How to respond when someone tells you they’re having suicidal thoughts

“Do we need to take the knives with us?” my friend asks.

The question is one I’ve never heard before. Two hours ago, I texted my friend and his husband that I was suicidal for the seventh time in my life. They both came over to hold me as I cried, and we watched RuPaul’s Drag Race. Both may never know how much I appreciate them. How much I appreciated their embrace. Though my depression makes me in some ways feel like a disgusting human being, to have them see me at my most vulnerable means the world to me.

Now they’re about to head home, and he’s asked the question about knives.

I almost laugh. Partly because I think he’s joking. Partly because I’m uncomfortable with people taking care of me when I’m suicidal. And partly because he’s not wrong—the knives have come up in my suicidal thoughts. But I also know that I’m safe, and I don’t want to follow through on the suicidal thoughts I’m having.

As we stand there in the kitchen, I realize that we are coming to this conversation from two different places. I am a Black, queer person who has navigated suicidality for much of my life. I am also a child and adolescent psychiatrist who has worked to keep kids safe when they’re experiencing suicidality.

My friends don’t have that experience or that background. This is new for them both. I can see it in my friend’s eyes—he’s terrified of losing me.

“No, I’m safe,” I say with a grounded voice.

I see them relax. I can tell they trust what I’ve said—and trust that I would tell them if I wasn’t safe to have knives in the house. As we hug goodnight, their arms hold me so tightly, as mine do them.

We are not taught how to respond when someone discloses that they’re suicidal. After all, it’s a terrifying prospect: your loved one, your family member, your friend is having thoughts of not being alive. Our minds often jump to the worst scenario. We might respond with unhelpful words only because we don’t know the right words to say.

As a psychiatrist with both professional and personal experience with suicidality, here’s how I recommend responding when someone opens up to you about being suicidal.

Don’t automatically assume they need to be hospitalized.

It’s important to not jump immediately to hospitalizing someone the moment that they disclose their suicidal thoughts. Not everyone needs to go to the hospital if they are suicidal. To understand who is most at risk, it’s helpful to understand the various levels of suicidal thoughts.

The first is passive suicidal thoughts. When this occurs, someone is having thoughts of not not being alive. Some variations of this are simply not wanting to wake up after they go to sleep, not minding if they were hit by a car or bus, or not minding if they suddenly died. But this person is not actively planning to hurt themselves.

The next is active suicidal thoughts without a plan. In this phase, the person has a multitude of thoughts of hurting themselves without a specific plan. They might briefly imagine different scenarios, but they don’t have a detailed plan of how they would follow-through with the thoughts.

The second to last is active suicidal thoughts with a plan and without intent. In this stage, a person is having specific thoughts of how to hurt themselves, yet they do not want to follow through with those plans.

The last is active suicidal thoughts with a plan and intent. This means that the person has a plan and they want to follow through with that plan. This is the most dangerous variant of suicidal thinking. If someone has active suicidal thoughts with a plan and intent, that is when you will likely move to hospitalization. However, even then, if the person has an established Safety Plan (more on that soon), there may be steps they can take before that, like talking to a therapist or psychiatrist.

When someone tells you they’re having suicidal thoughts, the first thing you can do is ask:

• Are you having thoughts of not wanting to be here or imagining how you might accomplish that?
• Do you have a specific plan to hurt yourself?
• Have you thought about how you might go through with that plan?

Then, once you know what stage they’re in, you can assess their needs. You can do this by asking questions like:

• What do you need?
• Do you need to call 988 or go to the nearest emergency room?
• Are you safe?
• Would you be comfortable telling me if you didn’t feel safe?

If the person states that they are not safe and are unable to stay safe, that’s when you want to call 988 or take them to the nearest emergency room.

Ask if they have a safety plan.

When the youth I work with say they’re suicidal, we build what is known as a Safety Plan, or a series of steps they follow to keep them safe. The goal of a Safety Plan is to help someone manage their suicidality and hopefully eliminate those thoughts. But, if they worsen, the Safety Plan also helps them know exactly what to do next.

A robust Safety Plan has the following:

• Your warning signs: This can include noticing when certain moods occur (such as anger that does not calm, tearfulness for several days), situations that are triggering, or noticing certain behaviors such as withdrawing from others.
• Your coping strategies: This can include relaxation techniques, physical activity, therapy, medication, and more.
• Your support system: This is the list of people you can reach out to for help (your friends, family, psychiatrist, therapist, 988, etc.). It can also include a list of people and places that can provide you with helpful distractions and grounding when you need a different kind of support.
• Rules for a safe environment: Depending on someone’s level of suicidality, this might include things like removing certain items from their home. The idea here is to modify one’s environment if necessary to remove immediate access to objects someone might use to harm themselves.

Make sure they feel heard.

It’s normal for your own fear to activate when someone discloses that they’re suicidal. We can become dismissive when we don’t know how to help the person or don’t understand what they’re going through. While you shouldn’t let your fear of saying the wrong thing stop you from saying anything, there are a few phrases I would recommend avoiding:

• “Cheer up.” This may undercut their struggles or feel like an extra burden for them.
• “It’s not that bad.” Or “You’re overreacting.” This can undermine their struggles instead of opening up an honest dialogue.
• “I know how you feel.” While well-meaning, everyone’s experience is different.

Instead, remind the person that they are loved and cared about. Many people living with suicidality are experiencing negative thought traps that make it hard for them to remember or believe that they matter. Having outside sources remind them that they are important and cared about can help anchor them to life. You want to remind them that they are not alone as they deal with their suicidality, and that they have people supporting them.

And if you’re ever not sure if a phrase would be helpful or not to someone experiencing suicidality, try saying it to yourself first and see how it feels to you. If it feels dismissive, try something else.

Ask how they want you to check in.

An important part of supporting someone living with suicidality is intentionally checking in.

I talk about this with my friends and family when I’m suicidal. We come up with plans for how and when to check in. With some friends, that involves texting every few days to make sure things are OK. With some family members, checking in involves touching base when we have our weekly conversations. For other people I’ve told about my suicidality, checking in means going for walks together or playing video games together (right now we’re on a Super Smash Bros, MarioKart, and MarioParty kick). Each one of them has asked how I want to check in with them to make sure things are going OK. We do so in a manner that doesn’t feel overwhelming yet also doesn’t let me withdraw from vital human connection.

Importantly, we don’t avoid the topic of my being suicidal. We don’t discuss it all the time, but we do discuss it. They might ask, “How are the suicidal thoughts?” or I might volunteer something like, “The suicidal thoughts are less frequent and less intense, which means we’re on the right track.” When we continue to have open conversations that are healing, my suicidality no longer feels like a dirty secret that I need to hide. Because of those conversations, I’ve been able to move through my suicidality feeling supported.

The bottom line: you being there makes a difference.

I am alive because of my friends and family. Their words have so often changed what could be an all-consuming experience into one that I could handle. Their sitting with me when I’ve been suicidal has changed my life. I don’t remember every single word each person has said, but I do remember the sentiment they imparted: that I mattered, that they trusted me, and that they were there with me.

You might not have all the right words. You may not know precisely how to react. However, by following at least some of the above, you can create space for someone to feel safe as they share that they’re suicidal. You can change a possibly overwhelming moment into one of deeper bonding with one another.

And for everyone living with suicidality, in case no one has said these words to you when you’ve shared that you’re suicidal, I’m going to say them now: I love you. I care about you.

Don’t give up hope. We’re all with you.