29 June 2021

Learning to Talk About Suicide: How to Help Those in Need

While the world continues to reopen and lift COVID restrictions, the realities of the mental health crisis in the world are still very present. During COVID-19, there were increased rates in mental health diagnosis, substance use, and suicidal ideation. Of these three, suicide is often the more challenging for people to grapple with. 

Why Is It so Hard to Talk About Suicide?

Suicide and suicide prevention feel very intense for many to bring up. If we worry about someone we know who may be struggling with suicidal thoughts, it’s normal to feel hesitant about asking that direct question. Is it insulting? Is it too dramatic? Does it bring additional stress to ask that kind of a question? 

There is also a lot of pain around asking something like this. It’s likely that you know someone who has completed or attempted suicide. You may have struggled, or are struggling, with suicidal ideations yourself. As you read this article, I hope that you take away nothing else, know that you're not alone and that there is help for you.

Why Is It Important to Talk About Suicide Now?

We are in a state of complex transition. Do we go back to the office or stay home? Do we get vaccinated? What is safe for our kids now? Also, contrary to popular belief, rates of suicide increase in the spring, not the colder months or holidays as some may assume. It is actually the lowest in December. A study from Johns Hopkins credits this phenomenon to a variety of reasons. One is allergies. Our bodies fight off viruses in the colder months. But it doesn’t fight off allergies well, which can lead to higher rates of depression. Rates of depression could be 42% higher than non-allergy seasons. 

The Psychiatry Advisor also points the peak in suicide rates to patterns around circadian rhythm. For example, spring brings time change, more light in the evenings, and other schedule changes with school and other activities that run on a school calendar. 

In reality, we don't yet have all the data on the true impact of COVID on depression and suicide rates. But there is data from the CDC that shows a ride in depression and suicidal ideation during the COVID shutdown. So even if we don’t fully know the impact, we know the impact is there. 

Other risk factors for suicide include previously diagnosed mental health disorders, past thoughts or mentions of suicide, someone with past suicide attempts, and someone expressing the feeling that they don't have anything to live for or that their death would be a benefit to someone.

What Do I Do if Someone I Know Might Be Having Suicidal Thoughts?

Be direct. Evidence-based practices like ASIST show through research that it is more likely to learn that someone is suicidal by asking them, “are you considering suicide?” Often, people want to default to a less intense path. Are you considering hurting yourself? Or are you having disturbing thoughts? These seem safer on some level, but in reality, it only manages the anxiety of the person asking the question, not the person with suicidal thoughts. 

The less direct path is less effective for reasons that may feel complex. If someone has decided in their mind to commit suicide, meaning they have active suicidal ideation, they may not see it as hurting themselves. Instead, they may see it as a way out of their pain. It is common for loved ones of someone who has completed a suicide to report that the individual seemed lighter or more at peace in their final days. As though their inner battle was at rest. To them, maybe it was. This is a hard concept for many to grasp, and it’s why the direct question is so incredibly important. Someone may say ‘no’ if being asked about self-harm but may say ‘yes’ if asked about thinking about committing suicide. 

Passive vs. Active Suicidal Ideation

Some people experience passive suicidal ideation, while others have more active thoughts. It's more common for people to experience passive ideation and never get to a place of making a plan to do so. But you should take both seriously, and seek help. 

Passive suicidal ideation occurs when an individual experiences thoughts of suicide or self-harm but has no plans to carry it out. They may be more of a “what if” type thought. 

Active suicidal ideation is when an individual has more developed plans of suicide and intends to carry them out. 

How Do Know if Someone Has Passive or Active Suicidal Ideation?

  1. Ask, “are you thinking about suicide?” (Note: it has been advised in recent years to no longer use the term commit or committed suicide. It lends itself to sounding wrong or even criminal. It is more correct to ask the question as written or use it as a verb, suiciding or suicided. Someone who has died from suicide has had a completed suicide, not committed suicide.)
  2. If yes, ask, “do you have a plan?”
  3. If yes, ask, “do you have the means to carry out this plan?”
  4. If yes, you need to call someone for help immediately. Calling 911 or going to the nearest emergency room is what healthcare professionals recommend, as this is an emergency. However, if the individual can decide on a safety plan, where they are under close watch from a loved one and kept away from ANYTHING they can use to harm themselves, this may be an option. However, it is important to emphasize the severity of one’s mental health. If they are ready to put a suicide plan into action, then they need a mental health professional to evaluate them as soon as possible. This is why going to an emergency room is recommended because someone can quickly be assessed and get help. 

Extra Resources for Those Thinking About Suicide

If you or someone you know is struggling with suicide and needs help, you can call the National Suicide Prevention Lifeline at 800-273-8255. 

Your community may also have resources to help with suicide prevention. It's helpful to look into health clinics that specialize in the age group of the person affected. For example, an adolescent may best be treated at an adolescent clinic.

If you have lost someone to suicide and need support, in addition to therapy and grief counseling, grief support groups are also helpful. They remind us that we are not alone in this struggle.

You can also search for therapists who offer therapy in your area on psychologytoday.com or explore platforms like Talkspace or BetterHelp.



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