Worried About Someone? Starting a Conversation That Could Save a Life

According to surveys and public health data, 13% to 17% of people experiencing suicidal thoughts would tell no one or are unsure who to talk to.  

Sometimes a person struggling with depression or suicidal thoughts may not ask for help, especially if they don’t have anyone in their life that they truly trust. Some individuals develop suicidal thoughts when they feel like they don’t have any other choices, so providing alternatives and assuring them there is another path forward can be transformative in their aid and recovery. 

Bridging the gap to a better outcome starts with having conversations. Friends, family members and coworkers may notice changes in a person’s behavior and want to intervene. Starting a conversation about such a sensitive topic can feel uncomfortable, but a compassionate, direct approach can create an opening for support, and real, tangible change can begin taking place from there. 

Conversation starters: Lead with concern 

Choosing a quiet, private moment and leading recent observations are optimal ways to start a conversation with a loved one. Statements and questions like, “You haven’t seemed like yourself lately. How are you doing?” can open the door without judgment. Avoid minimizing feelings or rushing to offer solutions, and be sure to listen, stay calm and let the person talk. 

If there is concern about an imminent suicide attempt, it is appropriate to ask directly. Something like, “Are you thinking about suicide?” Asking someone about suicide does not increase suicidal thoughts or behavior, making direct questions like these appropriate and sometimes necessary in determining whether a person needs immediate support.  

Additionally, some people experiencing suicidal thoughts may not be frank about their feelings. They may still deny having these thoughts when asked directly. That’s why staying engaged and following up – especially when warning signs still seem apparent – is key. 

Knowing the warning signs 

Depression can show up as:  

• Persistent sadness 

• Hopelessness 

• Irritability 

• Loss of interest in activities 

• Changes in sleep or appetite 

• Fatigue 

• Difficulty concentrating 

• Withdrawal from family or friends 

Symptoms can vary based on age, and children and teens may be more irritable or withdrawn rather than obviously sad. Warning signs of possible suicidal thinking can include:  

• Acting anxious or agitated and behaving recklessly 

• Extreme mood swings 

• Increasing drug or alcohol use 

• Sleeping too little or too much 

• Talking about a wish to die or plan to attempt suicide 

• Talking about being a burden to others 

• Talking about feeling hopeless or having no reason to live 

• Withdrawing or isolating 

It’s important to differentiate between the two forms of suicidal ideation to identify immediate short-term risks. The two forms of suicidal ideation are active and passive. 

• Passive suicidal ideation occurs when someone has thoughts of death without a clear plan or intent to end their own life. 

• Active suicidal ideation is when an individual’s suicidal thoughts turn into suicidal planning. People who experience active suicidal ideation become motivated to create an action plan to commit self-harm. Active suicidal ideation usually requires emergency treatment. 

Adjust the conversation for age 

With teens, adults and older adults, the goal is the same: create a safe space to talk without shame. When speaking with teens, ask open questions about school, friendships, relationships, online experiences and changes in behavior. Experts recommend taking signs such as irritability, withdrawal, poor grades and changes in sleep or eating seriously. 

Adults may be more likely to mask distress behind work, family responsibilities or substance use. Asking about recent losses, major stressors or changes in daily routines can help uncover what is happening. 

Signs or warnings of a potential suicide may not be easy to read in older adults. Sometimes, they may express passive suicidal ideation. The National Council on Aging list factors like social isolation, the death of a spouse and the grief associated with the loss, a recent or unexpected loss of independence dur to injury, chronic illness and pain and cognitive impairment as factors that could drive suicidal intent in older adults. 

Know when to get immediate help 

If someone says they plan to commit suicide, has a specific plan or appears in immediate danger, do not leave them alone. Help keep them away from lethal means and call or text 988, the Suicide & Crisis Lifeline. 

It is crucial to know that suicide attempts can occur for those without a history of mental health disorders, a diagnosable mental health condition or prior expression of suicidal ideation. For urgent, immediate support, click here for a list of crisis resource facilities open in Michigan and personalized care options. 

Additionally, knowing there are alternatives to suicide may sound like a basic principle, but when it is demonstrated to people struggling with a crisis, the outcomes can be lifechanging. Exploring peer-led support groups in one’s community that allows participants to talk about suicidal thoughts, feelings, or experiences without fear of being judged can help. Visit Mental Health America Michigan for localized resources and support.  

William Beecroft is the medical director of behavioral health at Blue Cross Blue Shield of Michigan. For more health tips and information, visit MIBlueDaily.com.