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Signs of suicidal thinking

• Withdraw from activities and people.
• Threats of suicide.
• Talking or writing about killing oneself.
• Acquiring means to kill oneself: stockpiling meds, buying rope, gun.
• Increased use of alcohol or drugs.
• Behaving recklessly.
• Revengeful/rageful.
• Anxious/agitated.
• Sleeping constantly or not being able to sleep.

Additional information and resources

View the American Foundation for Suicide Prevention Video , or visit the .

How to Help Someone who is Suicidal

ASSESS

Ask:

• Are you having thoughts of suicide?
• Do you have a plan for killing yourself?
• Do you have the things in your plan to do it?
• Have you decided when you’ll do it?

If he or she has a plan and are ready to carry it out, call 911.

• Even if there isn’t a plan, a suicidal person shouldn’t be left alone.
• If he or she has assured you of lack of intention and of reasons why not to do it, still try to engage him or her in a conversation.

LISTEN

Listen non-judgmentally. Don’t say “That’s ridiculous!” or “Don’t be stupid.” Affirm that you are hearing him or her, validate his or her feelings, empathize with how awful this must be.

GIVE

Give reassurance and information. There is help for this. Say, “Sounds like you’ve been really depressed (or anxious).” “Thinking things are hopeless is the worst trick depression plays on our thinking.” “There is help for this.”

ENCOURAGE

Encourage appropriate professional help. Refer to a mental health provider or call National Suicide Prevention Hotline: 1 (800) 273-TALK

Encourage self-help-reconnect with previous therapist, support system.

Self-harm can consist of any of the following behaviors:

• Cutting, pinching or scratching skin
• Burning skin
• Preventing wounds from healing
• Pulling out hair
• Punching or banging objects until bleeding occurs
• Purposefully overdosing on medication without suicidal intention

Reasons people self-harm:

• To feel something other than numb
• To relieve tension
• To get a feeling ‘out’ (usually anger or sadness)
• On a deeper level it may be a form of self-punishment
• Subconsciously, it may be to demonstrate desperation
• It is a coping mechanism.
• It is not necessarily suicidal, but may be a precursor to it

When helping someone who self-harms, address the underlying distress, but the actual self-harming behavior.

It is a coping mechanism – so focus on what needs to be coped with.

Focusing on the self-harm behavior may be experienced by the person as shaming or judgmental.

ASSESS for risk of harm: Assess if medical attention is needed. If the person appears unconscious, confused or disoriented, or if the person has rapid bleeding, call 911. Also call 911 if you find someone who’s overdosed or ingested poison.

LISTEN nonjudgmentally: If the person isn’t experiencing life-threatening injuries, state what behavior you’ve noticed and that you’re concerned for their well-being. It is important to remain nonjudgmental. The behavior may be hard to understand, but by remaining calm and focusing on the emotional distress that has led to the self-harm, you will be most helpful.

GIVE reassurance and information: Always emphasize that recovery is possible. If they want or need more information about what they’re going through, tell them about S.A.F.E. Alternatives (Self-Abuse Finally Ends). They can read the resources online or they can call the information line at 1 (800) DON’T-CUT (366-8288).

ENCOURAGE appropriate professional help: Because self-injury is a symptom of an underlying issue, it’s important to support the person in finding the appropriate help. Often, the person is experiencing psychological distress or a mental illness that needs to be addressed. While you want to be persuasive, make sure the person is still making their own decisions about how to proceed with treatment. But you can feel free to call doctors to find one accepting new patients, go with them to appointments, offer to drive or help out in similar ways.

ENCOURAGE self-help and other support strategies: Ask the person what has helped them feel better in the past or what supports – whether it’s family, friends, faith communities or other groups – have been beneficial. Encourage them to tap into those sources of comfort and to try other self-help strategies, like exercise, relaxation training or whatever best suits their situation.

Symptoms

Physical

• All the signs of the stress/fight-or-flight response
• GI upset/diarrhea
• Restlessness
• Muscle tension

Psychological

• Worry
• Irritability
• Fatigue
• Indecisiveness
• Mind going blank
• Poor concentration

Behavioral

• OCD behavior
• Distress in public or social situations
• AVOIDANCE

ASSESS for risk of suicide or self-harm. Ask, “Are you feeling so bad that you’re thinking of hurting yourself?”

LISTEN nonjudgmentally. Ask how the person is feeling and how long he or she has felt this way. Say what signs you’ve noticed. Keep the conversation going by using reflective responses: “So, you’re feeling like _____.”

GIVE reassurance. There is help for this. Validate: “It’s no surprise you’re feeling this way with everything you have going on.”

ENCOURAGE appropriate professional help.

ENCOURAGE self help/coping strategies like meditation and exercise.

Things you may observe in a depressed person:

• Thinking, moving and talking slowly, making conversation and other interactions difficult
• Not caring about personal hygiene and grooming
• Weight loss or weight gain
• Easily agitated
• Quick to tears or crying uncontrollably
• Appearing numb or unresponsive

ASSESS for risk of suicide or self-harm. Ask, “Are you feeling so bad that you’re thinking of hurting yourself?”

LISTEN nonjudgmentally. Ask how the person is feeling and how long he or she has felt this way. Say what signs you’ve noticed. Keep the conversation going by using reflective responses: “So, you’re feeling like _____.”

GIVE reassurance. There is help for this. Depression doesn’t last forever. Validate that one’s mood can become depressed with losses, chronic stress or even ‘out of the blue’ (without any apparent trigger).

ENCOURAGE appropriate professional help.

ENCOURAGE self help/coping strategies like re-engaging in former activities, socializing, proper sleep and diet; and exercise.

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