Mental Health First Aid for Suicidal Thoughts and Behaviors

If someone experiences suicidal thoughts or behaviors, you can offer mental health first aid support until professional help arrives.

Suicidal thoughts are psychological crises that are usually indicative of treatable mental health conditions like depression, anxiety disorders, substance use disorders and eating disorders. First aid for suicide risk is a type of assistance that you can offer to anyone who faces suicidal thoughts.

To receive immediate support for suicidal thoughts from a crisis counselor, call the National Suicide Helpline at 1-800-273-8255. This line is available at any time and is free and confidential. Trained counselors on the helpline can help you calm down if you are panicking, can listen to your struggles and give you advice on how to get help for suicidal thoughts.

Mental health first aid is a form of first aid support that you can provide to anyone who struggles with a mental illness or who is experiencing a mental health crisis, like suicidal thoughts. First aid is only a temporary solution, it is not designed to heal or fix a mental illness and should only be provided until professional help arrives. Mental health first aiders offer kindness during psychological crises and encourage treatment through psychiatric care or counseling. Mental health first aid courses are open to everyone. To take a course in your area, visit Mental Health First Aid USA.

What Are Suicide Warning Signs?

To provide effective mental health first aid, you must first be familiar with the warning signs of suicidal ideation. Signs that someone may be experiencing suicidal thoughts can include:

• Threats: verbally threatening to kill themselves.
• Obtaining lethal means: gaining access to firearms, dangerous drugs, poison or other means.
• Talking about death: bringing up death or suicide in conversations, writing about dying or posting on social media about suicide.
• Drastic mood swings: hopelessness, feeling trapped, rage, anger, irritability, anxiety or vengeful thoughts.
• Risky behaviors: acting recklessly or increasing drug or alcohol use.
• Uncharacteristic behaviors: sleeping too little or too much, avoiding friends and family members, giving away prized possessions and expressing goodbye sentiments to loved ones.

Verbal suicide threats are among the most serious suicide warning signs. Some people may think that if a person talks about killing themselves then they aren’t serious, but this is not true. Someone who talks about ending their life may already have a plan to do so. As a mental health first aider, take every suicide threat seriously, even if it sounds like a joke or offhand remark.

Is Self-Injury a Suicide Warning Sign?

There is a difference between suicidal behaviors and non-suicidal self-injury. Many people engage in self-harm behaviors with no intention of killing themselves. Please note: The content on this page is only useful to help someone who is suicidal. To learn how to help someone who is injuring themselves but is not suicidal, visit mental health first aid for non-suicidal self-injury.

Feelings of depression or anxiety can lead to suicidal thinking. If you or a loved one is experiencing suicidal thoughts or tendencies, call the National Suicide Prevention Hotline at 1-800-273-8255.

How to Provide Mental Health First Aid for Suicidal Thoughts and Behaviors

If you notice that someone displays signs of suicide risk, intervene immediately. Don’t assume that the person’s friends or family will act before you do. You may be the only person who recognizes the warning signs and can respond with mental health first aid support.

Most types of mental health first aid follow the five-step action plan called ALGEE, which is a mnemonic for:

• Assess for risk of suicide or bodily harm
• Listen in a nonjudgmental way
• Give reassurance and information
• Encourage appropriate professional help
• Encourage self-help and other support strategies

However, with an acute mental health crisis like suicidal thoughts and behaviors, this five-step plan may not apply. Depending on the circumstances of the situation, your actions may differ from the general ALGEE plan and it may be best to follow specific safety steps instead.

When Mental Health First Aid Isn’t Safe

If there is a threat to your physical safety, do not attempt mental health first aid. Call 911 immediately if the person has a weapon and is threatening to kill themselves or harm someone else. Although it may seem noble to put yourself in harm’s way, risking your safety — and that of the people around you — is not a wise decision and may only worsen the situation.

Step 1: To Assess Suicide Risk, Ask Questions

If you notice the warning signs of suicidal ideation in someone and there is no immediate threat to your safety, approach the person privately to begin mental health first aid for suicide risk. Since this could be a life-changing conversation, choose a time when both of you are free and find a setting that is free of distractions. To start the conversation, ask them directly about their suicidal thoughts. You can ask, “Are you having thoughts of suicide?” or, “Are you thinking about killing yourself?”

The importance of saying the word suicide when you talk with someone struggling with suicidal thoughts, use the word “suicide” in the conversation. Contrary to popular belief, this will not, “Put the idea in their head,” and won’t convince someone to act impulsively. In fact, saying the word suicide without a tone of dread can be comforting to someone who struggles with suicidal thoughts. Your confidence and empathy can put them at ease. When you talk about suicide openly, you break the stigma surrounding this issue and let someone know that it’s alright to talk about how they’re feeling and seek help.

Step 2: Determine Whether Someone Has a Plan for Suicide

Asking, “Are you thinking of killing yourself?” is an important first question in this conversation, but you will need to ask more detailed questions to determine the severity of the situation. To provide appropriate help, you need to understand whether someone has a plan to kill themselves or if they struggle with more vague thoughts like, “What’s the point in living?”

Three questions to ask to determine the level of suicide planning include:

• Have you decided how you would kill yourself?
• Do you know when you would kill yourself?
• Have you secured everything you need to follow your plan?

Typically, a higher level of preparation indicates more severe risk of suicide, but the absence of a plan does not mean that the person is safe. Other factors that influence a person’s plan and suicide risk can include:

• Previous suicide attempts: This increases the likelihood that someone will attempt suicide again.
• Drug or alcohol use: The use of harmful substances can lead to intoxication, which can make someone more likely to act impulsively.

Never Stay Quiet About a Suicide Plan

Someone who is contemplating suicide and has told you of their plan may ask you to keep it a secret. While you can practice discretion and respect the person’s privacy, to truly help them, you cannot agree to stay quiet about their suicide plan. Let them know this and involve them in the decision about who you will tell.

Step 3: Keep the Person Safe Until Help Arrives

Someone who is experiencing suicidal thoughts should not be left alone. Stay with them as long until you can see them off safely with a friend, family member or medical emergency personnel. If you cannot stay with the person, arrange for someone else to stay with them.

One of the most important parts of keeping a suicidal individual safe is knowing how to talk to them. It can be difficult to know what advice is supportive and what’s better left unsaid. Unsupportive behaviors to avoid during this time may look like:

• Expressing personal opinions about suicide
• Expressing judgmental thoughts and feelings
• Being critical of the person
• Attempting to reason with the person or correct them
• Fidgeting with a smartphone
• Offering unhelpful advice like, “You’ll get over it”
• Using guilt or threats, like “You will go to hell”

Instead, show support and solidarity through your words and actions, including:

• Telling them that you care and are there to help
• Explaining how their life makes a difference in yours
• Telling them that suicidal thoughts are common and don’t have to be acted on
• Explaining that suicidal thoughts are often symptoms of a treatable mental health condition

If they are willing, encourage them to talk about their thoughts and feelings, and listen without judgment. To be an active listener, practice:

• Maintaining open body language and comfortable eye contact
• Using minimal verbal prompts, like “I see,”
• Asking clarifying questions
• Being patient, not anxious to fill any silences

Step 4: Encourage Professional Help

Suicidal thoughts are often signs that someone struggles with a mental illness. Explain to the person you’re assisting that mental health conditions like depression and anxiety are treatable with the right care. Encourage them to get professional help as soon as possible and offer to help them find viable treatment resources.

Professionals and therapy options that can help someone overcome mental illness include:

• Psychiatrists
• Primary care doctors
• Licensed mental health counselors
• Certified peer specialists
• Psychotherapy options, including cognitive behavioral therapy
• Medication therapy with anti-anxiety medications like benzodiazepines
• Substance abuse counseling, if necessary

Additionally, you can recommend the treatment locator tool from the Substance Abuse and Mental Health Services Administration to help someone find doctors, counselors and treatment centers in their area.

Helpful Hotlines You Can Recommend

In addition to your company, you can also offer the person the telephone numbers of free, 24-hour crisis hotlines to let them know that support is always available to them. These confidential helplines are staffed with trained counselors who can help the person calm down in a crisis, understand their suicidal thoughts and find treatment resources in their area.

• National Suicide Helpline: 1-800-273-8255
• Substance Abuse and Mental Health Services Administration’s National Helpline: 1-800-662-4357
• American Psychiatric Association Answer Center: 1-888-357-7924
• American Psychological Association Public Education Line: 1-800-964-2000
• The National Mental Health Association: 800-969-6642
• The National Poison Control Center: 800-222-1222
• Alcohol and Drug Abuse Helpline: 1-800-821-4357
• National Institute on Drug Abuse Hotline: 1-800-729-6686

If the person you’re helping struggles with suicidal thoughts because of a drug or alcohol use disorder, encourage them to call The Recovery Village for free at  877.854.0399. Representatives on this confidential line are available to take their call, talk with them about addiction and recommend appropriate treatment programs.

Remember, despite your best efforts, some people will still die from suicide. You cannot force a person to get help, but as a mental health first aider, you can provide compassionate care and guide someone toward treatment.