What a Suicide Prevention Expert Says You Can Do to Save Lives
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Suicide prevention begins with having more open and honest conversations about an issue that unfortunately has an impact on too many people across the world.
The numbers tell one part of the story. In a 2019 report, suicide was the tenth leading cause of death in the U.S. In a 2020 preliminary CDC report, it declined to eleventh overall, but it's still too high.
Middle-aged white men had the highest rate of suicide in 2019, with men overall dying by suicide 3.63 times more often as women. And while we’re still waiting for concrete data, the Covid-19 pandemic may have exacerbated mental health issues, taking a particular toll on youth and young adults, minority populations, and any groups who experienced health and economic disparities pre-pandemic.
The other part of the story feels less quantifiable: the grief that comes from losing a loved one and the personal struggles that lead to someone considering suicide.
To learn more about suicide prevention, we reached out to Christine Yu Moutier, MD, the Chief Medical Officer for the American Foundation for Suicide Prevention (AFSP), a health organization that focuses on research, education, and advocacy to save lives and bring hope to those affected by suicide. AFSP is also partnering with Sound Mind Live for Un-Heard Mentality, a World Mental Health Day benefit concert featuring performances by Fantastic Negrito, Langhorne Slim, and Aisha Badru on Oct. 21 at Brooklyn Bowl in New York City.
Here’s what Dr. Moutier told us about how to talk to loved ones, the pandemic’s impact, and what you can do to actively prevent suicide.
What’s the most disturbing thing to you about deaths by suicide?
The most disturbing thing about any suicide death is that human suffering and serious mental health challenges are actually common—I think of them as part of the human condition. Suicidal thoughts are the mind’s attempt to problem solve during an experience of unbearable pain. The fact that many people don’t disclose their suffering or suicidal thoughts to someone they trust is extremely disturbing to me.
The takeaway from all of this is that we need to be paying attention to our mental health and potential warning signs for suicidal distress across the board regardless of age, gender, race, or ethnicity. If there’s someone in your life—whether you’re a teacher, youth worker, or family member—now is the time to start having open, authentic conversations about mental health to understand where people are with their mental health and help people get support or treatment they need.
How to talk to someone about suicide
It’s said that if you think that someone is thinking about suicide, you should ask them right out, “Are you thinking about suicide?” Should you really do that?
We’ve learned through research that asking someone directly if they’re thinking about suicide won’t “put the idea in their head”—most will be relieved someone starts a conversation. Asking someone if they are thinking of ending their life in a supportive, non-judgmental way actually provides the person with a way to share their internal experiences, possibly for the first time, and may provide a way for them to take a critical next step in addressing their distress.
Any tips on how to bring it up?
You don’t need special training to have an open, authentic conversation about mental health. Some quick tips for having a real conversation include:
When someone is struggling, ask open ended questions and practice active listening
Let the other person share at their own speed
Don’t pass judgment or offer advice — just be there
We all experience mental health differently, and that’s okay
Offer to connect them to help if they need it
Check back in later to show that you haven’t forgotten, you care, and you still want to be there for them
To find more tools and resources to have a real conversation with the people in your life, visit afsp.org/realconvo.
Why is talking about suicide important?
People have become increasingly comfortable talking about their mental health, particularly in the past year. But the topic of suicide — when it comes up — is still scary for many people to think about. It’s time to deepen the conversation. It’s only by learning more about what leads someone to suicide, the ways we can help prevent it, and what resources are available — and not being afraid to ask when we’re worried about someone, or for help when we need it ourselves — that we can empower our communities to address this leading cause of death.
How to know if you should talk to someone
How would you know if someone close to you is vulnerable to suicide? What are the risk factors?
There’s no single cause for suicide. Suicide most often occurs when stressors and health issues converge to create an experience of hopelessness and despair. Risk factors are characteristics or conditions that increase the chance that a person may try to take their life, including mental health conditions like depression, anxiety and/or substance abuse problems, environmental risk factors like access to lethal means, as well as previous suicide attempts, a family history of suicide, and/or childhood abuse, neglect, or trauma.
Something to look out for when you’re concerned about someone close to you is a change in behavior or the presence of entirely new behaviors. This is of sharpest concern if the new or changed behavior is related to a painful event, loss, or change. Most people who are considering suicide exhibit one or more warning signs, either through what they say or what they do.
What kind of changes in what they say should you look out for?
You should look out for talk of killing themselves, feeling hopeless, having no reason to live, being a burden to others, feeling trapped, or unbearable pain.
What kind of behavioral changes should you be aware of?
You should be aware of behavioral changes like increased use of alcohol or drugs, looking for a way to end their lives, such as searching online for methods, withdrawing from activities, isolating from family and friends, sleeping too much or too little, visiting or calling people to say goodbye, giving away prized possessions, aggression, and fatigue.
What would changes in mood look like that you should take note of?
Mood changes you should take note of include depression, anxiety, loss of interest, irritability, humiliation/shame, agitation/anger, or relief/sudden improvement.
If you suspect someone is having suicidal thoughts, what’s the first thing you should do?
If you suspect someone is having suicidal thoughts, express caring concern and encourage them to seek professional help. Mental health professionals have the education, tools and resources to support people who are struggling and suicidal and can help them work through challenges and mental health conditions.
Safety planning can also help, such as developing a list of things someone can do and people they can contact when they are feeling depressed or suicidal.
Are there any things you should specifically not do?
When having an open, honest conversation about mental health and/or suicide, it’s important to avoid phrases that could come off as dismissive, shaming or blaming such as “it’s all in your head.” Instead, use phrases that are focused on listening to the person and helping them in the moment such as “I’m right here with you.” After the initial conversation, make sure you follow up with them to let them know it was okay to open up, that you care, and that you’re still a “safe” person to talk about mental health with.
How can you indicate you’re a “safe” person to talk with?
The easiest way to let people know you're willing to talk about mental health is to be open about your own. Try to think of it in the same way you think about your physical health, allow it to come up naturally in conversation in the same way. If you’ve seen a mental health professional in the past, when the subject comes up, you can say something like: “I’ve had times in my life when I’ve struggled. I went to talk to someone, and it really helped me.” A casual reference can have a powerful effect, letting others know you’re a safe person to talk to if they ever need to reach out.
What to know about suicide prevention strategies
How preventable is suicide, really?
Suicides can be prevented.
It is also important to note that if you have lost a loved one or colleague to suicide, we can’t blame any one person or event since suicide is very multi-factorial. So prevention doesn’t mean we should look back in hindsight; it does mean we can strive to do better by shedding stigma and using the research-derived truths about suicide to work towards reducing risk.
To help reduce the risk, there are important actions we can each take to reduce suicide risk for the people in your life, including:
Let people in your life know you’re a safe person to talk to about mental health, and actively listen and engage when someone comes to you for help.
Connect with a friend, family member, or person in your community who you think might be struggling with their mental health.
What prevention strategies if you’re the one who’s at risk of suicide?
Open up to someone you trust about any struggles with mental health you have been coping with.
Schedule a check-up to talk to a doctor about your mental health, as well as your physical health.
Add crisis resource numbers to your phone and encourage a loved one to do the same.
If you have suicide risk factors like depression or a previous suicide attempt, learn about Safety Planning as a way to stay ahead of spirals in mood.
If urging the person to talk about it or get help doesn’t have an effect, what should you do?
Not everyone is ready to talk or seek out professional help right away. If you’re speaking with someone about their mental health and/or suicide, you can say something like “If you’re not ready to go in and meet with someone in person, you could call the National Suicide Prevention Lifeline at 1-800-273-8255, or if you don’t feel like speaking, just text TALK to the Crisis Text Line at 741741. They can tell you more about what it might be like to work with a doctor, counselor or therapist.”
You can also offer to speak with their primary care provider as a gentle next step — family and friends can provide information to health care providers without expecting a call back or for the healthcare professional to provide any confidential health information back.
If you think they're in immediate danger:
Stay with them
Help them remove lethal means
Call the National Suicide Prevention Lifeline: 1-800-273-8255
Text TALK to 741741 to text with a trained crisis counselor from the Crisis Text Line for free, 24/7
Encourage them to seek help or to contact their doctor or therapist
What’s one major misconception you think people have in regard to suicide?
People may think that a person at risk is “bent on suicide” and can’t be helped. For example, some say “well if someone is going to end their life, they’re just going to do it.” When people are in a suicidal crisis they are very ambivalent, often looking for signs and reasons to hope. If we provide a sense of support and connection, and if we remove lethal means from their environment, we help them live through those brief moments of intense risk. Research shows that about 90% of people who live through a suicide attempt don’t go on to take their lives. So saving a life in one moment can truly prevent suicide from occurring.
Let’s say someone is scared to talk about suicide with a loved one who is struggling, but they feel compelled to address it. What would your advice be to that person?
Trust your gut if you think someone’s having a hard time, and speak to them privately. Often, just talking about it can be the first important step in understanding where someone is with their mental health, and helping them get support or treatment if needed. Being available to have a real conversation about mental health is an important way we can all be there for the people in our lives, whether it’s a friend, family member, or someone in your community. All it takes is a willingness to be open, honest and present with the people you care about.
Here are some quick pointers you can use for having a real conversation with the people in your life.
The timing doesn’t have to be perfect: You may not always be able to speak with someone the moment you notice they might be struggling. It’s fine to circle back some other time to connect.
Offer to help connect them to someone else: If you suspect the other person might be more comfortable talking with someone else, you can say something like: “Is talking to me about this helping you right now? Or is there someone else you’d feel more comfortable with, who we can bring in to help support you?”
Follow up: Don’t just leave it at that conversation, follow up to let them know it was okay to open up, that you care, and that you’re still a “safe” person to talk to about mental health.
How much has Covid loneliness contributed to suicide rates?
COVID-19 and associated mitigation efforts such as physical distancing do not alone cause suicide. Suicide is complex, risk is dynamic, and an individual's personal risk factors combined with precipitants such as evolving experiences with isolation, depression, anxiety, economic stress, and suicidal ideation, and access to lethal means may lead to periods of increased risk.
We may not understand the entire impact of COVID-19 on suicide deaths for another year or longer as suicide mortality data takes time to collect and analyze in a meaningful way. Additionally, we know there can be a time lag in the manifestation of distress even months after the acuity of a traumatic or stressful period is over.
In light of all of this, I still remain optimistic that protective mental health measures are having a positive impact amid a time of collective distress and there’s a readiness to engage and implement effective suicide prevention strategies widely.
What you can do to help those who've lost people to suicide
What can help someone cope with the loss of a loved one to suicide?
Have a self-care plan that prioritizes your physical and mental health: Get enough rest, drink more water, and try your best to get regular exercise. Setting small daily health goals can give you a sense of accomplishment without feeling too burdensome. Tell others about your self-care plan so they can help support you.
It’s okay to not feel okay all the time: All of your feelings are valid, including those that are difficult or unexpected. Allow yourself to feel your authentic feelings, but also remember that it may take time to come to grips with a loss and the intensity of your feelings can change.
Be in the companionship of others: Talk to trusted friends and family about what you are feeling. Ways to stay connected can include a FaceTime meet up, inviting someone you know who is alone to a physically safe gathering, or calling or texting a friend.
If you’re having a lot of trouble coping with this loss, where can you get help?
If you are struggling with your mental health, reach out to a professional for support. You don’t have to feel alone with your grief, and it can be comforting to share what you are experiencing with a trained professional. You can also reach out to The Crisis Text Line by texting TALK to 741741 or National Suicide Prevention Lifeline at 1-800-273-TALK if you are feeling alone and struggling with your loss.
Reach out to an AFSP Healing Conversations Volunteer: This program gives suicide loss survivors an opportunity to talk (in-person or virtually) to another survivor that can provide guidance, empathy, resources, and information that may otherwise not be available. Often a relief for survivors is to have these kinds of conversations. Visit afsp.org/healingconversations to learn more.
For those who have lost loved ones to suicide, most of us don't want them to be defined by their final moments, their death. They were suffering with complicating factors and most often a mental health condition, all of which created a complex situation and a loss of hope. Remember the whole of their lives.
How can the average person get more involved in suicide prevention efforts?
There are important steps we can each take to get more involved in suicide prevention efforts such as advocating for mental health and suicide prevention policies that ensure everyone in your community has access to mental health care, suicide prevention training and funding for local crisis resources, as well as getting involved with your local AFSP chapter to help transform your community into one that’s smart about mental health, where everyone has support when they need it. Go to afsp.org to become an advocate, attend a suicide prevention program, or walk in an Out of the Darkness Walk.
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