What to Say to Someone Who is Suicidal
Watching a loved one experience thoughts of suicide can be incredibly anxiety-provoking and overwhelming. Although suicide may seem to come out of nowhere, there is often a history of mental health difficulties and suicidal ideation and past attempts. Suicidal ideation is experienced when someone has thoughts of suicide and may or may not have made plans [1].
As someone witnessing their battles with mental health, you may become worried for their safety and wonder what you should do or say. That said, it’s essential to know that you don’t need to be a doctor or therapist to check on someone you’re worried about, and that action is often a good option. In bringing awareness to Suicide Prevention Day, we’re going to unpack this complex topic and provide some practical tips on what to say when someone close to you is experiencing suicidal thoughts.
What is Suicide?
Put simply, suicide is a global health crisis, which is often preventable with the correct awareness and intervention. Now known as one of the leading causes of death in young people, around 800 000 people die from suicide every year [2]. In 2020, almost 5000 suicide-related deaths were registered in the UK alone, with men being around 3x more likely to end their lives than women [3].
It’s important to distinguish between suicide and self-harm, even though they are correlated. Self-harm can be described as the deliberate action of causing oneself harm but does not involve any intention of suicide [4]. Nonetheless, these actions are self-destructive and a sign of mental distress. The act can give the person a sense of emotional/psychological relief, often followed by feelings of guilt. This can create a vicious cycle of shame and a need for relief that can bring about more self-harm, shame, etc.
What are the Risk Factors of Suicide?
Self-harm can be considered a risk factor for suicidal ideation and suicide [5]. However, there are many other risk factors to look out for. These can include:
– A previous suicide attempt
– A family history of suicide
– Stressful life events. Such as divorce, financial struggles, losing a job etc.
– Past trauma. For example, a traumatic childhood or abusive relationship (may also be due to a current abusive or toxic relationship)
– Feelings of hopelessness. Perhaps you often hear your loved one talk about how nothing matters or that nothing can help them.
– Increased isolation. You may notice them spending an unusual amount of time alone.
– Excessive use of drugs or alcohol
– Interpersonal problems. They may be experiencing issues with close friends, family, or their partner.
– Existing mental health problems. They may have been previously diagnosed with mental health issues, such as anxiety or depression.
– Having a concrete suicide plan. This is perhaps the most critical factor. The more concrete a plan is (including when, where and how they intend to make a suicide attempt), the more at risk that person is.
Suicide and Suicidal Thoughts
Although thoughts of suicide are incredibly worrying to hear from a loved one, it’s important to remember that ample space exists between suicidal ideation and actually carrying out plans. Many well-functioning people will experience fleeting thoughts of being ‘better off dead’ at least once in their lifetime. Suicidal ideation doesn’t involve physically harming oneself or carrying out the decision to end one’s life. In contrast, those who are more likely to take their lives have a detailed plan of how they will carry it out. Regardless of whether your loved one is suicidal or just experiencing fleeting suicidal thoughts, taking action may be a good idea. If you feel the situation is out of your hands, always seek professional help.
The goal of the professional in any given case will be to first carry out a thorough risk assessment to evaluate whether suicide is indeed likely. When dealing with suicidal individuals, a professional will attempt to instil a sense of doubt in taking one’s own life. This is done, for example, by reinforcing that suicide may not be the only option and creating a plan to help them get out of their suicidal state. When working with a professional, for example, a psychologist, therapist or counsellor, a crisis plan is drawn up with the person if suicide or self-harm risk is detected. This is to reduce the chances of self-harm and suicide taking place. Here’s an NHS template for a comprehensive mental health crisis plan.
What to Say and Do
Knowing what to say when someone has suicidal thoughts can be incredibly difficult, and that’s completely normal! Despite feeling uncomfortable, it’s essential to talk to and connect with your loved one, understand their feelings, and show empathy, support and presence. Here are a few things you can say:
– Ask direct questions. The first step is to find out whether your loved one is in imminent danger of carrying out a suicide attempt [6]. Talking about it will not push them to act on their ideation and will likely reduce the risk by creating a space where your loved one can talk about it and express their distress if they feel like it. You can ask questions such as:
– How are you coping with things in your life lately?
– Are you thinking about suicide?
– Have you tried to harm yourself before?
– Have you thought about how or when you’d do it?
– Empathise with them and let them know they’re not alone. You can do this by actively and empathically listening to everything they say. Try rephrasing what they’ve said back to them, to make sure you understand and that they know you’re present. Although you don’t know exactly how they’re feeling, you can express empathy by recognising their pain. You can do this by saying something like, “It sounds like this is all very painful for you.”
– Ask them about their reasons for living and dying. Try to explore the ‘living’ reasons more deeply. Doing so will help them reflect on what keeps them going, what goals they’d like to reach and what experiences they might still want to have in their lives. This can help broaden their perspective on their current situation and act as a factor protecting them from suicide.
– If they’re comfortable, encourage them to get professional help. Knowing what to do to help someone who is suicidal is a challenging task, which can very quickly become overwhelming. The first step would be to ask them whether they have an existing crisis plan they might have put together with a professional in the past. If they do, you can offer your help using it. However, if they have never sought professional attention before, ask them calmly if they’d like your help with that. For example, by contacting their GP, phoning 111 or the Samaritans at 116 123.
– If they’re in immediate danger, ensure they aren’t left alone. In cases of imminent or immediate danger, being alone can increase the chances of self-harm or suicide. In case of an emergency, call 111 or 999.
What Not to Say or Do
Because this is such a sensitive situation, it’s essential to treat it carefully. Here are a few things to avoid when talking to your loved one who is experiencing suicidal thoughts:
– Don’t try to solve their problems for them. Although you might be tempted to solve the issues your loved one is struggling with, this is unlikely to be a solution. On the contrary, it may burn you out and make your loved one feel even more powerless and not understood.
– Don’t try to just cheer them up or distract them. Don’t tell them to ‘man up’, ‘snap out of it’ or ‘pull themselves together’. These terms may contribute to their shame and sense of helplessness. Instead, listen with empathy and without judgement to their narrative.
– Don’t compare their experience with your own feelings. You may feel inclined to compare your feelings with theirs, saying things like “I know how you feel” or “I wouldn’t be okay if you were gone”. This might make them feel frustrated and misunderstood, as you can’t ever really know how they’re feeling. It also shifts the focus of the conversation onto yourself, when instead it should be entirely on your loved one. Follow their lead.
– Don’t try to talk them out of suicide by telling them how much it will hurt their family and friends. Although this might seem like a good thing to say, it really isn’t. When someone is suicidal, it’s more than likely they are already experiencing feelings of immense guilt and shame. By reminding them of their friends and family, you risk making them feel more guilty.
– Avoid stigmatising terms. These include: ‘committed suicide’, ‘failed attempt’, ‘successful suicide’ etc. The word ‘commit’ may imply that suicide is a crime or a sin, reinforcing the stigma that suicide is selfish. Using words like ‘successful’ or ‘failed’ frames a tragic instance as something to be achieved.
Check in with Yourself
When acting as a support system for a friend or loved one at suicidal risk, it is imperative to also check in with yourself. This time can be increasingly distressing, and although you might not be thinking about your well-being at this time, it is crucial that you make an active effort to do so. This will actually increase the chances that you can be a helpful resource in this difficult time.
You may feel guilty, scared, angry, confused or frustrated during this time – all of which are completely normal responses. Try to be kind to yourself, give yourself time to rest and process everything happening. Talk to your friends, family or partner about how you’re feeling, and remember that prioritising your well-being is okay! To ensure you are supported during this time, if possible, consider setting up a support network of family, friends and mental health professionals for the person struggling and yourself if needed. If you need to reach out to a professional, don’t hesitate to contact any of the helplines listed below.
What to do if You’re Struggling
Helping loved ones who are suicidal or experiencing a loss due to suicide can be an incredibly difficult challenge for anyone. Although your sole focus may be on helping your loved one, checking in with yourself is essential. If you’ve felt depressed or anxious, consider reaching out to a professional. At Therapy Central, we use evidence-based interventions such as CBT (Cognitive Behavioural Therapy) and other approaches to help individuals get through difficult times and get their life back on track. In this way, you’ll be able to talk about your experience with professionals equipped to provide you with the help you need.
Consider contacting one of our qualified therapists today.
You can contact us and request a free 15 min consultation to see whether our help will suit your needs.
Note: We are not an emergency or crisis service and do not handle high-risk patients. For emergency help, please contact one of the helplines mentioned above and listed below.
