Suicidal ideation means thinking about ending one’s life. It doesn’t always mean someone will act on those thoughts, but it is a serious warning sign. You may be reading this because you’re worried about a friend, family member, or even yourself. The fact that you care already makes a difference.
Thoughts of suicide can occur in people with no obvious risk factors as well as in those with depression or chronic pain. Thankfully, there is hope and help. The first step is learning to recognize the overt and subtle warning signs so you can act early.
Overt Signs of Suicidal Ideation
Some warning signs are hard to miss. These overt signals include open talk about suicide or death. For example, someone might say things like “I want to die,” “I can’t go on,” or “You’d be better off without me.” They may write a suicide note.
Research shows that direct threats or planning behavior are strong red flags. This can include writing wills or farewell letters, buying a weapon or stockpiling pills, and giving away treasured possessions. Reckless or self-harming behaviors are also common overt signs. For instance, a person might engage in increased substance use or dangerous stunts without regard for consequences.
Other clear signs include intense mood swings and expressions of hopelessness or rage. If someone talks openly about suicide or makes a plan, take it seriously—asking them directly won’t put the idea in their head. Everyone from teens to young adults to the elderly can experience these signs. CDC data shows high rates of suicidal thoughts among youth (around 20 percent of US high school students) and young adults.
A person with a major depressive diagnosis (or other mental health struggle like bipolar disorder or PTSD) is at higher risk: suicidal thinking is a classic symptom of severe depression. People dealing with chronic illness or pain also have extra stress—the CDC lists “serious illness such as chronic pain” as a suicide risk factor.
Subtle Signs of Suicidal Ideation
Not all warning signs are obvious. Sometimes subtle changes in behavior can signal trouble. Watch for withdrawal and isolation. A once-sociable person may start avoiding friends, family, or activities they used to enjoy. They might stop returning calls or cut down on social media and hobbies.
Lethargy, lack of interest, and neglect of personal care can slip under the radar. Another tricky sign is a “sudden calm” or unexpected mood lift after a period of depression or crisis. Sadly, this can mean they’ve made a decision and feel a sense of relief. Changes in sleep or appetite—sleeping much more or less than usual—are also clues.
People with passive suicidal ideation may not openly say they want to die, but hint at it. For example, they might say life is meaningless, “I don’t see a way forward,” or “Everyone would be better off if I were gone.” They may lament feeling like a burden or trapped in unbearable pain. Giving away prized items (like a favorite book or heirloom) or organizing personal affairs can also be a quiet sign of planning.
Other subtle signals include unexplained irritability, anxiety, or secretive behavior. These changes are especially important to watch for in people who are experiencing stress—whether from school, work, family pressures, or issues related to sexual orientation.
Because these clues are easy to overlook, it’s important to notice big changes in mood, attitude, or habits. Trust your instincts: if something feels “off,” it’s better to check in than to ignore it. People at high risk may not show overt signs, making subtle cues all the more critical to catch early.
What to Do If You Notice Warning Signs
If you suspect someone is considering suicide, don’t panic, but act promptly.
Step 1: Ask Directly and Listen
Gently ask if they are thinking of harming themselves. Phrasing like “You’ve seemed down lately, and I’m worried – are you thinking about suicide?” can open the door. Contrary to myths, asking won’t make things worse. It simply shows you care and permits them to talk. If they do open up, listen without judgment. Let them express emotions. Validate their feelings by saying you care about them. You don’t have to “fix” their problems; just being present can be a huge relief.
Step 2: Keep Them Safe
Remove or secure any obvious means they might use. For example, take away firearms, extra medications, or objects they might use to hurt themselves. As the National Institute of Mental Health (NIMH) advises, reducing access to lethal means can save lives.
If you’re physically with them, stay calm. Sit together, offer a glass of water, or suggest a change of environment. Reassure them: “You are important to me, and I want you to stay safe.” In an emergency (if you believe they plan to act on their thoughts now), call 911 or take them to the nearest emergency room immediately.
Step 3: Connect Them to Help
Encourage professional support. You might say, “You don’t have to go through this alone. Let’s find someone who can help.” In the US, dial 988 to reach the Suicide & Crisis Lifeline (text or call) for immediate counseling. Trained counselors can guide you 24/7. Together, you can look up a mental health treatment.
A family doctor or psychiatrist can also assess suicide risk (often using a tool like the Columbia Suicide Severity Rating Scale) and recommend therapy or medication. Even contacting a local support group or trusted clergy member can help. Don’t forget: if the person already had contact with health care services, calling their crisis team or counselor is wise.
Step 4: Make a Safety Plan
Help them create a written plan for moments of crisis. A safety plan typically lists personal coping strategies, social contacts, and professional resources. For example: “If I start feeling worse, I will try my favorite music or take a walk” (internal coping), “I can call my friend Sam or my therapist or a crisis line” (support network), and “I’ll remove sharp objects and lock up medications” (making suicide harder).
Each step should feel doable to them. Involving them in writing this down gives them a sense of control. You can find free safety-plan templates online (or through a therapist) and fill one out together.
Step 5: Follow Up and Build Long-Term Support
Stay connected after the worst passes. Check in often with texts, calls, or visits. Send supportive messages like “Thinking of you – you’re not alone in this.” According to research, even simple ongoing contact can make a big difference. Encourage healthy routines: regular sleep, nutritious meals, gentle exercise, and creative or social outlets.
Supportive relationships are one of the strongest protective factors against suicide. Help them stay connected to friends, family, or community groups. Consider peer support groups or online communities for people with depression or chronic pain—sharing feelings with those who’ve “been there” can ease isolation.
For longer-term care, explore therapy and treatment options. Cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and medications (especially if there is major depression) can drastically improve quality of life. Innovative treatments (like TMS or SPRAVATO®) are available for stubborn cases.
The key is to ensure your loved one has professional guidance. Even if someone is under regular care, remind them of appointment dates and medications. If they’re a high school teen, involve school counselors; if an adult, consider psychiatric evaluation.
Above all, keep the conversation open. Phrases like “You matter to me” and “We will get through this together” can reassure someone in despair. As the CDC notes, feeling connected and having reasons to live protect against suicide. Remind them of goals or loved ones they care about, and affirm that feelings can change with time.
Getting Help for Yourself and Others
If you or the person you’re helping feels overwhelmed, remember you’re not alone either. Contact crisis lines (in the US, 988 or 800-273-TALK) for guidance 24/7. Support groups for family members of those struggling can also help you cope. Taking care of yourself—talking to friends, getting sleep, or even having a brief relaxation—lets you be their strongest support.
Suicide prevention is a community effort: schools, workplaces, and churches often have resources for stress and emotional pain. Chronic stress, bullying, and traumatic events can push someone toward suicidal thoughts. Reducing stressors (e.g., helping with school or financial aid) and building resilience can help reduce long-term risk. Above all, keep hope alive. Every conversation you have could save a life.
Relief Mental Health Can Help
If you’re looking for professional support right now, consider contacting Relief Mental Health. Our team specializes in evidence-based treatment for suicidal thoughts and the diagnoses behind them (like depression, anxiety, PTSD, etc.).
We offer a range of therapies – from medication management and counseling to advanced options like TMS, SPRAVATO® and IV ketamine – all personalized to each person’s needs. Our clinicians are trained to respond with care and urgency. Let us help you or your loved one regain control of your life.
