What to Do When You're Worried a Loved One Might Be Suicidal

Maybe it’s only a small change. Your friend seems more distracted than usual, or maybe he’s been a bit withdrawn. Maybe she gets angered more easily by small things, or the passion he used to have seems to have disappeared.

Maybe she’s told you outright. He’s been feeling really down lately. She wonders if the world would be better off without her, and this seems like the only way to make the pain go away.

Every day in the United States, an average of 117 people die by suicide. Of those people, 90 percent had a mental disorder at the time of their death.

But statistics like these lead to more questions than answers — how many would have responded to treatment? Who had previously reached out for help? How many times does this need to happen?

What can we do to prevent this from happening again?

Because suicide is preventable, and we can take action when we’re worried about a loved one’s safety, we talked to Shari Sinwelski, associate project director at the National Suicide Prevention Lifeline, to get some insight into what we need to know to prevent suicide. 

If you’re worried about a friend or family member, hopefully these tips help. If you want to know more information, the National Suicide Prevention Lifeline has a great resource here.

1. Know the signs.

One of the most obvious ways to know if someone’s considering suicide is if they’re talking about it. But the word “suicide” won’t always leave his or her lips. According to the American Foundation for Suicide Prevention, it’s important to look out for phrases that include themes like being a burden, feeling trapped, having no reason to live or experiencing unbearable pain.

Sinwelski said some signs are less obvious to the untrained eye, like a sudden shift in a person’s demeanor. Other examples include suddenly not taking care of themselves, change in sleeping patterns or eating patterns (which can go both ways: eating/sleeping too much or too little) or expressing disinterest in things they used to love.

In teenagers, Sinwelski added, it sometime takes the form of anger or loss of concentration. In most cases, a common thread seems to be something changes or seems off. There’s been a shift in mood or character. Also, if your loved one has a history of depression, other mental illness or a previous suicide attempt, he or she may be more at risk.

2. Don’t be afraid to ask direct questions. 

When you’re ready to approach a friend or loved one — or if they approach you — don’t be afraid to ask direct questions. There’s no evidence that talking to someone about suicide can “make them” suicidal — so don’t hesitate to use the word itself. On the contrary, research does indicate that talking openly about suicide lets a potentially suicidal person know he or she is not alone. If you’re worried about a friend’s behavior, there’s nothing wrong with asking upfront, “Are you thinking about killing yourself?”

3. Stay as calm as possible.

If the person starts to open up to you, although it may be hard, it’s important to stay calm.

“When people hear that a person might be thinking about suicide, your gut reaction might be to tense up,” Sinwelski said. “But that can sometimes make the person who’s having thoughts of suicide think you’re scared — and they might become more withdrawn.”

Instead of acting shocked or reacting in a strong way, Sinwelski said the best thing to do is create a safe space for the person, and listen. Thank them for opening up to you, and then ask what you can do.

4. Assess how serious the situation is.

According to Sinwelski, many people who have thoughts of suicide don’t end up taking their own life. But, we should still take their thoughts seriously. Some questions you can ask the person to evaluate their risk are, “How does the thought of taking your life make you feel?” “Have you thought about when or how?” The more information you have, the more you can evaluate the seriousness of the situation.

Sinwelski said the National Suicide Prevention Lifeline uses four factors to access a person’s risk, based on research done at Columbia University.

The first is desire — if the psychological pain they’re feeling is really enough to drive them to act upon their thoughts.

The second is capability — this could mean access to means such as firearms, but also includes their mental capability. When a a person uses drugs or alcohol, they may be more capable because their inhibitions are down. A previous suicide attempt is also a serious indicator someone is capable of attempting again. A family history of suicide or having a mental illness that makes them feel “unsafe in their own skin,” as Sinwelski put it, are also indicators that someone would be capable of following through on suicidal thoughts.

Intent is also an important factor — with the biggest indicator being a plan. A person who can give specific answers to “when” or “how” is more at risk.

The final factor is lack of connectedness — do they feel like they have no connections to our world? This includes friends, family, plans for the future, faith, pets or kids — anything to make someone feel they have something to hold on to.

5. Stay connected.

That last risk factor, Sinwelski said, is the easier way for friends and family to intervene. According to the National Suicide Prevention Lifeline, when you’re available to a friend in crisis, it can reduce the risk of suicide. Make sure your loved one knows you’re there to listen. Check in on them every day or two to see how they’re doing. Make yourself someone they can reach out to when they’re in distress.

6. Get help as soon as possible.

Of course, there are professionals you can reach out to when you’re worried about a friend or loved one. A little-known fact is that the National Suicide Prevention Lifeline is actually for people who are worried about loved ones too — not just for people who feel suicidal themselves. So call the lifeline, or reach out to a local counselor, therapist, or someone you trust. Encourage your friend to seek help for themselves if they haven’t already. Let them know there is hope — that suicide is not their only option, but that reaching out and getting help is choice that can keep them here.

“I would like to emphasize that suicide prevention is everyone’s responsibility,” Sinwelski said. “It’s not just for clinician or doctors. People are less likely to go to a counselor or a doctor than they are to show warning signs to their friends or family members. It’s really important  for people to not ignore that when they notice it — and feel empowered to help.”

Related: 23 Messages for Anyone Considering Suicide, From People Who’ve Been There