Talking about feelings of hopelessness. Refusing to make future plans. Hinting about how they might take their own life-those are just three signs that someone you love might be having suicidal thoughts.
“Most people who are suicidal are ambivalent even right up until an actual attempt-they have a real mix of life and death wishes,” says Michael F. Myers, M.D., a professor of clinical psychiatry at SUNY Downstate Medical Center. “That’s why we believe any kind of intervention can save lives.”
Something to keep in mind: There's only so much you can do when someone you love is having suicidal thoughts (and it's never solely your responsibility to make sure they stay safe). But, if someone you love is withdrawing or making plans for being gone, there are ways you can try to help.
1. Ask them about it.
One myth of suicide prevention is that talking about it can increase the risk that someone will actually take their own life, but it’s just not true. “The reality is anyone with a significant depression has passing thoughts of death and suicide in a simple desire to end their misery,” says licensed clinical psychologist Alicia H. Clark, Psy.D.
Instead of avoiding the topic, she recommends asking (with compassion) if things are so bad they have thought about death, or ending their life. Depending on the response, Clark recommends being prepared to follow up with questions like what they’ve thought about doing and why.
2. Tell them how much you love them.
Being contacted by someone who cares can go a long way toward limiting the isolation and helplessness a suicidally depressed person can feel, says Clark. “Letting a loved one know how much you care about them, and offering help, can be an important lifeline in keeping them safe,” Clark says.
3. Try to get them out and doing things.
People who are suicidal will often shut down and stop doing things that they enjoy. That’s why Mayer recommends encouraging your loved one to keep doing things they've always enjoyed by taking them out for a manicure or grabbing a meal together. It’s also a good idea to try to encourage them to try new activities and experiences, Mayer says.
4. Push them to seek help.
You can even do the legwork for them, researching good psychologists or asking for a referral, and actually escorting them to their appointments. If they’re reluctant to seek help, Mayer says there’s nothing wrong with saying encouragements like “Do this assessment-it’s one visit” or “Do this for your friends and loved ones.”
If your loved one has had a bad experience with counseling, Mayer says it’s important to encourage them not to give up. “This is critical, because many times an unqualified helper who says the wrong thing or does not offer any relief just makes things worse because then the suicidal person feels like no one can help them,” Mayer says.
5. Take them to the hospital.
If it seems like your loved one has a plan and you’re worried to let them out of your sight, try to take them to the ER and wait there while they get assessed, says Myers. “Asking them to call a therapist isn’t going to help at this point,” he says. This is a major step in helping someone who is seriously considering taking their own life, Clark says.
6. Give them some responsibilities.
When a loved one is depressed your instinct may be to take over their responsibilities for them, but while that may be appropriate in some circumstances-say, taking care of their children while they go to therapy-knowing that others are depending on them can actually help them resist suicidal urges, says Neeraj Gandotra, M.D., a psychiatrist, instructor at Johns Hopkins University School of Medicine, and the Chief Medical Officer at Delphi Behavioral Health.
These responsibilities should be compelling, but not overwhelming, says Gandotra-like asking them to take on dinner responsibilities a few times a week. This will help your loved one see that you rely on them, that they add a lot of worthwhile things to your life, that they can make meaningful contributions, and that you appreciate them, he adds.
7. Help them find their spiritual side.
Having a sense of spirituality has been shown to be protective against suicidal thoughts and urges, says Gandotra. What spirituality means and how you practice it will look different from person to person, so talk to your loved one about what makes them feel like a good person and connected to others and the universe. Encourage them to go with you to a church service, a retreat, or some other place that helps them feel a sense of being connected to humanity, God, or simply something bigger than themselves.
8. Make a life plan together.
One of the most worrisome symptoms of suicidality is when your loved one makes a plan for how they would hurt themselves. First, take this sign very seriously and get them help immediately, says Mayra Mendez, Ph.D., LMFT, a licensed psychotherapist and program coordinator for at Providence Saint John's Child and Family Development Center in Santa Monica, CA.
Then counter their "death plan" by helping them make a life plan, she says. "The one thing people considering suicide need most is hope," she explains. "Showing them what they have to live for can help bring that back."
9. Play the "what if" game.
It's common for people contemplating suicide to say things like "Everyone would be better off if I was gone" or "I'm such a screw up and there's no way to fix my life." Arguing with these feelings can get you caught up in an endless battle of words.
Instead, Gandotra says, challenge their perception by turning it around. "Ask them, 'What would you say to me or to a child if I told you I was worthless and my life was a disaster?'" he says. Encourage them to show the same love and gentleness they would to you, to themselves as well.
10. Dont minimize any self-harming talk or behaviors.
It's understandable to want to downplay a loved one's erratic or hurtful behavior-no one wants to think that someone they love is even contemplating suicide-but ignoring red flags only makes the situation worse, says Gandotra. "Don't minimize it when they talk about hurting themselves or you see evidence of self-harming behaviors, like cutting or drug use," he says. That means don't counter with something dismissive like "you don't mean that," when a loved one suggests they might hurt themselves. Instead, Gandotra recommends you "talk about it openly and let them know you take it very seriously."
11. Build a support team for when youre not around.
“Time alone, if a person is withdrawn and suicidal, allows for completion and should be avoided as much as is possible,” Clark says. But, because no one person can take on such a huge task alone, Mayer recommends building a network of friends and family that continuously know where your loved one is and that they are safe.
To help both your friend and yourself, recruit other friends and family members to form a network of support and love, says Mendez. "The more people who care about them, the better," she says. "To avoid making your loved one feel like you're gossiping about them behind their back, have them be a part of the process of talking to others." If you can't meet in person, you can do a conference call, an e-mail with your loved one cc'd, or a group text. But whatever you do, don't post about it on social media-that could elicit feelings of shame in such a public space.
12. Dont downplay cries for attention.
All humans need positive attention. People who are suicidal have often had difficult or traumatic life experiences and they may be asking for help in the best way they know how, says Gandotra.
Don't enable them in making bad decisions or allow them to manipulate you; the best thing to do is show that you hear them and you'll help them get professional help-and then leave the therapy to the pros.
13. Offer to be their emergency contact.
You know the box on every medical form that asks for the name and phone number of a person the doctor can contact in case of an emergency? Put your information there on your loved one's forms. Depressed people often feel like no one truly cares about them and they have no one to turn to. This is one simple way you can show them they're not alone, says Gandotra.
14. Look for signs theyre preparing for departure.
Before attempting to take their own life, some people will prepare by calling loved ones, giving away their belongings, writing letters, or making a will. Some signs may be very subtle so keep an eye out for any changes that may indicate their are preparing to move beyond the planning stage, Mendez says. Don't be afraid to bring up the behaviors that worry you and ask about them while expressing your love and concern, she adds.
If you or someone you love is struggling with suicidal thoughts, please contact the National Suicide Prevention Lifeline at 800-273-8255.