How To Help A Suicidal Friend: Things To Remember
By Sarah Fader
Updated December 18, 2018
Reviewer Michelle Lind
Realization often strikes in one moment. Perhaps you notice that your best friend has been drinking heavily and driving recklessly, seemingly without regard for their safety. Perhaps your spouse has withdrawn from their relationships and hobbies and seemed not to have any hope for the future. Perhaps you overheard your teenage son or daughter tell a friend that they don't want to be alive.
No matter how you find out, the realization that a loved one is considering suicide is always a shock. If you are wondering how to help a suicidal friend or family member, educating yourself, making yourself accessible, and familiarizing yourself with the resources available are crucial. Read on to learn how you can care for and support your loved one during this challenging time.
Seek Professional Help
If your loved one has described an immediate desire or plans to kill themselves, then your primary concern should be to seek professional help. In the best scenario, you will be able to take them to a nearby hospital emergency room and tell the admitting staff that they are "acutely suicidal." This phrase alerts the attending physicians and doctors that they are in danger of harming themselves and that immediate action should be taken to keep them safe.
In situations where getting to a medical facility is not possible, you should call an emergency operator (911) and stay with your loved one until medical help arrives. In the United States, there are also several other hotlines that can offer trained, professional crisis counseling to acutely suicidal individuals. Here are a few phone numbers to keep stored on your phone:
- 1-800-273-TALK (8255) or 1-800-799-4889 (for the hearing impaired): This number puts you in touch with the National Suicide Prevention Lifeline, a nationwide network of crisis centers that provides confidential support. If talking on the phone feels uncomfortable, you can also chat online with a hotline counselor here.
- 1-800-SUICIDE (800-784-2433): This number will take you to the National Hopeline Network.
- 1-800-USA-KIDS (872-5437): Contact this number to reach the Thursday's Child National Youth Advocacy Hotline.
- 1-800-273-8255 (or text 838255): Calling or texting this number will connect you with the Veterans Crisis Line, which provides support specifically tailored to veterans.
- 1-866-488-7386: This number puts you in touch with The Trevor Project, which offers crisis counseling for individuals within the LGBTQ+ community. You can also chat online on their website.
- The non-emergency phone number of your local police department, which may be able to help in escorting your loved one to the hospital
- The phone numbers of any doctors, therapists, psychiatrists, religious or spiritual community members, or supportive friends and family who may be able and willing to offer help during a crisis
After asking for permission to do so, you may want to consider saving each of these contact numbers in your loved one's phone, so that they can access them even when you are not around. Make sure they know that there is a range of support options at their fingertips every day and that there are accessible healthcare professionals who are trained to provide effective treatment for these kinds of thoughts and feelings.
Your loved one may already be receiving treatment for this issue from a psychiatrist or other mental health professional. If you know that this is the case, it is crucial that you contact any existing care providers to inform them of the situation. By taking this additional step, you can equip everyone who is involved in your loved one's care and treatment to respond appropriately to this crisis.
The rise of social media also creates situations in which a post or photo might alert you that a friend is thinking about suicide even if you are not able to help them directly. Social media websites Facebook, Twitter, Instagram, and YouTube work directly with the National Suicide Prevention Lifeline to respond to reports of self-harm or suicidal behavior with messages that provide resources and encourage the user to seek help. This should be viewed as a last resort if you are unable to seek help your loved one in any other way but can be extremely valuable if you cannot reach out to them in person.
Evaluate The Risk
If you know that a friend or family member is seriously considering suicide, then you are probably wondering what could have put them into such a state of distress and despair. Suicidal thoughts and feelings usually represent a catastrophic, temporary state of mind that develops in response to intense emotional, physical, or mental stress.
This stress does not feel like the normal, day-to-day frustration that everyone feels from time to time. It often emerges from a complex mingling of factors, which feel so unbearable and overwhelming that suicide seems like the most practical option. If these impulses seem impossible for you to understand, imagine how much more difficult it must be for your loved one to communicate what they are thinking and feeling.
Helping a person who struggles with suicidal ideation or self-harming behaviors can quickly become an overwhelming and stressful process. While it is impossible to completely put oneself in another person's shoes, educating yourself on the causes and conditions most commonly associated with suicide can give you an informed perspective on what your loved one is experiencing and show you the best ways to help them recover.
Mood disorders, such as major depression, dysthymia, and bipolar disorder, are the most common cause of suicidal ideation. In fact, research suggests that as many as 60 percent of suicides are committed by people who suffer from these types of mental and emotional conditions. An additional 30 percent of suicides are connected to other psychiatric disorders, such as schizophrenia, post-traumatic stress disorder, eating disorders, and other severe personality disorders. The National Institutes of Mental Health lays out more information about the causes of suicide here.
Those who suffer from co-occurring issues (at least two diagnosable mental or emotional disorders at one time) are also more likely to die by suicide. Traumatic events from past may also play a role in motivating suicidal behavior. Victims of child sexual abuse, child neglect, and domestic violence are much more likely to take their own lives, especially if they have not received care for dealing with those issues. Physical conditions such as chronic pain, disfigurement, and disability can also lead to severe depression and suicidal thoughts.
In many cases, external risk factors exacerbate these conditions to increase a person's risk of suicide. Has your loved one experienced a damaging personal event, such as the death of a spouse or the loss of a valued career? Have they recently been released from prison or charged with a crime? Has a close friend or family member also committed suicide? These are some of the external triggers that have been statistically proven to increase suicide risk.
See The Signs
One of the most important things that you can do for a friend who struggles with this issue is staying alert for any signs that their suicidal ideation is worsening. Following is a comprehensive, though not exhaustive, list of symptoms that often precede suicidal behavior. As you evaluate your loved one's recent behavior, ask yourself these questions:
- Have they expressed a desire to die or stop existing? Have they said that they feel "trapped" in their life?
- Do they frequently discuss death, draw images of death, or seem obsessed with media that depicts death?
- Do they exhibit signs of extreme emotional distress? Do they seem persistently hopeless, sad, frustrated, or guilty? Do they experience intense mood swings?
- Is there evidence that they have put intentional thought and effort into finding a way to commit suicide? For instance, have they searched online for suicide methods, acquired a weapon, or stocked up on prescription medication?
- Have their habits, such as sleep patterns or food consumption, changed dramatically over a short period?
- Have they withdrawn from relationships with friends and family? Do they frequently say that they feel like a "burden" to the people around them?
- Are they intentionally engaging in the hazardous behavior, such as reckless driving, risky sexual behavior, or irresponsible drug or alcohol use?
- Do they seem more irritable, agitated, or anxious than normal?
- Does their behavior point to a strong belief that they will die soon? For instance, have they written a will, spoken about last wishes, or given away treasured possessions, or said goodbye to friends and family?
If your answer to any of these questions is "yes," then now is the time to act. Remember that none of these signs should ever be trivialized, rationalized, or ignored. While anyone could be at risk, young adults, people from marginalized communities (such as LGBTQ+ individuals and Native Americans), and combat veterans are among the most vulnerable populations. Suicidal thoughts and actions are not just an attempt to get attention or garner pity. They are a sign of severe distress that should be taken very seriously. Don't wait for a sign that you cannot ignore.
Watch Your Language
During this conversation-and even while talking about the topic of suicide in regular conversation-it is important to use language that is clear yet compassionate. Avoid phrases like "successful" and "unsuccessful" suicide, which can give the action a positive connotation. The phrase "committing suicide" comes from the time when thoughts of suicide were treated as shameful and criminal, and hardly lends itself to openness. Instead, experts recommend using one of these alternatives:
- "Ended their life."
- "Took their life."
- "Died by suicide."
- "Attempted to end their life."
This kind of language treats people who struggle with suicidal thoughts with respect while accurately portraying the consequences of the action itself. No matter which words you choose, try to refrain from any language that sounds condemning or judgmental.
Have A Conversation
Talking openly and honestly about suicide can be an incredibly frightening and intimidating prospect, but it is a necessary step toward helping your loved one. Most people find it incredibly difficult to ask for help with their suicidal ideations. Lack of access to quality mental health care, lack of knowledge about their options, and lack of recognition for their emotional and mental needs are some of the most common obstacles that prevent people from getting the care that they need. Also, a huge variety of cultural, social, and personal factors can make people feel as if they must cope with problems on their own.
As a trusted friend, you have the unique powerful opportunity to confront these doubts and encourage help-seeking behavior. This dialogue can proceed along many different paths, but it always begins with listening. Don't rush in ready to offer advice, provide all the answers, or talk about your concerns. Instead, just let your loved one know that you are always there to support them and are willing to help in whatever way you can. They may want to discuss how they feel, or they may not want to talk about it. Be respectful and considerate, but don't shy away from expressing your concern and encouraging them to open further, whether to you or another trusted friend or family member. This kind of kind, reassuring response lays the foundation for better communication in the future.
If your loved one seems receptive to talking about their situation, then take a few minutes to explain the reasons why you are worried about them. Keep your comments observational and open-ended. "You've seemed sad lately," or, "I noticed that you haven't been to bowling night so far this month" leave opportunities for them to share what they are going through. Visit the Conversations Matter website or the Suicide Prevention Resource Center for more tips on building constructive dialogue.
It may also be appropriate to approach the topic directly. Many people worry that asking about these kinds of thoughts and feelings will make their loved one more likely to attempt suicide, but current data do not support this. A question like "Are you thinking about hurting yourself?" does not explicitly mention suicide, but it gives your loved one the chance to talk about their struggles without introducing the topic themselves.
In some cases, your loved one may express a desire to look for help. Offering to stay with them during this process can make it a lot easier for them to follow through on that desire. This support might mean holding their hand while they dial a suicide hotline, driving them to the hospital, or calling their mental health care provider on their behalf. Ask how you can best help them. Sometimes, however, your loved one may deny that they are thinking about suicide or refuse to have a conversation about it. This may make you feel angry or upset but try not to let it show in your words or actions. Simply remind them that you are always ready to provide a helping hand or a listening ear.
Remove The Means
Access to lethal items and environments can sometimes mean the difference between life and death. Experts have identified several objects and items that pose particularly high risks during a suicide crisis period:
- Sharp objects (knives, shaving razors, etc.)
- Toxic substances (such as household cleaners)
- Potentially lethal medications (especially antidepressant or antipsychotic drugs)
It is never easy to ask a loved one if they have a suicide plan, but it is a necessary conversation. If they are willing to talk about the ideations that they experience, gently ask if there is any way you can help reduce their access to dangerous objects and places. With their permission or participation, go through their house, identify high-risk items, and discuss how you can mitigate their danger. This may mean confiscating keys to firearms cabinets and safes or surrendering any guns to your local police department for safekeeping. It may also mean taking away sharp objects and potentially lethal household supplies.
It is important to be respectful during this process and to make sure that you are not removing your loved one's ability to take care of themselves. In the long run, taking away their sense of agency may make them feel even more helpless or distressed. Your aim should simply be to make their environment safer, so be sure that you set up plans to compensate for anything you remove from their lives.
For instance, if prescription drugs pose a risk, offer to take their medication home with you and deliver an appropriate dose to them each day. If taking away their car keys seems like a necessity, make sure that a trusted friend is always available to drive them where they need to go.
Removing any illicit drugs and alcohol from your loved one's environment is also a crucial element of suicide prevention. These substances impair judgment and remove healthy inhibitions, and combinations of them can lead to accidental suicide.
Hold Your Judgement
When listening to your loved one, you may be tempted to tell them that they are overreacting or feel that the problems they find so difficult to confront are easily solvable. If these thoughts ever arise, remind yourself that each person processes feelings of distress, sadness, and hopelessness in a very different manner. A situation that seems trivial or inconsequential to you may be completely overwhelming to someone else. Also, your loved one may be suffering from a severe psychiatric issue that complicates or disrupts rational thought.
Your task in this situation should be to put any judgmental thoughts on hold and act as compassionately, kindly, and understandingly toward your loved one as possible. Suicidal behavior is not a sign of weakness, failure, or bad character. Although this kind of thinking is not healthy or normal, it is common. Remind your loved one-and yourself-that most people need a great deal of support and help to get better, and that it is possible to recover completely even after a crisis.
Connect to Long-Term Care
After your loved one has received the immediate care that they need, it's time to look forward to the future.
Many people who are coping with suicidal ideation find it helpful to set up regular meeting times with a therapist or other mental health professional. You can use the Treatment Facility Locator compiled by the Substance Abuse and Mental Health Administration to find a licensed, credible therapist in the area. Good Therapy also allows you to search by ZIP code and find nearby treatment centers, psychiatrists, and even youth therapists. The American Counseling Association, American Psychiatric Association, and American Residential Treatment Association website also offers helpful advice for individuals seeking a therapist.
If visiting a therapist in person feels too intimidating, there are other options available. BetterHelp can help your loved one connect with experienced, accredited psychologists and therapists from the comfort of their own homes.
BetterHelp offers access to licensed, trained, experienced, and accredited psychologists (Ph.D. / PsyD), marriage and family therapists (LMFT), clinical social workers (LCSW / LMSW), and board licensed professional counselors (LPC).