When someone close talks about dying: ask, make safe, stay

1. Before you begin

"Anyway, you'd all be better off without me." It went past quickly, almost as a joke. Or it was a message, late at night. Or a person tidying their affairs, thanking you oddly, suddenly at peace after weeks of darkness.

You don't know whether you are overreacting. You are afraid of saying the wrong thing. You are afraid of "putting the idea in their head".

Three things, straight away.

Asking does not plant the idea. It is the most widespread fear, and the studies that examined it do not bear it out. Asking clearly is most often a relief.

A crisis is not a permanent state. The most acute period of danger often lasts hours or days. Buying time is already doing something.

What you do matters, and is not one person's responsibility. You are not a clinician, and you are not on call twenty-four hours a day. Your part is to listen, to make things safer, and to connect the person with help.

2. What suicidal thoughts are

They are common

Thinking about dying, wishing you were no longer here, imagining disappearing: these thoughts pass through many people at some point in their lives, often without any attempt. Their presence does not announce the irreparable, but it signals suffering that deserves attention.

They rarely come without ambivalence

Most people who think about suicide do not want to die: they want it to stop. It is this ambivalence that makes help possible. Part of them is looking for a way out, and it is that part you speak to.

What feeds them

Work on suicidal behaviour describes three elements that come up often: the feeling of no longer belonging to anyone, the feeling of being a burden on others, and the feeling of being trapped, with no possible way out. Someone who expresses any of these three deserves to be heard seriously.

It is not blackmail

"He says that to manipulate us" is a dangerous interpretation. Even when words are meant to obtain something, they express real distress, and the risk exists. You respond to the distress, not to the supposed strategy.

A crisis has a peak

Many attempts happen within a short window, sometimes less than an hour after the decision. That is precisely why making means less accessible changes outcomes.

3. Warning signs

What is said

• Talking about dying, disappearing, "stopping it all", even jokingly.
• Describing oneself as a weight: "you'd be better off without me".
• Saying there is no way out, that nothing will ever change.
• Saying goodbye, thanking people oddly, saying farewell "just in case".

What can be seen

• Looking for information or for means.
• Putting affairs in order, giving away treasured objects, writing messages of explanation.
• Withdrawing abruptly, no longer answering.
• Drinking more alcohol or using more drugs.
• Taking unusual risks.
• Seeming suddenly at peace after a very dark period: that calm is sometimes the sign that a decision has been made.

The context

• A previous attempt: this is the best-established risk factor.
• Depression, bipolar disorder, a psychotic disorder, an addiction.
• A recent discharge from psychiatric hospital, or a recent emergency visit.
• A loss: bereavement, break-up, redundancy, legal proceedings, debt, public humiliation.
• Chronic pain or illness, a recent disability.
• Isolation, and easy access to a dangerous means.

None of these on its own predicts an attempt, and their absence guarantees nothing. They tell you when to listen more closely and to seek help sooner.

4. What research says

Asking does not increase risk

This is the most frequent fear among families. Reviews of studies that examined the question, including in adolescents, do not find an increase in suicidal thoughts in people who were asked about it. Many people describe relief instead.

Removing means saves lives

This is the best-demonstrated prevention measure. When access to a lethal means is reduced — at the level of a country as at the level of one person's home —, the number of suicides falls, without other means entirely taking over. The crisis passes, and the means was not there.

Safety plans work

A written plan, built with the person, listing their warning signs, what soothes them, who to call and how to make their environment safer, is associated with a reduction in suicidal behaviour. In a large study carried out in the United States, in the emergency departments of hospitals for military veterans, combining a safety plan with follow-up calls went together with almost half as much suicidal behaviour over the following six months. The patients had not been allocated at random to the two groups being compared: other differences between them may therefore explain part of the gap. The result nevertheless points in the same direction as the body of studies as a whole (section 9).

Staying in touch matters

Long-standing and repeatedly replicated work shows that simple brief, regular contacts — letters, messages, calls — sent to people after a crisis reduce later risk. This is not therapy: it is a connection maintained.

The highest-risk periods

Risk is particularly high in the days and weeks following discharge from psychiatric hospital or an emergency visit. That is exactly when families often relax their attention, because "it is being taken care of".

Doctors see these people

A substantial share of people who died by suicide had seen a family doctor in the preceding month. In other words: the consultation is possible, it often takes place, and the subject is not always raised. Telling the doctor, with the person's agreement where possible, changes that consultation.

No-suicide contracts do not protect

Making someone promise "not to do anything", in writing or verbally, has not been shown to be effective and can give false reassurance. The safety plan has replaced it.

Common misconceptions

"Talking about it might give them the idea." No. This is one of the best-studied questions in the field.

"People who talk about it don't do it." False. Many people had expressed their intention, sometimes indirectly.

"If someone has decided, there's nothing to be done." The decision is rarely irreversible: ambivalence, the short window of crisis and access to means are three real levers.

"It's a moment of weakness, they need shaking up." Reproaches and challenges increase the sense of being a burden.

"It's a matter for professionals." They are essential, but it is usually someone close who notices, who asks, and who goes with the person to the appointment.

5. Asking: the actual words

Preparing the moment

Choose a calm time, with nobody else there and no rush, and give yourself time. Silence notifications. Sit down.

Start with what you observe

"For a few weeks now I've found you very different: you're not sleeping, you're not seeing anyone, you often say nothing matters. I'm worried about you."

Then ask the question, clearly

"Do you ever think about dying?"

"Are you thinking about suicide?"

Directly, calmly, without detours. Vague phrasings — "you wouldn't do anything silly, would you?" — invite reassurance and close the conversation. So do phrasings that already contain the expected answer — "you're not thinking about anything serious, are you?"

If the answer is no

You have not damaged anything. You have shown that the subject is possible with you. Say so: "If it ever happens, you can talk to me about it, I won't judge."

If the answer is yes

Don't rush to reassure. Say thank you: "Thank you for telling me. Tell me how long this has been going on." Then stay, and listen.

6. Listening without panicking

What helps

• Taking it seriously: "I believe you."
• Listening for a long time, without correcting or contradicting.
• Naming the suffering rather than debating it: "it must be exhausting to live with that."
• Asking open questions: "What is hardest?" "What has helped you hold on so far?"
• Tolerating silences and tears.
• Staying with the person, physically, when you can.

What closes the conversation

• Moral arguments: "think of your children", "it's selfish".
• Minimising: "it will pass", "you have everything to be happy about".
• Debating: trying to prove, point by point, that life is worth living.
• Immediate solutions: "you need to get out, take a holiday".
• Visible panic, which pushes the person to reassure you and to keep the rest to themselves.

Putting it in your own words rather than answering

When you are frightened, you want to answer quickly: to reassure, to correct, to offer a solution. Putting what you have heard into your own words helps more. This means saying back, in your own words, what you have understood, without adding anything to it, to check that you have heard correctly and to show that you are following.

"If I've understood properly, since the separation it's mostly the evenings that are unbearable, and that's when the idea of dying comes back."

"You feel you've tried everything, and that nothing can change any more."

Putting the idea of dying into your own words does not mean approving of it: you are showing that the suffering has been heard. Often the person corrects you or adds something, and the conversation moves forward. The mental health first aid guidelines, drawn up by consensus between prevention specialists and people who have themselves experienced suicidal thoughts, stress this active listening, taking seriously what the person is going through, and the calm of the person who is listening.

Replies to difficult remarks

Some remarks come up often, and they are the ones that leave you lost for words. Here are some ideas, to be put into your own words.

"You can't understand." Don't try to prove the opposite: "That's true, I don't know what you're going through on the inside. But I'd like to try. Will you explain it to me?"

"I'm a burden to you all." Don't argue, but don't leave the sentence without a reply: "I understand that you feel that way, and it must be very heavy. I care about you, and if I help you, it's because I want to. What gives you that feeling at the moment?"

"Promise me you won't tell anyone." "I can't promise you that: your life matters too much for me to keep a secret like that. What I can promise you is that we'll choose together, as far as possible, who to talk to about it, and that I'll always tell you who I'm talking to about it, and why."

"I was joking." A serious remark immediately turned into a joke still deserves a question: "All right. I'd still rather ask, because I care about you: do you ever think about dying?"

"What's the point? Nothing will change." Despair is part of the crisis: it says what the person feels now, not what is going to happen. Don't promise that everything will be fine: "Right now, you can't see any way out. I'm not going to tell you that everything will sort itself out. What I'm suggesting is that we look for help together for the next few days."

"I don't want to go to hospital." The fear of being admitted to hospital stops many people from talking. Say what is true: talking to a doctor does not mean being admitted to hospital, and a hospital stay is mainly considered when safety cannot be ensured in any other way. "Let's start by talking to your doctor about it. We'll work out with them what is needed, and I'll be there."

"Mind your own business." Anger is one possible reaction, and it is better not to take it personally. Stay calm and don't reopen the argument: "I understand that my question annoys you. I'm asking it because I'm worried about you, and I'm not going anywhere." If one of the situations in section 7 is present, the anger changes nothing about what needs to be done.

Looking for reasons to live

A useful and often soothing question: "What has kept you here so far?" The answers — a child, an animal, a belief, a person, a plan — are anchors worth noting: they will go at the bottom of the safety plan (section 9).

7. Judging how urgent it is

You are not making a clinical assessment: you are working out whether you have hours, days, or need to act now.

Questions to ask

• "Have you thought about how you would do it?"
• "Do you have what you would need at home?"
• "Have you thought about a time, a date?"
• "Have you made an attempt before?"
• "What is stopping you from doing it now?"

The more specific the plan, the more accessible the means and the closer the timing, the greater the urgency.

Act straight away if

• The person has a means within reach, or has started to act.
• They say they cannot keep themselves safe, or refuse to talk about it further.
• They are very agitated, or heavily intoxicated, with specific thoughts.
• They have just lived through a humiliating event or a sudden loss and appear determined.

In those cases: stay with them, remove what is dangerous, and call the emergency services. If you are on the phone and they are far away, keep them on the line and have someone else alert the emergency services in parallel.

If it is not immediately urgent

Seek advice the same day — a doctor, a suicide prevention line or a crisis service (section 10) —, arrange a consultation within the next few days, build the safety plan, remove means, and agree on what you will do if things get worse.

8. Putting dangerous means out of reach

This is the most effective measure, and the most concrete.

How to talk about it

Without negotiating the decision, but with the person: "Until things are better, I'd rather we kept this somewhere else. It isn't against you."

What gets put away

• Medication: keep only small quantities at home, give the rest to a relative or the pharmacist, and ask for small pack sizes to be prescribed.
• Firearms, if there are any: out of the house, entrusted to a third party or the authorities according to your country's rules. This is the single most decisive measure where a gun is present.
• Toxic products, large quantities of alcohol, anything the person has mentioned.
• Car keys, if driving is risky in their current state.

Without policing

The aim is not to make the home airtight, it is to put distance and time between the impulse and the act. A few minutes are sometimes enough to change an outcome.

Who keeps things, and for how long

Suggest a length of time rather than a permanent measure: "until things are better, and we'll talk about it again with your doctor". The American psychologists Barbara Stanley and Gregory Brown, who described the safety plan, provide for this point to be discussed with the person, often with the help of someone close, for a period agreed together. Choose a trusted person to keep what has been put away, outside the home if possible, and write their name on the plan. For whatever is most dangerous, it is better that the person in crisis does not have to deal with it themselves: someone close or a third party takes care of it.

If the person refuses

They may experience this request as a humiliation or a loss of control. Explain the reason for it, without dramatising: "It isn't that I don't trust you. The hardest moments pass, and I want there to be time between you and that moment." Offer choices rather than a single solution: who keeps things, where, until when. If they refuse everything, at least put away what is within your control, and talk about it with the doctor or the professional who is following them.

Alcohol

Alcohol lifts inhibitions and deepens dark thoughts. During a crisis it is better that there is none at home, and that the person does not drink alone.

What this measure does not do

Putting a means out of reach does not guarantee safety, and Stanley and Brown point this out: a person may look for another one. This measure therefore comes on top of being present, the plan and treatment; it does not replace them. It remains one of the best supported, because a crisis is often short: in an Austrian study of people admitted to hospital after an attempt, nearly half said that ten minutes or less had passed between the moment the thought of suicide came to them, on that occasion, and the act.

9. The safety plan

It is a single sheet, written with the person, ideally with a professional, kept within reach — on the phone, on the fridge. It has six parts.

1. My warning signs: what I notice when things are deteriorating (thoughts, sensations, behaviours).
2. What I can do alone to bring the pressure down: walk, a shower, specific music, go out, breathe, a game, writing.
3. Where to go and who to see to take my mind off it, without necessarily talking about this: a café, a friend's house, a public place.
4. Who to call among the people around me, with the numbers, and what I will say to them.
5. Professionals and emergency services: doctor, psychiatrist, helpline, crisis service, emergency number.
6. What has been made safe at home, and where.

At the bottom of the sheet, one last line: what matters most to me and makes me want to live, drawn from the reasons for living noted during the conversation (section 6).

Writing it together, step by step

The plan is built with the person, in their own words: a list of advice written by someone else is rarely any use at the moment of crisis. The best thing is to write it with a professional; if that is not yet possible, the two of you can make a start and take it to the next appointment. Choose a calm moment, never the height of the crisis. The pointers that follow come from the description given by Stanley and Brown.

Start from the last crisis. "Tell me about the last time it was hardest: what happened just before, and what helped you hold on?" This account provides the warning signs and the first ideas of what helps.

Specific warning signs. "I'm not doing well" sets nothing in motion. "I stay in bed in the afternoon", "I reread our old messages", "I keep telling myself I'm a burden" are signs you recognise in the moment, and they are what make you think of getting the sheet out.

Things you can do in the middle of a crisis. For the second part, look for what the person can do alone, even for a short time, and put first whatever is easiest or most effective. Then test it: "If you feel the way you did on Tuesday evening, do you really think you would do it?" If the answer is no, look for what would stop them, or find something else.

Places without alcohol. For the third part, choose people and places that take the person's mind off things without alcohol or other drugs.

People who have agreed. The fourth part does not necessarily contain the same names as the third: the friend you laugh with most is not always the one you can tell "I'm in danger". Ask the person whether they would really call these people, and whether they would help or might make the tension worse. With the person's agreement, let those who are on the list know, and check the numbers.

Help you can reach at night. The fifth part names only professionals the person is prepared to call, and it always includes help that can be reached in the evening and at the weekend: a suicide prevention line, the emergency services.

Means last. Putting means out of reach is discussed once the rest has been written: when the person sees that other ways out exist, they find it easier to agree to talk about it.

Keeping it within reach

A photo on the phone, a copy in the wallet, another on the fridge: the person must be able to find their plan in a few seconds, at the moment when they have the least energy. With their agreement, keep a copy yourself. Some people go through it once out loud, like a rehearsal, to check that it holds up.

How it is used

You work down the list in order, from the simplest to the most demanding. The plan is read again when things are going well, not only in a crisis. It is updated after every episode. If the person feels they can no longer keep themselves safe, even for a short while, they do not work down the list: they call the emergency services directly, or you call them.

Your part

You can help write it, keep a copy, and remind the person it exists: "remember your sheet? shall we look at it together?"

What we know about it

A meta-analysis, that is, a study that pools the results of several others, brought together six studies and more than three and a half thousand people: interventions of this kind reduced the risk of suicidal behaviour by about 40%. It found no effect on suicidal thoughts themselves. So the plan does not make the thoughts go away; it helps the person get through the moments when they become dangerous, while treatment deals with what feeds them.

10. Getting help, in practice

Who to contact

• The family doctor: they often know the person, can assess, prescribe, refer, and see them again quickly.
• A suicide prevention line: free and confidential in most countries, for the person and for you.
• A crisis service or psychiatric emergency care, when the situation cannot wait.
• The psychiatrist or psychologist already involved, if there is one: let them know.
• The emergency services, in immediate danger.

These lines can often be reached day and night; trained listeners answer people in distress, and often also family and friends who are worried. Look up the one in your country now and write down its number. In a study of eight American helplines, more than a thousand suicidal callers were assessed at the beginning and at the end of their call. On average, their suicidal state eased during the call, and among those who could be contacted again within three weeks, hopelessness and psychological pain continued to fall. The study had no comparison group: it does not prove that the call caused this improvement. What it does show is that people in great danger call these lines, and that on average they are better by the end of the call.

Going with them, not just pointing the way

Suggesting an appointment is not always enough. What really helps: making the appointment together, going with the person, waiting in the waiting room, asking with their agreement to come in for a few minutes to say what you have observed.

What you can tell the professional

"She told me yesterday she was thinking about dying. She mentioned a means. She has stopped seeing her friends for a month and sleeps very badly."

Facts, dates, sentences you heard. That is what is most useful.

If the person refuses

You can seek help on your own for guidance, call a helpline for families, and keep on suggesting. In serious and immediate danger, calling the emergency services is legitimate even against their wishes. The conditions for treatment without consent depend on each country's laws; professionals will tell you how to proceed.

11. After a suicide attempt

The first hours

An attempt calls for emergency care, even if it seems minor: it is one of the situations in section 7, the one in which the person has begun to act. A medication overdose is treated as an emergency even if the person says they feel fine, because some effects only appear after several hours. It is not for them or for you to judge whether it was dangerous.

At the emergency department, say what you know: what happened, at what time, and what was already worrying you before. With the person's agreement, ask to speak to the team, and do not leave without knowing what follow-up has been planned (section 12).

What you feel

Fear, anger, relief, guilt, sometimes all at once. Parents interviewed after their son's or daughter's attempt described a double shock: the attempt itself, then everything it turned upside down afterwards in the life of the family. These reactions are normal, and they deserve a place where they can be expressed (section 15). In the first few days, that place is not the person's bedside: anger there would be heard as a reproach.

What you can say

The first message can be very simple: "I'm glad you're here."

After an attempt, the person may feel ashamed, want to hide it, play it down, insist that "it was a stupid thing to do, it's over". Don't press, but don't close the subject either: say that you are ready to talk about it whenever they want to, and that it is not a forbidden subject. When they are ready, an open question helps more than a "why": "What was hardest, just before?"

In the months that follow

Stay concrete: going with them to appointments, making the home safe, regular contact. Avoid reproaches and "why did you do that". The risk of repetition is highest in the months that follow.

A meta-analysis of nearly a hundred and eighty studies, covering people seen in hospital after harming themselves on purpose, with or without the intention of dying, estimated that about one in six harm themselves again within the following year. This figure justifies staying attentive during these months; it also tells you that most do not do it again.

Keeping in touch after discharge

The brief, repeated contacts described in section 4 were designed for this period. In France, for example, the VigilanS service is offered to anyone admitted to hospital after an attempt, at the time of their discharge. They receive a card with a free number, which can be reached during working hours, where trained clinicians answer them if they are struggling; outside those hours, it is a suicide prevention line or the emergency services that should be called. If they have already made more than one attempt, the team calls them between ten and twenty days after discharge, then sends them a postcard or a text message every month for four months. After six months, every person is called back to take stock. Elsewhere, ask the team what exists. These contacts do not replace yours: a regular message, without interrogation, counts too.

12. The weeks that follow

Don't ease off too early

Risk remains high after a crisis, particularly in the weeks following a hospital admission or an emergency visit. The moment when "everything is better" is often the moment when families step back.

Preparing for discharge from hospital

The days after discharge from psychiatric hospital are among the most dangerous. A British study looked at people who died by suicide within three months of their discharge: more than four in ten had died in the first month, and nearly half of these before their first follow-up appointment. The first week was a particularly high-risk period. In the same study, people who had left hospital on their own initiative, or who had missed their last appointment, were found more often among those who died.

Before the return home, with the person's agreement, ask the team a few questions.

• Ask for the date of the first appointment and the name of the person who will see them: this appointment should be as soon as possible after discharge.
• Ask who to call if things deteriorate before that appointment, including in the evening and at the weekend.
• Ask whether a safety plan has been written, and what part you can play in it.
• Ask what needs to be put away at home before they come back.

If the person then misses an appointment, tell the team without delay.

The first days at home

Coming home can be harder than you imagine: the person returns to the places and the problems of the crisis, with less support around them than in hospital. Arrange for someone to be there for the first few evenings, without turning the home into a supervised ward. Keep the days simple: getting up, eating, going out a little, calling someone. And talk together about the week ahead: "Which moment is likely to be hardest? What shall we plan for that moment?"

Keep regular contact

Brief, regular news is better than long conversations far apart: a message in the morning, a Sunday call, a weekly coffee. Without systematically interrogating about suicidal thoughts: presence is often enough.

Rebuild on everyday life

Sleep, meals, outings, physical activity, gradually resuming activities. Our programme Behavioural activation: fighting depression describes this step by step, and can be read by two people together.

Spotting a relapse

Go over the warning signs in the safety plan together, and agree on a simple phrase that allows it to be said plainly: "I'm in the red."

Difficult dates

Birthdays, the date of a loss, holidays, the anniversary of an attempt: plan for those moments, and be present.

13. Particular situations

An adolescent

Take seriously what may seem theatrical; impulsivity is greater at that age. Involve both parents if possible, make the home safe, inform the school if there is bullying, and seek help quickly. Do not promise your child secrecy. If your teenager hurts themselves on purpose, for example by cutting or burning themselves, our guide When your teenager self-harms: understanding it and helping explains what the act does for them, what it says about suicide risk, and how to respond in the first hours and then in the weeks that follow.

An elderly parent

In older people, suicidal thoughts are disclosed to those around them less often than in younger people, and attempts are more determined. Depression, chronic pain, widowhood, loss of independence or a feeling of being a burden should all alert you. Our programme Helping a loved one who is withdrawing covers what often accompanies these situations.

Ask the question as directly as you would with a younger adult. Older people who die by suicide have, even more often than younger people, seen a family doctor in the preceding month: go with your parent to that appointment if possible, or tell the doctor what you are observing. Don't let anyone tell you that "at their age, it's normal to be sad". Depression in older people can be treated, and in a large American trial in general practice, depression care coordinated by a dedicated clinician, working with the doctor, made suicidal thoughts recede faster than usual care. Also go through the stocks of medication in the house with them (section 8).

A partner

You are both the closest and the most exposed. It is very hard to be partner, watcher and carer at once: ask a third person to share the load, and keep a professional involved.

A colleague

Don't stay alone with the information. Depending on the setting, point towards occupational health (the workplace health service) or internal support resources, and stay present as a person.

Someone who refuses all help

Some people refuse everything: the doctor, the helpline, the plan, sometimes the conversation itself. Behind this refusal there is often shame, the fear of being admitted to hospital or the conviction that nothing can help, and sometimes a bad experience of care. Ask what is holding them back, and listen to the answer: "What frightens you most about talking to a doctor about it?" A specific objection can be discussed; a blanket refusal rarely can.

Offer smaller steps, and let them choose whatever can be chosen: a doctor they know rather than an unfamiliar service, a call rather than an appointment, an appointment you go to with them. In the meantime, do what is up to you: make the home safe, seek guidance on your own, and keep the connection. That connection counts, even without treatment. In an American trial, people who had refused all follow-up after a hospital stay simply received, several times a year for five years, a short letter from a professional at the hospital: during the first two years, their suicide rate was lower than that of the people who did not receive any, then the gap gradually narrowed. Our guide Helping someone close who is depressed explains in detail how to bring someone towards care without forcing them.

Refusal changes nothing about the situations in section 7: in immediate danger, you call the emergency services, even against their wishes.

At a distance, by message

Take seriously what arrives in writing. Call rather than write. Ask where the person is, who is with them, and have someone nearby or the emergency services alerted while you keep the contact going.

If you live far from a vulnerable loved one, prepare before a crisis. Note their exact address and the contact details of someone close to them where they live: a neighbour, a flatmate, a friend. It is the emergency services where they are who will be able to step in. If they live in the same country as you, call the usual emergency number and say straight away where they are. If they live abroad, be aware that an emergency number dialled from where you are puts you through to the emergency services of your own country, not theirs: note in advance a number for the emergency services or the police in their town that can be called from abroad, and ask the trusted person there whether they would agree to call the emergency services themselves if needed. Agree on a rhythm of contact, a call on Sundays or a message every evening, and on what you will do if they do not answer. If you receive a farewell message and cannot reach them, do not wait: you cannot know whether they have already begun to act. Call the emergency services where they are, or have the person there call them, give their exact address, and stay reachable.

On social media

A very dark message posted late at night, a post that reads like a farewell: many people, particularly among the young, express their distress online. A review of studies notes that these messages sometimes allow others to step in. Take them as seriously as something said to you face to face. The Australian #chatsafe guidelines, developed with young people and prevention specialists for talking about suicide safely online, offer some pointers.

• If the message makes you fear immediate danger, call the emergency services where the person is without waiting, as described above for a loved one who lives far away, giving everything you know about who they are and where they are.
• Otherwise, contact them directly, by private message or, better still, by phone: say that you have seen their message, that you are worried about them, and ask the question directly.
• Report the post to the social network: the major platforms let you report content that mentions suicide, and reporting it does not get the person into trouble.
• Don't stay alone with what you have read: talk to someone close to them, or call a helpline to find out how to help them.

With alcohol or drugs

Intoxication increases impulsivity and lowers inhibitions: the level of urgency rises. Do not leave the person alone, and do not postpone the conversation "until tomorrow, when it's clearer" without having made the night safe.

14. What not to do

• Promise secrecy. Say it from the start: "I won't be able to keep this to myself if you are in danger."
• Have them sign a promise not to do anything: it does not protect.
• Dramatise or make light of it. Both cut the conversation short.
• Lay on guilt: "do you realise what you're doing to us?" That is exactly what feeds the sense of being a burden.
• Argue in order to prove that life is worth living.
• Watch without talking: silent surveillance exhausts and isolates.
• Stay alone with the information, or carry everything without relief.
• Look for definitive explanations: this is neither the moment nor your role.

15. Looking after yourself

What you are going through is heavy

Constant fear, hypervigilance, broken sleep, anger, guilt, exhaustion: supporting someone who thinks about dying is a severe test. It does not make you fragile.

In a British study in which relatives of suicidal people described their daily lives, one phrase summed it all up: "hard work for the whole family". They described worry going round in circles, other obligations piling up, secrecy, shame, helplessness and guilt. Asked about their needs, the same relatives said above all that they lacked practical help, respite and advice, and that they wanted to be recognised and involved in care.

What helps

• Sharing the load with other people close to them: organise between several of you.
• Talking to a professional for yourself, or calling a helpline for families.
• Keeping your own activities, even reduced.
• Accepting limits: you cannot be present continuously, and nobody can require that of you.
• Agreeing on what you would do if the worst happened, so as not to turn it over endlessly without a plan.

Organising who is there

If your loved one needs someone close by for a few days, draw up a rota with several people: who is there on which evenings, who calls in the morning, who takes over if you fall ill. Nobody can keep going alone twenty-four hours a day, and a shared rota stops everything resting on the person closest to them.

Stating your limits

You have the right to say what you can do, and what you cannot: "I can't answer at any hour of the night. At night, it's the helpline or the emergency department; I'll call you every morning at 8." A clear limit, with someone else to take over, lasts longer than total availability that ends up collapsing.

Asking for help for yourself

The professionals treating your loved one cannot always tell you what your loved one confides in them, but they can listen to you, and you can ask them to. Suicide prevention lines often take calls from family and friends too. And if exhaustion makes you think, as well, that everything would be simpler without you, this guide applies to you: talk about it the same day.

Guilt

"I should have seen it", "I said the wrong thing". Nobody can predict or fully control another adult's actions. Doing your best with what you know is already considerable.

16. If the worst happens

Bereavement after a suicide

It is particular: to grief are added guilt, anger, shame, unanswered questions, sometimes the judgement of others. People bereaved by suicide are themselves more exposed to distress and to suicidal thoughts: accepting help is not a luxury.

What helps

• Not staying alone with the questions.
• Peer support groups for people bereaved by suicide, which exist in many countries.
• Psychological support, early rather than late.
• Protecting the children in the family with simple, true words suited to their age.
• Being wary of definitive explanations: a suicide never has a single cause.

Our programme Grief: understanding it, getting through it, and knowing when to ask for help describes what helps and what should be a cause for concern.

17. When to seek help, and what to ask for

For your loved one

The family doctor, as a first port of call, to assess and refer.

A psychiatrist, in case of severe depression, bipolar disorder, a psychotic disorder, or a previous attempt.

A psychologist trained in managing suicidal crisis, for the safety plan and what follows.

An addiction service, if alcohol or other drugs are involved.

For you

A psychologist, a helpline for families, or a family association. You have the right to seek help for yourself, without your loved one.

Useful ways to put it

"My brother told me yesterday he was thinking about dying. I need advice today."

"My daughter is coming out of hospital after an attempt. How do I support her over the coming weeks?"

"I no longer know what to do or say, and I am exhausted."

18. Frequently asked questions

Might I give them the idea by asking? No. It is the most frequent fear, and the studies that examined it do not show an increase in suicidal thoughts among people who have been asked the question. Most often the person feels relieved that someone dared.

What if I ask badly? A clumsy but sincere question is better than silence. What counts is being direct, calm and available to hear the answer.

They said yes. Should I call the emergency services straight away? Not always. Call immediately if a means is within reach, if the act has begun, if the person is very agitated or heavily intoxicated with specific thoughts, if they have just been through a humiliation or a sudden loss and seem determined, or if they cannot keep themselves safe or refuse to talk about it any further (see section 7). Otherwise, arrange help the same day and make the home safer.

She refuses to see anyone. What can I do? Keep the connection, make what can be made safe, suggest smaller steps such as an appointment with the family doctor, and seek advice for yourself. In serious danger, call the emergency services even without her agreement.

Should I promise not to tell anyone? No, and it is better to say so beforehand: "I won't keep this to myself if you are in danger." Secrecy isolates you both.

Should I take the medication out of the house? Yes, keep only small quantities and give the rest to someone else. If there is a firearm, remove it from the home: that is the most decisive measure. It is not a punishment, it is time gained.

How do I know if things are better? Sleep, appetite, contact with others and the ability to look ahead are better indicators than "he says he's fine". Be wary of a sudden and complete calm after a very dark period.

I'm exhausted, I can't do this any more. What can I do? That is a signal, not a failure. Hand over to other people close to them, tell the professional who is following the person, and seek help for yourself. Support that lasts assumes that you hold up too.

What should I say just after a suicide attempt? "I'm glad you're here" is often enough to begin with. In the first few days, avoid reproaches and questions about why, stay present, and let the person choose when to talk about it. Section 11 describes the first hours and what follows in detail.

He's leaving hospital tomorrow. What should I prepare? A first appointment with a date, as soon as possible after discharge, the number to call if things deteriorate before then, the safety plan, a home where whatever was dangerous has been put away, and someone there for the first few evenings. The days after discharge are a period of risk (section 12).

Can I call a helpline for myself, and not for him? Yes. Many suicide prevention lines also take calls from family and friends who are worried. You can ask them how to raise the question, how to judge how urgent things are, or simply talk about what you are carrying.

I've seen a worrying message on social media. What should I do? Take it seriously. In immediate danger, call the emergency services where the person is. Otherwise, contact them privately, ask them the question directly, report the post to the social network, and don't stay alone with what you have read (section 13).

19. Key points

• Asking directly "are you thinking about suicide?" does not plant the idea: this is a well-established point.
• Most people concerned are ambivalent: that is what makes help possible.
• Sudden calm after a very dark period should alert you as much as despair.
• Removing dangerous means — medication, firearms, toxic products — is the most effective measure.
• A written safety plan, built with the person, reduces risk.
• Never promise secrecy, and do not have anyone sign a promise not to act.
• Risk stays high in the weeks following a crisis or a hospital stay: keep in touch.
• Going with someone to the appointment is better than advising them to go.
• After an attempt or a discharge from hospital, do not leave without a first appointment with a date, and stay present in the first few days, which are a period of risk.
• In immediate danger, stay, make safe, call the emergency services.
• Look after yourself and share the load: nobody holds up alone.

20. Sources and foundations

This guide is an original text written for Psychotip. It draws on published work, without reproducing material from any proprietary programme. It follows international recommendations on how to talk about suicide: no method is described in it.

Barber, C. W., & Miller, M. J. (2014). Reducing a suicidal person's access to lethal means of suicide: A research agenda. American Journal of Preventive Medicine, 47(3, Suppl. 2), S264-S272. https://doi.org/10.1016/j.amepre.2014.05.028

Bruce, M. L., Ten Have, T. R., Reynolds, C. F., III, Katz, I. I., Schulberg, H. C., Mulsant, B. H., Brown, G. K., McAvay, G. J., Pearson, J. L., & Alexopoulos, G. S. (2004). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: A randomized controlled trial. JAMA, 291(9), 1081-1091. https://doi.org/10.1001/jama.291.9.1081

Buus, N., Caspersen, J., Hansen, R., Stenager, E., & Fleischer, E. (2014). Experiences of parents whose sons or daughters have (had) attempted suicide. Journal of Advanced Nursing, 70(4), 823-832. https://doi.org/10.1111/jan.12243

Carroll, R., Metcalfe, C., & Gunnell, D. (2014). Hospital presenting self-harm and risk of fatal and non-fatal repetition: Systematic review and meta-analysis. PLoS ONE, 9(2), Article e89944. https://doi.org/10.1371/journal.pone.0089944

Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide rates after discharge from psychiatric facilities: A systematic review and meta-analysis. JAMA Psychiatry, 74(7), 694-702. https://doi.org/10.1001/jamapsychiatry.2017.1044

Conwell, Y., Duberstein, P. R., Cox, C., Herrmann, J., Forbes, N., & Caine, E. D. (1998). Age differences in behaviors leading to completed suicide. The American Journal of Geriatric Psychiatry, 6(2), 122-126. https://doi.org/10.1097/00019442-199821000-00005

Conwell, Y., Van Orden, K., & Caine, E. D. (2011). Suicide in older adults. Psychiatric Clinics of North America, 34(2), 451-468. https://doi.org/10.1016/j.psc.2011.02.002

Dazzi, T., Gribble, R., Wessely, S., & Fear, N. T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361-3363. https://doi.org/10.1017/S0033291714001299

Deisenhammer, E. A., Ing, C.-M., Strauss, R., Kemmler, G., Hinterhuber, H., & Weiss, E. M. (2009). The duration of the suicidal process: How much time is left for intervention between consideration and accomplishment of a suicide attempt? The Journal of Clinical Psychiatry, 70(1), 19-24. https://doi.org/10.4088/JCP.07m03904

Gould, M. S., Kalafat, J., HarrisMunfakh, J. L., & Kleinman, M. (2007). An evaluation of crisis hotline outcomes. Part 2: Suicidal callers. Suicide and Life-Threatening Behavior, 37(3), 338-352. https://doi.org/10.1521/suli.2007.37.3.338

Gould, M. S., Marrocco, F. A., Kleinman, M., Thomas, J. G., Mostkoff, K., Cote, J., & Davies, M. (2005). Evaluating iatrogenic risk of youth suicide screening programs: A randomized controlled trial. JAMA, 293(13), 1635-1643. https://doi.org/10.1001/jama.293.13.1635

Hunt, I. M., Kapur, N., Webb, R., Robinson, J., Burns, J., Shaw, J., & Appleby, L. (2009). Suicide in recently discharged psychiatric patients: A case-control study. Psychological Medicine, 39(3), 443-449. https://doi.org/10.1017/S0033291708003644

Joiner, T. (2005). Why people die by suicide. Harvard University Press.

Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A review of the evidence. American Journal of Psychiatry, 159(6), 909-916. https://doi.org/10.1176/appi.ajp.159.6.909

Luxton, D. D., June, J. D., & Comtois, K. A. (2013). Can postdischarge follow-up contacts prevent suicide and suicidal behavior? A review of the evidence. Crisis, 34(1), 32-41. https://doi.org/10.1027/0227-5910/a000158

Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., Hegerl, U., Lonnqvist, J., Malone, K., Marusic, A., Mehlum, L., Patton, G., Phillips, M., Rutz, W., Rihmer, Z., Schmidtke, A., Shaffer, D., Silverman, M., Takahashi, Y., ... Hendin, H. (2005). Suicide prevention strategies: A systematic review. JAMA, 294(16), 2064-2074. https://doi.org/10.1001/jama.294.16.2064

McLaughlin, C., McGowan, I., Kernohan, G., & O'Neill, S. (2016). The unmet support needs of family members caring for a suicidal person. Journal of Mental Health, 25(3), 212-216. https://doi.org/10.3109/09638237.2015.1101421

McLaughlin, C., McGowan, I., O'Neill, S., & Kernohan, G. (2014). The burden of living with and caring for a suicidal family member. Journal of Mental Health, 23(5), 236-240. https://doi.org/10.3109/09638237.2014.928402

McMyler, C., & Pryjmachuk, S. (2008). Do 'no-suicide' contracts work? Journal of Psychiatric and Mental Health Nursing, 15(6), 512-522. https://doi.org/10.1111/j.1365-2850.2008.01286.x

Mégarbane, B., Oberlin, M., Alvarez, J.-C., Balen, F., Beaune, S., Bédry, R., Chauvin, A., Claudet, I., Danel, V., Debaty, G., Delahaye, A., Deye, N., Gaulier, J.-M., Grossenbacher, F., Hantson, P., Jacobs, F., Jaffal, K., Labadie, M., Labat, L., ... Cerf, C. (2020). Management of pharmaceutical and recreational drug poisoning. Annals of Intensive Care, 10(1), Article 157. https://doi.org/10.1186/s13613-020-00762-9

Mental Health First Aid Australia. (2014). Suicidal thoughts and behaviours: Mental Health First Aid guidelines (Rev. ed.). https://www.mhfa.com.au/wp-content/uploads/2023/12/MHFA_Suicidal-Thoughts-and-Behaviours-Guidelines.pdf

Ministère chargé de la santé. (2024, February 5). Le dispositif de recontact VigilanS. Santé.fr. https://www.sante.fr/le-dispositif-de-recontact-vigilans

Motto, J. A., & Bostrom, A. G. (2001). A randomized controlled trial of postcrisis suicide prevention. Psychiatric Services, 52(6), 828-833. https://doi.org/10.1176/appi.ps.52.6.828

National Health Service. (2025, June 12). Poisoning. https://www.nhs.uk/conditions/poisoning/

Nuij, C., van Ballegooijen, W., de Beurs, D., Juniar, D., Erlangsen, A., Portzky, G., O'Connor, R. C., Smit, J. H., Kerkhof, A., & Riper, H. (2021). Safety planning-type interventions for suicide prevention: Meta-analysis. The British Journal of Psychiatry, 219(2), 419-426. https://doi.org/10.1192/bjp.2021.50

O'Connor, R. C., & Kirtley, O. J. (2018). The integrated motivational-volitional model of suicidal behaviour. Philosophical Transactions of the Royal Society B: Biological Sciences, 373(1754), Article 20170268. https://doi.org/10.1098/rstb.2017.0268

Orygen. (n.d.). #chatsafe: Responding. https://www.orygen.org.au/chatsafe/responding

Pitman, A., Osborn, D., King, M., & Erlangsen, A. (2014). Effects of suicide bereavement on mental health and suicide risk. The Lancet Psychiatry, 1(1), 86-94. https://doi.org/10.1016/S2215-0366(14)70224-X

Robinson, J., Cox, G., Bailey, E., Hetrick, S., Rodrigues, M., Fisher, S., & Herrman, H. (2016). Social media and suicide prevention: A systematic review. Early Intervention in Psychiatry, 10(2), 103-121. https://doi.org/10.1111/eip.12229

Robinson, J., Hill, N. T. M., Thorn, P., Battersby, R., Teh, Z., Reavley, N. J., Pirkis, J., Lamblin, M., Rice, S., & Skehan, J. (2018). The #chatsafe project. Developing guidelines to help young people communicate safely about suicide on social media: A Delphi study. PLoS ONE, 13(11), Article e0206584. https://doi.org/10.1371/journal.pone.0206584

Ross, A. M., Kelly, C. M., & Jorm, A. F. (2014). Re-development of mental health first aid guidelines for suicidal ideation and behaviour: A Delphi study. BMC Psychiatry, 14, Article 241. https://doi.org/10.1186/s12888-014-0241-8

Rudd, M. D., Mandrusiak, M., & Joiner, T. E., Jr. (2006). The case against no-suicide contracts: The commitment to treatment statement as a practice alternative. Journal of Clinical Psychology, 62(2), 243-251. https://doi.org/10.1002/jclp.20227

Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264. https://doi.org/10.1016/j.cbpra.2011.01.001

Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., Chaudhury, S. R., Bush, A. L., & Green, K. L. (2018). Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA Psychiatry, 75(9), 894-900. https://doi.org/10.1001/jamapsychiatry.2018.1776

World Health Organization. (2017). Preventing suicide: A resource for media professionals, update 2017 (WHO/MSD/MER/17.5). https://www.who.int/publications/i/item/WHO-MSD-MER-17.5

Yip, P. S. F., Caine, E., Yousuf, S., Chang, S.-S., Wu, K. C.-C., & Chen, Y.-Y. (2012). Means restriction for suicide prevention. The Lancet, 379(9834), 2393-2399. https://doi.org/10.1016/S0140-6736(12)60521-2

Content last reviewed: 2026.