Concerned about yourself or someone else?

The factors leading to suicide and suicidal thoughts are complex and uniquely personal. A series of small or seemingly insignificant issues may put an individual at risk, just as much as a life-changing event. However, there are some risk factors that may have an influence, e.g.

• Drug and alcohol misuse
• History of trauma, abuse, or violence
• Social isolation
• Money problems
• Family breakdown
• Anticipated or actual losses or life stresses
• Prior suicide attempts

People with a diagnosed mental health condition may also be at a higher risk of suicide. However, most people with a mental health condition will not die by suicide.

A conversation about suicide can be scary and painful, both for the person who is suicidal and for the person who is asking. Ask how they are feeling and be patient. You may not get much of a response at first. Calmly and gently give them the time and space to start to talk. Resist the temptation to rush in and suggest what to do.

1. Ask open questions (i.e., questions that cannot be simply answered with ‘yes’ or ‘no’, such as: ‘How are you feeling?’,’ How did that make you feel?’) to encourage the person to talk.
2. If you have real concerns that they are at their lowest point or feeling hopeless, ask clearly and calmly: “Are you having any thoughts of suicide?” or
   “Are you thinking about ending your life?”
3. If they dismiss this question, or try to laugh it off, don’t be too quick to move on. You could suggest that they still consider getting help. You may feel worried that you will say the wrong thing. You don’t have to make everything better there and then. Simply let them know you are there for them and that you understand things are hard right now. 

It’s not always easy. There may be indications that someone is feeling suicidal, such as uncharacteristic or unpredictable behaviour, but the signs may also be subtle or deliberately hidden. These are potential indicators of suicidal thoughts or feelings (although they may not always be related to suicidal thoughts):

• Talking about suicide: Any talk about suicide, death, or self-harm, such as “I wish I hadn’t been born,” “If I see you again…” and “I’d be better off dead.”
• Preoccupation with death: Unusual focus on death, dying, or violence. Writing poems or stories about death.
• Seeking out lethal means: Looking for ways to kill themselves.
• No hope for the future: Feelings of hopelessness and being trapped (“There’s no way out”). Belief that things will never get better or change.
• Self-loathing, self-hatred: Feelings of worthlessness, guilt, shame, and self-hatred. Feeling like a burden (“Others would be better off without me”).
• Getting affairs in order: Making out a will. Giving away prized possessions. Making arrangements for family members.
• Saying goodbye: Unusual or unexpected visits or calls to family and friends. Saying goodbye to people as if they won’t be seen again.
• Withdrawing from others: Withdrawing from friends, family, or society. Increasing social isolation. Desire to be left alone. 
• Self-destructive behaviour: Increased alcohol or drug use, reckless driving, unsafe sex. Taking unnecessary risks as if they have a “death wish.”
• Sudden sense of calm: A sudden sense of calm and happiness after being extremely depressed can mean that the person has made a decision to attempt suicide.

However, someone at a very low point may be skilled at suppressing signs and even appear happy and no different to usual.

Unless someone tells you, the only way to know if they are thinking about suicide is to ask.

If someone does say that the are feeling suicidal, stay as calm and present as you can:

• Take them seriously – always assume that someone is telling the truth about their suicidal feelings as people can and do act upon them
• Listen to them – simply giving someone the space and time to talk about their feelings can be helpful in itself
• Avoid debating the value of life, minimising their problems or giving advice. You may think that you understand or have experienced something similar, but everyone’s circumstances are different. What was right for you may not be right for someone else
• Encourage them to get help with thinking about a way forward

Make sure they know where and how to get help:

• It can be overwhelming for someone to take the first step to get help. They may need your support.
• Ask them if they would like some support and whether you can help with this, e.g. by contacting a family member or signposting them to services.
• If someone is reluctant to get help, let them know that you are there for them. Give them information on support services for when they are ready.
• Check back with them later. Show them you are concerned for their welfare.

There is still considerable stigma around talking about suicide. Someone who is thinking about suicide is likely to be feeling:

• Lonely / isolated
• Frightened
• Ashamed
• Unable to ask for help, however desperately they need it

Listening can help save a life.

By listening you are giving someone the space and opportunity to start to share their thoughts. Active listening requires you to concentrate, understand, respond and remember what is being said.

Talking about suicide does not make it more likely to happen.

Sometimes people are reluctant to ask directly about suicide because they think they will put the idea in the person’s head – but this isn’t the case. Similarly, if a person is suicidal, asking them about suicidal thoughts will not increase the risk that they will act on these.

Talking about suicide reduces stigma and is often the first step to recovery.

It is more important to be genuinely caring than to say ‘all the right things’. Try to be supportive and understanding and listen actively to the person with undivided attention.