How to Talk About Suicide

If you’re wondering how to talk about suicide, you’re not alone. Suicide is an incredibly difficult topic.

Even therapists, counselors, and other mental health practitioners may struggle with how to talk about it.

That said, it’s essential that we talk about suicide. Discussing thoughts of suicidal ideation is likely to save a life. 

According to a 2014 review of 13 published studies, speaking about suicidal ideation reduces the risk of suicidality and improves general mental illness in clients seeking treatment. 

People who experience suicidal thoughts often don’t want to die. They desperately want to escape unbearable suffering. 

One conversation could save a life.

First, the latest stats on suicide in America

Whether we’re mental health practitioners or not, it’s clear that suicidal ideation and suicide attempts touch most of us. 

Suicide is considered a public health issue—like heart disease, diabetes, cancer, or COVID-19.

One person died by suicide every 11 minutes last year

Suicide was responsible for 49,449 deaths in the U.S.—about one death every 11 minutes in 2022, according to the U.S. Centers for Disease Control and Prevention (CDC).

While the CDC’s data found that suicide deaths among people ages 10-24 in 2022 had decreased by about 8%, compared to 2021, it showed that U.S. suicide deaths increased among those over 45 years old—with a 7% increase among people ages 45-64, and an 8% increase in those over 65.

In 2022 men made up 80% of suicide deaths

Men now make up almost 80% of suicide deaths in America, and in 2022, just over 39,000 U.S. men died by suicide. 

Among LGBTQ youth ages 13-24, the Trevor Project’s 2022 survey found that 45% had seriously considered attempting suicide in the previous year. 

During that same year, the 2022 National Veteran Suicide Prevention Annual Report showed that 17 U.S. military veterans die by suicide every day—over 6,000 people a year.

Over half of adults know someone who has had suicidal thoughts

According to a 2020 Harris Poll, over half (55%) of the 2,000 U.S. adults surveyed said that they “know someone who has had suicidal thoughts or behaviors.” 

Additionally, approximately one quarter (24%) of survey participants responded that they themselves had thought about or attempted suicide.

“One myth about suicide is that only people with mental health conditions experience suicidal thoughts,” clinical psychologist and senior director of Newport Healthcare Center for Research and Innovation, Michael Roeske, PsyD, told CNN in 2022.

“A lot of people don’t necessarily fit criteria for a mental health disorder, but in very stressful situations, they lose an important job, they find out about an infidelity with a long-term marital partner, and they go, ‘Oh, my gosh. I don’t know how I’m going to go forward living,'” explains Roeske. 

What’s holding us back from talking about suicide?

While most respondents of the 2020 Harris Poll (78%) said they would be interested in helping someone they know who is at risk for suicide, the majority noted there are barriers stopping them from discussing suicide with others. 

The most common barriers mentioned were:

• Not knowing the right words (31%) 
• Not having enough knowledge (28%) 

In the survey, the most common barriers cited that prevented those respondents who had considered or who had attempted suicide from reaching out for help were: 

• Feeling like nothing will help (67%)
• Lack of hope (63%)
• Not knowing how to get help (55%)
• Embarrassment (55%)

Saying something to start the conversation is better than saying nothing out of fear

Therapist and SimplePractice Pollen author Ben Caldwell, PsyD, acknowledges that most people are afraid of saying the wrong thing when discussing suicide. However, he says: “It’s far better to have the conversation with the person, even if it means stumbling through it, then to say nothing out of fear of making a mistake.” 

“I’ve found it helpful to approach the topic of suicidal thoughts with confidence,” explains counselor and SimplePractice Pollen author Kristin Trick, LPC-S, RPT, owner of Grounded Counseling and Services. “If we show discomfort with this topic, it’s likely the person we’re addressing will minimize or deny these thoughts because they think we can’t handle them.” 

“Make sure that you are focused on asking questions and trying to listen,” advises therapist and SimplePractice Pollen author Ryan DeCook, LCSW. “Focus on expressing empathy and showing care, not on giving advice or immediate solutions”

While starting a conversation about suicide can come with discomfort or uncertainty, it is worth noting that the more we talk about it, the more normalized the discussion becomes, according to therapist and SimplePractice Pollen author Heather Oglesby, MA, MFTC, LPCC.

“With intention and practice, our brains, emotions, and nervous systems can learn how to ask questions from a place of care and to listen from this place as well,” Oglesby says.

What to say if someone is struggling and expresses suicidal ideation

If a client, family member, friend, or colleague is struggling with mental health issues, a stressful life situation, or suicidal ideation, check in with them using a narrative, person-centered approach.

“When thinking about starting a conversation with someone you’re concerned about, it is critical that you approach the conversation with curiosity, compassion, and with a non-assuming stance,” says Oglesby. “If you’re motivated out of a genuine concern for the person, think about ways in which you can seek understanding from their perspective.” 

According to the American Foundation for Suicide Prevention (AFSP), If you think someone is considering suicide, assume you are the only person who will reach out to discuss it with them.

The AFSP recommends you do this by:

1. Talking to them in private.
2. Listening to their story.
3. Telling them you care about them.
4. Asking directly if they are thinking about suicide.
5. Encouraging them to seek treatment or contact their doctor or therapist.
6. Avoiding debating the value of life, minimizing their problems, or giving advice.

Say: ‘How are you?’ or ‘How are you really?’

What do you say to start off this check-in or honest conversation?

According to Caldwell, there’s really no wrong way to start the conversation. 

“Sometimes a simple ‘How are you, really?’ is enough to get the ball rolling,” he says. 

Caldwell explains that the typical greeting of “How are you?” can sometimes work to start these conversations too. 

However, Caldwell also acknowledges that many people often presume that phrase to be a social greeting, similar to “Hello,” instead of being a question that prompts authentic and meaningful response. Therefore, he points out, even despondent people will often answer “How are you?” with “Fine” out of a sense of social appropriateness.

Say: ‘I’m feeling a little worried about you and wanted to check in— would that be OK with you?’

Oglesby suggests you consider starting off the conversation by saying, “Hey, I’ve noticed that you don’t seem like your usual self these days. I am feeling a little worried about you and wanted to check in. Would that be OK with you?”

“By giving the person permission to open up, you’re creating a space that can feel more open rather than cornered or forced to respond a particular way,” she says. 

“If they are open to sharing more, continuing to ask open-ended questions—like ‘How long have you been feeling this way?’ or ‘How has all of this been impacting you?’—can create more safety within the conversation,” Oglesby adds.

Say: ‘I’ve noticed you seem down lately’ or ‘You’ve been unusually quiet’

“You can describe why you’re concerned and what you’ve observed,” Caldwell says. “For example, you might say: ‘I’ve noticed that you seem down lately’ or ‘You’ve been unusually quiet.’” 

Then, Caldwell explains, you can reassure them that you’re ready to offer support in whatever way would be useful. 

“That might just involve providing an empathetic ear,” he says. 

“It might also involve helping the person connect with a mental health professional, or with crisis resources such as texting TALK to 741741 or texting or dialing 988,” Caldwell adds.

Say: ‘Sometimes when we feel like nothing’s going right, thoughts of hurting ourselves can come up. Is that happening to you?’ 

According to Trick, we can open the door for conversation by making a general statement, such as, “Sometimes when we feel like things are falling apart or that nothing’s going right for us, thoughts of hurting or even killing ourselves can come up. Is that happening to you?” 

“If their answer is yes, we need to ask more questions to evaluate their level of risk,” Trick says. 

The follow-up questions Trick recommends include:

• “How often do you think of suicide?” 
• “Do you have a plan of how you’d kill yourself?”
• “Do you have access to these means?” 
• “What’s keeping you from acting on suicidal thoughts?” 
• “What are your reasons for living?”

She explains that their feedback to these questions can help us develop a safety plan. 

“We can identify supportive people who need to be included and positive actions to take in helping the person stay safe,” she says.

Say: ‘I’ve noticed life’s gotten difficult. Do you want to tell me about it?’

Clinical psychologist Justin Baker, PhD, director of The Suicide and Trauma Reduction Initiative for Veterans at The Ohio State University Wexner Medical Center, told CNN that he recommends asking an open-ended question, such as: “Hey, I’ve noticed life’s gotten overwhelming these past couple days. Do you want to tell me about it?”

As the person responds, listen, express appreciation for them sharing their story, and offer to help figure it out together, without offering advice on how to handle it, Baker explains.

However, according to Baker, if your loved one seems more at risk or in the process of attempting suicide, “you no longer have [the] time or… luxury to get their opinion.” 

In that case, Baker advises to seek medical care or call 911 or 988.

Say: ‘I care,’ ‘You are not alone,’ or ‘It’s OK not to feel OK’ 

Oglesby says that the key element to this conversation is communicating validation. 

“To do this, you simply aim to recognize that what they are going through is real, is difficult, and that they don’t have to go through it alone,” she says. “As you communicate this validation, it may be appropriate to ask if they’ve thought about seeking support and you might even offer to help them navigate that process if they would like.” 

Another way to offer validation is to normalize that suicidal thoughts are actually really common and sometimes a “natural” response to extreme despair, stress, and pain, Oglesby recommends.

“While normalizing someone’s suicidal thoughts, you can add that you want to be with them through this and that you don’t want them to feel alone in what they are facing,” she says.

Say: ‘Have you ever thought of hurting yourself?’ or ‘Are you planning to hurt yourself?’

According to Caldwell, you should ask direct questions during the conversation. 

“It’s important to ask questions like ‘Have you ever thought of hurting yourself?’ and ‘Are you planning to hurt yourself?’ says Caldwell. “These questions aren’t going to somehow encourage the person to harm themself.” 

Similarly, Caldwell explains that it’s OK to directly use the word “suicide” in your conversation, so long as you’re able to say it in a calm, regular tone of voice. 

“If your voice changes to a whisper when using words like ‘hurt yourself’ or ‘suicide,’ the person might presume that you find the possibility to be overwhelming,” he says. “Consequently, they may then deny such plans, simply to—as they see it—avoid being a burden to you.”

Say: ‘Are you having thoughts of suicide?’

It can seem intimidating, but we should not shy away from asking direct questions about suicide, says DeCook.

He says to consider asking the following questions, respectively: “Are you having thoughts of suicide?” “Have you decided how you would harm yourself?”  “Do you have any of the things you would need to carry out your plan?” 

DeCook points out that these are all questions that are reasonable and important to ask.

Say: ‘That sucks. I’m sorry’

While it can be helpful to focus on parts of the person’s life that bring them purpose, hope, and belonging, Caldwell cautions not to force these things. 

“If the person starts opening up about the pain they’re in, saying ‘That sucks. I’m sorry’ may bring the person more comfort than saying something like ‘But there are so many people who care about you,’” he says.

End the conversation with a plan of action 

If it’s possible, try to end the conversation with a plan of action, Caldwell advises.

“What will the person you’re worried about do next?” he says. “That plan may involve contacting crisis resources, spending time with friends or loved ones, scheduling a therapy session, or other steps to build their safety and support.” 

Consider whether there are any next steps for you to take. 

“Perhaps you can help them by gathering information or contacting others on the person’s behalf,” Caldwell suggests. 

“From a clinician perspective, talking about and assessing suicide can become rather routine, especially if you’re working with populations who might be higher risk or have higher acuity,” says Oglesby. “However, familiarity with the topic doesn’t mean that every conversation with clients will look the same.” 

Oglesby recommends the CAMS (Collaborative Assessment and Management of Suicidality) Model, which honors the subjective nature of each person’s experience with suicide while providing some structure in how the topic is discussed. 

With the CAMS Model, clients are asked to rate various aspects that are associated with suicidality (psychological pain, stress, agitation, hopelessness, and self-hate) to assess overall risk. 

“From here, it’s then crucial to explore with clients what actually drives suicidal thinking,” Oglesby says “Whatever the client discusses, this will eventually form into key aspects of the treatment plan, and using this approach, you can share with clients from the very beginning that you are going to be regularly asking about this topic and collaboratively processing through what changes might be possible.” 

Even silently holding space or holding someone’s hand can help

Knowing that creating or holding space for conversations about suicide can reduce the risks and symptoms of suicidality, and understanding that a third of Americans attribute their silence to being afraid they’ll say the wrong thing or fear they don’t have the right words or enough knowledge to reach out to someone they’re concerned about, one important point is that there may be no need to even speak to show that you are there for someone in need.

“Simply being present with someone in their pain, without trying to solve it for them, is very powerful,” says Caldwell. 

Caldwell mentions a scene in the 2006 movie Little Miss Sunshine. During a cross-country road trip with his family, a teenage boy (Dwayne, played by Paul Dano) discovers that he’s colorblind. Dwayne—devastated that his dream career, flying fighter jets, has been destroyed—demands that his family stop the van, and he runs off into a field. 

“During this scene, each member of his family tries to convince Dwayne to get back into the van, and fails—because they’re trying to convince him,” Caldwell explains. “Then, his little sister simply sits next to Dwayne and puts her arm around him. It doesn’t take long at all before he’s ready to rejoin the family.”

Caldwell says he holds that scene in mind when treating clients in crisis.

“No platitudes, no urgency. Just company,” he says. 

What not to say when talking about suicide

According to Caldwell, while there are some things it’s probably better to avoid saying during a conversation with someone we’re worried about, we shouldn’t avoid having the conversation because of our fear of inadvertently saying the wrong thing.  

“It’s unlikely that saying any of these things during your conversation with them will somehow make the person’s situation worse,” Caldwell says. “While they’re not actively helpful, they’re also not likely to be damaging.”

Still, there are some guidelines to try to keep in mind, if possible.

Don’t say: ‘I know things will get better for you’ and don’t make promises about the future

Telling someone “I know things will get better for you” can come off as unrealistic at best, and patronizing at worst, explains Caldwell.

Don’t make promises about the future, he says. 

“It may be tempting to reassure someone that their situation will be better tomorrow, that a partner who recently left will come back, or that a family relationship is going to heal with time,” he continues. “But you can’t know with certainty that these things will happen.” 

While Caldwell says it’s fine to hold and to express hope, he recommends you don’t make promises or guarantees for things that are out of your own control. 

Don’t say: ‘I can’t believe you feel that way’ or ‘I don’t believe you’

“I’ve heard clients share that sometimes they haven’t been believed when they’ve disclosed suicidality to a loved one and, at times, even to mental health professionals,” says Oglesby. 

According to Oglesby, the most important thing you can do for someone who is struggling is to believe them. She acknowledges that this may sound easy, however, it’s often difficult when our own reactions of fear or confusion arise. 

“If someone feels safe enough to share their experiences with suicidal thoughts with you, make sure to never communicate disbelief,” she says. “Instead, show up with a belief in their experience, which in turn, can help them find belief and trust in who they are.” 

Don’t say: ‘This isn’t that big of a deal’ or ‘You shouldn’t hurt your family like that’

We may think these statements are well-intentioned. However, Oglesby points out that these types of phrases communicate a larger message that the person is “bad,” because they are experiencing suicidal ideation.

“The quickest way someone might shut down in this conversation is if they feel minimized or blamed,” she explains. “If you say something like, ‘This isn’t that big of a deal” or “You shouldn’t hurt your family like that,” you may see an instant disconnection from the person you are trying to have an important dialogue with.” 

Don’t say: ‘Call me any time’

“As much as we may want to help, it’s important that we don’t say ‘Call me any time’ unless we can 100% completely guarantee we’ll be available when that person reaches out,” advises Trick.

Instead, Trick recommends that helpers in this scenario—whether professional or personal—ensure the person has the National Suicide and Crisis Lifeline phone number (988), in case the person is in crisis at a time when we are unavailable. 

Don’t argue with their pain or demand they justify their feelings

Don’t argue with their pain, or demand that they justify their feelings, Caldwell advises.

“You’re there to offer support, not to engage in a power struggle,” he says. 

Don’t speak too much yourself or give advice

It’s also important that we don’t speak unnecessarily in these conversations, according to Trick. 

“We should give the person sharing our full attention and prioritize listening to them rather than trying to give them advice or attempting to empathize with them,” she says. 

“An excellent resource for those wanting to know more about crisis intervention is the LivingWorks Applied Suicide Intervention Skills Training (ASIST),” Trick recommends. “The training provides practical skills to use in crisis conversations and teaches participants how to evaluate different suicide risk levels.” 

Don’t center the conversation on yourself

“You may have a history of your own that you believe could be helpful,” Caldwell explains. “But you shouldn’t presume what you went through is a good analogy for what the person you’re talking to is going through.”

If you do want to offer examples or stories from your own life, Caldwell suggests that  you:

1. Ask the person whether they want to hear your story first
2. Acknowledge out loud that your story isn’t exactly the same as what the person is going through now
3. Keep it brief

Don’t use threats to try to prevent the person from acting on their suicidal thoughts

DeCook advises, “Do not use threats to try and prevent the person from acting on their suicidal thoughts.”

Don’t agree to keep it a secret

If the person with suicidal feelings asks you not to tell anyone, DeCook says you should not agree to that.

“Don’t agree to keep it a secret,” he says.

Don’t say: ‘Commit suicide’ or ‘committed suicide’

How we talk about suicide matters, and the words we choose to use can also contribute to stigma. 

Over the past decade, the language around suicide has evolved. The phrase “commit suicide” is now considered outdated, and harmful by experts, including mental health practitioners, non-profit organizations, journalists, and editors. 

The Associated Press (AP) Stylebook, which guides the usage of language in online and offline newspapers and magazines, added an entry in 2015 about suicide. In its 2015 guidance, the AP Stylebook directs writers to avoid using the phrase “committed suicide,” except in cases where it is a direct quote from authorities. Instead, AP recommends writers use “died by suicide.”

“Committed in that context suggests possibly an illegal act, but in fact, laws against suicide have been repealed in the U.S., at least in certain states, and many other places,” AP’s former Deputy Standards Editor David Minthorn told Poynter in 2015. “So, we’re going to avoid using that term on our own. Althought it’s a term that authorities widely use, and we will use it while quoting authorities.”

To Minthorn’s point, when the word “commit” is used in English in the transitive form (as it is in the phrase “commit suicide”), it typically refers to a crime or a sin. Consider the phrases commit murder, commit a robbery, commit a felony, or commit adultery.

This phrasing and usage of the word “commit” implies a sense of wrongdoing and a sense of fault. Connecting suicide with fault, crime, or sin adds to the stigmatization that can stop people from reaching out for help.

Suicide is a cause of death. For the same reason we don’t say that someone died by “committing cancer,” we should avoid saying someone “committed suicide.”

Don’t say: ‘Completed suicide,’ ‘successful suicide,’ ‘failed attempt,’ or ‘unsuccessful suicide attempt’

According to the Suicide Prevention Alliance, using the words “completed” or “successful” when referring to a suicide can imply that suicide isa positive act to be accomplished. For that reason, these words and phrases can be harmful when discussing suicide.

“The litmus test for talking about suicide is to substitute the word ‘cancer’ for the word ‘suicide’ to see if the sentence still makes sense or if it has a negative connotation,” Clinical psychologist Sally Spencer-Thomas, PhD, wrote in a 2021 article on the use of language with regard to suicide. “We wouldn’t say ‘committed cancer’ or ‘successful cancer.’ We would simply say ‘cancer death’ or ‘died of cancer.’  Thus, when it comes to suicide, we should say ‘suicide death’ or ‘died of suicide.’

For those still saying or writing “committed suicide,” “completed suicide,” or “unsuccessful suicide attempt,” it’s time to begin using alternatives. 

Spencer-Thomas calls on workplaces, schools, faith communities, and healthcare organizations to use safe and compassionate language to help challenge stigma, misinformation, and myths about suicide. “To do this, we need to craft safe and powerful messages, work collaboratively with traditional media outlets, and use social media strategically,” she wrote.

Changing the words we use may change the way we and those around us, including our clients, friends, and family members, think about and talk about suicide.

Suicide warning signs

If you’re concerned that someone may be suicidal, something to look out for is a change in behavior or the presence of entirely new behaviors, according to the American Foundation for Suicide Prevention (AFSP). 

The AFSP also shares the following warning signs.

Talk

If a person talks about:

• Killing themselves
• Feeling hopeless
• Having no reason to live
• Being a burden to others
• Feeling trapped
• Unbearable pain

Behavior

• Increased use of alcohol or drugs
• Looking for a way to end their lives, such as searching online for methods
• Withdrawing from activities
• Isolating from family and friends
• Sleeping too much or too little
• Visiting or calling people to say goodbye
• Giving away prized possessions
• Aggression
• Fatigue

Mood

• Depression
• Anxiety
• Loss of interest
• Irritability
• Humiliation/shame
• Agitation/anger
• Relief/sudden Improvement

What to do if someone you know exhibits warning signs of suicide

If someone you know is dealing with suicidal thoughts: 

1. Do not leave the person alone.
2. Remove any firearms, alcohol, substances, or sharp objects that could be used in a suicide attempt.
3. Text TALK to 741741 to connect with a trained crisis counselor.
4. Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text or dial 988.
5. Take the person to an emergency room or seek help from a medical or mental health professional.

Additional resources

Mental Health First Aid – DeCook recommends this skills-based training course as a great resource, especially for non-clinicians to get some tips and training on how to effectively speak with loved ones when they are struggling with various mental health challenges, including suicidal thoughts.   

The American Foundation for Suicide Prevention has over 50 local chapters across the country with local support for those considering suicide and their loved ones. Find a local chapter.

The Suicide Prevention Resource Center offers online courses and webinars.

SimplePractice has a webinar on Taking Action for Suicide Prevention.

The Suicide Awareness Voices of Education (SAVE) foundation provides resources for those who have survived a loss by suicide. 

SimplePractice Learning is offering 1.5 hours CE  A Therapist’s Loss: Grieving our Clients (Live) on September 29, 2023 from 9 AM to 10:30 AM PT. (NOTE: If you register for this event but are unable to attend, a recorded version that provides 1.5 hours CE credit will be available at no additional cost.)

READ NEXT: How to Cope in the Aftermath When a Client Dies By Suicide

 

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