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I had a patient who, many years ago, lost her adult daughter to suicide. This patient was one of the most gracious people I knew. She was a loving mother and grandmother, a NICU nurse who cared for sick babies, and an empathetic person who was always quick to attend the needs and feelings of others.
After the tragedy, she would travel and discover things her daughter would have enjoyed, which instantly reminded her of her loss. She would wonder, "What if?" What could she have done to prevent the suicide? It broke my heart to see her struggling to be strong for the rest of the family. Years later, they are still trying to put the pieces back together.
This family is not unique in their heartbreak. Suicide is the 10th leading cause of death in the United States, with almost 45,000 victims every year. Approximately 123 Americans die from suicide each day, but many more attempt suicide or are plagued by suicidal thoughts.
Suicide is a serious and complicated issue. There isn’t a foolproof fix for suicidal thoughts, and it’s not always easy to see when someone is contemplating suicide. As an often taboo and stigmatized topic, people are afraid to seek help or share their experiences with suicide. Fortunately, there are more and more resources to help those who are struggling and to empower their loved ones with the knowledge and tools to help.
For those who are struggling to help their loved ones, here are five important tips to open the conversation for those who are feeling alone in their struggle with suicide.
1. Know the risk factors of suicidal thoughts.
Risk factors are instances that make a person more likely to experience suicidal thoughts.
Mental Illness
One major risk factor is having a mental illness. These mental illnesses include:
- Depression
- Anxiety
- Bipolar disorder
- Schizophrenia
- Personality disorders
- Substance misuse
It is estimated that most people who complete suicide had an underlying, often undiagnosed mental illness. But it’s important to point out that not everybody who has committed suicide had a mental illness.
This pattern may differ based on culture. In North America, about 12 percent of those who committed suicide did not have a mental illness. In East Asia, about 30 percent of people who committed suicide did not have a mental illness.
Even if you're confident that a loved one is not struggling with any mental health issues, you should still take other signs of suicidality seriously.
Another major risk factor for suicide, especially for teens and young adults, is sexual and gender minority status. While heterosexual individuals have a 4 percent chance of attempting suicide in their lifetime, lesbian, gay, and bisexual individuals have an 11 to 20 percent risk, and transgender individuals have a staggering 30 percent lifetime risk of attempting suicide.
The majority of sexual and gender minority people’s suicide attempts happen before they turn 21. This is a global public health crisis that we can’t ignore, and we can start by being aware that the LGBT+ people in our lives may be suffering in silence.
Other Risk Factors
- Trauma
- Abuse
- Chronic illness
- Relationship loss
- Financial loss
- Exposure to suicide
- Sense of hopelessness
- Isolation
- Lack of social support
Additional factors for suicide include previously experienced trauma or abuse, current suffering from chronic illness, and recent relationship or financial losses. Being exposed to suicide, whether through a family event, in school, or the media, also increases one’s vulnerability. A sense of desperation, isolation, and—importantly—a lack of social support also contribute to putting one at risk.
2. Look for the suicidality warning signs.
When it comes to warning signs, which are more immediate signs that someone is considering or planning suicide, the clearest is when a person talks about wanting to die or mentions actively looking for a way to kill themselves.
More often than not, when people are at the depths of their hopelessness, they talk about having no purpose, feeling trapped, acting as a burden to others, or being unable to bear their pain. They may also seem disengaged, increase their drug and alcohol use, experience extreme mood swings, or act in a more reckless manner.
When it seems the crisis has been averted and your loved one is seemingly more at peace, it’s understandable to want to let out a big sigh and take a break from crisis management. And you should certainly take care of yourself!
Just remember to continue checking in with the person who was just in crisis—sometimes this sense of tranquility can come from a feeling of resolution if they have made up their mind to commit suicide experiences. The progress in their functioning may also be a “boost” in their ability to carry out a suicide attempt. So it’s important to keep communication open and supportive even after the worst of the storm seems to have passed.
3. Don’t be afraid to ask about suicidal thoughts.
There is a fear, even amongst many mental health professionals, that asking someone about suicide is going to “put the idea into their head” and increase their likelihood of committing a suicide act. This is not true.
If someone is at risk of having suicidal urges, the idea of suicide will not be new to them. Asking them about it will not make them more suicidal. But asking could reduce risk.
Talking about feeling suicidal can decrease stigma and give the person nonjudgmental permission to express their feelings. You can only provide someone with assets and support if you know what they need.
How to have a conversation about suicide
That being said, it is of course still difficult to start a conversation about suicidal thoughts, even if you're very close to someone. It’s normal to feel hesitant. But once the taboo is broken, the conversation isn't as scary as you might imagine.
Here's one way to broach the subject if you’ve noticed warning signs:
“I noticed that you’ve been seeming really down lately. You mentioned that you feel like you’ve lost the will to live. Do you have thoughts about hurting yourself?”
If they say yes, or if they have already more explicitly talked about wanting to die, you can ask about their intentions:
“When you say that you want to die, do you mean that you want to end your life? Does it ever feel so bad that you think about suicide?”
“Do you have a plan for when or how to kill yourself?”
These questions can seem awfully scary to ask. Of course, you don’t want the answer to be yes. But if it is, they were already feeling that way before you asked. By starting this dialogue with them, you’re not making it worse. You’re providing a path to seeking help.
If you discover that someone you care about is suicidal, what next?
4. Show empathy, not shame or guilt, in your support.
If you’ve already started a conversation with someone contemplating suicide, that’s a good start! You may feel inclined to immediately start problem-solving or putting emergency suicide hotline numbers into their phone.
These are good steps to take, but first, remember that the person in front of you just opened up about the most agonizing, and perhaps shameful, feeling they’ve ever had. Take a moment to first acknowledge their feelings with compassion:
“I’m so sorry you’re feeling this way. It must be horrible.”
You may be tempted to jump in with points about why they shouldn’t feel so down, emphasizing that their problems aren’t so bad, or that they would be hurting other people by committing suicide—anything to put a stop to their thoughts. But this approach can minimize their own pain and make them feel even more guilty and isolated than they likely already do. They feel this way because, to them, the problems they face do seem unsolvable.
Even if you don’t agree that the person's problems are hopeless, you can identify with what they're feeling:
“I can see that you feel really hopeless. What a terrible feeling to have! I can’t even imagine.”
Don’t worry—you're not agreeing that their situation is hopeless. You’re not tacitly encouraging them to consider suicide by validating their feelings.
Likewise, shaming and guilting is not helpful—this simply slams the door shut between you and the person opening up to you. They’ve undoubtedly already thought about how hurtful their suicide would be to others. But when someone is at the depths of despair, anything may seem necessary to stop the pain. Shaming will only deepen those feelings of helplessness.
A better alternative is to let them know you can see their pain, that you’re here to listen, and that you care about them. Once you’ve made clear this unconditional support, you can start to help in a more hands-on way.
5. Connect your loved one with suicide prevention and other resources to prevent imminent harm.
Removing risk is the most important and immediate thing you can do to help. For example, if they have a plan to end their life soon, you should call emergency services or take the person to the Emergency Department.
If the person you are supporting has said that they plan to commit suicide using a certain method, you can help to limit their access to this method for now. Ask them if you can hold onto their weapon for safe-keeping, for example, or offer to drive them home.
Recognize that you may not be able to remove every risky thing from their life, so it’s just as important to connect them with resources for the long-term.
One great resource is the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Responders are trained to provide immediate support to people in crisis. The website Save.org also has valuable information and links to excellent resources.
If the person you’re supporting does struggle with mental health or substance use, encourage them to establish regular care. They may not be in the right mindset to research an already complicated health care system. Simply finding a local clinic and calling to learn about what they can do to assist your loved one could be a major help.
Apart from professional resources, you can help tremendously by connecting your loved one with daily resources. Social connections can be the most important thing to a person who feels alone.
This doesn’t mean you have to drag them to large gatherings—quality is more important than quantity. Spend time with them, do activities they’ve enjoyed in the past, introduce them to other good friends, and encourage them to join groups that can provide support. For example, you could encourage a young LGBT+ person to join a school’s LGBTQ student union.
6. Take care of yourself.
This is of vital importance. Those who die from suicide are not the only victims. People who lose loved ones due to suicide, or experience a loved one contemplating or attempting suicide, also undergo an incredibly difficult experience.
A recent study found that 48 percent of people have been exposed to another’s suicide at some point in their life, and as such, they are twice as likely as others to develop depression or anxiety. They were also much more likely to experience suicidality themselves. If they were close to the person who committed suicide, they had a quadruple risk of post-traumatic stress disorder compared to people who have not been exposed to another’s suicide.
If someone close to you has attempted or completed suicide, make sure you have your own strong support network. Talk with your family, friends, and any religious or other community leaders you feel you can rely on. Even if you’re managing well and are high-functioning, it can be beneficial to seek out mental health support and a safe space to process the event.
If you’re currently supporting someone who is contemplating suicide or recovering from an attempt, don’t forget to check in with your own feelings and ask for help when needed. It’s easy to feel like you are the only one with the ability to help, especially if you're the person's parent, closest friend, teacher, or sibling, but just by listening, empathizing, and offering your love, you are doing your best.
Your support is an incredible help to the person suffering suicidal thoughts. Even as you offer yourself, talk with them about bringing others into their support network. Let them know of the resources that exist to help them.
Meanwhile, get your own needs met. Don’t neglect your own nutrition, exercise, rest and sleep, social engagements, and the things that fulfill you and bring you happiness. It’s OK to do things that make you laugh. After all, part of how you can help is by showing that there is goodness and hope in life.
