When Suicide Prevention is Hard to Talk About

Part of our 10 for when series:

SUICIDe prevention

Talking about suicide can feel uncomfortable. We may worry about saying the wrong thing, or not knowing what to do.

Here’s the hopeful part: there is help, and there’s a lot of it.

When It’s Hard to Know What to Say About Suicide:

Warning signs, risk factors, and ways to start the conversation

Suicide prevention is something we can all learn more about. There are signs to recognize, conversations we can have, and resources that can help us better understand what someone may be going through, whether it’s ourselves or someone we care about.

And the good news? You don’t have to have all the answers. There are people, organizations, and resources ready to help. Sometimes knowing where to look is a meaningful place to start.

10 for When is a monthly series dedicated to one mental health topic at a time, with ten practical resources you can save, share, and come back to whenever they’re useful.

For September, we’re focusing on suicide prevention and gathering some of the many resources available to help you learn, connect, and find support.

This month’s focus: SUICIDE PREVENTION

A note before you begin: This piece discusses suicide and suicidal thoughts. If you're currently struggling or thinking about suicide, you don't have to figure it out alone.In the U.S., you can call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24/7.

Mental health struggles can be difficult to talk about. Suicide can feel even harder.

Not because it shouldn't be discussed, but because it can be difficult to know what to say. You may not know who around you has experienced suicidal thoughts, attempted suicide, or lost someone to suicide. And because suicide is such a deeply personal subject, it's understandable to worry about saying the wrong thing, causing harm, or pushing someone to talk about something they're not ready to discuss.

But silence doesn't make the subject disappear.

Talking about suicide openly, carefully, and without judgment is one part of creating a culture where people can ask for help at any level of concern, including before they reach a crisis, and during a crisis.

Suicide Is More Common Than Many of Us Realize

More than 720,000 people die by suicide around the world each year, according to the World Health Organization. WHO's most recent global estimates report approximately 727,000 suicide deaths in 2021. Suicide occurs across ages, cultures, and communities, and its causes are complex. (World Health Organization)

Suicidal thoughts are also more common than many people realize.

According to the Cleveland Clinic, one study found that 10.6 million U.S. adults, or 4.3% of the adult population, experienced suicidal thoughts. The same source reports that 18% of people under age 18 in that study had thought about attempting suicide.

Statistics like these matter, but they don't tell an individual's story. Suicidal thoughts can range in intensity and may come and go. These thoughts and any attempts are important indicators that appropriate support, assessment and intervention should be considered and taken seriously. 

My Experience With Suicide

Growing up, I had a close family member attempt suicide.

From that moment on, my emotionally and mentally immature pre-teen brain interpreted it as a selfish decision: a choice to leave me and the rest of us behind because life had simply become too hard.

As I've gotten older, spoken with people who have experienced suicidal thoughts, learned from people who work in mental health, and read more about suicide prevention, I've come to understand the experience differently.

One idea that helped shift my perspective was this:

"Suicide is not chosen; it happens when pain exceeds resources for coping with pain."

— David L. Conroy, author of Out of the Nightmare: Recovery from Depression and Suicidal Pain

A note of caution: the context of this is psychological pain and limited coping resources.

I would now put it a little differently.

Suicide is not adequately explained by calling someone selfish, weak, or simply unwilling to keep going. Suicidal behavior can at times emerge from a variety of stressors compounding, such as an overwhelming combination of psychological pain or life circumstances that seem insurmountable, substance use, past trauma, ongoing isolation, access to lethal means, and a host of other factors.

For someone experiencing a suicidal crisis, their perception of what options are available may become extremely narrowed. They may genuinely struggle to see alternatives that might become visible again with time, support, treatment, and a reduction in immediate danger.

That doesn't mean suicide is inevitable. It means that a person's experience of their options during a crisis may not reflect the full range of options available to them outside that crisis.

And that's one reason connection matters.

Survival Is Possible

Suicidal thoughts can be frightening. They can also change.

Not everyone who experiences suicidal thoughts attempts suicide, and not every suicide attempt is fatal. Importantly, survival of a suicide attempt can provide an opportunity for recovery, treatment, and connection to ongoing support. 

According to research summarized by the Harvard T.H. Chan School of Public Health, the large majority of people who survive a suicide attempt do not go on to die by suicide later. The research cited by Harvard found that approximately 70% had no further attempts, while approximately 23% made a subsequent nonfatal attempt and about 7% eventually died by suicide.

These numbers shouldn't be interpreted as a prediction for any individual. They do, however, reinforce an important point: a suicide attempt does not mean that someone is destined to attempt again or die by suicide. Recovery is possible.

After an attempt, a person may experience many complicated emotions, including fear, relief, anger, shame, grief, or confusion. Compassion, professional support, and ongoing safety planning can all be important parts of recovery.

Warning Signs of Suicide

Warning signs aren't always obvious, and they can look different from person to person. A single behavior does not necessarily mean someone is suicidal. What matters can include a new or increased behavior, a combination of signs, a real plan being made, or a noticeable change following a painful event, loss, or other significant stressor.

According to the Mayo Clinic, warning signs can include:

• Talking about suicide or death, including saying things such as "I wish I were dead" or "I wish I hadn't been born"

• Seeking access to lethal means

• Withdrawing from friends, family, or other social contact

• Significant or sudden mood changes

• Becoming unusually preoccupied with death, dying, or violence

• Expressing feelings of hopelessness or being trapped

• Increasing use of alcohol or drugs

• Significant changes in eating, sleeping, or other routines

• Engaging in risky or self-destructive behavior

• Giving away possessions or getting affairs in order without an obvious reason

• Saying goodbye to people as though they may not see them again

• Becoming severely anxious, agitated, or noticeably different, particularly alongside other warning signs

It's worth remembering that some people experiencing suicidal thoughts show few outward signs, while others may communicate their distress directly. That's why taking someone seriously when they tell you they're thinking about suicide is so important. (Mayo Clinic)

Risk Factors Are Not Predictions

There are also circumstances and experiences associated with increased suicide risk.

According to the CDC, these can include a previous suicide attempt, major loss, substance use, lack of access to healthcare, and stigma associated with seeking help.

Other factors can include experiences of trauma or abuse, social isolation, relationship difficulties, financial stress, chronic pain or illness, discrimination, and other circumstances that can increase distress or reduce access to support. (World Health Organization)

But there's an important distinction:

Risk factors do not predict suicide.

They help us understand circumstances in which risk may be higher. They cannot tell us with certainty who will or will not experience suicidal thoughts or behavior.

That distinction matters because people are more complicated than checklists.

We Are Not Our Thoughts

You may or may not have heard the phrase we are not our thoughts before.

It can be a difficult concept to understand at first. It was for me.

But learning to notice thoughts without automatically treating them as facts became an important part of how I learned to relate to my own mind.

Our thoughts are real experiences, but a thought isn't necessarily a fact, prediction, instruction, or permanent truth.

When someone is experiencing suicidal thoughts, though, simply telling them to "think differently" isn't enough. In an acute crisis, professional support and immediate safety may be necessary.

For me, the useful idea is not just don't believe your thoughts. It's creating enough space to notice what the mind is saying and then bringing another person into that space.

I love this quote from Salma Hayek about the meaning we give to other people's words. I think there is something useful here, too, about creating distance from the thoughts that can feel overwhelmingly personal.

"If I start insulting you, in another language, you feel nothing, they don't mean anything to you... because it's you who puts meaning to it..."

— Salma Hayek

If a thought tells you that suicide is the only possible solution, you don't have to argue with it alone.

You can tell someone.

You can ask for help.

You can give yourself time.

And you can let someone else help you see options that may be difficult to see in the middle of a crisis.

Preventing Suicide Takes All of Us

Suicide prevention isn't one person's responsibility.

It happens at multiple levels: individual, relational, community, and societal. Research-supported prevention strategies include strengthening social connection, improving access to behavioral healthcare, developing coping and problem-solving skills, and reducing access to lethal means when someone is at risk. (World Health Organization)

For individuals and communities, prevention can look like:

• Learning healthy coping and problem-solving skills

• Seeking mental health support when you need it

• Building and maintaining meaningful connections

• Paying attention when someone you know seems to be struggling

• Taking changes in behavior or direct expressions of suicidal thoughts seriously

• Helping someone at risk connect with professional or crisis support

• Talking about suicide openly and without judgment

• Reducing stigma around mental health and help-seeking

• Supporting access to quality physical and behavioral healthcare

• When someone is at elevated risk, helping create distance between them and lethal means

For some people, tracking patterns in mood or other symptoms can also be useful information to bring to a healthcare professional. If you notice significant mood changes connected to your menstrual cycle, for example, tracking those patterns may help you and a clinician understand what is happening. It shouldn't, however, be treated as a stand-alone suicide-prevention strategy.

"I wish I had known that this too shall pass. You feel bad right now? You feel pissed off? You feel angry? This too shall pass. You feel great? You feel like you know all the answers? You feel like that everybody finally gets you? And there you are. This too shall pass. Time is your ally. And if nothing else, just wait. Just wait. Just wait it out."

— Tom Hanks

That idea of time matters.

So does connection.

The CDC identifies a range of protective factors that may help buffer against suicide risk. These include:

• Individual protective factors, such as effective coping and problem-solving skills and a strong sense of cultural identity

• Relationship protective factors, including supportive relationships with partners, friends, and family and feeling connected to others

• Community protective factors, including connection to school, community, and other social institutions, as well as access to consistent, high-quality physical and behavioral healthcare

• Societal protective factors, including policies and practices that reduce access to lethal means among people at risk

Protective factors don't guarantee safety, either. They are part of a larger picture.

How to Talk About Suicide

If you're struggling

If you're experiencing suicidal thoughts, you deserve support even if you're not sure whether what you're experiencing is "serious enough."

Start with a safe person you trust. That might be a friend, family member, teacher, healthcare provider, therapist, mentor, or another person you feel comfortable telling.

The Jed Foundation offers guidance on how to tell someone you're thinking about suicide, including:

• Decide who in your life you want to tell

• Reach out in a way that feels comfortable

• Be prepared for different responses

• Be clear about what you're feeling

• Ask them to help you connect with a crisis resource or professional support

• If you're currently safe, consider creating a safety plan with someone you trust and, ideally, a qualified professional

You don't need to have the perfect words.

"I'm not feeling safe with my thoughts right now. Can you stay with me?"

is enough to start a conversation.

If you think someone you know may be struggling

You don't need to become their therapist.

You do need to take what they're telling you seriously.

The 988 Suicide & Crisis Lifeline recommends several practical steps for supporting someone who may be suicidal:

• Be direct. Talk openly and matter-of-factly about suicide.

• Listen. Give them room to express what they're experiencing.

• Be nonjudgmental. Don't shame, debate, lecture, or try to win an argument about whether they "should" feel this way.

• Stay connected. Let them know they're not alone.

• Don't promise secrecy. If someone's safety is at risk, involve additional support.

• Don't dare or challenge them.

• Don't panic or react with shock. A strong reaction can make it harder for someone to keep talking.

• Offer hope without minimizing what they're experiencing.

• Help create safety. If appropriate and safe to do so, help reduce access to lethal means.

• Connect them with professional or crisis support.

The 988 Lifeline describes five evidence-based action steps as:

Ask. Be there. Help keep them safe. Help them connect. Follow up. (988 Lifeline)

And importantly, asking someone directly about suicide does not cause them to become suicidal. Direct, compassionate questions can create an opportunity for someone to tell you what they're actually experiencing. (Mayo Clinic)

If someone tells you they have an immediate plan or are in imminent danger, don't leave them alone if you can safely stay with them. Contact 988 for guidance or emergency services when necessary.

Where to Go From Here

Suicide and suicidal thoughts are tough subjects.

And they're important to talk about.

Talking about suicide doesn't create suicidal thoughts. What it can create is an opening: an opportunity for someone to say, I'm not okay.

Sometimes that opening is all we can offer. 

Sometimes that opening is connecting someone with the support they need.

And sometimes, that's a very big thing.

If you or someone you know is experiencing suicidal thoughts, please seek support. In the U.S., you can call or text 988 to connect with the 988 Suicide & Crisis Lifeline. You can also use the Lifeline's online chat. You do not need to be at the point of attempting suicide to reach out. (Cleveland Clinic)

If there is an immediate danger or someone has already seriously harmed themselves, call 911 or go to the nearest emergency department.

You don't have to know exactly what to say.

You just have to start somewhere.

if you’re struggling with TALKING ABOUT SUICIDE - view our list of 10 for When.

10 for When is your go-to swipe sheet of tools, resources, and support for the moments when the hard stuff shows up, because it will. Consider this your standing invitation to be a little more ready than you were yesterday.

Disclaimer: This blog is not meant as professional advice or counseling. If you are in emotional distress or experiencing thoughts of harm to yourself or others, help is available 24/7:

• If in crisis, call 988

• Text HELLO to 741741 to connect with a Crisis Text Line counselor

• Call the National Suicide Prevention Lifeline:

  • 1–800–273–8255 (TALK) Spanish & English

  • Deaf & Hard of Hearing TTY 800–799–4889

• Call 911

• If you need mental health treatment but cannot afford it, contact Rise Above The Disorder, a 501(c)(3) non-profit dedicated to making mental health care accessible to everyone: YouAreRAD.org