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Straight Talk on Suicide

Straight talk on suicide: graphics of a phoenix, suicide prevention ribbon, and semicolon

Suicide is a huge issue for people dealing with mental illness. While it doesn’t only affect people with mental illness, that’s the focus of this page. It’s important that we talk about it—not just talk around it, but straight talk on suicide in all its messiness and complexity. The conversation needs to address a range of different experiences related to suicide as well as the need for more effective mental illness treatment to mitigate risk. It’s important to hear the voices of those of us who have tried to take our own lives.

Based on 2018 figures, suicide is the 10th leading cause of death in the US, with men dying 3.56 times as often as women due to higher lethality methods. This is a massive problem, but it tends to be buried away under a little bit of shame and a whole lot of stigma.

So let’s talk about it. This page includes links to crisis services and loads of other suicide prevention resources.

Table of Contents

Suicide: The Basics - image of a phoenix

Suicide: The Basics

“Suicidal ideation” (abbreviated SI) is the psychiatric term for suicidal thinking. It’s not an illness in and of itself, but it can be a symptom of major depressive disorder, bipolar disorder, borderline personality disorder, and various others. Not everyone who experiences thoughts of suicide has a mental illness, although many do.

Just as people have unique experiences of mental illness, there are unique experiences of suicidal thinking. The more you get to know your own pattern of illness and SI, the better the position you’re in to detect the warning signs early and take action to keep yourself safe.

Passive and active suicidal ideation (thoughts of suicide)

Active & Passive Suicidal Ideation

Passive SI is along the lines of “I wish I was dead” or “I’d be better off dead,” but it doesn’t take that next step to thinking about actually doing something to make dying happen.

Active SI involves thoughts of actually doing something to end your life. The intent, plan specificity, and means availability can be variable. The higher those are, the more likely it is that the safest place to be is in hospital.

SI can also be described in terms of how it comes and goes. It may be “fleeting” if the thoughts sometimes come into your head but don’t stick around for very long. Some people experience chronic SI, with acute flare-ups in response to stressors. Some people are impulsive with their suicidality, while others may engage in meticulous planning.

Recognizing your patterns can put you in a better position to recognize what’s not dangerous for you and what requires quick action in terms of changing up your treatment plan.

Risk & Protective Factors

There are usually multiple factors that contribute to suicidality, including both predisposing factors (like mental illness) and situational factors. While it’s impossible to accurately pinpoint someone’s level of risk, the more risk factors they have, the greater the degree of concern.

Risk factors

Some of the major risk factors are:

  • Mental illness (mood disorders in particular)
  • Substance misuse (alcohol and other substances can disinhibit you, making you more likely to act)
  • A previous suicide attempt
  • Family history of suicide
  • Significant life stressors, including bullying
  • Adverse childhood experiences (ACEs)
  • Access to lethal means
  • Suicide contagion (exposure to graphic or sensationalized talk of suicide)
  • Loneliness
  • Hopelessness
  • Impulsivity
  • Physical pain
  • Traumatic brain injury
  • Unemployment, socioeconomic insecurity

Protective factors

Helping to balance out the risk factors are protective factors, including:

  • Family, social and professional supports (ideally some of each)
  • Spiritual or philosophical beliefs that act as a deterrent
  • A sense of responsibility towards others (such as pets)
  • Stable socioeconomic situation
  • Mental illness treatment

Identifying your protective factors while not in crisis can help give you a sense of what to lean into when things get hard. The most effective way to approach prevention is to not only try to reduce risk factors, but also improve protective factors.

Statistics

Males die by suicide almost four times more often than females do in the US, and twice as often worldwide. At least in part, this is because they tend to use more lethal methods like firearms, but cultural expectations to “man up” likely play a role as well. The Mental Health Commission of Canada has a fact sheet on men’s mental health and suicide.

In the U.S., suicide is the 2nd leading cause of death among people aged 15-34, the 4th among 35-44 year-olds, and the 5th among age 45-54 year-olds. In older age groups, natural causes start to overtake suicide as the leading causes of death, but that doesn’t mean that suicide stops. The highest suicide rate for females is in the 45-64 age bracket (10.2 per 100,000 people), and for males, it’s the 75+ age bracket, at 39.9 per 100,000. (Sources: CDC, NIMH, Our World in Data)

Warning signs

For people around us, suicide may seem like it comes out of nowhere, there are often warning signs. The acronym IS PATH WARM identifies red flags, especially when they represent deviations from that person’s norm. If you’re experiencing suicidal ideation yourself and can check off a lot of these indicators, that’s a sign that it’s high time for intervention.

Suicide warning signs: IS PATH WARM
  • I deation
  • S ubstance abuse
  • P urposelessness
  • A nxiety
  • T rapped
  • H opelessness
  • W ithdrawal
  • A nger
  • R ecklessness
  • M ood changes
Crisis resources for suicide prevention - image of a phoenix and hands with hearts on palms

Suicide Crisis Resources

This is a selection of some of the suicide prevention resources available in some of the major English-speaking countries. While I do periodically check that it’s up to date, I can’t guarantee that the contact details are always current.

Crisis lines are typically run by non-profit agencies, and the people answering the phones are volunteers trained in supportive, non-judgmental listening. They will try to avoid calling emergency responders, but they’ll do so if there is an imminent risk of harm. In an interview with Buzzfeed, the associate director of the National Suicide Prevention Lifeline said that confidentiality is breached due to safety concerns for less than 3% of calls.

Crisis Resources by Country

988 countrywide crisis lines are coming to both the US and Canada, but aren’t quite here yet. Suicide.org and Wikipedia had info on international resources. I’ve also put together a page on carrd.io as an easy reference for these resources.

Australia

Canada

UK

  • CALM (Campaign Against Living Miserably): webchat for men
  • Papyrus HopeLineUK for adults under 35, call 0800 068 41 41 or text 07786209697
  • Premier Lifeline: Christian faith-oriented crisis line, call 0300 111 0101
  • Samaritans crisis line 116 123
  • Shout crisis text line: text Shout to 85258

USA

Apps

While contact info for crisis resources in these apps is country-specific, they still have content that’s useful for anyone wherever they are. Some have safety planning templates, which are noted below.

Safety Planning

In times of crisis, most people aren’t thinking very clearly. Putting together a safety plan ahead of time allows you to consider what the warning signs are that a crisis is building and identify interventions for the early, middle, and most intense stages of the crisis.

These sites have safety planning tools:

Safety plan for suicide prevention from Mental Health @ Home

There are two free resources available on the Resources page They’re similar, but the Safety Plan is more geared toward chronic mental illness, while Feeling Suicidal? is geared more towards acute stressors.

More Resources

Straight Talk on What’s Missing

A lot of suicide prevention campaigns focus on suicide awareness, including being aware of crisis lines. Crisis lines/texts/chats are definitely a great resource when you need someone to talk to who will provide supportive listening; however, when the underlying problem is mental illness, all the crisis lines in the world aren’t going to address the illness that’s causing the suicidal thoughts. There’s more on this issue in the post What a 988 Suicide Hotline Can (and Can’t) Accomplish.

So absolutely, reach out to a crisis line to talk, but just as importantly, reach out to a mental health professional to help you manage your illness. Whether that starts with an appointment with your GP, finding a therapist, or making a trip to the emergency department, getting the illness better under control will ultimately be the most effective way of dealing with suicidality.

The sad reality, though, is that there is a very real risk of reaching out and not being taken seriously, or being told that you’re either not suicidal “enough” or “too” suicidal to be helped. Or perhaps there’s a year-long waitlist for appropriate treatment. Reaching out only works if the people and the system you’re reaching for don’t suck.

Besides the systems issues, the currently available treatments for mental illness don’t work for 100% of people, 100% of the time—not even close. Suicide can never be 100% preventable until that happens. In the meantime, though, we have to do the best we can with what we’ve got, as difficult as that may be.

Suicide stigma - image of a phoenix

Suicide and Stigma

Sadly, there’s a lot of stigma around suicide. This has been around for centuries, and the Catholic Church was an early driving force. These views made their way into English common law, which made suicide illegal. To this day, there are countries where it remains illegal, bizarre as that may seem.

While early stigma was primarily related to sinfulness, modern stigma has different areas of focus. This post on suicide stigma looks at research identifying the most common stigmatized attitudes about someone who suicides:

  1. punishing others
  2. selfish
  3. hurtful
  4. reckless
  5. weak
  1. irresponsible
  2. attention-seeking
  3. cowardly
  4. senseless
  5. ignorant

The Role of Language

Language matters when it comes to mental illness, but words are a reflection of the underlying attitudes of the people using those words. Changing attitudes is what will make a lasting difference, not trying to control people’s words.

There are a lot of different terms that various advocacy groups have deemed stigmatizing, and recommendations are often conflicting. We need to talk more about suicide in order to change people’s attitudes, and giving people a list of things they’re not supposed to say runs the risk of shutting down dialogue rather than getting it started.

These posts explore the issue of language and whether it’s a useful target for reducing suicide-related stigma:

Media Reporting

How the media reports on suicides matters. Suicide contagion is a well-recognized phenomenon that involves an uptick in suicide rates that can occur following public suicides when there’s been inappropriate reporting. Carefully following suicide reporting guidelines can decrease the risk of this.

Do's and don'ts for media reporting of suicides

Suicide Reporting Do’s

  • include local crisis line information and other community resources
  • include warning signs and information about what to do
  • report on suicide as a public health issue and look for links to broader social issues
  • get information from suicide prevention experts
  • word headlines carefully – avoid using the word “suicide” or sensationalizing
  • be particularly careful when reporting celebrity suicides
  • avoid printing photos of the deceased, or use only print a small, non-prominent image

Suicide Reporting Don’ts

  • use prominent placement (e.g. front page) or undue repetition
  • use photos of the location/method of death or family/friends grieving
  • describe a suicide as inexplicable or without warning
  • characterize suicide as “successful” or “unsuccessful”/”failed”
  • report specific details of the method
  • speculate about or offer simplistic causes for the suicide
  • normalize or romanticize suicide or present it as the solution to problems
  • use melodrama, hyperboles like “suicide epidemic” or labelling locations as suicide “hot spots”
  • publish suicide notes

These sites have more info:

Straight talk on suicide - graphic of a phoenix

Straight Talk on Suicide

There are a couple of things I would like to make very clear:

1) Suicide is not selfish—not even a little bit.

2) Guilt isn’t effective as a suicide prevention strategy—it doesn’t work to try to guilt-trip someone out of suicide.

Yes, suicide hurts those left behind, but that’s not what the word selfish means. Here’s Google’s definition: “(of a person, action, or motive) lacking consideration for others; concerned chiefly with one’s own personal profit or pleasure.” There’s neither profit nor pleasure in suicide, so let’s put that nonsense to bed right now.

I’d also like to call bullshit on some of the quotes floating around online about suicide. The correct attributions are unclear.

  • “Suicide doesn’t end the pain. It just passes it on to someone else.” – As previously mentioned, trying to guilt trip people out of suicide doesn’t help them; it only makes the person pulling that nonsense an asshole.
  • “Suicide is a permanent solution to a temporary problem.” – Chronic mental illness is a permanent problem, and it’s not useful to belittle it this way.
  • “Suicide doesn’t end the chances of life getting worse, it eliminates the possibility of it ever getting any better.” – Yes, as a matter of fact, it does end the chances of life getting worse, so it’s really not a helpful way of presenting the message that there is a possibility of things getting better.

How much does your suicidality relate to what others may or may not think about you dying vs. continuing to live? The post Suicidality and Other People’s Perspective looks at how we might answer these questions:

  1. If someone you cared about said that the world is definitely better with you in it and they want you to stay alive, and you were magically able to know that they sincerely meant it, would that change anything for you?
  2. Do you think others would be traumatized by your death?
  3. Do you think the important people in your life would be better off without you?

You can read about my own experiences in this post that gets up close and personal. Suicide is tough to talk about, but it’s absolutely essential that we do so.

Potential barriers to help-seeking for suicidal ideation

Barriers to Help-Seeking

Treatment needs to be available, but it also needs to be accessible and acceptable. There can be multiple barriers to help-seeking for people experiencing suicidal ideation, including stigma, fear of becoming a burden or being judged by others, or fear of being hospitalized (or dismissed by the ER).

Given how traumatizing police involvement and hospitalization can be, it’s absolutely crucial to address the systemic barriers that can make all the “reach out” in the world feel meaningless. There has to be something acceptable and effective within reach.

Cognitive Deconstruction

In the book Suicidal: Why We Kill Ourselves, Jesse Bering described a process called cognitive deconstruction, which is a mental narrowing of focus and time frame of reference that can occur in the lead-up to suicide. The future and consequences cease to exist; there’s just now. That now is a very concrete, non-abstract place, with everything tuned out except the one thing that’s focused on.

This sounds very much like my own experience leading up to attempting suicide. Recognizing that process is occurring can be an important sign that it’s time for some form of intervention. You can read more in this post on cognitive deconstruction. It helps what can seem like an entirely illogical thought process to make a lot more sense.

Is Suicide a Choice?

If suicide is a choice, does that mean that it’s blameworthy, selfish, and all that other stigmatized crap? I suspect that one of the reasons that some suicide prevention advocates argue that it’s not a choice is to try to avoid leaving that door open.

However, the reality is a lot more nuanced than that. Suicidal ideation as a symptom of mental illness is not a choice. However, suicide itself is an intentional action, not a passive state of being or an automatic, involuntary act.

Being a choice doesn’t mean that there are better choices available, or that the menu of options includes what you’d like it to. Mental illness severely limits the options that are on that menu. On a two-option menu of dying or living in intense pain, living could sometimes appear to be a worse choice than death.

To deny the element of choice loses sight of the fact that we need to make sure better options are available to people. Suicide having an element of choice is actually a good thing, because it means that it’s possible to introduce better choices to have a more livable life.

LGBTQ+ Youth Elevated Risk

Because of factors like bullying, microaggressions, and lack of social support (including family support), LGBTQ+ youth have significantly elevated rates of suicide. LGB youth attempt suicide five times more often than heterosexual youth. Suicidal ideation is even higher among trans youth than LGB youth, and higher still for trans youth who want puberty-blocking or other hormonal treatment but are unable to access it.

What’s important to keep in mind here is that there’s nothing inherent in being LGBTQ+ that makes people suicidal. This is entirely society’s fault for not supporting these youth.

It Gets Better Project and The Trevor Project are resources that specifically target this population.

Self-Harm (Non-Suicidal Self-Injury/NSSI) vs. Suicidality

Non-suicidal self-injury (NSSI) is a more specific term than self-harm that makes it clear that the self-injury is not intended to result in ending one’s life. The post Harm Reduction for Self-Harm has more info on managing NSSI as safely as possible.

Self-harm and attempting suicide aren’t the same thing. They both cause harm, but the intent is quite different. There are a variety of reasons why people may self-harm, including to release emotional pain or to create physical pain to cut through emotional numbness. I briefly self-harmed early in the course of my illness, and it was a way of managing suicidal ideation to prevent myself from acting on it.

People can experience suicidal ideation and at the same time engage in NSSI, so it’s important not to overlook one and focus solely on the other. Unfortunately, there is a risk that people, including health care providers, may minimize suicidality when there’s also NSSI, so you may need to advocate hard for yourself.

Social Media

If you post on social media about being suicidal, there’s a possibility that someone might report you to the social platform. At that point, they’ll probably send you a list of crisis line contacts, but more importantly, they may temporarily disable your account. The intent may be good, but it can end up cutting people off from an important support system.

Part of your safety planning process might involve considering how to reach out effectively on social media in times of need. Broadcasting messages to thousands of followers may end up worrying and/or triggering large numbers of other people without actually doing anything to help you get more effective support. A more focused plan for connecting with key supports may help you get the help you need without risking having your social account suspended.

The following posts have more on this topic:

The Mental Health Commission of Canada has information on how to have safer conversations about suicide on social media.

Suicide Attempt Survivors

Let’s also talk about suicide attempt survivors. It’s not a subject that gets talked about much, but there are quite a few of us out there. I’m a multiple attempt survivor myself. It’s been about 8 years since my last attempt, and while my depression is treatment-resistant, the suicidal ideation is pretty well controlled with meds. I’ve never been an impulsive attempter, and when SI does flare up sometimes, I know from past experience that I’m able to make it through prolonged periods of constant suicidality, so I’m able to put it in context that a week or two of suicidality isn’t high risk for me. Looking to your past to understand your patterns can help with making more effective, safe decisions moving forward.

Everyone’s experience is different. Some people regret the attempt afterwards, while others, such as myself, regret not dying. There’s no one right way to feel, and by sharing our experiences collectively, we can help others recognize that they’re not alone in their experience and those experiences are valid.

As an attempt survivor, I had a strong reaction to a chapter in Jesse Bering’s book Suicidal that included excerpts from the journal of a teen who had ended her life. It was done with her parents’ permission, and I suppose there isn’t really an entitlement to privacy when you’re dead, but it’s certainly not something I would want to happen. You can read more in this post on privacy and completed suicide.

suicide prevention symbols: awareness ribbon, semicolon, phoenix

Symbols can be a powerful way of representing one’s relationship with suicide. The awareness ribbon can speak to anyone, but the other two are more personal. A semicolon tattoo is a common choice among those who have survived an attempt; it represents where a sentence could have ended, but the writer kept on going instead. The mythical phoenix rising from the ashes is a powerful metaphor for dying and rising again. I have a phoenix tattoo to represent surviving my last attempt.

Resources for attempt survivors:

Suicide Forums

As much as some people may disagree with it, there are websites that have forums in which people talk about methods. I firmly believe that trying to control access to information isn’t what will reduce suicides; what we really need to do is make it easier to live. If people are looking for information, they will find it, and as long as there are suicidal people, there will be people gathering to talk about methods. Means restriction is a helpful way of making it harder to die; I don’t think attempts at information restriction accomplish the same thing. So let’s talk about how we can intervene to make life more livable for people that get to the point of being this desperate.

There’s more on this subject in the post The New York Times’ Take on a Suicide Forum – My Thoughts.

Suicide Survivors

While “suicide attempt survivors” refers to those who have attempted and lived, the term “suicide survivors” is used to refer to people who have lost a loved one to suicide.

Resources:

Advocacy Campaigns and Resources

If you’re interested in getting involved in larger-scale advocacy work, these sites have resources that may be of interest to you:

Resources for systems-level change

Systems-level strategies to prevent suicide
CDC

Suicide Prevention Resources for Professionals

Clinical Resources

Continuing Education

Other Resources:

Learn more about suicide - illustration of a phoenix

Learn More About Suicide

These sites have lots of suicide prevention info:

Suicide Prevention Training

These sites have courses/learning resources about suicide geared towards a broad audience:

Books About Suicide

I’ve reviewed these books on Mental Health @ Home.

TED Talks