By Mark D. Rego, MD
Each year, more than half a million people arrive at emergency rooms because they are contemplating suicide or because they have already hurt themselves. Despite the care they received, in the year that follows the visit, they are still at a high risk for suicide.
Of course, that outcome is a nightmare scenario for their loved ones. In the aftermath of suicide, family and friends often carry the burden of wondering what their role “should” have been in preventing the tragedy.
Accordingly, friends and loved ones deserve some guideposts for navigating what to do if someone they care about is at risk for suicide.
Predicting when someone is about to attempt to take their life is difficult. Indeed, that task should be left to the treating clinician. Your “job,” however, can involve watching for direct and indirect signs of suicidality and severe distress.
Direct signs are when someone you care about says they feel like hurting or killing themselves. Indirect signs are more subtle — the early warning signs that someone is worsening. For instance, they might make negative statements like, “life is not worth it anymore,” or “I am useless.” They may try to gather the means for self-harm, like saving up pills or acquiring a weapon.
Beyond noting the harmful behavior, you should not try to determine what the risk is. Rather, you should go directly to them and discuss what you’ve observed. Then, you can contact their clinician or other help. If a clinician is not available, then contact someone respected by the patient, like an authority figure, faith leader or anyone they feel close to and trust. Using this approach, you will be able to gather more information to share with the treatment team.
When discussing suicide, remember the following:
Naturally, there are times when the situation may get more complicated. What if, for example, you cannot be sure if your family member is being open and truthful with you? This (and other complexities) certainly happen. Rely on guidance from the treating clinician when you’re feeling uncertain.
As you help your friend or family member navigate treatment, it’s important that you know what sufficient mental health care looks like. Unfortunately, it’s common for patients to call their clinicians for help and to receive a voicemail instructing them to go to the ER or call 911 for any problems after office hours. This response is a sign that they may need a different clinician.
A visit to the ER is necessary in significant emergencies but can often be avoided. Unless urgent action is needed, it is better to work things out with the clinician, as they know the patient and can use the situation as a learning experience to manage difficulties in the future.
If the clinician feels a visit to the ER is necessary for safety, then they should make that decision and call the ER in order to give appropriate history and be in touch with the staff there to discuss follow-up.
Ideally, a clinician should follow three principles whenever they work with a patient thinking of suicide.
Your loved one may also need therapy around a recent crisis, like a break-up, job loss or other interpersonal problem. These interventions are an important part of treatment as they can decrease the pain from certain life events.
Ultimately, if they have had significant suicidal ideation, made a suicide attempt, been psychiatrically hospitalized or have a serious mental health condition, then it’s important to be prepared for a crisis.
Your role is not to know what treatment your loved one needs or when they need a specific intervention. Rather, it is to be a form of support and connection for them and a form of guidance for their providers. No one knows a person better than their friends and family members, making you an invaluable asset to the treatment team.
Dr. Mark D. Rego is a psychiatrist with 30 years of experience. He spent 25 years in practice and has now written a book, “Frontal Fatigue. The Impact of Modern Life and Technology on Mental Illness.” It will be out Oct. 12, 2021. Visit markdregomd.com for more information.
We’re always accepting submissions to the NAMI Blog! We feature the latest research, stories of recovery, ways to end stigma and strategies for living well with mental illness. Most importantly: We feature your voices.
Check out our Submission Guidelines for more information.
Call the NAMI Helpline at
text "NAMI" to 741741
Find Your Local NAMI