Having the "Are You Okay?" Conversation With a Coworker

Why this matters

Many people who die by suicide showed signs in the weeks before, and in a trade shop the person who saw them is often a coworker who noticed and did not know what to say. The conversation that helps is short, direct and learnable: you notice, you ask plainly, including the suicide question by name, you listen without fixing, you connect the person to help, and you follow up. None of it requires training as a counselor. It requires being willing to sit through about ten uncomfortable minutes, and knowing what to do with the answer.

This card owns that conversation. The warning signs that should start it are covered in a sibling; see related: Suicide in the Trades: The Warning Signs.

Asking directly does not plant the idea

This is the belief that stops most people, so settle it first. A 2014 systematic review in Psychological Medicine (Dazzi and colleagues) pooled the studies on whether asking about suicide increases suicidal thinking, and found it does not; several studies found asking was followed by reduced distress. The person who is thinking about it already has the idea. What they usually do not have is someone who has made it safe to say out loud.

The opposite mistake is the softened question. "You're not thinking of doing anything stupid, are you?" tells the person which answer you can handle. "Are you thinking about killing yourself?" tells them you can handle the true one. Use the word.

Pick the moment, not the perfect moment

• Private, not public. In the truck at the end of a job, over coffee before the shift, a walk to the supply house. Never in the shop with the crew around.
• Side by side works. Many tradespeople talk more easily in a truck than across a table, because nobody has to hold eye contact.
• Leave time after. Do not start it with eight minutes before the next call. You need to be able to stay if the answer is yes.
• Lead with what you saw. Two or three specific, recent observations, not a judgment. "You seem off" invites "I'm fine." "You've missed three Mondays and you didn't eat lunch all week" is hard to wave away.

If you are the owner or a supervisor, know that your title changes how it lands. Say outright that this is not about his job.

The conversation, line by line

A real version, between two techs who have worked together for six years. The second tech has been quiet for about two weeks, missed three of the last four Mondays, and said on Tuesday that his family "would be better off with the life insurance," then laughed.

TECH A: Got a minute before we head back?
TECH B: Yeah, what's up.
TECH A: You've been quiet. Missed a few Mondays.
        And Tuesday you said the family would be
        better off with the insurance. That stuck.
TECH B: I was joking.
TECH A: Maybe. I'm asking anyway. Are you thinking
        about killing yourself?
TECH B: ... Sometimes. Not like I've got a plan.
TECH A: Okay. Thank you for telling me. What's been
        going on?
TECH B: Wife left in March. Back's shot. Money.
TECH A: That's a lot. Will you call 988 with me
        sitting here? Or we call your doctor.
TECH B: I'll call. Stay in the truck.

What each line is doing:

• "Got a minute before we head back?" Private, and with time after.
• The three observations. All specific, all recent, and the third is the one that matters most: a comment about others being better off without him is a recognized warning sign, and a laugh after it does not cancel it.
• "Maybe. I'm asking anyway." He gave you an exit and you declined it without arguing about whether he was joking.
• The question, plainly. No "you wouldn't," no "stupid."
• "Thank you for telling me." The most important line in the exchange. He just took a risk; reward it. Do not react with shock, a lecture or "you've got so much to live for."
• "What's been going on?" Then listen. He is not asking you to fix his marriage, his back or his money, and trying to will make him stop talking.
• The handoff. You offer a specific action, with you present. "You should talk to someone" is an instruction he can agree with and never act on.

When the answer is yes: the next ten minutes

How you act depends on how close the danger is. Ask two follow-up questions in plain words: "Do you have a plan?" and "Do you have what you'd need to do it?"

If he has a plan, the means, or a time frame, or you believe he is in danger now: do not leave him alone. Call 988 together, or call 911 if he is in immediate danger, has already taken something, or will not stay with you. Stay with him until a professional or a family member takes over. Do not drive him to the emergency room yourself if he is agitated; call 911.

If he has thoughts but no plan: call or text 988 with him there, or call his doctor or the shop's EAP line together, before you leave. The 988 Suicide and Crisis Lifeline answers 24 hours a day by call, text or online chat; a veteran can press 1 for the Veterans Crisis Line.

Ask about firearms, specifically. More than half of U.S. suicide deaths involve a firearm, per CDC data, and suicidal crises are often short. Putting time and distance between a person and a gun during a crisis saves lives. "Would you let your brother hold onto your guns for a few weeks?" is a reasonable thing to ask. State laws on transferring firearms, even temporarily, vary: some states require a background check for any transfer and some make exceptions for exactly this situation. A local gun shop, a law enforcement agency or the 988 counselor can tell you what your state allows. The same logic applies to stockpiled medication.

Do not promise to keep it secret. "I won't tell anyone" is a promise you may have to break to keep him alive. Say instead: "I'm not going to spread this around, but I'm not going to sit on it if you're in danger."

When he says yes and will not call

This is the fork that freezes people, so decide your moves in advance.

First, take away the fear that usually sits behind the refusal. Many tradespeople refuse 988 because they think it sends police to the house or puts something on a record. Tell him what actually happens: a trained counselor answers, talks with him about what is going on, and works out a plan with him. The Lifeline's own figures put the share of contacts that involve emergency services at a small fraction, around 2 percent, and those are mostly cases of immediate danger. It is not a report to anyone, and his employer never hears about it.

Offer a smaller step. If 988 is too much, offer his own doctor, the EAP line, a pastor or someone he already trusts, and make the call together. "Who would you be willing to talk to?" gets further than repeating the first offer.

If he refuses everything and has no plan: you can call 988 yourself, as the person supporting him, and ask what to do next; the counselors coach supporters. Agree on a specific next contact before you part ("I'm calling you tonight at eight"), and consider telling a family member he trusts, telling him first that you are doing it.

If he refuses everything and you believe he is in danger now: call 911. That decision is yours to make, it is the right one, and the friendship that survives it is worth more than the one that does not get the chance. Many areas now also have mobile crisis teams, reachable through 988, that send mental health workers rather than police.

When the person is younger or junior to you, the power gap changes things. A first-year apprentice may say yes to whatever the journeyman suggests, including "you're fine, right?" Ask with more space, and wait longer for the answer. If you are his supervisor, say plainly that his job and his apprenticeship are not affected by anything he says.

When the answer is no, or a deflection

Most of the time the answer will be no, and often it is true. Take it, and keep the door open: "Okay. I'd rather ask and be wrong. If that changes, I'm the guy you call, any hour." Then do the follow-up anyway.

If the no comes with continuing warning signs, or someone else has seen something you have not, it is reasonable to ask again later or to bring in someone closer to him. A spouse or a family member he trusts is often the right next person; do not go around him without good reason, and tell him first if you can.

If he gets angry, do not match it. "I'm asking because I'd rather have you annoyed with me than gone" ends most of those exchanges.

Following up is half the conversation

A single conversation is a door opened. What keeps it open is what you do in the next week.

• Within 48 hours: a text or a word. "Thinking about you. Did you get through to anyone?" Not a check-up on whether he called; a sign that the conversation did not scare you off.
• Within a week: another short check-in in person, ideally in the same kind of setting where he talked before.
• Practical help: a lighter route for a few days, an hour off for an appointment, a ride. Concrete help says more than repeated questions.
• Treat him normally the rest of the time. He is not fragile glass now. Joke with him, give him work, keep him in the crew.

If you are the owner, check your own workload decisions against what you now know: a man who is in this state and also working 60-hour weeks of on-call is not being helped by the schedule. See related: Designing an On-Call Rotation Around Sleep.

Look after yourself afterward

Having this conversation takes something out of you, especially if it went to a 911 call. Tell someone you trust that you had a hard conversation, without the details. The 988 line is also there for people supporting someone else, and so is the shop's EAP. If the person you talked to later dies despite everything, that is not a failure of your conversation; suicide has many causes and the person who asked is never the reason. See related: The Shop Response After a Sudden Death SOP.

References

• Dazzi T, et al., Does asking about suicide and related behaviors induce suicidal ideation? Psychological Medicine, 2014
• 988 Suicide and Crisis Lifeline (call or text 988, online chat; press 1 for the Veterans Crisis Line)
• CDC, suicide data and statistics, including firearm share of suicide deaths
• See related: Suicide in the Trades: The Warning Signs
• See related: What an Employee Assistance Program Is and How a Small Shop Gets One