Signs of Suicide

Important: If you or someone you know has shown any signs of suicide call 9-1-1 immediately. The National Suicide Prevention Lifeline is 800-273-8255.

Warning Signs of Suicide and Risk Factors: They Are There if You Know What to Look For

If you do a Google search for “Is it okay to ask someone if they are suicidal,” you will get 280 million responses.

At the top of the list is the National Suicide Prevention Hotline. It has resources for those who are contemplating suicide and for people worried about their loved ones. If you are trying to help someone, the first thing the hotline does is show compassion for you and how stressful it must be for you to be worrying about them. The literature encourages you to take care of yourself. Next, it guides you on a list of warning signs and then suggests you contact the hotline to discuss how to approach your loved one.

Those at the helpline and online on the website give you dos and don’ts when you bring up the topic. It’s so helpful to have someone guide you during such a hard time.

That’s what you can be for your friend: a person who shows them compassion and concern and lets them know you’re there to support them. That’s pretty comforting, right?

Open discussion is what helps people move through a situation instead of hiding with feelings of despair that there is no way out. Open discussion is also a way to move beyond the stigma associated with feeling alone with the pain. Or shame. Or trauma. Or sadness. Or grief.

Now, let’s keep the discussion going.

According to the National Institute of Mental Health, there are three types of definitions for thoughts and actions around suicide: suicide, suicide attempt, and suicidal ideation.

Suicide is a fatality resulting from self-injury where the intent was to die as a result of the action.

A suicide attempt is a non-fatal, self-directed act where the intent was to die as a result of the action. Serious injury or no injury may result from this act.

Suicidal ideation is defined as considering suicide, and perhaps beginning to plan the act.

What Made You Suspect Someone Might Be Becoming Suicidal?

You didn’t just wake up in the morning wondering if your 16-year-old son, 25-year-old best friend, or 58-year-old dad might consider it an option to end their life. Think about it. Call it gut instinct, but something worried you.

Suicide is typically planned ahead of time and is rarely spontaneous.

People who are suicidal might try to hide their feelings or seem unusually calm, but there are some more worrisome signs they are considering it:

• Giving away special keepsakes or favorite items from their possessions to people close to them
• Sleeping more or not at all
• Admitting they have considered suicide
• Paying long overdue monetary debts, in large or small amounts
• Losing someone they admired or were close to from suicide
• Deep shame from a past wrong they feel judged for
• Self-harming, such as cutting the skin on the inside of arms or upper thighs (to semi-conceal marks or overdosing on medication
• The anticipation of humiliation during an upcoming event where personal details will be exposed, such as a court hearing or school appointment
• Loss of job, marriage, or custody of children
• Feeling hopeless or unable to escape problems
• Voicing thoughts that everyone would be better off without them around, either despairingly or trying to pass as a joke
• Having access to firearms or another ready method to kill themselves, and have discussed it
• Using social media or the internet to read, write about suicide, or post disturbing, dark thoughts
• Little interest in life or activities in which they previously found enjoyment
• A sudden turn to alcohol or illegal drugs to escape

Now carefully read through this list above one more time, mentally checking boxes to those that apply to your loved one. Remember that question in the beginning: “Is it okay to ask someone if they’re suicidal?” According to experts in the mental health field and with the National Suicide Hotline, that answer is “yes.”

The 2020 National Suicide Prevention Month slogan was #BeThe1To, encouraging people to reach out and be the one to ask others if they are okay. It is important to be direct and to approach the person and discussion in a non-judgmental way. Ask the scary question and allow them to talk and share their feelings. This is a time to be a loving listener.

This is not a time for religious debates or lectures on the value of life. It is not a time for acting shocked. And as hard as it may be, do not allow yourself to promise them secrecy. At a scary, overwhelming time like this, the two of you need help. And it will comfort them to know they are not alone anymore.

You can help them make contact with the trained counselors at the suicide prevention hotline, from their primary physician, or mental health caregiver, if they already have one*. If they are not suicidal, their mental health may still need assistance.

Check back with them when you promise. It has been proven that follow-up care is critical in creating suicide prevention.

*If they have access to firearms or you feel they are in immediate danger, call 9-1-1.

Factors That Increase or Decrease Somebody’s Risk For Suicide

Increased Risk Factors (Group):

Whether it is environmental to their surroundings, an element of their personality, or predisposed in their cultural upbringing, some things make people at a higher/lower risk level for the potential to attempt suicide.

According to the 2019 National Survey on Drug Use and Health, 4.8% of adults had suicidal thoughts, with 11.8% of the 18-25 age bracket experiencing the highest rate of suicidal thoughts and 6.9% of those with more than two races.

Not meeting traditional expectations, major suffering by an ethnic group, or emotional turmoil over bullying or sexual orientation are situations where there is a higher-than-average rate of suicidal thoughts, ideation, or attempts.

Increased Risk Factors (Individual):

• Prior suicide attempt(s)
• Misuse of alcohol or other drugs
• Mental disorders, particularly depression and other mood disorders
• Chronic disability or disease
• Access to lethal means
• Losing someone who died by suicide, especially a family member
• Social isolation
• Lack of affordable access to mental health care

Factors That Help Protect Against Somebody’s Risk For Suicide

Protective factors are personal or environmental characteristics that help protect people from suicide:

• Accessible, affordable, effective mental health care
• Connections in community and with friends and family
• Life skills (knowing how to use problem-solving, coping, and adapting skills in daily life)
• Strong self-esteem and purpose or meaning to life
• A strong belief system, whether cultural, religious, or personal that discourages suicide.

How to be a Lifeline and Talk With Someone Who Has Attempted Suicide

It is very common to feel anger, shame, guilt, fear, overwhelmed, depressed, worried, and even relieved. As strange as it may seem, the relief comes from knowing you are not the only one worried about them and now they are getting the mental health care they need.

And when you’re overwhelmed already, remembering the dos and don’ts on how to talk with someone just adds to the burden. Instead, focus on the dos for now and just support your friend.

Do say whatever comes easiest for you, but here are three ideas to start a visit:

• I’m sorry you’ve been feeling so awful. I’m so glad you’re still here.
• I’m here for you. Remember that you can always talk to me if you need to.
• I want to help you. Tell me what I can do to support you.

Treatment After Attempting Suicide

How Long Will They Be in the Hospital?

Once the physical immediacy involving life-saving efforts is stabilized, efforts toward recovery should be put in place.

While at the hospital, your loved one’s state of mind at that time will be evaluated. If they are deemed to be of urgent danger to themselves or others, the physician may put them on a psychiatric hold until their mood is stabilized.

If the most pressing urgency seems to have passed, they are coherent, and indicating they understand and will receive follow-up care, they would most likely be discharged.

Your loved one may be discharged from the hospital the day they were treated, as strange as that seems, with directions to receive follow-up care with a mental health provider. Perhaps they have already been referred to a psychiatric hospital for outpatient treatment and recovery and to work on a plan toward improved mental health.

These steps may be delayed if more time for physical recovery is needed beyond the emergency room.

Next Steps Toward Suicide Prevention and Recovery

This will probably be a confusing time for them, and they may be exhausted. Your role, if you are present, can be to gather all the information given by the hospital staff and outtake counselor. You can reach out to your loved one’s family physician for direction and with your insurance plan or community resources for the next steps.

Before You Leave the Hospital

• Many of the questions above will be asked again by their current therapist following the hospital stay or at a treatment center during an intake assessment.
• Family members will be asked to remove things from the home the at-risk person could use to harm themselves (such as firearms) and to only keep low levels of prescription medications and alcohol.
• Ask the hospital staff or your loved one’s therapist exactly what your role is—and is not.

Remember you can help, but as difficult as it can be to accept, you cannot ultimately control another person’s actions and are not responsible for their decisions.

Assess Reason(s) Behind the Suicide Attempt

Keep in mind why they attempted suicide. Professional help will address the reason behind the suicide attempt, teach them how to cope with mental health, and help them build a stronger life going forward.

Things a professional will consider are:

• What psychiatric or medical conditions are present and have they or are they being treated?
• Did something occur recently that may have contributed, such as a family loss or medication change?
• What are the person’s thoughts on the attempt (regretful to have done it, sad it was unsuccessful)?
• What are the details behind the attempt? Was there a note? Is this the first attempt or a longstanding pattern? What was the method used in the attempt?
• What support do they have in place at home and are therapy plans in place?

You can be non-judgmental, showing love and support, even if you don’t understand their struggle. Just accept that they are struggling and they need help. Your presence, actively bringing them to appointments, and attending family therapies if invited, will go a long way to help you understand and to give them a comforting support system.

Key Points to Remember

• Asking about suicide does not create the ideation of suicide. This idea perpetuates stigma the mental health community is seeking to remove when asking someone who is struggling if they need help.
• Take care of yourself. If you find yourself struggling with helping a loved one, or have lost a loved one, you can call the number below or seek assistance from a mental health provider.
• The National Suicide Prevention Hotline is open 24/7, every day. The number is 800-273-8255.

If you or someone you love is struggling, we can help. At SUN Behavioral Houston, we’ve created a caring, healing environment and will be there for every step of your journey to recovery. Call us at 713-796-2273 to learn more!

FAQs:

What Are Three Verbal Warning Signs of Suicide?

Three verbal warning signs of suicide would be:

• “It would be better for everyone if I wasn’t here.”
• “I’ve thought about killing myself.”
• “I just want it to end.”

If a Friend is Showing Signs of Suicide, Whom Should You Tell?

If a friend is showing signs of attempting suicide, you can first consider if it is an imminent threat because they are saying they’re about to do it or are in close proximity to a firearm. If so, call 9-1-1.

If that doesn’t appear to be the case, and you can discuss concerns, encourage them to make an appointment with a mental healthcare provider or call the National Suicide Prevention Hotline at 800-273-8255. If they will let you approach their family—or they are your family—you can support them and each other until their therapist returns your call.

How Can You Recognize Signs of Suicide?

There are many signs of suicide and some are more obvious than others. When looked at as a whole, it may paint a compelling pattern.

Here are just a few examples:

• Posting disturbing images on social media or researching online with suicide as a keyword
• Giving away items they care for to others, perhaps a pet or family heirloom
• Saying it would be better for everyone if they weren’t around
• Isolating
• An upcoming stressful event such as a court hearing or loss of custody for children