Asking the Hard Questions: How to have a #RealConvo about Suicide

As fall semester kicks into full swing, you may find yourself overloaded with stress from adjusting to your new course schedule, acclimating to college life, or picking up new extracurricular activities. Sometimes, people who experience stress and other mental health symptoms also experience suicidal ideation.  

September is National Suicide Prevention Awareness Month and because of that, this post will focus on ways to talk about suicidal thoughts and feelings, whether you’re experiencing these symptoms yourself or you’re worried about someone who might be in distress.  

Why do people experience suicidal ideation? 

While there is no singular cause of suicide, available research indicates that people struggling with suicidal feelings often have significant stressors and health concerns that surpass their existing coping skills. Many people with depression have thoughts of suicide, and suicidal ideation is also common for folks struggling with anxiety or substance use. However, it is important to note that having suicidal thoughts does not necessarily indicate that you or someone you love has a psychological disorder! Sometimes life can feel very overwhelming and difficult to bear without meeting diagnostic criteria for a mental illness.  

Recognizing Risk 

People who have previously attempted suicide are more likely to try again compared to folks who haven’t tried to kill themselves. If you know your friend has a history of suicide attempts, this may be an indicator that they will try again in the future. People who have been diagnosed with a mental health condition, like depression, bipolar disorder and anxiety are also more likely to attempt suicide.  

There are also environmental risk factors to consider. A friend who is experiencing suicidal ideation and has access to a gun has a higher risk of attempting suicide compared to someone who doesn’t have a gun in their home. Folks who are chronically bullied, exposed to another person’s suicide, or experiencing a personal crisis are also more likely to try to take their life.   

The National Alliance on Mental Illness and the American Foundation for Suicide Prevention (AFSP) identify signs of suicide by changes in behavior, mood, and speech.  

Changes in Behavior 

A dramatic change in behavior may indicate that someone is suicidal. Increased drug and alcohol use, social withdrawal, aggression, and impulsivity are also signs. People who are feeling suicidal may also sleep much more or much less than they normally do or give away their belongings and say goodbye to people.  

Changes in Mood 

Noticing that your friend’s mood has changed may also be a sign that they are contemplating suicide. Many people who experience suicidal ideation feel irritable, shameful, depressed, anxious, or agitated. Other folks might demonstrate a loss of interest in things they normally enjoy.  

Sometimes, people feel like their symptoms have suddenly improved. This is especially important to look out for because people with depression are often physically exhausted by their symptoms. When they start to feel better, they may also feel that they have the energy to attempt suicide.  

Changes in Speech 

It’s also important to pay attention to the conversation topics you have with your friend. People who express feelings of hopelessness or worthlessness may be at higher risk of attempting suicide. Folks who are feeling suicidal may also talk about feeling trapped or stuck in their symptoms and believing that there is no reason to live. Other people may say that they are worried about being a burden to other people and bluntly tell you that they want to kill themselves.  

Understanding Severity 

Does this information sound scary? Overwhelming? Relatable? It’s important to note that many people have thoughts of suicide. It doesn’t mean that you’re a bad person or that you’re “crazy” for feeling this way. Sometimes life is really hard and we want to escape the pain or stress we’re feeling so that things don’t hurt so badly.  

Here are a few things to look out for, in order from least severe to most severe, if you or someone you love is feeling suicidal: 

• Passive suicidal thoughts, such as “I don’t know if I can do this anymore.” 
• Active suicidal thoughts, such as “I think people would be better off if I were dead.” 
• Active suicidal thoughts with a plan, such as “I’ll just shoot myself and get this over with.” 
• Active suicidal thoughts with a plan and intent, such as “I’m determined to find ammo for my gun so that I can kill myself.” 
• Active suicidal thoughts with a plan, intent, and means, such as “I’m going to go home and load my handgun and shoot myself.” 

Talking about suicide  

• Give your undivided attention to the person you’re talking to: “I can tell this is really hard for you to talk about. I’m going to turn off the TV so that you know you have my full attention.”  
• Express your concern in an empathic and nonjudgmental way: “I noticed you’ve been talking a lot recently about dying. I’m concerned about your safety and I want to talk about what you’re going through.” 
• Validate the pain they are experiencing: “That sounds awful. Given what you’ve told me, I can see that you’re really hurting and I understand that you want to make your pain go away.”  
• Tell them you care about them and want them to stay alive: “I really care about you and your happiness and safety. I want to make sure that we can find a way to keep you safe and alive.” 
• Acknowledge that you are grateful for their bravery in sharing their story with you: “I’m grateful that you shared your story with me. That’s a vulnerable thing to do and I think you’re really brave to have told me.” 
• Be direct. A lot of times people who are feeling suicidal are afraid to talk about what they’re feeling. Oftentimes, asking the person directly will make them feel relieved to finally be able to talk about how they’re feeling: “I noticed you said ____. Sometimes when people feel that way, they consider killing themselves. Are you thinking about suicide?”  

Don’t: