Suicide Prevention

If a friend or family member tells you that he or she is thinking about death or suicide, it's important to evaluate the immediate danger the person is in. Those at the highest risk for suicide in the near future have a specific suicide PLAN, the MEANS to carry out the plan, a TIME SET for doing it, and an INTENTION to do it.

The following questions can help you assess the immediate risk for suicide:

Do you have a suicide plan? (PLAN)
Do you have what you need to carry out your plan (pills, gun, etc.)? (MEANS)
Do you know when you would do it? (TIME SET)
Do you intend to take your own life? (INTENTION)

Level of Suicide Risk

Low – Some suicidal thoughts. No suicide plan. Says he or she won't attempt suicide.
Moderate – Suicidal thoughts. Vague plan that isn't very lethal. Says he or she won't attempt suicide.
High – Suicidal thoughts. Specific plan that is highly lethal. Says he or she won't attempt suicide.
Severe – Suicidal thoughts. Specific plan that is highly lethal. Says he or she will attempt suicide.

If a suicide attempt seems imminent, call a local crisis center, dial 911, or take the person to an emergency room. Remove guns, drugs, knives, and other potentially lethal objects from the vicinity but do not, under any circumstances, leave a suicidal person alone.

When someone says he or she is thinking about suicide, or says things that sound as if the person is considering suicide, taking action is ALWAYS the best choice. Here's what to ask:

• How are you coping with what's been happening in your life?
• Do you ever feel like just giving up?
• Are you thinking about dying?
• Are you thinking about hurting yourself?
• Are you thinking about suicide?
• Have you ever thought about suicide before, or tried to harm yourself before?
• Have you thought about how or when you'd do it?
• Do you have access to weapons or things that can be used as weapons to harm yourself?
• Asking about suicidal thoughts or feelings won't push someone into doing something self-destructive. In fact, offering an opportunity to talk about feelings may reduce the risk of acting on suicidal feelings.

You can't always tell when a loved one or friend is considering suicide. But here are some common signs:

• Talking about suicide — for example, making statements such as "I'm going to kill myself," "I wish I were dead" or "I wish I hadn't been born"
• Getting the means to take your own life, such as buying a gun or stockpiling pills
• Withdrawing from social contact and wanting to be left alone
• Having mood swings, such as being emotionally high one day and deeply discouraged the next
• Being preoccupied with death, dying or violence
• Feeling trapped or hopeless about a situation
• Increasing use of alcohol or drugs
• Changing normal routine, including eating or sleeping patterns
• Doing risky or self-destructive things, such as using drugs or driving recklessly
• Giving away belongings or getting affairs in order when there is no other logical explanation for doing this
• Saying goodbye to people as if they won't be seen again
• Developing personality changes or being severely anxious or agitated, particularly when experiencing some of the warning signs listed above

Encourage the person to seek treatment. A suicidal or severely depressed person may not have the energy or motivation to find help. If the person doesn't want to consult a doctor or mental health provider, suggest finding help from a support group, crisis center, faith community, teacher or other trusted person. You can offer support and advice — but remember that it's not your job to substitute for a mental health provider.

Follow-up on treatment. If the doctor prescribes medication, make sure your friend or loved one takes it as directed. Be aware of possible side effects and be sure to notify the physician if the person seems to be getting worse. It often takes time and persistence to find the medication or therapy that’s right for a particular person.

Offer to help the person take steps to get assistance and support. For example, you can research treatment options, make phone calls and review insurance benefit information, or even offer to go with the person to an appointment.

Encourage the person to communicate with you. Someone who's suicidal may be tempted to bottle up feelings because he or she feels ashamed, guilty or embarrassed. Be supportive and understanding, and express your opinions without placing blame. Listen attentively and avoid interrupting.

Be respectful and acknowledge the person's feelings. Don't try to talk the person out of his or her feelings or express shock. Remember, even though someone who's suicidal isn't thinking logically, the emotions are real. Not respecting how the person feels can shut down communication.

Don't be patronizing or judgmental. For example, don't tell someone, "Things could be worse" or "You have everything to live for." Instead, ask questions such as, "What's causing you to feel so bad?" "What would make you feel better?" or "How can I help?"

Never promise to keep someone's suicidal feelings a secret. Be understanding, but explain that you may not be able to keep such a promise if you think the person's life is in danger. At that point, you have to get help.

Offer reassurance that things can get better. When someone is suicidal, it seems as if nothing will make things better. Reassure the person that with appropriate treatment, he or she can develop other ways to cope and can feel better about life again.

Encourage the person to avoid alcohol and drug use. Using drugs or alcohol may seem to ease the painful feelings, but ultimately it makes things worse — it can lead to reckless behavior or feeling more depressed. If the person can't quit on his or her own, offer to help find treatment.

Remove potentially dangerous items from the person's home, if possible. If you can, make sure the person doesn't have items around that could be used for suicide — such as knives, razors, guns or drugs. If the person takes a medication that could be used for overdose, encourage him or her to have someone safeguard it and give it as prescribed.

Be proactive. Those contemplating suicide often don't believe they can be helped, so you may have to be more proactive at offering assistance. Saying, “Call me if you need anything” is too vague. Don’t wait for the person to call you or even to return your calls. Drop by, call again, invite the person out.

Encourage positive lifestyle changes, such as a healthy diet, plenty of sleep, and getting out in the sun or into nature for at least 30 minutes each day. Exercise is also extremely important as it releases endorphins, relieves stress, and promotes emotional well-being.

Make a safety plan. Help the person develop a set of steps he or she promises to follow during a suicidal crisis. It should identify any triggers that may lead to a suicidal crisis, such as an anniversary of a loss, alcohol, or stress from relationships. Also include contact numbers for the person's doctor or therapist, as well as friends and family members who will help in an emergency.

Continue your support over the long haul. Even after the immediate suicidal crisis has passed, stay in touch with the person, periodically checking in or dropping by. Your support is vital to ensure your friend or loved one remains on the recovery track.