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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

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How to Talk About Suicide

Recognizing and Responding to Suicide

A man and woman talking.

Suicide occurs across and within all races and cultures. Within Indian Country, the rates are higher than in the general population. The subject of suicide carries the stigmas of depression and death, the fear that just talking about it will make it happen, and other stigmas, including:

  • Suicide is a cry for help
  • When a person decides to end his or her life, there is nothing that can be done to stop him or her
  • A person won' commit suicide if he or she has children, just bought a new car, or is just having a "difficult time"

The reality is that suicide is preventable, and help is available.

People may not show any signs of the intent to kill themselves before they commit suicide. But there are behaviors that may indicate a person is at risk for killing themselves, and it is important to be aware of warning signs and risk factors. If you notice any warning signs for suicide, starting a conversation with the person may save their life.

Learn to recognize the warning signs:
  • Hopelessness; feeling like there is no way out
  • Anxiety, agitation, sleeplessness, or mood swings
  • Feeling like there is no reason to live
  • Rage or anger
  • Engaging in risky activities
  • Increasing alcohol or drug abuse
  • Withdrawing from family and friends

The presence of any of the following signs requires immediate attention:

  • Thinking about hurting or killing themselves
  • Looking for ways to die
  • Talking about death, dying, or suicide
  • Self-destructive or risk taking behavior, especially when it involves alcohol, drugs, or weapons
Resources:
  1. Recognizing and Responding to Suicide Risk in Primary Care (RRSR-PC) Exit Disclaimer: You Are Leaving www.ihs.gov
  2. Veterans Crisis Line Exit Disclaimer: You Are Leaving www.ihs.gov
  3. National Suicide Prevention Lifeline Exit Disclaimer: You Are Leaving www.ihs.gov

How to Begin the Conversation

Before talking with someone you are concerned about, have suicide crisis resources available, such as the National Suicide Prevention Lifeline number, 1-800-273-8255 (TALK), or numbers and addresses of local crisis lines or treatment centers. Mention what signs prompted you to ask about how they are feeling. Mention the warning signs that prompted you to ask the person about how they are feeling, the words used, or behavior displayed (signs make it more difficult to deny that something is wrong).

Ask the Question

Ask directly about suicide. Ask the question in such a way that is natural and flows over the course of the conversation. Ask the question in a way that gives you a "yes" or "no" answer. Don't wait to ask the question when the person is halfway out the door. Asking directly and using the word "suicide" establishes that you and the at-risk person are talking about the same thing, and lets them know you are not afraid to talk about it. Ask:

"Are you thinking about killing yourself?"

or

"Are you thinking about ending your life?"

How NOT to Ask the Question

"You're not thinking about killing yourself, are you?"

Do not ask the question as though you are looking for a "no" answer. Asking the question in this manner tells the person that although you assume they are suicidal, you want and will accept a denial.

Validate the Person's Experience:

  • Talk openly
  • Don't panic
  • Be willing to listen and allow emotional expression
  • Recognize that the situation is serious
  • Don't pass judgment
  • Reassure that help is available
  • Don't promise secrecy
  • Don't leave the person alone

Get Help

Share available resources with the person. Be willing to make the call, or take part in the call to the National Suicide Prevention LifelineExit Disclaimer: You Are Leaving www.ihs.gov at 1-800-273-8255 (Talk). The toll-free confidential Lifeline is available 24 hours a day, seven days a week.

Let the person know that you are willing to go with them to see a professional when they are ready. If you feel the situation is critical, take the person the closest Emergency Room or call 9-1-1. Do not put yourself in danger; if at any time during the process you are concerned about your own safety, or that the person may harm others, call 9-1-1.

Never negotiate with a person who has a gun, call 9-1-1 and leave the area.

If the person has done harm to him or herself in any way, call 9-1-1.