pensive woman gazing out of bus window, suicide prevention concept

When Alison* was 14 years old, she attempted suicide. She started seeing a therapist but made a second suicide attempt at age 21. “My relationship with mental illness is equivalent to me rolling in a pile of tiny splinters for many years and then asking someone to take them out all at once. In reality, it is a slow, painful process, digging out each individual splinter and closing up the wound one by one,” she says. “But over the past several years, I’ve gotten help. There are times where I stop therapy and medications entirely because I’m frustrated with the whole process, but I always go back. It does truly get better, but I constantly have to remind myself it is a gradual better.”

Stories like Alison’s aren’t uncommon. In fact, suicide rates in the US are on the rise—as of 2017 (the most recent data available), suicide is the second-leading cause of death in 15- to 34-year-olds.

“There are a few reasons why rates may be on the rise,” says Sarah Younggren, a licensed clinical social worker and child and adolescent specialist at Mental Health Colorado, a nonprofit organization**. Having healthy relationships is an important protective factor against suicide. Young people today may not have as many opportunities to form positive relationships with peers and trusted adults as they once did. Triggering events such as a breakup, prolonged bullying, loss of friends, and pressure to succeed can all be contributing factors to suicide when one is already struggling with depression or anxiety.”

Here’s what you need to know to spot warning signs and help a friend who you’re worried might be at risk.

male friends sitting outside talking suicide prevention

Warning signs

In a recent Student Health 101 survey, over 60 percent of students said they’ve heard someone they know express suicidal thoughts. So how do you know when comments about suicide are serious warning signs?

According to the National Suicide Prevention Lifeline, there are two major red flags:

  1. If the comments are new or increasing
  2. If the comments are tied to a specific event (like a breakup or rejection from grad school)

Other signs to watch for

  • Talking about feeling like a burden
  • Making comments about feeling hopeless or having no reason to live
  • Behaving recklessly or increasing their use of alcohol or drugs
  • Extreme mood swings
  • Isolating themselves from friends and family
  • Making a plan to kill themselves or taking steps to enact it

What to do if someone you know expresses suicidal thoughts

Hearing someone you know talk about suicide can be a terrifying situation. How do you know the right thing to say or do?

Start by following these five steps from the National Action Alliance for Suicide Prevention and the National Suicide Prevention Lifeline:

1. Ask

If you’re worried that a friend or classmate might be thinking about suicide, ask them about it. Saying “Are you thinking about suicide?” in a nonjudgmental tone gets the issue out into the open so that you can talk about it and help them get the help they need. Talking with your friend about suicide might even help decrease their suicidal thoughts, according to a 2014 review of research studies.

As they’re talking, practice active listening: Respond with a nod of your head or verbal “uh-huh,” ask questions, look them in the eye, and summarize what you’re hearing. For example: “It sounds like you’re feeling really hopeless and lost after your breakup and you don’t think it’s going to get any better.” Also try to listen for any reasons they may want to stay alive and help them focus on those reasons (e.g., “You mentioned how much you love your dog and how you feel like she needs you”).

2. Keep them safe.

Once it’s out in the open, try to assess how immediate the risk is. Have they already taken steps to try to complete suicide? Do they have a specific plan? If they have a plan and the means to make it happen (e.g., access to a gun or lethal pills) you may want to take the next step to remove the risk by taking them to the emergency room or calling the police. If you’re not sure what the right move is, call the National Suicide Prevention Lifeline (1-800-273-8255) or chat with a counselor online who can help talk you though the situation.

3. Be there.

Sometimes just being there for someone—whether it’s on the phone or in person—is the best thing you can do. Social connections are a powerful preventative factor against suicide, according to a report by the Centers for Disease Control and Prevention. “When we don’t have those social connections, it can contribute to depressed feelings and feelings of isolation,” says Younggren. “It’s not always about trying to fix it or solve it, rather just sitting in it with them,” she says.

Make sure you can follow through when you commit to offering support. In other words, if you tell your friend they can call you anytime, day or night, make sure you’re able to pick up—if you know you won’t be able to, talk with them about alternative options, like another friend who might be available while you’re in class or any other situation where you won’t have your phone on hand. The National Suicide Prevention Lifeline is also open 24/7.

closeup of holding hands, suicide prevention concept

4. Help them connect.

One of the best things you can do for someone having suicidal thoughts is to make sure they have a safety net of professionals: Text them the number of the National Suicide Prevention Lifeline, take them to check out counseling services on campus, and/or help them connect with a local therapist.

One thing to know: If you report a classmate you’re worried about to a residence advisor, counselor, or parent, they will likely take action, says Younggren. Reporting laws vary by state, but in the vast majority of cases, “this is not something that will be kept confidential—nor should it be,” she says. If you’re worried about being identified, Younggren says that in some cases the reporting student’s name can be kept confidential, but be aware that a crisis team may want to ask you more questions.

5. Follow up.

If someone you know is considering suicide, make sure you continue to check in on them and be supportive. Regular texts and calls help them understand that they’re not alone. Something as simple as sending a postcard to show you care has been shown to reduce the chances of a repeated suicidal act—a text works too.

What NOT to do:

  • Don’t act shocked or judgmental. This will put distance between you and might cause the person at risk to shut down.
  • Don’t promise to keep it secret. The most important thing for someone contemplating suicide is to get professional support.
  • Don’t blame yourself. It’s important to know it’s not all on you to save someone. “Whether someone attempts or dies by suicide is absolutely not your fault,” says Younggren. Having awareness of the warning signs and familiarizing yourself with the steps above are the most important things you can do, she says.

If you are having suicidal thoughts, get help now

If you’re having suicidal thoughts, reach out for help. You can call the National Suicide Prevention Lifeline at 1-800-273-8255 or chat with a counselor through its online portal anytime, day or night. “Professionals are highly trained to help you through the feelings of hopelessness and despair and process those emotions,” Younggren says. “Mental health professionals teach you that there is a way through these emotions, that nothing is permanent, and that you are not alone.”

At the very least, reach out to someone you trust—a family member, a friend, a favorite professor or coach—and tell them how you’re feeling. Talking about it and making your feelings heard can be powerful.

*Name has been changed.

**Mental Health Colorado is a nonprofit organization that does not endorse any products.

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Article sources

Sarah Younggren, LCSW, Mental Health Colorado.

Carter, G. L., Clover, K., Whyte, I. M., Dawson, A. H., et al. (2005, September). Postcards from the EDge project: Randomised controlled trial of an intervention using postcards to reduce repetition of hospital-treated deliberate self-poisoning. British Medical Journal. doi:10.1136/bmj.38579.455266.E0

Centers for Disease Control and Prevention. (2008). Promoting individual, family, and community connectedness to prevent suicidal behavior. Retrieved from https://www.cdc.gov/ViolencePrevention/pdf/Suicide_Strategic_Direction_Full_Version-a.pdf

Dazzi, T., Gribble, R., Wessely, S., & Fear, N. T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361–3363. doi: 10.1017/S0033291714001299

National Institute of Mental Health. (2019, April). Suicide. Retrieved from https://www.nimh.nih.gov/health/statistics/suicide.shtml

National Suicide Prevention Lifeline. (n.d.). How and why the five steps can help. Retrieved from http://www.bethe1to.com/bethe1to-steps-evidence/

National Suicide Prevention Lifeline. (n.d.). How to help someone else. Retrieved from https://suicidepreventionlifeline.org/help-someone-else/

Student Health 101 survey, June 2019.