Each year, close to 800,000 people around the world die by suicide, according to the World Health Organization, and for every suicide, there are many more people who attempt it.
The thing is, suicide is preventable. And while prevention is a complex issue that involves many different factors — like collaboration between healthcare providers, individuals, friends and family members, and treatment services — it can start with recognizing the warning signs and taking them seriously.
To help you understand the warning signs of suicide and the most responsible and helpful ways to respond (and maybe save a life), BuzzFeed Health talked to Daniel Reidenberg, PsyD, executive director of Suicide Awareness Voices of Education and Eric Beeson, PhD, licensed counselor and professor at [email protected]. Here’s everything you should know.
1. Before we get started, here are the resources you should be aware of when dealing with a potentially suicidal person.
Just so we don’t bury the lede, you can play a very important role in helping someone who is grappling with suicidal thoughts, but you’re not a professional and you can only do so much. Your goal is to get a person the help they need; when, how, and what kind of help will differ from situation to situation (which we’ll go over), but here is all the important stuff, right up top:
National Suicide Prevention Lifeline can be reached at 1-800-273-TALK (8255).
Crisis Text Line can be reached by texting HOME to 741741.
Suicide helplines outside the US can be found here.
911 is not just for obvious physical life-or-death emergency — it’s a totally viable option if you’re not sure where to start and you need help now.
Primary care doctors are a great first step in a non-crisis situation for someone who doesn’t have a therapist or counselor. Call their office and say, “I’m a patient (or friend of a patient) of so-and-so’s. This is what’s happening, what do you think I should do?” — which might mean making an appointment or utilizing another resource the office suggests.
You can learn about what other options are available in a mental health crisis here.
2. Intervening doesn’t always have to be about preventing an imminent suicide attempt. It can also be about connecting with someone and keeping them from getting to a worse place.
According to Beeson, suicide risk exists on a spectrum. “It’s a cumulative process of life experience after life experience, tied with biological predisposition to certain mental illness, tied to environmental and psychological factors,” he says. “There’s not one event that ‘pushes someone over the edge.’ It’s a continuum and we’re all on it somewhere — some of us are just closer to a suicide death than others.”
So, that said, someone doesn’t have to be on the far end of the continuum to show warning signs that you might pick up on — and you don’t have to wait until someone seems to be an immediate suicide risk to reach out.
3. You want to look at how many warning signs of suicide are present, since pretty much everyone shows one or another at some point.
This list of warning signs is important and necessary, but it can also be overwhelming. Because, well, they can apply to anyone, not just people who are suicidal.
“People increase their use of alcohol. People act recklessly. People withdraw. People isolate,” says Beeson. Instead of thinking about it like, Are these warning signs present? Beeson suggests asking, How many are present? How many of these things does a person do over the course of a day, a month, a year?
4. Hopelessness about the future is an especially important warning sign to look out for, especially in young people.
There’s no hard and fast rule about what warning signs suggest a definitive suicide risk or when exactly you should reach out to help. However, any time there is a sense of hopelessness attached to other warning signs — meaning, the belief that it’s never going to get any better and that a future doesn’t exist without the pain they’re feeling — that’s when a suicidal thought might transition into an actual suicidal desire or plan, says Beeson.
Again, you don’t want to wait for this hopelessness to offer or seek help, but it’s an important warning sign to be aware of.
5. Overall, trust your gut, because if you think something is going on, it can never hurt to reach out.
“If your gut’s telling you something is going on, it probably is,” says Reidenberg. “So, you either need to reach out or you need to get somebody else involved.”
6. Once you decide that a person might need help, make sure you’re the right person to reach out to them — because you might not be.
According to Reidenberg, you want to check yourself before making any moves. If you have a personal, religious, or moral bias, a strong fear of the topic, or if you just think you’re not equipped to handle the conversation, that’s OK. Those kind of things can get in the way of coming at it from a place of compassion instead of judgment or alarm. If that’s the case, your involvement might be more detrimental than helpful.
If you decide you’re not the right person, it’s your job to find someone who is — a close friend, family member, mentor, etc. — and let them know your concerns so they can reach out.
7. If you do decide to have a conversation with them, you should have a plan of action ready in case it turns out that yes, they do need help.
Since your concern is that this person may be feeling suicidal, you have to be prepared for the answer to be yes. If it is, your priority becomes getting them help and not leaving them alone until you have it worked out, says Reidenberg. Make sure that going in, your schedule is free and you know how to respond, including having resources ready in case you need them.
8. You might have the urge to be vague or feel them out, but you should eventually ask directly about whether they’re having thoughts of suicide.
It’s a common worry that asking about suicide will put the idea in someone’s head, says Reidenberg, but that’s not the case — there’s a lot of research that demonstrates that talking about suicide won’t lead to suicide. In fact, you want to be direct. You can start with something like, “Hey, you don’t seem to be doing so well. Have you been thinking of hurting yourself?” as an entry point, but you don’t want to stop there.
“After that, you might transition to the direct questions like, ‘Are you thinking about killing yourself or have you thought about killing yourself?’” says Beeson.
9. If they say they’re thinking about suicide, ask a few questions to evaluate immediate danger.
Every person and situation is going to be different — but in assessing risk, a good place to start is sussing out whether they have a suicide plan, the means to carry out that plan, a time set, and the intention (do they intend to carry out this plan or is it only a thought at this point?). The more of those things a person has, the higher the risk, which can inform which resources you should seek out.
“These are the hardest questions to ask, but they’re key assessment pieces,” says Beeson. “How severe does my reaction need to be? Do I need to take them to a hospital right now, or can we wait and talk things out?”
If a suicide attempt seems imminent, call a crisis center, dial 911, or take the person to an emergency room. You can also take basic measures like making sure they don’t have access to guns, drugs, knives, and other potentially lethal objects; and of course, do not leave them alone.
10. Stay calm and focus on asking about them, engaging them in conversation, and listening. Panicking or insisting too hard on getting help immediately can backfire.
The more calm and centered you can be and sound, the better. Their world is already in chaos, and projecting your own anxieties and fears onto them will only add to that. Engage them in conversation about anything. If they want to talk about their pain, absolutely, but you can also talk about their future, their goals, their past, their friends, what they’ve accomplished and achieved, things they’re proud of — all those things that are difficult for them to recall during suicidal crisis moments, says Reidenberg.
“Panicking confirms the idea that’s probably already going through their mind that something is wrong with them or that they’re bad or that they need to be punished,” says Beeson. “You just have to be calm so you don’t perpetuate the internal dialogue that may have led to their suicidal thoughts in the first place.”
11. Don’t get too caught up in worrying about saying the wrong thing, but there are a few general rules of thumb for what not to say.
Don’t be judgmental or guilt-trip them. Saying things like, “You’re not thinking about doing something stupid, are you?” or “You wouldn’t want to hurt your family like this” can increase the person’s sense of burden or guilt.
Don’t say you know what they’re going through. Because you don’t. You want to acknowledge their pain and feelings, not make it about yourself. Instead, express empathy with something like: “It sounds like you’re in an incredible amount of pain right now. It sounds different than anything I’ve ever experienced.”
Don’t provide platitudes or passive optimism. Saying vague things like, “Don’t worry, it gets better” or encouraging them to move on or get over it negates and belittles their experience. Instead, focus on concrete examples of how recovery is possible (which we’ll go over in a second), even if it can be impossible to imagine right now.
12. Do what you can to provide a sense of hope.
You don’t want to make promises you can’t keep (like, “Don’t worry, we’ll make sure you never feel like this again”), but you do want to drive the point home that their life is important and that it can get better.
“Even though the person who is suicidal might not feel that hope, they’re looking for it and can’t find it on their own,” says Reidenberg. “So you need to act as a conduit to that hope. Your mood can convey that hope is real, that recovery is possible, that treatment works, that there are many alternatives and many different ways to get treatment and to get help.”
13. Even if it’s not an immediate crisis situation, encourage them to get on the phone with a crisis hotline or text line, their therapist, etc., or ask if it’s okay if you do it while they’re there.
Getting in contact with someone who is trained for this kind of thing will help you guys make a game plan.
Again, the National Suicide Prevention Lifeline can be reached at 1-800-273-TALK (8255) and the Crisis Text Line can be reached by texting HOME to 741741.
14. If they insist it’s not serious enough to get in contact with a professional but you’re still worried, make a mutual agreement to check in. And then make sure you do.
“Then your job is to say, ‘Let’s agree that if you start feeling worse, you’ll call me or text me or reach out to me or someone else,’” says Reidenberg. Take the time to brainstorm what some specific signals are that might suggest they’re in a dark place again, because when they’re in it, it can be hard for them to tell.
Then, set up a time when you can just touch base. “You just want the other person to know that at least you’re going to check in — and it’s critical that you do follow up,” says Reidenberg. “If you say to somebody who’s a moderate risk that you’re going to check in and then you don’t, that’s bad. They could be counting on that.”
If they can’t agree to those terms, don’t leave it at that — go back to suggesting that you guys talk to a professional now rather than later.
15. Also make a point of asking what’s helping them get through right now so you know for future reference.
If they’re saying that they’re not in a great place but don’t feel the need to reach out to a professional yet because they’re dealing with it, ask for specifics. What’s getting them through it? Is it certain people? Hobbies? Their pets? A certain book or show? You want to know so if and when they get back to a suicidal place, you know things you can remind them of that help them, says Reidenberg.
16. If you have a close relationship with this person, look into how you can be a part of their recovery moving forward.
It’s totally normal to struggle with guilt and other conflicted feelings about your role in a suicidal person’s life, according to Beeson. Obviously, you are not to blame, but it’s natural to wonder what signs you missed or what you could’ve done to be more supportive.
“Sometimes family members deal with that by separating themselves from the situation and will say, ‘OK, they have the problem. I need to get this person to a professional so the professional can fix them,’” says Beeson. “And then they think they’ve done all they need to do and it’s not their responsibility anymore.”
However, it’s more effective to remain engaged. “Sometimes it’s about, ‘OK, maybe I need to do my own work as a family member,’” says Beeson. “‘Maybe I need to get my own treatment. Maybe we need to consider family or relationship counseling.’ If it gets to the point where professional help is going to be engaged, it’s important to show the person, ‘Yeah, I’m not to blame, you’re not to blame, but we’re in this together and I’m willing to do my work too.’”
17. Lastly, remember that human connection and caring about the impact you can have on those around you goes a long way.
“The way we treat people is important,” says Beeson. “It’s not as much about preventing suicide as it is about protecting life and building quality connections with people. Solid research shows that social connectedness is the number one preventative factor against just about everything.”