Estimated reading time: 9 minutes
Content Warning
This blog post is focused on a heavy topic. If at any point you are feeling overwhelmed, please take a break and when you’re ready, you can come back to it.
What is Suicidal Ideation?
First, suicide is defined as the act of intentionally ending one’s life.
Suicidal ideation, often called suicidal thoughts, are thoughts someone may be having about killing themselves. These thoughts can range from brief, fleeting ideas to having a detailed plan including a planned means and timeframe. It’s vital to take suicidal ideation seriously and to seek help from mental health professionals or support networks if you, or someone you know, are experiencing these thoughts.
It’s also important to note that most people who are contemplating killing themselves do not necessarily want to die, they want the pain they are experiencing to end.
How to Ask If Someone Is Experiencing Thoughts of Suicide
1. Pick an Appropriate Time and Place
Before we start a risk assessment, whether it’s for suicide or another crisis, we want to make sure we are cultivating an environment that will maximize the other person’s privacy and comfortability.
To do this we should choose and create a safe environment:
- Avoid public or noisy places, avoiding distractions
- Do your best to meet with the at-risk individual when both of you are calm and in a headspace to have a productive conversation
- Ensure that you have adequate time to have this potentially life saving conversation
2. Start by Expressing Your Concern
In addition to setting the physical stage of a safe, quiet environment, we want to create a supportive, caring environment through our body language, tone of voice, and word choice.
When approaching how to ask the suicide question itself, it can be helpful to use the “empathetic formula.” The idea behind this formula is to recognize that you’ve been noticing changes in a person and are wanting to show them that you care. Even if someone isn’t experiencing suicidal thoughts, this can open into a valuable, nurturing conversation as you demonstrate you are coming from a place of concern, not judgement.
Here’s the empathetic formula: [Warning sign you’ve noticed in the at-risk individual, or a paraphrase of something they’ve mentioned] + [Asking if they’ve been having thoughts of suicide]
Here’s an example of how we may begin this conversation with the empathetic formula: “Hey, thank you so much for setting the time aside to chat with me today. I wanted to preface this conversation by saying that this is a safe space so please share as much as you’re comfortable with. I’m worried because I’ve noticed that you’ve been expressing feeling hopeless. Sometimes when people feel this way they may be thinking about suicide. I wanted to check in and see if you’re currently experiencing thoughts of suicide.”
3. Ask if They Are Having Thoughts of Suicide Directly
Research shows that asking at-risk individuals if they are having suicidal thoughts does NOT increase the risk of suicide or suicidal ideation, so when we ask someone if they are having thoughts of suicide, we want to ask them directly. This helps:
- Reduce stigma
- Encourage disclosure
- Prevent misunderstandings
- Facilitate immediate help if needed
4. Don’t Force Them To Answer
If you have asked this person if they are experiencing suicidal thoughts and they don’t answer, we don’t want to force them to. Be patient and give them a few minutes of silence if they need it. They may need a bit of time to process what you are asking, or think about how they want to respond. Don’t feel the need to fill the silence unless a lot of time, such as three or four minutes, has passed and they are still silent in response to your question. If this is the case we want to remind them this is a safe space but we should not pressure them into giving us an answer.
If they don’t answer or say “maybe”, “I don’t know”, or something along the lines of “I’d prefer not to answer” we should still follow along with these threat assessment steps.
They may express that they are not comfortable talking about this with you. If this is the case, ask them if there is someone else they would feel comfortable talking to. Let them know you are always there to listen.
Do not punish them for not answering and do your best to not take it personally. You are showing your concern, and showing them that someone does care. Sometimes you have to meet someone where they are at even if it’s not what you were hoping for.
5. Do Your Best to Stay Calm if They Say Yes
It takes tremendous courage for someone to admit they are having thoughts of suicide. Do your best to listen and validate the struggles they are experiencing.
Avoid saying things like
- “But you have so much to live for!
- “Think about how this would affect X, Y, Z, person” or
- “That’s so selfish, how could you think about doing that to yourself”
These statements undermine the very real pain that the at-risk individual is likely experiencing. Instead, we want to try things like
- “Thank you for sharing this with me. You’re not alone, I’m here to listen”
- “That sounds like it’s been really tough, how can I help you?”
- “I’m really glad you let me know how you’re feeling”
6. Gather Some Depth on the Severity of Their Suicidal Ideation
When gathering depth on the severity of a person’s suicidal ideation we can
- Ask them if they have a plan
- This includes if they have a timeframe, as well as how they are planning on killing themselves (the means)
- Consider asking things along the lines of “if you were to kill yourself, how would you do it?”
- You can also include follow up questions like “do you have an idea of when and/or where you plan on killing yourself
- For safety, if an at-risk individual has a means or way that they would kill themselves, we want to have a discussion with them about how they can remove or limit their access to it
- This includes if they have a timeframe, as well as how they are planning on killing themselves (the means)
At-risk individuals may also experience thoughts of suicide without having thought of how, when, or where they would do it. If this is the case, we can check more broadly into the thoughts they’re experiencing. We can ask questions like how often they have thoughts of suicide, if there are any times (such as in the evenings) that the thoughts get worse, how long these thoughts last for, if there are any triggers that set these thoughts into motion, etc. Allow them to share as much as they are comfortable with.
While gathering depth we want to validate their feelings and do our best to listen non-judgmentally.
7. Offer Them Assistance
If they are not in immediate danger of hurting themselves we can support them by
- Continuing to listen without judgement, validating and honouring their feelings
- Respecting their privacy, patient checking in and following up with them
- Offering distraction to bring some relief such as taking them on a nature walk, going for a meal together, etc.
- Offering practical help such as helping them to create a safety plan or assisting them in finding professional support
8. Take Care of Yourself
You owe yourself the love and support you offer others!
It can be helpful to think about helping yourself and others with an oxygen mask analogy. When flying on a plane, the safety presentation tells us to put on our OWN oxygen mask first, before helping others put theirs on. Similarly, it’s important to care for yourself so you can help others if you choose to. Just like how we can’t pour anything out of an empty cup, we need to make sure we have resources and energy for ourselves before extending that to others.
Consider reflecting on your self-care practices while also brainstorming new ideas you could use through using a Self-Care Wheel exercise from the University of Alberta Student Union’s Peer Support Centre. Additionally, check out out our blog post on self-care.
A Concluding Note
Suicide is preventable. By recognizing warning signs, fostering open communication in a safe environment, and providing timely support, we all have the opportunity to save lives and offer people experiencing suicidal thoughts help.
Additional Resources
Crisis Lines & Other Emergency Services
- Call or text 988 – Suicide Crisis Hotline
- Call Kids Help Phone (1-800-668-6868 or text “connect” to 686868)
- Call the 1-855-242-3310 – the Hope for Wellness Helpline, or chat online at hopeforwellness.ca
- Call 911 or get to the nearest emergency room if needed
Free Courses
- How to Help: Suicide Awareness | Learning at The Outreach Centre
- Zero Suicide Alliance | Suicide Awareness Training
- Health Knowledge Courses – link to a variety of mental health and suicide prevention courses
- Professional Development Training Modules | The Jason Foundation, Inc. – link to a variety of mental health and suicide prevention courses
Courses For Purchase
- LivingWorks Education USA – asynchronous online
- ASIST: Applied Suicide Intervention Skills Training – synchronous and in-person (various locations)
- Our Children Are Sacred – synchronous and in-person in Edmonton, AB
- QPR Online Gatekeeper Training – asynchronous online
- Opening Minds – Workplace Mental Health Training – in-person and online options
Indigenous Perspectives – Videos
- Sylvia McAdam – this 5 minute video from Sylvia McAdam offers Cree teachings on suicide
- Supporting Tribal Youth at Risk for Suicide: Honouring Children, Mending the Circle – this is a 1 hour recording of a past seminar from the Suicide Prevention Resources Centre at the University of Oklahoma Health Science Centre more focused on Indigenous populations in that area
Indigenous Perspectives – Websites
- Indigenous People, Trauma, and Suicide Prevention
- First Nations Health Authority (based in British Columbia)
- Assembly of First Nations (based in Ontario)
Blog post adapted from the McKinney Psychology presentation: Suicide Prevention and Intervention – How To Ask If Someone Is Having Thoughts of Suicide as part of our Risk Assessment Series. For more information, please contact our office.