Suicidal ideation, which includes thoughts about not wanting to live or wanting to take action to end one's life, is typically an early stage of suicidality, says Becka Ross, LCSW chief program officer at Crisis Text Line. “Sometimes these thoughts are vague, more of a wish to disappear than a real thought of death,” says Gina Pellicci, LMSW, who specializes in working with individuals who struggle with suicidal ideation. “Sometimes they are explicit, including plans and vivid imagery about a method they might use to commit suicide.” But ideation can also include passive thoughts of being okay if death were to happen spontaneously. In short: It’s hard to know how best to react to this kind of disclosure.
It’s also important to note that suicidal ideation is common, and there isn’t a universal reason why some people experience it, says Carlene MacMillan, MD, psychiatrist and founder of Brooklyn Minds. In some cases, it can be a symptom of a mood disorder, such as depression or bipolar disorder. Often, more persistent suicidal ideation is a feature of personality disorders such as borderline personality disorder. For others, however, the thoughts may stem from traumatic experiences or highly stressful life events. In a study conducted last year by the Centers for Disease Control and Prevention (CDC), around 10.7 percent of respondents reported suicidal ideation within 30 days before filling out the survey. “Having suicidal ideation in and of itself does not mean a person has any one specific diagnosis, and a qualified mental health professional should do a thorough diagnostic assessment,” Dr. MacMillan says.
Ultimately, Pellicci says, suicidal ideation often comes from wanting relief from pain and not knowing how else to get it or not believing it could come in any other way. “It is often accompanied by hopelessness and loss of joy in life,” she says. “The combo of all these things can be a perfect storm to create suicidal ideation.”
So if someone you love has opened up about suicidal ideation, there are ways to lend safe and effective support. “It is important to take a curious, non-judgmental, and empathic stance when someone expresses suicidal ideation,” says Dr. MacMillan, adding that you should ultimately encourage your loved one to seek professional support. Below, experts share clear and actionable ways to encourage that process.
6 ways to support someone with suicidal ideation
1. Listen and assess the situation with empathy
“We often may be tempted to fix someone's pain, but it is much more powerful to support our loved ones and to be present for them,” says Pellicci. It is also crucial, she explains, to understand that expressing thoughts of suicide can be a coping mechanism for some and does not necessarily mean there is an intention to act on the thoughts. Still, it can be hard to tell the difference for those who are not trained in suicide risk assessment. So remaining open and compassionate is crucial.
If a friend indicates that they’re grappling with ideation, it's important to ask follow-up questions. “The research shows that asking about suicidal thoughts will not ‘plant the idea of suicide’ or induce suicidal behavior,” says Ross. Don’t be afraid to use the word "suicide" or ask whether the person has plans. In fact, the National Council for Mental Wellbeing suggests asking: Are you having thoughts of suicide? Do you have a plan to kill yourself? Have you decided when you’d do it? Do you have everything you need to carry out your plan? These questions will help you determine (to the best of your ability) whether your loved one is in immediate danger.
If it sounds like there's an immediate threat (or if you're not quite sure) it's important to “take suicidal threats seriously,” says Pellicci. If you are worried, don't keep it to yourself—stay with the person for as long as possible and call 911, a suicide hotline, or if the person's mental health provider if they have one.
If you don’t think there’s an immediate threat, you can still provide mental health resources. Remind your loved one that you care about them and that 24-hour helplines are available whenever needed. You can suggest the National Suicide Lifeline (1-800-273-8255) or The Trevor Project for LGBTQIA+ youth (1-866-488-7386). If your loved one would rather not talk to someone on the phone, they can reach the Crisis Text Line by texting HOME to 741-741.
2. Provide compassionate reassurance
“Knowing someone is there and thinking of you is so helpful,” Pellicci says. But remember to be non-judgmental since there is a lot of stigma around suicidal ideation. “Do not blame your loved one for how they are feeling,” she says. “Make it clear you love and value the individual and their life,” says Dr. MacMillan, adding that you can express gratitude for their transparency. This can help alleviate some of the stigma and potential shame that your loved one might feel after opening up, she says.
3. Don’t downplay how your loved one is feeling
It’s helpful to work from the assumption that everyone's pain is real and is as tough as they say it is, says Pellicci. “Keeping that in mind can be helpful,” she says. Additionally, Dr. MacMillan cautions against toxic positivity, whereby we try to get someone to “look on the bright side” of a given situation. “Do not tell them what they’re experiencing is trite or say invalidating things like ‘suicide is selfish’ and ‘don’t be ridiculous, we wouldn’t be better off without you,’” she says. “Statements like 'everything happens for a reason' and 'God only gives us as much as we can handle' generally are not helpful when someone is experiencing suicidal ideation.”
4. Keep risk factors in mind when suggesting coping strategies
In addition to recommending the numbers above, you might also try to reduce potential threats and triggers. “If the individual has easy access to firearms, if possible, remove them or secure them,” says Dr. MacMillan. It's also tempting to try and "distract your friend with less than healthy coping mechanisms, but try to resist the urge, Dr. McMillan says. “Illicit drugs and alcohol can increase the risk of completing suicide so while it may be tempting to ‘grab a drink’ with them to relax, this type of coping should not be encouraged.” Instead, listening with compassion, providing reassurance, and sharing relevant information are the best ways to support someone through suicidal ideation.
5. Ask what typically helps when they're feeling this way
Dr. MacMillan recommends asking your loved one if they’ve experienced it in the past and what typically helps them. Also, it can be supportive to learn what coping skills are helpful and participate in those activities with your loved one. For example, Pellicci has many clients who find scent soothing, so in this situation, their friends or family will often light candles together when they are struggling. Your friend might mention a therapist, a family member, or some other coping strategies—encourage them to lean on those supports that have worked in the past.
Even if your loved one doesn’t have a wealth of resources, Pellicci says that your time and support may help more than you know. “And sharing that you understand this is a thing many people experience at some point in their lives can be helpful since there is often a lot of shame around [suicidal ideation],” she says.
6. Seek additional support (for you and your loved one)
While you shouldn’t leave your loved one alone until you’ve agreed on support (perhaps they agree to call their therapist or contact the Crisis Text Line), remember that you aren’t in this alone. “Do not feel like you need to be the sole support—take care of yourself and help connect [them] to appropriate mental health supports,” says Ross.
Additionally, it's essential to remember that you can’t support your loved one alone. Suicidal ideation often, if not always, requires the support of professionals. While you can be present or encourage, you can’t absorb all of the responsibility. “It is very difficult seeing someone you love suffer, and taking care of yourself through this is important,” Pellicci says. Don’t be afraid to reach out to your own mental health providers to make sure you’re processing and caring for yourself as well.
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