Every year, over 500,000 people visit emergency rooms in the United States because they are thinking about suicide or have already self-harmed. Despite all of the care they received, they were still at an elevated risk of suicide a year after their visit.

A suicide is a tragedy for not only the individual, but also their loved ones. After such an event, it’s common for family and friends to reflect on what role they could’ve played in prevention.

Friends and loved ones often do not know what to do if they think someone they care about is suicidal. To help, here are some guideposts.

Observing For Signs Of Suicidality

It is difficult to predict when someone close to you might attempt suicide. If you are worried about someone, the best thing you can do is have a conversation with them and ask if they are thinking about harming themselves. You can also look for signs of suicidal thoughts or severe distress.

When someone you care about says they feel like suicide is the only way out, it’s known as an express sign. Indirect indicators are more subtle — early warning signals that someone is getting worse. They may say things like, “Life isn’t worth living anymore,” or “I am worthless.” They may attempt to save up pills or get a weapon in order to commit suicide.

After you have observed the harmful behavior, it is best to go directly to the patient and discuss what you saw. Then, you can reach out to their clinician or other help resources. If a clinician is not available, then try contacting someone respected by the patient that they feel close to and trust, like an authority figure or faith leader. With this approach, you will be able obtain more information to share with the treatment team which will be helpful in developing a care plan.

Talking Effectively About Suicidality

When discussing suicide, remember the following:

1. Saying the word “suicide,” or asking about how someone might harm themselves, will not cause someone to attempt suicide. In reality, directly discussing suicide is one of the most common and effective ways to intervene.
2. By being open to discussion, you are dissipating the power of negative thoughts. If your loved ones have been having suicidal thoughts, it may be reassuring for them to know that they can discuss the topic without upsetting you. On the other hand, if these thoughts are new for them, hearing you speak about it in a calm and serious manner may be comforting.
3. You should inquire about a specific strategy. How will they accomplish it? When? Inquire about the specifics of the plan. Let them know that you’d want them to contact their treatment team. If they refuse, you’ll need to talk with the treatment team yourself. You shouldn’t get into an argument during this conversation. If things appear to be out of control, call 911 and then the clinician who is treating your loved one.

Naturally, things may get more difficult from time to time. What if you can’t be sure whether or not your family member is being honest with you? This (and other issues) certainly does occur. When you’re unsure, trust the treating physician’s advice.

Knowing What Proper Treatment Looks Like

It’s vital to understand what adequate mental healthcare entails as you support a loved one through treatment. Regrettably, it’s not uncommon for patients who reach out to their clinicians for assistance outside of office hours to only get voicemails telling them to go to the ER or call 911 in case of an emergency. If this is the response they consistently receive, it may be time to switch clinicians.

In the event of a serious emergency, a trip to the ER is required; nevertheless, it might often be avoided. Unless immediate action is required, it’s preferable to work things out with the clinician since they are familiar with the patient and can use the situation as a learning experience in future. If the doctor believes a trip to the ER is necessary for safety, he or she should take that decision and call ahead to arrange appropriate background and stay in touch with personnel at the ER so that you may discuss follow-up.

When working with a patient who has considered suicide, a clinician should adhere to three principles.

1. As healthcare professionals, we are the protectors of our patients when they are unable to do so themselves. This includes being transparent with patients and their loved ones about what to expect, such as not leaving them alone for extended periods or coming in for emergency appointments if necessary. We will also be the ones to determine whether a medication adjustment or hospital visit is needed.
2. For a suicidal patient to feel connected, it is important that the practitioner builds a relationship with them. This could build connections with anyone, whether that be family members or other patients.
3. Treat the underlying problem with medication if possible. Medications, particularly those for anxiety and sleeplessness, have been found to lower suicide rates.

If your loved one is experiencing a recent crisis, like for example, a break-up or job loss, interventions around these events may become part of their treatment plan. These can help to lessen the pain from certain life occurrences. If they have been displaying serious signs of mental illness, such as suicidal ideation or attempts, psychiatric hospitalization ,then it’s vital to be prepared for any future crises.

Yours is not to figure out what treatment your loved one requires or when they require a certain therapy. Rather, it is to provide support and connection for them while also serving as a source of direction for their care providers. You are an important asset to the treatment team because no one knows someone better than their friends and family members, making you an invaluable part of the team.