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10 Things to do when someone you know may be suicidal

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SAVE | Someone You Know Is Suicidal.

  1. Let them know you are concerned
    • “When you say ‘sometimes I just want to end it all’ I take it seriously”
    • “You seem especially (down, angry, withdrawn, sad, …) lately and I’m concerned”
  2. Ask them if they are suicidal. Be direct, avoid euphemisms.
    • “Are you thinking about killing yourself?”
  3. Explore their thoughts and plans
    • “Have you thought about how you might kill yourself?”
    • “Do you actually have the [gun, pills, rope, …] available?
    • “How likely are you to act on these thoughts?”
  4. Decide how dangerous the suicidal threat stands
    • Emergency: they have a concrete plan, access to the plan, and feel likely to act
    • Urgent: concrete plan, but don’t have access to plan, or don’t feel like acting on it now
    • Important: vague plan, no access, credibly affirm they won’t act on thoughts
    • There is no unimportant threat
  5. Take action to reduce the threat
    • If the threat level is Emergency
      • take them to hospital emergency room, or
      • call 911 (ask for mental health officer if your community has them)
    • If threat level is Urgent
      • ask for commitment to not act on plan without calling and talking to someone (you, suicide hotline, pastor, emergency room, therapist)
      • reduce lethality of plan
        • remove guns, pills, alcohol, …
        • arrange for them to not be alone
      • commit to helping them find professional support
    • If the threat level is Important
      • commit to helping them find professional support (MD, psychiatrist, mental health therapist)
      • follow through till they get help
  6. Acknowledge the reality and depth of their pain
  7. Affirm your care and concern
  8. Affirm that things can get better
  9. Commit to follow-up
  10. Follow-up

3 thoughts on “10 Things to do when someone you know may be suicidal”

  1. Jay, I think this is really good work.

    I think the bullet that has the three categories gets confusing with the “important” response at the end – maybe each of the three could be set apart with their own recommended responses.

    I wonder if the response to the emergency level needs to be stronger – CALL 911 IMMEDIATELY. THIS IS AN EMERGENCY CALL THEY WILL RESPOND TO. BUT MAKE SURE YOU HAVE THE PERSON’S LOCATION/ADDRESS BEFORE YOU CALL! Hotel rooms can be hard to find.

    Thanks for this helpful entry!

    1. Thanks Jennifer,

      Providing specifics for the 911 call is a good point.

      Regarding how quickly to call 911, I tend to lean towards giving people as much self-control as possible. If they are willing to go to the emergency room themselves or call 911 themselves, I’d like to give them that chance before I take that freedom away. On the other hand, I will tell them that I will do anything in my power to keep them alive, including calling 911.

  2. This is very helpful, Jay. Your emphasis on being clear and direct is really good. So often getting things out clearly so the level of threat can be assessed is a relief and guide to the person having suicidal thoughts/behaviors as well as the person in the helping role.

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