Suicide is a huge issue for people dealing with mental illness. It doesn’t just affect people with mental illness, but that’s the focus of this page. It’s important that we talk it, and that conversation needs to address a range of different experiences with suicide as well as the need for more effective mental illness treatment to mitigate risk.
Based on 2018 figures listed on the American Foundation for Suicide Prevention site, suicide is the 10th leading cause of death in the U.S., 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.
“Suicidal ideation” (abbreviated SI) is the fancy therm term for suicidal thinking. It’s listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) as a symptom of a major depressive episode, which can occur in disorders like major depressive disorder, bipolar disorder, and schizoaffective disorder. Suicidality can also occur in the context of other disorders, including psychotic disorders and trauma disorders.
SI can happen in a number of different ways. It may be described as “fleeting” if the thoughts come into your head but don’t stick around for very long, although they can be recurring. Some people experience chronic SI, which may have acute flare-ups in response to triggers.
Just as people have unique experiences of mental illness, they have unique experiences of suicidal thinking. The more you get to know your pattern of illness and pattern of SI, the better the position you’re in to detect the warning signs early and take action to keep yourself safe.
There are two broad types of suicidal ideation.
Passive SI is along the lines of “I wish I was dead” or “I’d be better off dead,” but not taking that step to thinking about doing something to make that happen.
That’s where active SI comes in. If there is a very specific plan, with available means, and intent to act imminently, the best place to be at that point may be in hospital.
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. It definitely resonated with my own experience leading up to attempting suicide. There’s a post on cognitive deconstruction here.
Non-suicidal self-injury (NSSI)
Self-harm and attempting suicide aren’t the same thing. They both cause harm, but the intent is quite different. Non-suicidal self-injury (NSSI) is a more specific term than self-harm that captures that difference in intent. The post Harm Reduction for Self-Harm has more info on managing NSSI.
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 is also NSSI, so you may need to advocate for yourself.
Risk & protective factors for suicide
Not everyone who thinks about suicide or tries to end their life has a mental illness, but a lot do. No single risk factor means someone definitely will become suicide, and there may be an interplay between multiple contributing factors. That often looks like a combination of predisposition because of factors like mental illness, and a stressor that becomes the straw that broke the camel’s back.
Some of the major risk factors are:
- Mental illness
- Substance misuse
- A previous suicide attempt
- Family history of suicide
- Significant life stressors
- Adverse childhood experiences (ACEs)
- Access to lethal means
- Suicide contagion (exposure to graphic or sensationalized talk of suicide)
Helping to balance out the risk factors are protective factors. ‘These can include family, social and professional supports, spiritual or philosophical beliefs that act as a deterrent, and a sense of responsibility towards others (such as pets). Identifying your protective factors while not in crisis can help give you a sense of what to lean on when things get hard.
Straight talk on suicide and mental illness
Will suicide ever be 100% preventable? Not unless there are treatments that are a) available and accessible to all, and b) effective for more people than respond to currently available treatments.
There can be significant barriers to help-seeking around suicidal ideation, including stigma, and it doesn’t matter how many services there are if they’re not accessible.
But one thing I do know is that guilt is not suicide prevention strategy, although sadly, that doesn’t seem to stop the ignorant. I’ve seen this kind of thing on Twitter, and there is nothing remotely helpful about it.
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.
Let’s also talk about suicide attempt survivors. Everyone’s experience is different. Some people regret the attempt, while others, such as myself, have very different regrets. There is 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.
There’s more in this post on suicide attempt survivors.
Suicide Prevention Resources
This is a selection of some of the suicide prevention resources available in some of the major English-speaking countries. This information was correct at the time of publishing, but may change without notice.
For countries that aren’t covered on this page, these sites have international resource information:
The MH Crisis Angels are a Twitter-based peer support service. DM them for support.
- Beyond Blue Support Service: 1300 22 4636
- Kids Helpline: 1800 55 1800
- Lifeline Australia: call 13 11 14, also has online chat
- MensLine Australia: 1300 78 99 78
- Suicide Call Back Service: 1300 659 467
- The Samaritans: call 135 247
- Canadian Association for Suicide Prevention: has listings for crisis centres across the country.
- Crisis Services Canada: a Canada-wide crisis line number at 1-833-456-4566, text to 45645, or online chat.
- Crisis Text Line: powered by Kids Help Phone – text HOME to 686868
- Kids Help Phone: call 1-800-668-6868 (they also have an app)
- CALM (Campaign Against Living Miserably): webchat for men
- Shout crisis text line: text Shout to 85258
- 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
- The Suicide Prevention Lifeline: call 1-800-273-TALK (8255) – probably the most widely recognized resource; they also run the Lifeline Crisis Chat online crisis chat in partnership with Contact USA
- I’m Alive online chat support
- Crisis Text Line: text HOME to 741741
- Suicide.org has state by state crisis line info
- The Trevor Project: Lifeline, online chat, and text to support LGBTQ youth
- Veterans Crisis Line: call 1-800-273-8255 (option 1), text 838255, or online chat
Suicide prevention and safety planning apps
While contact info in these apps is country-specific, they still have content that’s useful for anyone wherever they are.
- A Friend Asks (US)
- Be Safe (Canadian)
- BeyondNow (Australian)
- My3 (US)
- ReliefLink (US)
- Stay Alive
- Suicide safety plan (UK)
- Suicide? Help! (UK)
- The Lifeline (Canada)
- American Foundation for Suicide Prevention (AFSP): information and advocacy
- Centers for Disease Control and Prevention (CDC): Suicide Prevention
- National Alliance on Mental Illness (NAMI): Navigating a Mental Health Crisis
- Suicide Prevention Resource Center (SPRC): lots of info on suicide prevention
- Zero Suicide Alliance: has free online suicide prevention training modules
There are two free suicide resources available from the MH@H Store. They’re similar, but the Safety Plan is more geared toward chronic mental illness, while Feeling Suicidal? is geared more towards acute stressors.
Other safety planning tools:
- Consortium for Organizational Mental Health: Coping with suicidal thoughts
- A safety plan template developed by Brown & Stanley is available on a number of sites, including the Suicide Prevention Resource Center
- Beyond Blue has a Beyond Now safety plan web version that’s also available through the BeyondNow app
- GetSelfHelp has a safety plan template that’s accompanied by a filled out example
- StudentsAgainstDepression.org, a UK-based site, has a Keeping Myself Safe worksheet
- WRAP (Wellness Recovery Action Plan): crisis & post-crisis plan templates
What’s not on this list
While these kinds of crisis resources can help you get through difficult moments, they don’t address the underlying problem. In many cases, that underlying problem is mental illness.
When mental illness is the underlying issue, crisis lines can be useful in a supportive capacity, but what really needs to happen is effective mental health treatment. So reach out to a crisis line to talk, but even more importantly, reach out to a mental health professional to help you manage your illness. Whether that starts with an appointment with your GP or a trip to the emergency department, getting the illness better under control will be the most effective way of dealing with the suicidality.
Language, Stigma, and Suicide
Unfortunately, there’s a lot of stigma around suicide, and language can play a role in that.
Research published in the journal Crisis using the Stigma of Suicide Scale found that the ten most common stigmatized views endorsed were that someone who suicides is:
- punishing others
The post Stigma and public views on suicide goes into more detail on this research. The Stigma of Suicide Scale is available in both long form and short form on the Australian National University website.
Language matters when it comes to mental illness, but the underlying beliefs are the problem, not the words themselves. Some mental health advocates are quite strict about language that should be acceptable when it comes to suicide. In particular, the term “committed suicide” is often a target.
The concern is that it suggests that suicide is a crime (and yes, even now, attempting suicide is illegal in some countries). Except I’m not seeing any indication that there’s stigmatizing intent with the use of the rather versatile word “commit.” I’ve heard people express surprise upon hearing about the criminal interpretation, as such a thing had never crossed their mind.
Given that, perhaps it’s more effective to focus on issues where intent is a problem. My concern is that language policing where there’s no corresponding ill intent may have the opposite of the intended effect. In these two posts I elaborate further around this:
- How picky should we be about suicide-related language?
- Is “committed suicide” worth making an issue out of?:
Media Reporting of Suicides
The way that the media reports suicides matters. There’s a recognized phenomenon called suicide contagion, and it’s an uptick in suicide rates that can occur following public suicides. Careful reporting can decrease the risk of this
Social Media and Suicide
- How should social media platforms handle reported suicidal posts? If someone reports a post of yours as suicidal, it’s possible that the platform could temporarily bloc you from posting.
- What goes too far on social media? People often turn to social media for support, but if someone broadcasts a message to their thousands of followers that they’re planning to take pills tonight, that probably doesn’t help them get appropriate help, but it potentially triggers a lot of people.
- What if a stranger tells you they’re suicidal? I saw this issue raised by a mental health writer who would sometimes get people contacting her through her website who were actively suicidal. This post talks about how to navigate that kind of situation.
Reviews of Books About Suicide
- After Suicide by Charlotte Underwood
- Hello I Want to Die Please Fix Me by Anna Mehler Paperny
- Reasons to Stay Alive by Matt Haig
- Suicidal: Why We Kill Ourselves by Jesse Bering
- The Balance Between Life and Death by Elizabeth Holland
TED Talks on Suicide
These graphics are from the American Foundation for Suicide Prevention.