Suicidal thoughts - How to support someone

Overview

• People have suicidal thoughts for different reasons.
• If you’re worried that someone may be having suicidal thoughts, you can talk to them. You can ask them how they’re feeling.
• Talking to someone about their suicidal thoughts doesn’t usually make them more likely to end their life.
• You can help someone who is feeling suicidal by listening, without judging them.
• You can support someone to think about other options to deal with their feelings. Such as accessing support from the NHS, charities, or self-help.
• If someone is in crisis, you can help them to get support from mental health or emergency services.
• Supporting someone with suicidal thoughts might have an impact on you, so it might help you to get support.

About

Why do some people have suicidal thoughts?

There are different reasons why people have suicidal thoughts.

If someone is exposed to a ‘risk factor’, they’re more likely to have them.

A risk factor might include:

• A previous suicide attempt
• A family history of suicide
• Difficult life events, such as experiencing a traumatic childhood or physical or emotional abuse
• Stressful life events like a relationship ending or losing your job
• Feeling hopeless
• Feeling isolated or not having social support
• Anger at other people, often due to perceived or real mistreatment
• Acute emotional distress
• Excessive use of drugs or alcohol
• Living with a mental health condition
• Having a physical health condition, especially if this causes chronic pain or serious disability
• Problems with work or money

The more risk factors a person has, the more likely they’ll have suicidal thoughts.

People are more likely to take their own life if they have access to the means to do so.

Why might someone think about ending their life?

There are lots of reasons why someone might think about ending their life. Some reasons are to:

• escape what they feel is an impossible situation,
• relieve or end unbearable thoughts or feelings,
• relieve physical pain or incapacity, or
• emotionally hurt someone.

What kind of thoughts may someone have?

When someone has suicidal thoughts, they might think some of the things below:

• I have let myself and other people down
• I am a burden
• I am a failure
• No one needs me
• I’m not good enough
• There’s no point in living
• I will never find a way out of my problem
• I’m weak, I can’t bear this pain
• I have lost everything
• I’m useless
• Things will never get better for me
• Nobody cares about me
• I’ll show them what they have done to me
• If I die, it’s the best for everyone

Can medication cause suicidal thoughts?

Some studies suggest there can sometimes be a link between taking, or withdrawing from, medication and having suicidal thoughts. The medications include antidepressants and benzodiazepines.

Others think that the overall benefit to people of these medications outweigh the risk of suicidal thoughts.

The use of antidepressants isn’t usually recommended in children and young people under the age of 18. This is because there's evidence that, in rare cases, they can trigger thoughts about suicide and self-harm in this age group.

Someone you know might start to have suicidal thoughts after beginning taking or withdrawing from medication for mental health. If they do, suggest they urgently contact their GP or psychiatrist for advice.

For more information see our webpages on the following:

• Antidepressants
• Benzodiazepines
• Medication – Choice and managing problems
• Suicidal thoughts – How to cope

Warning signs

What are the signs that someone might be having suicidal thoughts?

A change in someone’s personality or behaviour might be a sign that they are having suicidal thoughts. You may be the best judge of when someone you know is behaving differently.

Changes can include:

• Becoming anxious or restless
• Being more irritable or agitated
• Being more confrontational or angry
• Becoming quiet and distant
• Having mood swings
• Acting recklessly, such as taking risks they wouldn’t normally
• Sleeping too much or too little
• A lack of energy
• Not wanting to be around other people
• Avoiding contact with friends and family
• Saying they feel hopeless or worthless
• Saying they can’t see a way out of a difficult situation
• Finding it hard to cope with daily issues
• Having problems with work or studying
• Saying negative things about themselves

The following things could indicate that someone is thinking of attempting suicide:

• Threatening to hurt or kill themselves
• Talking or writing about death, dying or suicide
• Saying goodbye or sending messages that feel like an ending
• Preparing or making plans to end their life, such as storing up medication
• Putting their affairs in order, such as giving away belongings or making a will

Sometimes, signs that something is wrong can be more difficult to spot. Like cheeriness which may seem fake to you. Or they may joke about their emotions, such as saying something quite alarming that is disguised as a joke.

There are things you can do if:

• you’re worried about someone, but they won’t talk about how they’re feeling, or
• someone tells you they’re having suicidal thoughts.

It’s best to take action if:

• your gut feeling is that someone is having suicidal thoughts, or
• they are experiencing mental health issues and you’re worried about them.

See the next section below for advice and information and what action you can think about taking.

Are people who live with a mental illness at greater risk of suicide?

People living with a mental illness are more likely to feel suicidal and attempt suicide.

Research shows that someone is more likely to attempt suicide if they’ve recently been discharged from a mental health facility.

Is there a link between self-harm and suicide?

Self-harm means that someone harms themselves on purpose. Self-harm isn’t a mental health condition, but it is often linked to mental distress.

Someone who self-harms doesn’t usually want to die. They may self-harm to deal with life, rather than as a way of trying to end it.

But people who self-harm are more likely to die through suicide.

See our webpage on Self-harm for more information.

Helping someone

How can I help someone who is having suicidal thoughts?

If you think that someone might be having suicidal thoughts, you can encourage them to talk about how they’re feeling.

You might feel uncomfortable talking about suicidal feelings. You might not know what to say. This is entirely normal and understandable. It might help to.

• Let them know that you care about them and that they aren’t alone
• Empathise with them. Be aware you don’t know exactly how they feel. You could say something like, ‘I can’t imagine how painful this is for you, but I would like to try to understand’
• Be non-judgemental by trying not to criticise or blame them
• Repeat their words back to them in your own words. This shows that you are listening. Repeating information can also make sure that you have understood it properly
• Ask about their reasons for living and dying and listen to their answers. Try to explore their reasons for living in more detail
• Focus on people they care about, and who care about them. And who they might hurt by leaving them behind
• Ask if they have felt like this before. If so, ask how their feelings changed last time
• Reassure them that they won’t feel this way forever, and that intensity of feelings can reduce in time
• Encourage them to focus on getting through the day rather than focussing on the future
• Ask them if they have a plan for ending their life and what it is.
• Encourage them to seek help that they are comfortable with. Such as help from a doctor or counsellor, or support through a charity such as the Samaritans
• Follow up any commitments that you agree to
• Make sure someone is with them if they’re in immediate danger
• To help them to get professional help
• Get support for yourself. See the next section below for more information.

Remember that you don’t need to find an answer, or even to completely understand why they feel the way they do. Listening to what they have to say will at least let them know you care.

If they’re not ready to talk, you can say you’re there for them if they want to later. But showing that you’re there for them can be helpful.

If you’re unsure if someone is having suicidal thoughts, you can ask:

• “Are you thinking about suicide?”,
• “Are you having thoughts of ending your life?”, or
• “Are you thinking about killing yourself?”

If can often be better to ask direct questions rather than vague ones. It’s usually better to address the person’s feelings directly rather than avoiding them. Asking someone about suicide doesn’t usually mean that they’re more likely to kill themselves. And it might be a relief to them to talk about it.

What won’t usually help someone who is feeling suicidal?

When someone tells you that they are feeling suicidal your first thoughts may be to:

• Try and find a solution to their problems
• Tell them to ‘cheer up’, ‘pull themselves together’, ‘man up’ or ‘snap out of it’
• Change the subject
• Give them advice
• Ask questions unrelated to how they’re feeling, to distract them
• Tell them that they have no reason to feel like that
• Tell them that they shouldn’t feel like that, or they’ll feel better soon
• Downplay the seriousness of how they’re feeling
• Compare their situation to someone’s whose seems worse
• Tell them you know how they feel
• Compare their feelings to your own personal experiences
• Tell them that they should be grateful for having a good life
• Tell them that are being silly

These responses are unlikely to be helpful. They may make someone feel:

• ‘small’ or insignificant,
• stupid for feeling the way they do,
• rejected,
• unheard,
• alone,
• like ‘no one understands,’
• guilty,
• patronised,
• criticised, or
• analysed.

Reassurance, respect, and support can help someone to recover from a difficult time.

You can find more suggestions of how to support someone on the Mental Health UK website here: www.mentalhealth-uk.org/suicide

What if someone is saying they want to end their life now?

Talking about suicide can sometimes be a plea for help. But don’t assume that someone won’t attempt to take their own life if they talk about suicide. Always take suicidal feelings seriously.

You may talk to someone about their feelings, and it seems as though they want to end their life soon. Try to keep them safe in the short term.

How do I keep them safe?
You can help them by:

• Not leaving them on their own
• Talking to them. See the beginning of this section for more information
• Seeking professional help. See the next section below for more information
• Helping them to create a crisis plan
• Removing items that they can end their life with. Examples include:
  
  • sharp objects such as razor blades and knives,
  • cleaning products,
  • drugs or medication, and
  • belts, cords, wires and rope.

What’s a crisis plan?

A crisis plan is sometimes called a safety plan. Ideally a crisis plan should be made before someone is in crisis, but it is never too late to start.

If someone is being supported by a NHS mental health team, they might already have a crisis plan in place. You can ask them to show you their crisis plan if they have one. But it is their choice whether to show you.

The aim of a crisis plan is to think about what support someone needs when they are in crisis. This may include:

• not being alone,
• removing certain objects from the home,
• talking to a certain person or helpline,
• talking to a professional,
• distraction techniques, and
• including reasons to live, such as pictures of family.

Distraction techniques can include:

• Read a book or magazine
• Watch a film or TV
• Go to a museum
• Walk in a green space like a park
• Draw or paint
• Listen to music
• Sing
• Listen to nature
• Spend time with a pet

You can find some more ideas of distraction techniques here: www.papyrus-uk.org/wp-content/uploads/2018/10/Distraction-Techniques.pdf

Remember to write down the names and contact details of people who would be able to help them.

There is no set way for how a crisis plan should look. There is a crisis plan template at the end of the factsheet that you can download by clicking the link at the top of this page.

You may find it useful to have your own copy of their crisis plan. So, you know what to do to help them if they’re in crisis.

For more information see our webpages on the following:

• Suicidal thoughts – How to cope
• Worried about someone’s mental health?
• Getting help in a crisis

Support services

What services can help someone who is having suicidal thoughts?

People who have suicidal thoughts can experience them differently. Some might actively be planning to end their lives. Others might have the thoughts without planning to act on them.

There are different options for professional support, depending on the situation of the person experiencing suicidal thoughts. There is information on these options below.

If you think their life is in danger, you can act immediately. A mental health emergency should be taken as seriously as a physical one. You’ll not be wasting anyone’s time.

Emergency services and accident and emergency (A&E)

If someone is in immediate danger of taking their own life you can:

• call emergency services on 999 to ask for an ambulance, or
• take them to A&E at their local hospital.

Paramedic and hospital staff will decide on the best support for them. This might be things like support in the community from an NHS crisis team or admission to hospital.

Contact the local NHS urgent mental health helpline

The NHS urgent mental health helplines are for people of all ages.

You can call for:

• 24-hour advice and support for you or someone you care for,
• help to speak to a mental health professional, and
• an assessment to help decide on the best course of care.

You can find details of your local NHS urgent mental health helpline at: www.nhs.uk/service-search/mental-health/find-an-urgent-mental-health-helpline. Or you can call NHS 111 to ask them for details.

NHS crisis team or home treatment team

NHS crisis teams give short term support for people having a mental health crisis. They’re sometimes called the home treatment team. They try and prevent people from needing to go to hospital and should be available to contact 24 hours a day, 7 days a week.

You usually need a medical professional to refer someone to the NHS crisis team. Such as the person’s GP or someone from the NHS urgent mental health helpline.

If they’ve been supported by the crisis team before, they might be able to contact them directly for support.

Community mental health team (CMHT)

If a person is with their local NHS CMHT, they might be able to help from them. They can contact their care coordinator, normal point of contact or whoever is on duty that day.

GP

The person’s GP might be able to offer an emergency appointment and support. Or the surgery might have trained mental health workers who can help.

If the person you care for is refusing to seek help, you may want to let the their GP know your concerns. Professionals might need to share the information you give with your relative. If you don’t want this, you can explain to the professionals how it might affect your relationship.

For more information see our webpages on the following:

• Confidentiality and information-sharing, and
• GPs and your mental health

NHS 111

You can call the NHS on 111 or visit their website www.111.nhs.uk . They can advise you if you have an health problem and you’re not sure what to do. They’ re open 24 hours a day, 7 days a week.

Crisis or recovery house

Crisis or recovery houses provide short-term accommodation where staff support people who are having a mental health crisis.

These services aren’t provided in every area but ask your local NHS urgent mental health line about them. Or you can search online, typing in ‘crisis house [location]’. You usually need to be referred by a NHS mental health or social services professional.

Some areas might have drop-in sanctuaries, safe havens or crisis cafes as a supportive place for someone to go during a crisis. You can search online to see if there are any in your local area.

Emotional support services

Emotional support services help by listening to someone’s concerns and giving them space and time to talk through how they feel. Emotional support services aren’t the same as counselling services, but staff are trained skilled listeners.

You can find details of emotional support services in the Useful contacts section at the bottom of this page.

Use Shout text service

Shout is a free, confidential, 24/7 text messaging support service for anyone who finding it hard to cope. They can text Shout to 85258 to connect to a trained person to help them. See www.giveusashout.org for more information.

NHS talking therapy services

NHS talking therapy services are sometimes known as ‘IAPT’ services. IAPT stands for Improving Access to Psychological Treatments. If the person you care for doesn’t need urgent support, they might be a service that can help them.

They are free to use and provide talking therapies, group support and online tools. You can self-refer to your local service. If the service think it’s necessary, they might recommend that you be referred to a specialist NHS mental health team.

You can find your local NHS talking therapy service by calling NHS111 or searching on the following NHS website: www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/nhs-talking-therapies

See our webpage on Talking therapies for more information.

What happens next after services are involved?

There can be different next steps depending on the situation of the person experiencing suicidal thoughts. Some outcomes might be.

• Being supported in the community by the local NHS crisis team or community mental health team. Or another specialist NHS mental health service.
• Being supported in the community by their GP and other primary care services. Such as their local NHS talking therapy service.
• Going to hospital as a voluntary patient. This means that they agree to be in hospital and can leave at any time, even if professionals advise against that.
• Going to hospital under the Mental Health Act. This means that they are being detained in hospital against their will. This is sometimes known as being ‘sectioned.’ This will only happen if they are a serious risk to themselves or other people because of their mental health. And they need assessment or treatment in hospital.

You might think the person you care for is a serious risk to themselves or other people because of their mental health. You can ask services to do a Mental Health Act assessment.

For more information see our webpages on the following:

• Getting help in a crisis,
• NHS mental health teams, and
• Mental Health Act

Getting support

How can I get support for myself?

If you know someone who talks about suicide or has attempted it, you might feel a mix of emotions. Such as feeling upset, frustrated, confused, guilty, angry or scared. These are all normal responses.

Supporting a person who has suicidal thoughts can be emotionally draining, so you might need support yourself. You could try the following.

• Talk to friends and family.
• Talk to an emotional support helpline. There is a list of emotional support lines in the Useful contacts section at the bottom of this page.
• Talk to your GP about medication or talking therapies for yourself.
• Talk to their care team or their local council about a carer’s assessment.
• Join a carers service. They are free and available in most areas. You can look on the following websites Carers UK: www.carersuk.org and Carers Trust: www.carers.org/search/network-partners
• Join a carers support group for emotional and practical support. Or set up your own.
• Join online support forums and groups.
• Join or lead on a campaign. Sometimes it can be helpful to connect with others and be involved in something that makes positive change. For example, Samaritans run suicide prevention campaigns: www.samaritans.org/support-us/campaign
• Take some time to concentrate on yourself.

What is a carer’s assessment?
You have a right to have a carer’s assessment through the local authority if you need support as a carer. A carer’s assessment will work out what effect your caring role is having on your health. And what support you need, such as practical support and emergency support. You might get support from social services if you meet the eligibility criteria.

To get a carer’s assessment you need to contact the local authority of the person you support.

It’s common for people to not consider themselves to be a carer. If you give someone lots of support, such as emotional or practical support, you are a carer.

How do I get support from my peers?
You can get peer support through carer support services or carers groups. You can search for local groups in your area on the internet. You can find all Rethink Mental Illness peer support groups here: www.rethink.org/help-in-your-area/support-groups.

For more information see our webpages on the following:

• Carer’s assessment
• Supporting someone with a mental illness

Further reading

Mental Health UK
Resources and information about suicide for friends and family.

www.mentalhealth-uk.org/suicide

UK National Suicidal Prevention Strategy
Research publication about suicide prevention in the UK.

www.researchbriefings.files.parliament.uk/documents/CBP-8221/CBP-8221.pdf

Royal College of Psychiatrists’ Suicidal Prevention National Transformation Programme
NHS England’s multi-agency programme for suicide prevention across 37 areas in England. To reduce deaths by suicide by 10% by 2020/21.

www.rcpsych.ac.uk/improving-care/nccmh/national-suicide-prevention-programme

National Suicidal Prevention Alliance (NSPA)
An alliance of over 1,000 public, private, voluntary, and community organisations working to prevent suicide in England.

www.nspa.org.uk

Stay Alive app
The Stay Alive app is a pocket suicide prevention resource for the UK, which includes useful information to help you stay safe. You can use it if you are having thoughts of suicide or if you are concerned about someone else who may be considering suicide.
In addition to the resources, the app includes a safety plan, customisable reasons for living, and a life box where you can store photos that are important to you.

Website: www.prevent-suicide.org.uk/find-help-now/stay-alive-app

Useful contacts

Samaritans
The Samaritans give people confidential emotional support. In some areas they have local branches where you can go for support.

Telephone: 116 123 (UK) (24 hours)
Address: PO Box RSRB-KKBY-CYJK, P.O. Box 90 90, Stirling FK8 2SA
Email: jo@samaritans.org
Website: www.samaritans.org

ASSISTline
National helpline offering supportive listening service to anyone throughout the UK with thoughts of suicide or thoughts of self-harm. They are open 24/7 for those aged 18 or over.

Telephone: 0800 689 5652
Website: www.spbristol.org/NSPHUK

Saneline
Work with anyone affected by mental illness, including families, friends and carers. They also provide a free text-based support service called Textcare. And an online supportive forum community where anyone can share their experiences of mental health.

Telephone: At the time of writing, because of the COVID pandemic the usual number of 0300 304 7000 isn’t in operation. But you can call 07984 967 708 and leave a message and someone will get back to you. The Support Forum, Textcare and other services are operating as normal.

Textcare: www.sane.org.uk/what_we_do/support/textcare
Support Forum: www.sane.org.uk/what_we_do/support/supportforum
Website: www.sane.org.uk

CALM (The Campaign Against Living Miserably)
CALM is leading a movement against suicide. They offer accredited confidential, anonymous and free support, information and signposting to people anywhere in the UK through their helpline and webchat service.

Telephone: 0800 58 58 58
Webchat: www.thecalmzone.net/help/webchat
Website: www.thecalmzone.net

PAPYRUS (prevention of young suicide)
Charity that offers emotional support to people under 35 who are suicidal. They can also support people who are concerned about someone under 35 who might be suicidal.

Telephone: 0800 068 41 41
Text: 07786 209697
Email: pat@papyrus-uk.org
Website: www.papyrus-uk.org

SOS Silence
SOS silence brings together anyone affected by suicide, whether they be bereaved, having thoughts of suicide, or have attempted suicide. They have a listening support service, and in-person support groups.

Telephone: 0300 1020 505
Email: support@sossilenceofsuicide.org
Website: www.sossilenceofsuicide.org

The Mix
If you’re under 25 and need help but don’t know where to turn, call the Mix for free. They’ll explore your situation with you and find organisations that may be able to help you further.

Telephone: 0808 808 4994
Crisis support: text THEMIX to 85258 for crisis support (24 hours a day, every day) - www.themix.org.uk/get-support/speak-to-our-team/crisis-messenger
E-mail: www.themix.org.uk/get-support/speak-to-our-team/email-us
Telephone Counselling: www.themix.org.uk/get-support/speak-to-our-team/the-mix-counselling-service
Webchat: www.themix.org.uk/get-support/speak-to-our-team
Website: www.themix.org.uk

Shout
If you’re experiencing a personal crisis, are unable to cope and need support, text Shout to 85258. Shout can help with urgent issues such as suicidal thoughts, abuse or assault, self-harm, bullying and relationship challenges.

Text: Text Shout to 85258
Website: www.giveusashout.org

Support Line
Support line offers confidential emotional support by telephone, email and post. They try to help people find positive ways to cope and feel better about themselves.

Telephone: 01708 765200
Address: SupportLine, PO Box 2860, Romford, Essex RM7 1JA
Email: info@supportline.org.uk
Website: www.supportline.org.uk

Maytree
Maytree is a national registered charity based in London. They provide a unique residential service for people in suicidal crisis so they can talk about their suicidal thoughts and behaviour. They offer a free 4 night, 5 day one-off stay to adults over the age of 18 from across the UK. Their aim is to provide a safe, confidential, non-medical environment for their guests

Telephone: 020 7263 7070
Address: 72 Moray Road, Finsbury Park, London, N4 3LG
Email: maytree@maytree.org.uk
Website: www.maytree.org.uk