Supporting someone in distress or with suicidal thoughts

It is not always possible to know when someone is experiencing suicidal thoughts. Some people:

• do not tell others when they are struggling or having suicidal thoughts
• do not show any outward signs of experiencing suicidal thoughts
• do not even appear sad or distressed.

There are many different reasons that people are not open about their suicidal thoughts, including:

• stigma
• embarrassment
• fear
• shame
• not wanting to burden others
• wanting to sort the situation out on their own.

Instead of relying on recognising the signs of suicidal thoughts, the safest thing you can do is to respond with compassion and support whenever someone you know is having a difficult time. Try to do this regardless of whether you think they are currently having suicidal thoughts.

It is also helpful to know what some of these signs are in case the person you know is showing them.

Saying or doing things that concern you

They might:

• talk about suicide, death or dying
• say they have no ‘way out’ or no solutions to their situation
• say that they ‘don’t want to be around anymore’, ‘can’t do this anymore’ or ‘can’t go on for much longer’
• say they have no hope for the future
• say they feel helpless, hopeless, or trapped
• say that things will never get better or change
• say that they feel worthless, guilty or ashamed
• say that they feel like a burden or have feelings of self-loathing
• search for information about suicide online
• make a Will, or tell other people what they want to happen after they have died
• make arrangements for other people to look after family members or pets.

Changes in mood

You might notice that they:

• are ‘lower’ or more depressed than usual
• seem agitated, anxious or distracted
• seem unusually angry, frustrated or irritable
• withdraw from other people.

Unexplained sudden improvement in mood

Sometimes when someone is suicidal or has made a plan to end their life, their mood can seem to suddenly improve for no obvious reason.

You might notice that they seem happier or calmer than they have in a long time. They might also stop talking about negative things to convince others that they are fine.

Changes in behaviour or doing things that are out of character

• saying goodbye to people as if they won’t see them again
• making unusual or unexpected visits or calls to family and friends
• drinking alcohol or using drugs more often than usual.

Becoming isolated or disconnecting from life

• contacting friends and family less than usual
• falling behind at work or with hobbies
• not looking after themselves or their home
• calling in sick to work more often.

Acting more spontaneously or erratically than usual

• giving away their possessions or spending lots of money
• showing little concern for the future
• engaging in risk-taking behaviour, unusual gambling or violence.

These aren’t signs that someone is definitely suicidal. However, these are probably signs that someone is struggling and needs support, and they should be taken seriously.

If someone you know is going through a difficult time, or you are worried that they might be having suicidal thoughts, the most helpful thing you can do is talk to them about it. Compassionate help from someone who cares can make a real difference to someone who is distressed.

Simply telling someone that you have noticed a change in them or that you know they’re going through a tough time is an important first step. It also might make it easier for them to confide in you in the future if they ever do start having suicidal thoughts.

What if talking makes things worse?

It is a common myth that talking about suicide can make someone more likely to act on their feelings. However, research shows that this is not the case. Being able to be open and honest about suicidal thoughts, speaking about them, and being encouraged to seek support can help someone to stay safe.

Suicidal thoughts are much more common than people realise, but it can be hard to talk about them. It is normal to find conversations about suicide difficult, or to feel unsure about how to start them, especially if you haven’t done so before.

In the next section we share some tips to help you start a conversation about suicidal thoughts.

It can be difficult to talk about suicide, but there are some things you can do to make this easier for both you and the person you’re worried about.

Before

It isn’t always possible to plan ahead for these conversations, but if you can, here are some things to consider.

Create a supportive space

• Step away from whatever you are doing, and make time for the conversation so that it can happen without anyone feeling rushed.
• Find a quiet place free from distractions like other people, bright lights or noise.
• Offer the person their favourite hot drink.
• Keep a discreet packet of tissues on hand in case they are needed.

Consider what you are going to say

Prepare an opening sentence. You should choose something that you feel comfortable saying, but here are some examples:

‘I know you’ve been having a tough time, and I’m worried. Can we talk about how you’re feeling?’

‘I’ve noticed you seem down lately, would you like to tell me how you’ve been feeling?’

‘You seem really stressed lately, is everything okay?’

Think about how you will respond

If you start a conversation about suicide, be prepared for an honest answer. Plan to respond calmly, reassuringly and without judgment.

Before you start, you could spend a couple of minutes doing a calming activity by yourself. For example, a grounding, relaxation or breathing exercise. This can help you to stay calm during the conversation.

During

Try to stay calm

Talking about suicide can be difficult because of stigma, fear or embarrassment. You will probably find this conversation more difficult if you don’t have training, or if you’re having the conversation with someone you care about. Staying calm can help the other person to feel calmer too.

Try to speak slowly

In difficult conversations, slowing your speech can help you to feel calmer. Speaking slowly can also help the other person to feel calmer, and give them time to find the right words to express their feelings and take in what you are saying. Talking about suicide can be difficult, so don’t worry if there are long silences or times when the person finds it difficult to speak.

Try to use clear language

When someone is feeling overwhelmed, they might find it harder to take in information. Keep communication clear, short and simple, and use neutral, non-judgmental and calm language.

Avoid stigmatising language

Avoid using judgmental, invalidating or dismissive language that could be misinterpreted, offend someone or shut down the conversation. Here are some examples of what not to say. We have provided some examples of things you can say in the next section.

‘Suicide is selfish.’

‘What about all the people that care about you, that you’d be leaving behind?’

‘You will just be passing on your pain to your loved ones.’

‘Everyone finds life hard and has ups and downs, but they don’t feel suicidal, so why are you suicidal?’

‘Suicide is a sin.’

After

Take a moment

After a difficult or distressing conversation, take a moment to gather your thoughts if you can. If you can’t do this straight away, promise yourself that you will take some time for yourself as soon as you can.

Take time to reflect

After a difficult or distressing conversation it can be helpful to reflect on what went well, and what could potentially be changed or improved next time.

Get support

It can be useful to discuss the emotional impact of a conversation like this with someone you trust. This may be with someone you already know or with a helpline that offers support to family, friends and carers.

Focus on your own wellbeing

After a difficult or distressing conversation it is important that you focus on your own wellbeing. You could make yourself your favourite hot drink, connect with a trusted person, or get some fresh air or exercise.

It is normal to feel that you need to talk to someone yourself after speaking with someone who has said they are feeling suicidal. It can bring up difficult emotions that are important to process.

You can find out more about caring for yourself at the end of this resource.

Planning for future conversations

Even if you do not feel confident asking someone directly about suicide, you can still have a supportive conversation about how they can get help if they’re struggling. Once you’ve started talking about feelings, they might open up about suicidal thoughts. If not, starting the conversation might give you the confidence to ask directly.

They might also tell you that they are fine. You cannot put the idea of suicide into someone’s mind just by asking how they are, so even if someone says they are OK, always ask more than once. You can also consider asking again at a later date.

If you are worried about someone but they don’t want to talk no matter how much you try, let them know that you will be there for them in the future if they change their mind or need someone to talk to. If they begin to feel suicidal or if things get worse, they will know they have someone to turn to.

You could also suggest that they speak to someone else, and help them to think about who that might be. For example, their partner, a family member, a close friend, or even their GP or a mental health professional.

If someone you know tells you that they are having suicidal thoughts:

Remain calm

Listen carefully to what they say. Let them tell you everything that they want to without interrupting them. Don’t make assumptions about what they are trying to tell you. If you are unsure what they mean, ask them to explain.

Once they have finished speaking, there are a few things you can do to respond in a helpful way.

Validate their feelings

You can do this without agreeing with or encouraging their suicidal thoughts. For example, you could say:

‘This sounds incredibly difficult, I’m so sorry you are feeling like this.’

‘It’s completely understandable that you want the pain to go away. You deserve support.’

Tell them about the help available

You cannot support someone with suicidal thoughts on your own, and it is very important that you are not the only one who knows what is happening. Try to encourage them to seek professional support from someone who has training in mental health and in supporting people who experience suicidal thoughts.

You could start by asking them what kind of support they have had already. If this is their first time asking for help, suggest that they reach out to their GP. You could say to them:

‘I think it would be really helpful for you to speak to a professional who can understand and help you with the way that you are feeling. Shall we have a look at some options together?’

You could also share our resource for people who are experiencing suicidal thoughts. This contains lots of helpful information about the support their GP might offer.

If they are already under the care of mental health services, you could encourage them to share how they are feeling with these services.

Provide practical help

You could:

• Offer to support them in making an appointment with the GP or calling NHS 111 (they should select the option for mental health).
• Offer to go with them to a GP appointment.
• Tell them they can contact you if they need to talk to someone.
• Encourage them to speak to other trusted people about how they are feeling.
• Help them to make a safety plan. Even if they end up making a safety plan with a professional at a later date, it might still be helpful for you both to complete one together while they are waiting for professional help. The Staying Safe website can guide you to make a safety plan on your own or with someone you trust.

What if I say the wrong thing?

It’s normal to worry about what to say to someone when you think they might be experiencing suicidal thoughts. There isn’t one perfect thing you can say, and you can only try your best. It’s more important to be kind, patient and to show that you care than to focus on using exactly the ‘right’ words.

The main thing is to listen to what you are being told, and to respond calmly, without judgement or blame. Below are some other things you should avoid.

Try not to tell them that you know how they feel

Even if you have experienced these kinds of thoughts yourself, everyone experiences thoughts and feelings differently. People with suicidal thoughts can feel as though no one could possibly understand how they are feeling.

Try not to make them feel guilty or ashamed for having suicidal thoughts

It is important not to make them feel worse by telling them how their death would impact others. They might be very aware of this, or they might feel that people would be better off without them, even when this is not true. Instead, thank them for telling you, and acknowledge the bravery it has taken to seek the support they need.

Try not to tell them they are going to be fine

Minimising or dismissing suicidal thoughts can make someone feel worse. People with suicidal thoughts should be taken seriously and responded to with compassion and understanding.

Try not to fix everything yourself

It’s completely understandable to want to fix things yourself, especially if you care a lot about someone or are very worried about them. However, it’s important that they receive help from other people, including professionals.

Remember, you don’t need to try to fix the situation and things probably won’t be solved by one conversation. You can support the person by showing them that you are happy to continue having conversations, and that you are there for them if they need your support.

Remember these important things

• Suicidal thoughts should be taken seriously and the person you are worried about will likely need support from a professional.
• It is safer not to promise to keep suicidal thoughts secret.
• Only offer to help in ways that feel manageable to you. An important part of your role might be helping the person to find support from others.
• Supporting someone with suicidal thoughts can be hard, so it’s important for you get support too.

If you think that someone is about to harm themselves or has harmed themselves call 999 immediately and ask for an ambulance.

Once you have done this, or if you aren’t sure if they are going to harm themselves or not, here are some things you can do:

If you are with them

If you are with the person, you should stay with them and try to help them to manage their intense or difficult feelings.

In our resource for people who are experiencing suicidal thoughts, we include a list of things that people can do to stay safer, including ways to distract themselves. Take a look at this list with them, and see if there are any things that they might find helpful. You should also encourage them to contact a specialist helpline.

If you are not with them

If you aren’t physically with someone when they are having these feelings, try to keep in contact with them and encourage them to reach out to someone who is with them or is nearby. If they are in an unsafe place or a place where they could come to harm, then try to encourage them to move to a safe place.

If you are able to meet up with them quickly then this can be very helpful. If not, you could support them to seek urgent professional help, including speaking to a professional on their behalf. You should try to get their consent before speaking to a healthcare professional for them, but this might not always be possible. The most important thing is that you do what is right for the person and help them to access the support they need.

Sometimes suicidal thoughts can become so strong that professional support is needed. When this happens, it is likely that support from friends and family alone won’t be enough to keep a person safe. If you have any concerns about your ability to keep someone safe, reach out to a healthcare professional straight away. Even if the person you know has tried to seek support in the past and doesn’t want to try again, please encourage them to keep trying.

There are some important things to know about suicidal thoughts and feelings. These things can be difficult to read about, but they can help you to understand what help you can give and the limitations of what you can do.

• Suicidal thoughts and feelings can be incredibly difficult to imagine if you haven’t experienced them. Some people compare suicidal thoughts to extreme physical pain because of how overwhelming and unbearable they can be.
• Suicidal thoughts are not personal. If someone tells you that they want to die or are experiencing suicidal thoughts, this does not mean that they do not care about you. It also does not necessarily mean that you are doing something wrong.
• Talking to someone about suicide won’t make them more likely to act on their feelings.
• You are unlikely to be able to stop someone from feeling suicidal on your own, even though there are things you can do to help.
• It is not possible to predict or know exactly when someone will attempt suicide, even if you know that they are experiencing suicidal thoughts.
• Many people can feel suicidal and at the same time be fearful for their own safety.
• Many people are uncertain or have mixed feelings about whether they want to live or die when they are considering suicide. Even if someone feels that they have no option but to end their life, they might still feel unsure, and it is never too late to help them.
• Someone might not want to end their life, but want the pain they are experiencing to stop.
• Some people are unable to think about any other options or solutions to their situation and see suicide as their only option.

Supporting someone who is experiencing suicidal thoughts can be incredibly challenging. It can be distressing to see another person in distress, and to be unable to ‘fix’ things for them. Below are some things that you can do to care for yourself when you are supporting someone who is experiencing suicidal thoughts.

Share your worries

Just as the person you are supporting needs someone to speak to, you will also need someone to share your worries with. This could be a trusted friend or family member. Or, if you are worried about sharing your feelings with someone you know, you could contact a helpline like those included at the end of this resource.

Make time for yourself

It is important that you make time for yourself when you are caring for someone else. This could mean making sure you have some time each day to relax. For example, by getting some fresh air, calling a friend, or reading a book.

If you don’t feel comfortable leaving the person you are caring for on their own, you could ask a friend to come round while you take some time for yourself. Remember, you won’t be able to care for other people if you don’t also care for yourself.

Get help for your mental health

It is unfortunately common for people who support someone who is suicidal to develop their own struggles with their mental health. If you are experiencing poor mental health, it is important that you seek help too. Speak to your GP if you are struggling.

Find out if you are eligible for extra support

If you spend a lot of time caring for someone who is suicidal, you might be considered a ‘carer’. This means you could be eligible for certain benefits and support. Find out more in our resource on caring for someone with a mental illness, or speak to your GP.

Support lines

You can contact the following organisations if you need to speak to someone:

• Samaritans – Samaritans offers listening and support to people in times of need. They are open 24 hours a day, 7 days a week.
• Shout – Shout is a free, confidential text messaging service for anyone in the UK who needs support. They are open 24 hours a day, 7 days a week.
• Childline – Childline is a free, confidential support service for people under the age of 19. They are open 24 hours a day, 7 days a week.
• SANEline – SANEline is a national mental health helpline that offers specialist emotional support, guidance and information to anyone affected by mental illness. You can find SANEline’s opening hours on their website.

Charities

• Campaign Against Living Miserably (CALM) – A charity focused on suicide prevention that offers resources for people struggling, and a helpline.
• The International Association for Suicide Prevention – The IASP has a database where you can find suicide support services in your country.
• How to support someone who is feeling suicidal, Mind – The charity Mind has a page for people who know someone who is feeling suicidal.

Websites and apps

• Staying Safe – This website offers resources to support people who are experiencing thoughts of self-harm or suicide, including an online safety plan template with tried and tested suggestions.
• Stay Alive – This website and free app have information and support functions for people who are experiencing suicidal thoughts.

This information was produced by the Royal College of Psychiatrists’ Public Engagement Editorial Board (PEEB). It reflects the best available evidence at the time of writing.

Clinical experts: Dr Alys Cole-King, Dr Sanjukta Das and Dr Nisha Shah

Experts by experience: Jan Giles, Melinda King and Eshan Vadgama

The experts by experience who helped to develop this resource are people who have experienced suicidal thoughts in the past, or who have supported a loved one experiencing suicidal thoughts.

Full references available on request.