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 about it—not just talk around it, but straight talk. The 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 from the American Foundation for Suicide Prevention, 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.
Straight Talk On Suicide – Overview:
“Suicidal ideation” (abbreviated SI) is the fancy 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. It’s not a mental disorder in and of itself, though, and not everyone who experiences thoughts of suicide has a mental illness.
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.
Types of suicidal ideation
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 doesn’t take that next step to thinking about actually doing something to make dying happen.
That’s where active SI comes in. This is thoughts of doing something to end your life. The plan may be more or less specific, and the means to carry out the plan may or may not be immediately available. The level of intent can also vary.
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.
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 (alcohol and other substances can disinhibit you, making you more likely to act)
- 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
- 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 into when things get hard. The most effective way to prevent suicide is to not only try to reduce risk factors, but also improve protective factors.
Suicide Prevention Crisis 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 writing, but may change without notice.
For countries that aren’t covered on this page, these sites have international resource information:
988 countrywide crisis lines are coming to both the US and Canada, but aren’t quite here yet.
The MH Crisis Angels are a Twitter-based peer support service. DM them for support.
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.
Suicide prevention websites
- 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
These sites have safety planning tools:
- Consortium for Organizational Mental Health: Coping with suicidal thoughts
- Suicide Prevention Resource Center has a safety plan template developed by Brown & Stanley that’s also available on a number of other sites
- Beyond Blue has a Beyond Now safety plan in a web version and also on the BeyondNow app
- GetSelfHelp has a safety plan template along with a filled-out example
- StudentsAgainstDepression.org: this UK-based site has a Keeping Myself Safe worksheet
- WRAP (Wellness Recovery Action Plan): crisis & post-crisis plan templates
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.
What’s not on this list: Mental health treatment
Crisis lines/texts/chats are a great resource when you need someone to talk to who will provide supportive listening. But that’s not the whole picture.
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.
So absolutely, 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 ultimately be the most effective way of dealing with the suicidality.
Unfortunately, the currently available treatments don’t work for 100% of people, 100% of the time. 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.
Stigma Around Suicide
Sadly, there’s a lot of stigma around suicide. This has been around for centuries, and the Catholic Church, and, in particular, St. Thomas Aquinas, was an early driving force. These views made their way into English common law, which made attempting suicide illegal. To this day, there are countries where it remains illegal.
While early stigma related to sin, modern suicide stigma has different areas of focus. The post Stigma and public views on suicide looks at research published in the journal Crisis identifying the most common stigmatized attitudes about someone who suicides:
- punishing others
Language matters when it comes to mental illness, but language choices arise from underlying beliefs, not the other way around. Some advocates argue that the term “commit suicide” should never be used, because it implies that suicide is a crime; less common is the argument that even the term “completed suicide” is stigmatizing.
But if the underlying stigmatized beliefs are that suicide is selfish and punishes others, berating someone for using “commit suicide,” when it likely hadn’t even crossed their mind that this suggested criminality, is probably missing the mark.
These posts look at this issue more closely:
- How picky should we be about suicide-related language?
- Is “committed suicide” worth making an issue out of?:
Media Reporting of Suicides
Straight Talk on Suicide and Mental Illness
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 – you can’t 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.
Barriers to help-seeking
Treatment needs to be available, but it also needs to be accessible. There can be multiple barriers to help-seeking for people experiencing suicidal ideation, including stigma, fear of becoming a burden, or fear of being hospitalized.
In the end, though, it comes down to a balance of risks and benefits. The potential risk of not seeking help is dying. There’s nowhere lower to go with seeking help.
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 to reach out for help. You can read more about cognitive deconstruction here.
Suicidality vs. self-harm (non-suicidal self-injury or NSSI)
Non-suicidal self-injury (NSSI) is a more specific term than self-harm that captures 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 in as safe a way 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 is also NSSI, so you may need to advocate for yourself.
Suicide attempt survivors
Let’s also talk about suicide attempt survivors. It doesn’t get talked about much, but there are a fair number 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 in 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.
Social Media and Suicide
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:
- How should social media platforms handle reported suicidal posts?
- What goes too far on social media?
- What if a stranger tells you they’re suicidal?
These graphics are from the American Foundation for Suicide Prevention.