Suicide is tremendously hard to talk about. It can be especially overwhelming for people without mental health training. Yet friends and family are often the first to learn that a loved one is having suicidal thoughts.
As therapists, we can do more to help someone in crisis. Underestimating this need is a terrible mistake. Suicide is the second leading cause of death for 10 to 34-year-olds, says the National Institute of Mental Health.
We can help people learn safe, helpful ways to respond to those whose suffering is so great, they see no other way out.
Here are 10 questions and answers about talking with someone who you are worried may be suicidal.
1) How do you know someone might be suicidal?
You may hear them say statements like:
- “I wish I was never born.”
- “Your life would be so much better without me.”
- “I feel like I’m just taking up space.”
If hearing such statements worries you, it should. These sentiments are warning signs that a person is thinking about suicide, also called suicidal ideation.
Though these are passive suicidal statements, they should be taken very seriously. They may mean a person is thinking about ending his or her life. This person is struggling with a mental health crisis and we need to attend to this.
Even passive thoughts of suicide deserve prompt attention. Respond immediately. To know better what to make of the statements you just heard, ask more questions.
2) What behaviors are warning signs for suicide?
Some people may keep their thoughts and plans for suicide to themselves, which makes helping them very difficult.
However, those considering suicide sometimes show signs that they are thinking, preparing, or seeking the means to carry it out. Suicide warning signs (adapted from helpguide.org) include:
- Appearing agitated, anxious, irritable
- Becoming extremely sensitive and strongly reactive to criticism
- Talking, writing, journaling or joking about suicide
- Making statements like “I’d be better off dead”
- Withdrawing from activities or friends
- Gathering special items to give friends or family
- Saying what sounds like a final goodbye
- Seeking out the means to kill themselves — a weapon, substance, or dangerous location
3) If a person seems troubled, is it safe to ask if they are thinking about hurting themselves? Can asking increase the danger of suicide?
It is a myth that asking questions will increase the chance people will harm themselves.
Asking questions shows you care.
One of the most important things you can offer — as a therapist, family member, bystander or friend — is living proof that someone cares.
People start thinking of suicide when they feel hopeless and alone in their struggle. They do not see a way out. Telling them they are not alone — and really meaning it — is huge. They desperately need someone to care.
4) What kind of questions can you ask someone if you are worried about their mental health?
Here are some questions you can ask:
- “You seem really depressed lately — how are you handling that? Getting help?”
- “Do you think about hurting yourself?”
- “What do you think about your future?”
- “Are you feeling hopeless?”
- “Have you thought about doing something about that?”
In general, ask to learn if the person could be a danger to him- or herself.
5) What if you are not sure what to make of the answer, or the person is resisting help?
If you are in relationship with someone and you are fearful they might hurt themselves, tell them so. You can say,
- “I am worried about you.”
- “I care about you.”
- “I am scared you may be thinking of hurting yourself because…”
Tell your loved one why you are worried. Listen. Offer to help them get support. Remind them they are not alone, you care!
Call a therapist as soon as possible. You will need support to take good care of yourself and your loved one. Your loved one will need help to evaluate and treat their depression. You may not be able to see the therapist right away, but your call will help you get the support you need.
If you see warning signs of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or 911.
The Crisis Text Line also helps people through live text messaging with a trained specialist: Text “START” to 741-741. See resources below for more support.
6) If you ask someone “Have you thought about hurting yourself?” and the answer is yes, can you believe the answer?
I would urge you to believe the answer. They are telling you they need help!
7) What do you do with the answer? What do you do when you realize, for example, “my child just said: “I’ve thought about taking all the medicine in the cabinet….’”?
If your child has told you something that shows a thought-out way they would end their life or hurt themselves, call their therapist, a suicide prevention hotline, hospital, or 911. You may decide to take them to the nearest emergency room to avoid leaving them alone.
It does not matter if your child says they are going to hate you for getting them help. They may hate you, but by taking action, they will still be alive. That is the priority.
8) What if I suspect that my child is just being dramatic?
A person who feels enough emotional pain to make desperate statements needs someone to assist them in getting support.
It is true that a person can talk of dying, and not intend to take his or her own life. But a suicide attempt or suicidal ideation are not mere stunts for attention. They are important ways people communicate dangerous levels of distress. More of us need to know how to respond.
“Most people who die by suicide tell someone they plan to hurt themselves before they take their lives,” says the American Society for Suicide Prevention.
If someone talks to you of their own death, or the means to carry it out, you have a precious, urgent opportunity to act before it is too late.
9) Isn’t suicide rare?
Suicide is not nearly as rare as people think.
Suicide is the second leading cause of death for people aged 10 to 24 — second only to accidental death. Suicide rates have gone up 28% from 1999 through 2016. The up-trend is continuing.
10) Who is at greatest risk of suicide?
No one is 100% immune to mental health conditions that can raise the risk of suicide.
People who are experiencing depression are at risk for suicide. It can come with general depression, Post-Traumatic Stress Disorder (PTSD), and bipolar disorder. It can come with a number of other mental health conditions.
Teens and young adults can experience emotions with greater intensity since their brain is not fully developed until the mid-20’s and may have difficulty regulating their thoughts and feelings within a range they can tolerate.
In his book Brainstorm: The Power and Purpose of the Teenage Brain, psychologist Daniel Siegel describes the “emotional spark” of adolescence, in which “emotions can arise rapidly and intensely with out the calming influence of the prefrontal cortex” (the reasoning part of the brain which redevelops during this time). Therefore, people may be more susceptible to suicidal ideation during adolescence and young adulthood than at other points in their lives.
Resist the urge to judge, dismiss, or try to talk someone out of how they feel. Asking questions and taking action to get needed support are two of the most important things we can do to prevent the tragedy of suicide.
Even If You Feel Hopeless, There Is Hope
We are only human — nobody is perfect. Sometimes we misunderstand each other, or get overwhelmed by what is going on inside of ourselves. But we do not need to be perfect to be healthier, happier, and more supportive to ourselves and each other in the ways we need it most.
People can — and do — recover even from the darkest, most frightening places a mind can go. Even if you feel like giving up, hope is not lost. Hope and caring are meaningful, powerful gifts we can give each other — ones that can make all the difference in relieving anguish and saving lives.
Active Minds – helping students on college campuses change perceptions of mental health
Crisis Text Line – Text “START” to 741-741
Josh Anderson Foundation – providing teens with mental health education
National Suicide Prevention Lifeline: 1 (800) 273-8255
See also the National Suicide Prevention Lifeline website
Local To Alexandria Virginia:
Alexandria 24-Hour Emergency Mental Health Services
720 N. St Asaph St, Alexandria, VA 22314
PRS Crisis Link (formerly Crisis Link)
24/7 regional hotline: 703-527-4077