Psychological first aid

Suicide risk: somebody who says they want to die

2 of 3 lessons

← Psychological first aid

This lesson is about suicidal crisis — what to do when a person says, or hints, that they are thinking of killing themselves.

Ask directly. "Are you thinking about killing yourself?" Asking does not put the idea in anybody's head — this is one of the most persistent myths in the field and it is wrong. Asking plainly, without flinching, is usually a relief to the person and it is the only way to know what you are dealing with.

Then stay.

  • Do not leave them alone, and do not hand them a phone number and walk away.
  • Remove or reduce access to the means where you safely can, and where you cannot, keep yourself between the person and it only if that is safe for you.
  • Listen without arguing. Do not debate whether their reasons are good ones, do not list the people who would be upset, do not tell them it is selfish. Every one of those ends the conversation.
  • Do not minimise. "You have so much to live for" is heard as "you are not being listened to".
  • Do not promise secrecy. Say early that if you believe they are in danger you will get help, and that you will tell them when you do it.
  • Take every threat seriously, including one from somebody who has said it before, including one that sounds theatrical, and including one from somebody who has been drinking.

Get them to help, and stay with them until somebody takes over: the emergency number, a crisis line, an emergency department, a specialist service. If you are in a service that has a protocol for this, that protocol governs.

Afterwards, for you. Being the person somebody said this to is heavy. Talk to somebody. The next lesson is about that.

Source. World Health Organization, Suicide fact sheet, https://www.who.int/news-room/fact-sheets/detail/suicide ; WHO mhGAP Intervention Guide, https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme ; WHO, Psychological first aid: Guide for field workers, https://www.who.int/publications/i/item/9789241548205

What this is not. Reading, not training, and not clinical assessment. Nothing here qualifies anybody to judge risk.

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