, ‘right’. Nonverbal cues can include nodding the head, leaning forward, stroking one’s chin, not folding one’s arms across the chest, watching the person’s eyes without staring and assuming a relaxed stance.
Open-ended questions encourages the subject to talk and invite them to tell their story. It allows the subject to elaborate and avoids ‘yes’ or ‘no’ answers. The negotiator may ask ‘tell me more about…’ in order to get more detail from the subject.
I messages are a variant of self-disclosure that should be used sparingly. It introduces alternatives to the subject’s actions. An example of a good I-message is, “When drugs are involved, I get worried, because it can cause people to act irrationally and sometimes hurt people without meaning to.”
Reflecting meaning is the ability to show the subject that the negotiator understands the content and emotion of his or her situation. It can be used to summarize understanding and to give the subject the chance to clarify any issue that the negotiator does not understand. This would be a way of building report.
In part three of this series, we will examine the other steps The Behavioural Change Stairway: empathy, rapport, influence leading to behavioural change.
Remember, help is available. If in distress, please go to your nearest emergency room. The Canada Suicide Prevention Service is also available 24/7/365, in English and French, at 1-833-456-4566.
References
- Ireland, C., Fisher, J., and Vecchi, G. (2011) Conflict and crisis communication: principles and practice. New York: Routledge.
- McMains, M., Mullins, W and Young, A. (2020) Crisis negotiations: managing critical incidents and hostage situations in law enforcement and corrections (6th edition). New York: Routledge.
- St-Ives, M. and Collins, P. (2011) The psychology of crisis intervention for law enforcement officers. Toronto: Carswell Thompson Reuters.
Peter Collins is the operational forensic psychiatrist with the Ontario Provincial Police’s Criminal Behaviour Analysis Section. He is also a member of the crisis/hostage negotiation team of the Toronto Police Service Emergency Task Force. Dr. Collins’ opinions are his own. Contact him at peter.collins@utoronto.ca.
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