14.8 — Suicide: What to Say and What to Do

If you are thinking about ending your life right now, call one of these. They are free, confidential and answered by people trained for exactly this.

In India: Tele-MANAS — 14416. Free, 24 hours, multiple languages. KIRAN — 1800-599-0019. Free, 24 hours. Emergency — 112.

If you are in immediate danger, or have taken something, call 112 or go to the nearest emergency department. Tell somebody where you are.

Read the next section even if nothing else on this page.

If it is you

Three things that are true and do not feel true right now.

The state is temporary even when the situation is not. Suicidal crises are frequently short — hours to days. The intensity you are feeling now is not a permanent reading of your life; it is a state, and states end. Studies of people who survived attempts find that a majority did not go on to die by suicide, and many report relief that they lived.

Your thinking is currently constricted. In this state, options narrow until it appears there is one. That narrowing is a feature of the crisis, not a discovery about reality. Other options exist and you cannot see them at the moment, and that is what the state does.

And you are not a burden. That specific belief — that others would be better off — is one of the most common features of suicidal thinking, and it is one of the most reliably wrong. The people who love you would not be relieved. They would be destroyed.

What to do now, in order.

Put distance between yourself and the means. Give the tablets to somebody. Leave the place. This one action saves more lives than any other, because crises pass and access at the wrong moment is what turns a crisis into a death.

Tell one person, in plain words. "I'm having thoughts of killing myself and I'm frightened." Say the actual words — people miss hints, and this is not the moment for hints.

Get through the next hour, not the rest of your life. Then the next one.

Do not be alone. Go to somebody, or ask them to come.

And do not use alcohol or drugs. They remove exactly the restraint you need right now.

If it is somebody else

Ask directly

The most important thing on this page.

"Are you thinking about killing yourself?"

Plain words. Not "you're not thinking of doing anything silly?"

Asking does not plant the idea. This is a myth, it is widespread, and the evidence is against it — asking about suicide does not increase risk and frequently reduces distress, because it gives permission to say something the person has been carrying alone.

And then be able to hear the answer. If you ask and they say yes, do not visibly panic. The next thing you say determines whether they keep talking.

Then

Listen, without arguing. Do not tell them what they have to live for. Do not explain how much it would hurt you — that adds guilt to somebody already convinced they are a burden.

Take it seriously. Every time. There is no such thing as an attempt that was only for attention — a person doing that is a person in enough distress to do it, and they need help either way.

Ask about the plan. "Have you thought about how?" A specific plan, a chosen method, a time, or having obtained the means indicates much higher risk and means acting now rather than later.

Reduce access to means. Ask directly to take them. This is the intervention with the strongest evidence behind it.

Do not leave them alone if the risk is immediate.

Get help with them, not for them. Make the call together. Go with them.

And do not promise secrecy. "I can't promise not to tell anybody, because I'm not going to let you die. I will tell you who I'm telling."

Afterwards

Follow up. The days and weeks after a crisis, and particularly after discharge from hospital, are a period of elevated risk. A message, a visit, a call — regular contact in that period has evidence behind it.

And keep treating them as a person rather than as a risk.

What raises risk

Not to diagnose — to know when to act.

Previous attempts. The strongest single predictor.

A specific plan and access to means.

Recent loss — a relationship, a job, a death, a humiliation.

Depression, particularly with hopelessness. Bipolar disorder. Psychosis. Alcohol and drug use, which is present in a large share of deaths because it removes restraint.

Physical illness, chronic pain, and recent discharge from psychiatric care.

Isolation.

And giving things away, sudden calm after a period of severe depression, saying goodbye, and putting affairs in order. The sudden-calm sign is dangerous and frequently misread as recovery — a decision made can produce peace.

Some facts worth having

Rates are higher in men in most countries, while attempts are more frequent in women — a pattern usually attributed to method and to help-seeking.

In India, suicide is a leading cause of death among young adults, and the rate is high by international comparison. Common contributing factors identified include family and relationship problems, illness, academic failure and financial distress.

Restricting access to means works at population scale. This is one of the best-established findings in prevention — barriers on bridges, restricting pesticide access, limiting pack sizes. Pesticide restriction in particular has been associated with substantial falls in suicide deaths in South Asia. The lesson: means matter, and removing them saves lives rather than displacing the death to another method.

And responsible reporting matters. Detailed coverage of method is associated with increases; coverage that includes help-seeking information is associated with decreases.

If you have lost somebody

It is a different grief, and the two things that make it harder are the why that has no answer and the guilt of things not noticed.

You could not have known. People conceal it, frequently completely, and hindsight (11.5) makes signs visible that were not visible at the time.

Bereavement by suicide carries elevated risk for the bereaved, which means your own support is not optional.

And specific support exists for people bereaved this way, and it helps more than general grief support.

What to do

Save 14416 and 112 in your phone now.

Learn the direct question — "are you thinking about killing yourself?" — and be willing to use it.

If somebody is at risk: ask, listen, remove the means, do not leave them, and go with them for help.

And if it is you: put distance between yourself and the means, tell one person in plain words, and get through the next hour. Call 14416. People are there right now, and this is exactly what they are for.

Next: 14.9 turns to a different question the evidence answers better than most people expect — how a criminal is actually made.