Suicide Prevention: Let’s Get Awkward!

“Are you thinking about suicide?” It’s an awkward question, right? 

Scary, even.  If there’s one thing we know from suicide research, however, it’s that this question, though uncomfortable, is essential. So let’s get awkward, because it’s September, and September is National Suicide Prevention month.  There’s no better time to talk about what to do if someone you love is talking about suicide, or if you suspect they are considering it.  

Healthcare providers are trained to support people who are contemplating suicide, but people who are contemplating suicide may not always be connected with or choose to talk to their provider. People in this position may be more likely to talk to friends and family, or friends and family may be more privy to any warning signs the person displays. 

Friends and family, however, often (understandably) have zero training in suicide prevention, and it can be challenging to know what to do when your loved one is struggling.

Here’s a crash course.

Know the warning signs.

Sometimes, a suicidal person will come right out and say they are thinking about suicide. Other times, they may express their ideation in less clear ways: 

• Watch out for statements such as “I wish I were dead,” “I don’t want to exist,” “I wish I had never been born,” “I want to go to sleep and never wake up,” “I just want to give up,” etc.

• Withdrawal

• Change in personality, behavior, sleep patterns, etc.

• Giving away belongings/seeming to wrap up affairs

• Decreased care for personal safety/increase in risky behavior 

• Seeming to collect ways to complete suicide, such as securing a weapon or other means, or stockpiling medications

If you are concerned that someone may be considering suicide, don’t avoid asking the question. 

• First of all, remain calm, warm, and approachable.  It’s helpful to communicate that you are safe to talk to.

• Asking someone if they are considering suicide will not give them the idea.  It will, however, create space to talk about it.  Some ways to approach this might be, “Are you thinking about suicide?” “Have you had thoughts of ending your life?”  “Are you thinking about dying?” 

• Communicating that you’re not afraid to talk about suicide may create a greater sense of safety for the other person to talk about it.  It’s okay to use the word “suicide.”

• It’s also ok to ask if the person has made a plan for how they would complete suicide.  This is valuable information for knowing how to support the person.

• Ask if they have access to the means they are considering.

• Ask if they have harmed themselves before.

Once you have asked the question(s), what comes next?

• Identify risk. If the person is at immediate risk (for instance, actively trying to access means/harm self in the moment, or you have reason to suspect imminent harm), call 911. 

• If the person has a clear plan but the risk is not immediate, they still need help; however, you may not need to call emergency services.

• Get help–you don’t have to (and shouldn’t) do this alone! 

• Notify other safe adults who may also be able to support the person

• If the person is willing to be connected with a professional, you may help them get to the hospital or set up a counseling appointment.  Some areas have mental health urgent care clinics. Crisis lines can be a valuable resource for both the person struggling and for you as you provide support. In the United States and all its territories, you can 

Access 24/7 help via the 988 Suicide and Crisis Lifeline by calling or texting 988.  

What if the person denies being suicidal, but I’m still suspicious?  

• It’s essential to listen to what people are saying, both with their words and their actions.

• If your loved one denies suicidal ideation or intent and you are still concerned, let them know that you are available to talk if they need to, and check in with them on a reasonable basis.

• If they seem to be struggling, offer help with connecting them to a therapist or doctor.

What if they say they ARE suicidal, but refuse help?

• If the person is at imminent risk for harm, call 911.

• Your local crisis line or the national 988 Suicide and Crisis Lifeline may be resources that can provide guidance for you as well as garner support for your friend or family member who is struggling.  

• If the person has a safe support network, consider teaming with others to support your friend or family member who is struggling.  

What should you NOT do?

• Don’t get angry.  It can be difficult to do, as anger is a natural reaction to threat; and, your loved one will be less likely to be forthcoming when anger is involved.

• Don’t goad or taunt the person, or dare them to do it.  

• Don’t reply with judgment, criticism, or shame.  

• Don’t ignore or dismiss feelings or experiences.

• Don’t take on more responsibility for their well-being than is yours to take.

You are not responsible for the outcome.

We can’t state this enough.  Some people do die from suicide, despite others’ best efforts to support.  You can’t control the outcome, nor are you responsible for it.  What you can do is offer a safe, non-judgmental space to discuss concerns, and offer to connect the person with supports and resources.  

If you need support while supporting a struggling loved one, counseling can help provide the support you are looking for.   Counselors are happy to help you navigate your emotions as you support the people you care about. Don't wait till the last minute, seek services early.

Be Awkward! Ask the question that may save a life.

Written by Katrina Swenson, LMHCS, a Senior Clinician and Supervisor at Olympia Therapy PLLC.