What to Know When Asking About Suicidal Thoughts

It can be daunting to talk about a loved one's thoughts of self-harm.

Posted Jun 11, 2018

Kate Spade and Anthony Bourdain were successful, widely beloved, and seemed to lead enviable lives. But their recent suicides—and reports of both celebrities’ longstanding struggles with depression and mental illness—highlighted a sobering fact: suicidal ideation can impact anyone, and a respectable public face can conceal unspoken private turmoil.

When suicide is brought to the forefront of the public’s consciousness, “it highlights the fragility of people,” says Shairi Turner, the Chief Medical Officer of the suicide prevention resource Crisis Text Line—which leads many to wonder what they can do if they suspect someone they love might be thinking of suicide. “People are always uncomfortable with the thought that someone wants to kill themselves,” Turner says. Broaching the subject—particularly with someone you’re close to—can feel nerve-wracking, awkward, or entirely impossible.

Loreanto/Shutterstock
Source: Loreanto/Shutterstock

But experts emphasize that the best thing anyone can do for someone who seems unusually depressed or is showing other warning signs of suicide is to initiate a conversation, and that showing up at all is important regardless of whether you say exactly the right thing. If you want to ask a loved one if he or she is feeling suicidal, here’s what to keep in mind as you get started.

Don’t be afraid to start the conversation. “People think that by asking [if someone is suicidal], they’re suggesting suicide,” Turner says. But the vast majority of suicide-related research—including a comprehensive literature review published in 2014—suggests that open conversations about suicide are unlikely to increase suicidal ideation and may actually decrease it.

You don’t have to use terms specific to suicide or self-harm if they make you uncomfortable, Turner says. Often, it’s easier to start by pointing out other possible warning signs—withdrawal from normal activities, for instance, or frequent crying spells—as a way to open the door to a larger conversation without jumping directly into questions about suicide.

“Not talking about it reinforces that it’s not OK to talk about,” says Elana Premack Sandler, an associate professor at Simmons School of Social Work. “If someone is thinking about suicide, and no one asks them about it, there may be no one to whom they feel safe raising the topic. Not bringing the idea of suicide to the surface maintains silence,” which increases overall risk, she says.

Do your research. If you don’t have mental health training yourself—or any personal experience with depression and suicidal thoughts—the idea of starting what’s likely to be a challenging and emotionally fraught conversation can be daunting, Turner said. Many are afraid they’ll say the wrong thing. But while “you don’t have to be a professional to ask the question,” she said, “it always helps to do some research—the more you know, the more you can help.” While a quick online search will bring up dozens of resources, this overview from the Suicide Prevention Lifeline is a comprehensive starting place for anyone looking to better understand depression or help someone in a crisis.

Have resources at hand when you speak. Feeling suicidal is a terrifying, isolating time in someone’s life, and loved ones who suffer may not feel like they have the energy or motivation necessary to seek help. Turner advises beginning the conversation with a list of resources—the number for the Suicide Prevention Lifeline (1-800-273-8255) or Crisis Text Line (text HOME to 741741), for example, or the name and number of a nearby therapist with available appointments.

Be prepared to dig deeper. Some people with suicidal ideations will be resistant—especially at first—to calling a hotline, finding a therapist, or exploring other kinds of mental-health treatment. If your loved one deflects or declines to pursue the resources you’ve suggested, explore why. “Ask how they feel about looking for help,” Turner says, and try to identify the barriers that are in the way. A lot of people who have suicidal thoughts are afraid of stigma or unwanted attention, in which case, an anonymous resource like Crisis Text Line can be a low-risk place to start. Others balk at the expense of therapy and may benefit from you exploring low-cost options on their behalf.

It’s also important to remember that in some cases, your support can only go so far. “People aren’t always going to take the steps they need to take until they’re ready,” Turner says. While it’s always a good idea to try to uncover what’s keeping someone from making use of available resources, in the end, “you can only encourage and offer your support.”

Check back in. “Reaching out often to friends you think may be in need” is critical, according to Evan Kleiman, a research associate at Harvard University who studies risk and resilience factors for suicide. He cites the “caring letters” study, where researchers sent postcards to a group of people who had recently left the hospital after a suicide attempt. “Five years after this time, those who received the postcard were less likely to have died by suicide than those who didn’t,” he says. “This difference went away 14 years later. This suggests that reaching out has a beneficial effect—but doing so frequently is important.”

Suicidal thinking has traditionally been viewed as a gradual escalation, Kleiman says, where “people build up a desire to die over a long time and eventually, some act on this desire.” But research has shown “that suicidal thoughts can escalate rapidly and be somewhat short-lived.” In his own work, he has found that suicidal thinking can fluctuate dramatically over even short time periods—emphasizing the importance, he says, of checking back in regularly and empathetically with anyone who may be at risk.

Remember that reaching out, while difficult, is worth the effort. “None of this is easy,” says Sandler. “Opening up any of these lines of conversation makes both people vulnerable and involves risk. But it is likely worth the risk, if it means you can be a part of building a network of support around a person.”

Resources:

For immediate help, 24/7: National Suicide Prevention Lifeline, 1-800-273-TALK, or Crisis Text Line by texting TALK to 741741.

To find therapists near you, see the Psychology Today Therapy Directory.