Suicide Prevention Month: Starting the Conversation

Realizing your loved one is acting differently, off, reclusive, or just generally not acting like themselves, can take a while. We make excuses that maybe they’re just burnt out from work or they’re having a bad day, but when those days grow longer and the behavior doesn’t change, it’s time to consider speaking to them about it.

Talking about someone’s mood or changes in their behavior may make you feel afraid or uncomfortable because you don’t want to upset them or for them to push you away. The fact that you noticed and you feel called to help is reason enough to speak out anyway. Noticing itself is the first step in helping them get better.

Suicide Prevention Month is a time to reach out to these loved ones. Someone struggling with these thoughts needs to find a reason to stay. Even if you think you may just be imagining a difference, if you don’t know if you should say something, or if you’ll make it worse, it’s still worth checking in with your loved one who seems different. Start the conversation and keep it simple. Just letting them know you care may be enough.

The thing nobody says out loud

No one wants to consider the possibility of suicide even if they sense it. Families can make every excuse in the book to avoid addressing the heavy possibility someone may be considering ending their life.

Maybe you blame yourself. Maybe you are avoiding an uncomfortable conversation. Maybe you just tell yourself everything is ok and you don’t need to get involved. Accepting how deep the weight a loved one is carrying and actually naming it takes courage. Silence during these times grows loud and can even be mistaken for a lack of caring or an acceptance of the behavioral change.

If someone you love is depressed enough to be thinking about suicide, the worst thing you can do is leave them alone with it. You do not need the right words. You need to let them know you want them to stay. Have courage and overcome the fear of being pushed away. Just planting the idea that someone cares may save their life. Reach out because even the smallest caring interaction can bring relief.

What you might be seeing

If you’re reading this page, it probably means you have already noticed something. Maybe you haven’t let yourself line it all up and seriously consider the possibility of suicide. But once you consider all of the signals together, it makes it harder to keep explaining them away.

Changes usually show up in three places. In what your loved one says, in what they do, and in how they seem. None of the following is a checklist you grade someone against. It’s just what families tend to notice when they look back.

What they say

• They talk about being a burden to everyone around them
• They say they feel trapped or that there’s no way out
• They don’t see the point in much of anything anymore
• They describe a pain that sounds bigger than they can carry

What they do

• They’ve pulled away from the people and the things they used to love
• Their sleep has changed a lot, either far too much or hardly at all
• Their drinking or drug use has picked up
• They’ve started tidying up loose ends, giving things away or putting affairs in order before there’s any reason to

How they seem

• Hopeless, or carrying an anxiety and irritability that won’t settle
• Suddenly calm after a long hard stretch, which can sometimes follow a decision rather than signaling a recovery

Seeing one of these on its own doesn’t necessarily mean an individual is struggling deeply enough to consider ending their life. Plenty of us sleep badly or cancel plans for a month without any deeper meaning. What matters is a wider change, and more so matters when a few of these show up together or have a sharper incline in their occurrence. When you know someone well enough, you are more likely to feel the difference between simply having a rough month and having a deep underlying hurt.

If it helps to know you aren’t imagining things, an estimated 14.3 million adults seriously considered suicide in 2024 alone. No matter what you think a loved one is carrying, know that sometimes it can spiral into something deeper, and they are not alone in that reality. They aren’t strange for carrying it, and you aren’t overreacting for noticing.

How do you ask if your loved one is considering suicide?

Carefully consider the moment you open the conversation. Make sure to wait until you are somewhere private. Make sure there aren’t time constraints to allow for the space to let it all out. Make sure to avoid bringing it up in the middle of an argument.

Sometimes sitting beside each other rather than directly across from one another makes the heavy conversation a bit easier. Maybe in the car, while you’re both busy cooking or focused on a task, or even on a walk out and about. Less eye contact makes it easier to let out hard truths.

The best approach for asking these tough questions is being direct. Ask plainly. “Are you thinking about suicide?” When you’re vague with your questions, you will get vague answers. Then just listen earnestly to their answer. Stop talking and let them let it out.

We can’t “fix it” in one day, we can’t just “change it” with positivity, so don’t argue with how they feel, and don’t rush them to look on the bright side. Just be there for them as a listening ear even if it scares you. You’re showing them this can be said out loud to another person and that person won’t fall apart or walk away.

What not to say

These conversations are often dependent on the individual’s receptiveness, the circumstances of the situation, and the emotions that arise during them. There really is no perfect script, so just open it up privately in a comfortable space and be a listening ear. Don’t put it off for another month just because you don’t have the right words. Showing up clumsily beats not showing up at all. If you’re worried about saying the wrong thing, consider the few things listed below that tend to close a door that was just starting to open.

Don’t argue them out of how they feel. Don’t start listing everything they have to live for, either. It feels more like an instruction to stop talking or minimizing their emotions rather than feeling like reassurance.

Don’t promise to keep it a secret. You may not be able to keep that promise if they fall deeper into these feelings. Breaking your word in the middle of a crisis may feel like a betrayal and make things worse.

Try not to make it about your own reaction. Falling apart and not being able to keep yourself together while they are opening up won’t make for a beneficial conversation. They don’t need to end up managing your distress instead of describing their own. It may even drive them to start keeping things from you to “protect you” from the truth.

If nothing comes to you at all, you can always just say so. “I don’t know what to say, but I’m not going anywhere,” show them you are here to stay.

What happens after the conversation?

Hopefully the talk goes better than expected and everyone exhales. But if two weeks slide by and nobody brings it up again you might feel a bit stuck. The reality is just having one conversation is a first step. Opening that door to healing, not completely resolving it in the span of an hour.

Follow up a few days later

Quickly check in. Show them they are on your mind and you still care. It may even matter more than the first talk did, because it proves you weren’t just having a moment. It shows them you meant what you said.

Take the next step with them

Sit beside them while they call 988. Drive them to their appointment. Fill out the forms together. Be in the room when they talk to their doctor. Depression makes small tasks feel enormous, so having someone just there makes it easier. Walk the journey alongside them and love them through it.

Don’t carry it alone

Share with others who care about your loved one’s wellbeing. Listen to your clinician’s advice. If they build a safety plan with your loved one, know that’s a normal part of good care and not a sign things have gone badly. It’s a plan for a hard night, written down while everyone is calm enough to think clearly, so nobody is improvising when it matters. Understand how you fit into the plan.

The openings for a conversation are more common than you think

One study of nearly 5,900 people who died by suicide found 83 percent had a healthcare visit in the year before their death. You have the opportunity to reach out, and you don’t have to fix a lifetime of pain in one conversation. You just have to make one of those moments happen on purpose.

When substance use is part of the picture

Substance use may raise the risk of suicide, or could be a symptom of them considering that choice. If your loved one is drinking heavily or using drugs on top of everything else you’ve been noticing, you’re looking at two things that make each other worse.

Alcohol deepens depression, lowering the threshold for acting on a suicidal thought that might have otherwise passed on its own. Alcohol also weakens impulse control, so these negative thoughts are far more likely to get acted on while someone is drinking. People often start drinking to quiet the depression, and the drinking ends up deepening the very thing they were trying to escape.

Even if an individual stops using, it does not mean they are no longer at risk. Those first few weeks can be some of the hardest, because the numbing is gone, the weight of the last few years shows up all at once, and their coping mechanism is no longer available. Expect that stretch to be rough, and don’t let it catch you off guard. Any good treatment plan accounts for it from the start.

What actually happens when you reach out

That first phone call is just a conversation. You don’t have to make a full commitment to treatment. Someone will simply ask what’s been going on. Professionals need to know how long it’s been going on and what you’ve already tried to help you plan what kind of support your loved one needs.

There are dual diagnosis programs to help if your loved one has a substance use issue coinciding with a mental health issue, where both sides get looked at together. Depression and substance use are dealt with together in one plan, because treating one while ignoring the other rarely has a long lasting effect. One team, one plan, both conditions.

At APEX Recovery, your insurance gets checked during that same call, so you’re not left guessing about coverage. You can call just to ask questions without agreeing to anything.

Just reach out

You don’t need an extensive plan or a perfect opening line to check on your loved one. You just need to say something. Ask the question plainly, listen to whatever comes back, and stay in it after the conversation ends.

Your loved one may not be ready to talk the first time you bring it up. They may brush it off, insist they’re fine, or get defensive that you asked at all. It is never wrong to ask if you are worried, and even if they don’t respond you still may have affected them. Sometimes the thing that matters most is knowing somebody noticed. Ask again next week anyway. Change happens when somebody keeps showing up.

You also don’t have to be the only one carrying this. Bring in the people who love them. Lean on a clinician. Let them help you figure out the next steps. Humans are meant to carry circumstances like these together.

Suicide Prevention Month sits as a reminder to us to speak up. Even if it isn’t September you can still speak up if the need arises. The people who need to hear from you will still need it in November and in February. If someone came to mind while you were reading this, maybe you should take this opportunity to consider having a conversation with them.

Sources

• SAMHSA, 2024 National Survey on Drug Use and Health
• Ahmedani BK et al., Health Care Contacts in the Year Before Suicide Death
• Borges G et al., A Meta-Analysis of Acute Use of Alcohol and the Risk of Suicide Attempt