Asking about suicidal thoughts and behaviour

Acute suicidal risk is indicated by the presence of pressing thoughts of suicide, severe hopelessness or guilt, social withdrawal, agitation, announcements of suicide, and concrete plans. If you believe somebody to be at imminent risk of suicide, don’t be afraid to ask the person directly about your concerns (e.g. “You seem quite down and distressed. Have you been thinking of taking your own life or harming yourself?”).

It is not the case that asking such questions will trigger suicidal behaviour if suicidal thoughts are not already present, and indeed your directness may come as a great relief to someone who is suicidal. If the person acknowledges thoughts of suicide, try to establish how strong these thoughts are and whether the person has made concrete plans or has previously engaged in suicidal behaviour.

Listen empathically to their responses and explore whether there is anyone else that you can involve, such as family or healthcare professionals. It is important to note that an acute suicidal crisis is usually temporary and it is crucial to prevent harm during the acute phase. You should involve the suicidal person in decision-making wherever possible. Don’t be judgmental or display shock, listen empathically and seek help for the person, by encouraging them to do so or by initiating this yourself.

If the person fulfils the criteria for compulsory hospitalisation, then ensure that they are committed. Even if they don’t meet the criteria for compulsory hospitalisation, you should still try to facilitate their accessing mental health services as appropriate. Do not leave a suicidal person alone: ensure that family members or significant others are on the scene and accept responsibility for their safety.