Suicide touches nearly everyone in every community. Most of us know someone who has died by suicide or someone who has struggled with suicidal thoughts or behavior. Yet, despite how common it is, people hesitate to talk openly about suicide. People fear saying the wrong thing to someone who has attempted to end their life, or are struggling with thoughts of dying by suicide, or are afraid they will encounter something they don’t know how to handle.
Many people worry that bringing up the topic of suicide will somehow “put the idea in someone’s head.” This is a myth* – in fact, the opposite is true. Silence is what makes things more dangerous, having open conversation saves lives.
*Sources: https://afsp.org/ethicalreporting/ and https://pubmed.ncbi.nlm.nih.gov/24998511/
Talking about suicide directly, using the actual word, can be one of the strongest tools we have for prevention.
”Asking someone, “Are you thinking of killing yourself?” can be the best way to identify someone at risk of suicide. “**
**Source: https://www.nimh.nih.gov/health/publications/suicide-faq
Most people who think about suicide don’t actually want to die. What they want is relief from mental or physical pain, hopelessness, or feeling trapped. Someone who is in crisis may feel unable to imagine a future where anything changes and gets better. Suicide may feel like the only solution, although many who experience these thoughts are deeply conflicted, and still searching for hope.
It’s important to remember that most (but not all) people who die by suicide give verbal or behavioral clues beforehand. An example would be someone who used to take pride in looking sharp and appearance was very important to them, and they start to wear the same clothes every day, or stop showering.
Another example could be an employee who used to always be on time, never late on deadlines, who starts calling in sick often, showing up late and not putting enough effort into their work. There can be other underlying causes for both of these examples, but they are red flags that could indicate more.
Suicide is rarely impulsive. Thoughts and actions build up over time, and opportunities for intervention exist if we learn to recognize the signs and act. Many hospitals now send patients forms asking about their patient’s wellbeing before and after surgeries, with specific questions targeting people who might have suicidal thoughts.
People at risk often show more than one warning sign across three areas: what they say, how they act, and how they seem emotionally.
Talking About
- Wanting to die or kill themselves
- Having no reason to live
- Feeling like a burden
- Feeling trapped or in unbearable pain
Behavior Changes
- Withdrawing from friends, family, or activities
- Increased use of alcohol or drugs
- Increased risky or self-destructive behavior
- Searching for means or ways to die (weapons, pills, etc.)
- Saying goodbye or giving away possessions
- Neglecting responsibilities or self-care
- Withdrawal from activities they used to enjoy
Mood Shifts
- Depression or deep sadness
- Irritability, rage, or humiliation
- Anxiety or panic
- Sudden calmness after distress, or a sudden improvement in someone’s mood after despair (a sign someone may have decided to act on their suicidal thoughts).
Sometimes the signs are in the words themselves. A person might quietly say, “I’m tired of fighting,” or “Everyone would be better off without me.” Even phrases like “What’s the use? Nothing’s going to change,” carry weight. Each one deserves attention and compassion.
Here are some additional red flag phrases: “I just want all of this to stop.” “I can’t keep doing this anymore.” “I don’t see the point in trying.” “Soon you won’t have to worry about me.” “I wish I could just go to sleep and not wake up.” “I’ve said my goodbyes already.” Or, “I feel invisible, like I don’t matter to anyone.” Each of these verbal signals show deep pain and deserve a caring response.
Recognizing the signs is the first step; speaking up is the second. Asking someone if they are thinking about suicide will not “put the idea in their head.” Instead, it shows you care.
Gentle discussion starters:
“I’ve been worried about you. Can we talk about how you’re feeling?”
“I noticed some changes in you, and I wanted to check in.”
“You don’t seem yourself lately, and I care about you. How are you really doing?”
“I just want to check in. What’s been on your mind lately?”
“You’re important to me, and I’d like to understand what you’re going through.”
“You matter to me, and I’m here if you want to talk about what’s going on.”
“I may not have all the answers, but I’ll listen. Do you want to tell me what you have been thinking about?”
“You don’t have to go through this alone. Can you let me in on what you’re feeling?”
If they share suicidal feelings, continue with compassion:
“When did you start feeling like this?”
“What has been hardest for you lately?”
“You are not alone, I want to help you. Please talk to me?”
“That sounds really painful. Can you tell me more about what you’re going through?”
“I care about you, and I want to understand what this feels like for you.”
“Has anything made these feelings stronger or harder recently?”
“When things feel this heavy, what thoughts go through your mind?”
“I may not have all the answers, but I’m here to listen and stay with you.”
“Would it help to talk through some options for support together?”
Do:
- Be present. Your calm presence can reduce isolation.
- Listen without judgment. Let them share freely, even if it’s painful to hear.
- Encourage professional help. Offer to go with them to a doctor or counselor.
- Show empathy: “That sounds really hard. I’m glad you told me.”
There’s an important difference between sympathy and empathy. An example of sympathy could be,“I’m sorry, I know how you feel.” But unless you’ve been in the same place, you really don’t know. Empathy, on the other hand, is about listening to the person. Being present without judgment and showing you want to understand.
Don’t:
- Argue, minimize, or lecture about the value of life.
- Promise to keep it a secret – safety comes first.
- Offer quick fixes or pressure them to “cheer up.”
Some things not to say:
“You’ll get over it.”
“Other people have it worse.”
“Just think positive.”
“But you have so much to live for.”
“You’re being selfish.”
“Snap out of it.” Or,
“It’s all in your head.”
Responses like the above minimize the pain as if it’s temporary or unimportant. It can create feelings of guilt and add shame to an already heavy emotional burden. The last thing we want to do is invalidate their very real emotional pain.
“I know exactly how you feel.” Even if well-meaning, can feel dismissive because no two experiences are identical.
Get immediate help if you believe someone is at risk:
Call or text 988, the Suicide & Crisis Lifeline (U.S.).
If danger is immediate, call 911 or take them to the nearest emergency room.
Stay with them until help arrives, or make sure someone else can.
Other resources include:
National Suicide Prevention Lifeline Dial 988 or you can text or chat
TrevorLifeline, Part of the Trevor Project. Crisis intervention and suicide prevention phone service available 24/7/365. 1-866-488-7386
The Veterans Crisis Line connects Veterans and Service members in crisis and their families and friends with qualified, caring VA responders through a confidential toll-free hotline, online chat, or text. Dial 988 and Press 1, 24/7. Chat online. Text to 838255
The Suicide Prevention Resource Center
Crisis Text Line: Text HOME to 741741 from anywhere in the United States – 24/7, free, confidential. A live, trained volunteer Crisis Counselor receives the text and responds, all from their secure online platform
Trans Lifeline: A 24/7 hotline available in the U.S. and Canada staffed by transgender people for transgender people. 1-877-565-8860 (United States)
Suicide Prevention and Care Program. The Federal Health Program for American Indians and Alaska Natives
Prevention isn’t only about responding in crisis. It’s also about creating an environment where conversations about mental health are normal, safe, and stigma-free.
Check in regularly with friends and family, not just when something seems wrong. Encourage open discussions about stress, anxiety, and emotional struggles. Share mental health resources in your workplace, school, or community.
It is recommended to seek help or assist in getting professional help for the person in need as the very first step, but having the tools to assist in case of crisis can be very helpful as well.
There are resources out there, such as:
QPR (Question, Persuade, Refer) https://qprinstitute.com/about-qpr
Mental Health First Aid https://www.mentalhealthfirstaid.org/
The ConnectTM Program (A program of NAMI NH) https://theconnectprogram.org/
Suicide is preventable. When we move past the discomfort of the word itself and step into real, caring conversations, we create lifelines. Asking, listening, and helping someone connect to support could be the action that saves their life.
For more information about our programs, please visit https://www.westbridge.org/programs/.
WestBridge provides evidence-based treatment for adults and their families experiencing mental illness with or without substance use. Contact admissions for inquiries and questions