Beyond the Taboo: How to Talk About Suicide
In honor of September being Suicide Prevention and Awareness Month, we're tackling a topic that many of us find uncomfortable, but one that we absolutely must talk about.
As a psychiatrist, it's a topic that is near and dear to my heart, and something that I discuss on nearly a daily basis. But for my non-mental health friends out there, it's time to empower you, our listeners—friends, family members, and colleagues—to be a part of the solution. Not just because conversations save lives, but because things we DON’T talk about become taboo, and when it comes to suicide, that taboo can have deadly consequences.
So, let's break it down. We're going to cover three key things today:
1. How to recognize the warning signs in someone you care about.
2. How to start the conversation and bring it up, because it can feel awkward.
3. And how to respond, whether they are or aren't suicidal.
Host: First, let's talk about the warning signs. Now, I want to be clear—these are not a checklist to diagnose someone. This talk is for educational purposes only. It is to inform and empower. Think of these actions or behaviors as red flags. If you see one, be on alert. If you see several of them together, or if there's a significant change in a person's behavior over a short period of time, it's a signal to pay closer attention and possibly intervene.
The signs can be broken into 4 categories: talk, behavior, mood, and history.
Talk: Listen for direct or indirect statements. They might say things like:
"I wish I could just disappear."
"My family would be better off without me."
"I can't take this pain anymore."
"You won't have to worry about me much longer."
Or they might talk about feeling trapped or being a burden to others.
Behavior: Look for significant shifts. They might start:
Withdrawing from friends, family, and activities they used to enjoy.
Giving away or selling prized possessions.
Saying goodbye to people as if it's the last time.
Telling people in your life how important they are to you, that your friendship has meant so much, when they aren’t typically effusive or appreciative.
An increase in substance use, like drinking or drugs.
Or a sudden, inexplicable shift from being very sad for a long while to being very calm or even happy. That can sometimes mean they've made a decision.
Mood: Changes in mood are also critical. Be on the lookout for:
Extreme mood swings.
Hopelessness and a sense of being trapped.
Uncontrolled rage or irritability.
And of course, severe depression or anxiety.
I know this is a lot to take in, but remember, the key is to notice a change. If your usually social friend starts to isolate themselves, or your optimistic colleague seems hopeless, that's your cue to lean in.
History: It's complex, but certain things increase risk. The biggest one? Mental health conditions. Things like depression, anxiety, bipolar disorder, PTSD—especially if they're untreated or poorly managed.
Other factors include:
Past or current (!) trauma or abuse.
Substance use: Alcohol and drugs can impair judgment and worsen mood.
Major life stressors or loss: Divorce, job loss, fear of losing one’s job or spouse, death of a loved one or pet.
Chronic pain or illness.
Previous suicide attempts are a significant risk factor. Past behavior doesn’t dictate future behavior, but it’s a damn good predictor.
And unfortunately, family history of suicide can also play a role. Even suicide of a close friend can, on some level, grant the person a sort of “unconscious permission” to relieve themselves of pain in this way, especially if suicide has been on their minds.
So you've noticed one or more of some of these signs. Now comes the hard part: bringing it up. You might be thinking, "What if I put the idea in their head?" That is a common myth, and it's simply not true. Much like talking to your teens about sex doesn’t put the idea into their heads. Hormones, peer pressure, and social media did that long before you did. And study after study shows that asking someone directly about suicide does not increase their risk. In fact, it often provides a sense of relief—a signal that someone finally sees their pain. A taboo only exists only if we don’t talk about it. It increases in power and pain only if we don’t talk about it. And the likelihood of something bad happening only increases if we don’t talk about it!
So, how do you do it? First, make sure you’re in a private space. Them the key is to be direct, but kind. You want to use a calm, non-judgmental tone.
Start by expressing your care and concern for them. You could say something like:
"Hey, I've noticed you haven't been yourself lately, and I'm really concerned about you."
“I haven’t seen you around the gym/our favorite coffee shop/or work much lately.”
"I've been worried about you, and I wanted to check in. How are you doing?"
After you've opened the door, be direct. Here are a few ways to phrase it:
"Are you thinking about suicide?"
"I'm worried about you. Are you having thoughts of hurting yourself?"
"Sometimes when people are going through what you're going through, they think about ending their life. Have you had any of those types of thoughts?"
You might feel your heart racing just thinking about saying those words, and that's okay. It’s a brave and loving thing to do. The most important thing is to create a safe space for them to be honest.
Now on to our final point: how to respond. This is where you can become a lifeline.
Scenario A: They say "Yes, I am thinking about suicide." This is the moment to stay calm. Your job is not to solve their problems, but to keep them safe in this moment. Don’t react, don’t try to talk them out of it, don’t tell them they have so much to live for. This is your own protectiveness/defensiveness talking.
First, thank them for their honesty. "Thank you so much for telling me. That took incredible courage."
Ask them if they have a plan. This is a critical question. "Have you thought about how you would do it?" If they say yes and have access to the means (like a weapon or massive amounts of unsafe medication), this is a very high-risk situation.
Do not leave them alone. If possible, stay with them. If not, get them to a safe place with someone else. You don’t want to be alone in this situation. Even if you think you will be safe, even driving to the nearest emergency room can become a life-threatening situation if they are actively wanting to die.
Get professional help immediately. This is not something you have to handle on your own. Call the National Suicide Prevention Lifeline at 988. They are available 24/7. Call 911 if they are in immediate danger.
Scenario B: They say "No, I'm not thinking about suicide." That's wonderful news, but your job isn't over.
Thank them for their honesty. "I'm so relieved to hear that. Thank you for being open with me."
Validate their pain. Don't say, "Oh good, so everything's fine then." Instead, say, "Even if you're not thinking about that, I can tell you're in a lot of pain. I'm here for you, and I want to help."
Offer support. "Let's grab a cup of coffee next week." "I'm here to listen whenever you need to talk." Encourage them to seek help from a professional, a doctor, or a therapist.
Regular check-ins are good. You actually want to be a little annoying and almost forceful here. A lot of folks, especially the ones suffering from depression “don’t want to be a burden” on someone else. Set up a daily text or phone check-in and try to do something social at least once a week. Why? One, because they could still be suffering…and two, they may not have been entirely honest with you about NOT being suicidal and trying to throw you off the trail. OR they may have felt surprised and defensive OR they may not have yet felt comfortable sharing that with you. Or anyone, for that matter.
In both scenarios, the most powerful thing you can do is listen without judgment. Don't say things like "You have so much to live for" or "Look on the bright side." That can minimize their pain. Or engage in toxic positivity and ignoring their current reality. Just listen. Let them know you hear them.
Suicide is not a character flaw. It's a mental health crisis. It’s not a character judgment. It doesn’t mean they’re weak. They are overwhelmed by life circumstances and likely crappy neurochemistry. Some of the coolest people I know have made it through the worse times imaginable and lived to tell the tale. These are also some of the most courageous, most resilient, and kindest people I know. Why? Because they know that life can break you down, but because they didn’t let it, they are leading by example.
By educating ourselves and having the courage to speak up, the courage to dissolve the taboo, we can change the narrative, and hopefully even the outcome. We can replace silence with conversation and despair with hope.
If you or someone you know is in crisis, please call or text 988 anytime in the US and Canada. In the UK, you can call 111. These are free, confidential resources that can provide immediate support.
In both cases, listen without judgment. Your presence, your willingness to listen, and your directness can be life-saving. Don’t NOT ask the question because you could be embarrassed. You will NEVER regret asking. You’ll get over the embarrassment a lot faster than you will their loss.
Thank you for listening today and for being a part of the mental health conversation. Let's make this September a month where we all commit to being a little more courageous, a little more compassionate, and a little more aware, and a lot more vocal. NO MORE TABOOS!