Suicide Prevention: A Therapist’s Guide to Talking About Suicide

Content Warning: This article discusses suicide but we believe difficult conversations around how best to discuss mental health in respectful and non-stigmatizing ways is important. If you are in a life threatening situation, please call the National Suicide Prevention Lifeline +1 (800) 273-8255, call or text 988 for the Suicide and Crisis Lifeline, or use these resources to get immediate help.

There are few words that carry as much weight — and stigma — as the word suicide.

According to the American Psychiatric Association, suicide is the 10^th leading cause of death in the US, claiming tens of thousands of lives each year. Even with so many deaths, frank discussions of suicide — and important actions for suicide prevention — remains taboo.

Why We Avoid Discussing Suicide

While there can be a wide range of reasons one might avoid discussing suicide prevention, many falsely believe that talking or asking someone about suicide may give them the idea, or maybe push them beyond their ability to cope with their distress. In fact, the opposite is typically true. While it’s important to know risk factors and warning signs, we also have to be willing to talk about suicide in order to prevent it.

Let’s dive further into the reasons we avoid discussing suicide:

• Stigma
  People who have mental health problems still experience shame and judgment. We’re afraid we’ll embarrass someone by asking about suicide risk.
• Misunderstanding suicide’s causes
  It’s common for people to worry that bringing up suicide could increase the risk. While many factors contribute to suicide, suggestion is rarely one of them.
• Fear of responsibility
  What if you ask someone about suicide and they admit they’ve considered it? Fear of being unable to handle the problem keeps many of us silent.

Benefits of Talking About Suicide Prevention

Now, let’s look at the benefits of a frank conversation. Research suggests that asking a person about their suicidal thoughts may actually help with suicide prevention. Other benefits include reduced tension, improved connection, and offering alternate options.

Knowing someone cares can provide relief for a person who may be suicidal. Giving voice to their thoughts and expressing their feelings aloud, knowing someone is there to listen, can be truly lifesaving.

Isolation or feeling alone can also increase suicidal ideations, while connection with another person reveals a world beyond the limited view of their present state of mind.

Sometimes a person considers suicide when they can no longer see any way out of a bad situation. Mental health conditions can change their thinking, making it difficult to consider alternative options, though they may be plentiful. A supporter’s fresh perspective can offer relief or a way out.

A Therapist’s Guide to Talking About Suicide Prevention

Bringing up suicide is a daunting task, it can feel awkward and painful for you and for the person whose mental health you’re worried about. It’s better to have the conversation than to not, however; a life is far more important than the temporary awkwardness.

Be sensitive to their feelings and avoid a judgmental tone, use “I” statements, focusing on the fact you’re worried about them rather than telling them how they feel. Avoid dictating a plan or minimizing their concerns. It’s a delicate balance between support and intervention.

Here are 6 steps for having a difficult conversation with someone you’re concerned about.

1. Let them know you care
   First, explain you’re concerned and want to help. You can point out a few signs you’ve noticed, such as withdrawal or that they’ve not been “seeming themself.” Be careful, though; avoid sounding critical. A laundry list of complaints won’t help.
2. Be supportive without making assumptions
   Most likely, you can’t truly say, “I know how you feel,” so don’t. Simply point out that while you might not have experienced suicidal thoughts, you are willing to listen and help as much as you can.
3. Ask them if they’ve thought about suicide
   It’s scary to be so direct, but when asked in a supportive, non-judgmental fashion, a question such as, “have you had thoughts of hurting yourself?” shows you’re not afraid to help out.
4. Get more information
   If the person has suicidal thoughts, gently ask if they have a plan for how they’d do it, including any time frame or specific trigger event. Also find out if they have the means to do it, such as access to weapons or medication.
5. Make a safety plan
   Discuss the importance of going to a therapist or to their regular medical provider. Offering to go with them and assuring they won’t be alone, can be a comforting gesture. Identify specific ways they can reach out to you or others if suicidal thoughts worsen. Be prepared with a suicide hotline number or other professional contact you can reach immediately if necessary.
6. Commit to more conversation
   Make arrangements to check in routinely, especially until the person gets into professional treatment. Don’t overwhelm them with demands, but understand you’ll need to reach out regularly until things get better.

A Word of Caution

While helping a person who’s having suicidal thoughts, be careful about getting in over your head. You are not a therapist. You can only support the person in a general way so they can get the help they need.

Also remember, you are not responsible for any choices they make. Someone dealing with a serious mental health problem may not make the same decisions you would. Recovery happens in fits and starts, so don’t take it personally if things don’t improve as quickly as you’d hoped.

While suicide carries stigma and shame, we can’t prevent it if we’re afraid to talk about it. For more information about warning signs and risk factors, check out the National Institute of Mental Health’s suicide information page. If you or someone you care about is having thoughts of suicide, call 1-800-273-TALK immediately for assistance. Breaking the silence can save lives.