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How to Help Someone Who is Suicidal

One of the greatest barriers to suicide is social connection, and there are many things people can do to help prevent death to suicide. The fact that you are visiting this page, putting in the effort to help protect someone at risk is profound. This page is intended to provide some clarity on what it’s like to experience suicidal thoughts, and guidance on what you can do if someone is at risk.

Keep in mind, that no one person can be ultimately responsible for another person’s life. If you have someone in your life who might be risk of suicide, please reach out to others to support you while you’re helping the person at risk. These suggestions for caring for others work best if you also focus on caring for yourself.

It’s also recommended that you reach out to a trained San Francisco Suicide Prevention counselor to go over your concerns.  Everyone caregiver and person-at-risk’s circumstances are unique, and you deserve individualized support.  Operators are available 24/7 at 415-781-0500.

What should I do if someone told me they’re suicidal?

Disclosing thoughts of suicide is a painful, difficult thing to do.  If someone admitted this to you it must mean that they trust you in some way, and want some specific sort of help that they believe you can provide.  The reason they approached you in particular may vary: perhaps they consider you a comforting, trustworthy person.  Maybe based on your career they feel you’re equipped to handle this disclosure better than others.   Or maybe they know you have been through something similar, and won’t judge them for admitting their thoughts.

Regardless of the reason, it’s generally a positive sign that someone chose to disclose to you.  By telling someone else they are putting a barrier in place preventing them from attempting.  They know a third party could potentially intervene by calling emergency services or getting others involved.  The act of admitting their thoughts is a gesture toward safety.

When someone tells you they’re suicidal, respond with empathy and gratitude.  “That sounds so painful, but I’m so glad you’re telling me this” works well.  Next, you should check for immediate safety by performing a risk assessment, and if possible have a conversation about what they’ve been going through to help connect them to safety.

What if I’m not sure they’re suicidal?

While there’s no way to know how many people have had thoughts of suicide, the rising rates of suicide attempts suggest that suicidal desire is quite common. Unfortunately, the nature of suicidal thoughts often prevents disclosure. People who believe that they don’t deserve to live may also feel like they don’t deserve support, and are thus hesitant to admit how they’re feeling.

But if you are wondering if someone is suicidal, it’s probably because they’ve been giving off some cues that they’re not doing well.  Perhaps they have stopped engaging with life-affirming activities, they seem distant and withdrawn, seem careless about hygiene or appointments.  More common is casual references to low self worth: “No one cares about me anymore.”  “There’s no reason for me to go on.”  “What’s the point of trying?”

Signals suggesting suicide are unique to the individual, and can be any major change in behavior.  It may be hard for a casual acquaintance to notice the change or see it as unusual, but loved ones can usually see that there’s something wrong.  If you notice any abrupt changes suggesting a lack of wellness, especially verbal cues hinting at suicide, it’s best to ask directly:

  1. First, point out the worrying cues: “You’ve been canceling on all of our plans, you haven’t been eating, and you keep saying there’s no point in going on anymore.”
  2. Then express your concern: “I care about you.”
  3. Normalize these as signs of suicide: “I know that this could mean that someone is thinking of ending their life.”
  4. Ask directly: “I want to know because I want to help you: Are you thinking of suicide?”

For more information about warning signs, please read this page.  If you feel uncomfortable asking directly, try calling San Francisco Suicide Prevention operators at 415-781-0500 to ask any questions you might have.

How do I assess for suicide risk?

“Suicide assessment” may sound like a daunting clinical task, but it’s actually simple and intuitive: suicide assessment is a short process of determining if someone has a logistical plan of how to attempt suicide.  Most people who have suicidal thoughts do not attempt suicide, and most people who attempt suicide do not die by suicide.  By asking practical questions about suicide plans, you can help determine if the crisis is primarily emotional, or if there’s also a physical component.

After someone tells you they are feeling suicidal, you need to ask about their PLAN:

  1. Plan: Does someone have a specific plan in place?
  2. Lethal: Is this plan lethal?
  3. Access: Do they have access to this plan?
  4. Now: Do they plan on using it in the immediate future?

For example, if someone says they have a plan to use a firearm on themselves but don’t have a firearm or a way to access it, they aren’t at acute risk.  If someone says they have a firearm in their home but don’t plan on using it in the next 24 hours, they’re at a higher risk and will require some intervention to keep them safe in case they become impulsive.  If someone says they have access to a firearm they plan on using later in the day, they require immediate intervention to keep them safe.

For more information about risk assessment, read an in-depth explanation here. Or call 415-781-0500 to speak to a live counselor about risk.

What should I say to someone who is having suicidal thoughts?

At San Francisco Suicide Prevention all of our counselors go through an extended training process to help them recognize de-escalation of suicidal thoughts is not about what a person says, it’s about how they listen.  It may feel like your job as a caregiver is to come up with the perfect pearls of wisdom to shift someone’s perspective about life.  Or perhaps you need to build up their self-esteem, make them see how great they really are.  Unfortunately, this often digs the person-at-risk deeper into their distress.

Instead, use the following listening techniques:

  • Validate: Tell them that their feelings make sense, that it’s okay to feel the way they do.  Many people fear this will encourage feelings of suicidality.  Instead it encourages communication and connection, which decrease suicidal thoughts.
  • Ask Open-Ended Questions: Being curious at the person-at-risk shows they are valuable, that their opinions and perspectives matter.  It will also help you understand where they’re coming from.
  • Paraphrase: As the person-at-risk is explaining their circumstances, paraphrase to clarify what they’re saying.  It demonstrates that you’re listening intently, and will allow them to evaluate if what they’re saying is what they want to be saying.

After feeling truly heard and listened to, people-at-risk usually de-escalate.  The conversation naturally leads toward discussions of positive things, future plans, and most importantly: self-care.

How can I help de-escalate someone who is suicidal or in crisis?

While many people feel depressed, it does not mean they are in crisis or suicidal.  Suicide attempts usually happen during crisis periods.  Crisis is usually short term in nature, often lasting hours to days, and in some cases weeks.  It does not go on forever.  And during this time, the person’s normal problem-solving strategies are not sufficient to bring the individual to his or her usual steady state.  In short, the person is at risk of doing impulsive acts while in crisis, perhaps a suicide attempt or perhaps other risk-taking or health-harming behaviors.

When someone is in crisis, our goals tend to be short-term in nature.

We try to:

  • Bring the person back to the pre-crisis state
  • Keep the person supervised and safe until the crisis feelings pass
  • Remove potential methods of harm from the person’s surroundings.  For more information on means removal, please read here.
  • Help the person feel more control over their problems or life circumstances
  • Help the person create an action plan or help the person use mental health or other services
  • Help the person grow and become stronger as a result of effective problem solving
  • And if the situation is out of control or very high risk, call 911 and have the person taken to a psychiatric emergency service.

Five Steps to Help Suicidal Friends and Family Members

  1. Let the person talk.
    In most cases, talking is good. If the suicidal person is talking out their problems, they are not harming themselves.  Listen without judgment and do not try to make the suicidal person feel guilty.  Suicide happens when there is too much pain for someone to tolerate.  Think of the people you would turn to if you were in a crisis and act as you would want them to act.
  2. Reduce Isolation:
    Depressed and suicidal people often feel very alone and isolated.  Hang out with friends or family members feeling depressed or alone, even when you feel too busy. It helps them.  They may help you someday.
  3. Supervise.
    Usually, suicide is a solitary act. People tend to do it when they are alone.  Sometime just having people stay with a suicidal person for hours to days, until the crisis passes, can make all the difference. Sometimes family members or groups of friends take shifts to assure 24 hour supervision. Also it reinforces to the person that someone truly cares.
  4. Contract:
    Contract (i.e., make a verbal agreement) with the person to contact help whenever they feel in crisis and before they make an act of harm.  That helping person could be you, a crisis hotline, or their counselor.  Contracting to contact more than one person is better, because a single caregiver might not be always available.  Also honor your end of the contract.  If you tell a person in crisis that you will call tomorrow, call the person!
  5. Get Help.
    Work with your loved one to get help.  There are many mental agencies in your community that can help, find referrals in San Francisco.