Starting The Conversation About Suicide

‘Are You Thinking About Killing Yourself?’

Chances are you know someone who has thought about killing themselves. In 2022, roughly 5 percent of adults had serious thoughts about suicide.

These are your friends. Your co-workers. Your neighbors.

In Indiana alone, 1,079 lives were lost to suicide and 262,000 adults had thoughts of suicide in 2020, the latest data available, according to the National Alliance of Mental Illness. In Illinois, the numbers were even greater: 1,488 lives were lost to suicide and 376,000 adults had thoughts of suicide.

And studies show people who have lost loved ones through suicide are more likely to have thoughts of suicide themselves.

“One basic misconception is that asking about suicide will make someone think about suicide,” said Tina Hoffmann, community improvement health coordinator for Franciscan Health’s Central Indiana communities. “This isn’t true. We ask about suicide to ensure both parties in the conversation are clear on what we are discussing.”

What Are Possible Warning Signs Of Suicide?

Some of the warning signs of suicide can be overt, such as comments like “I wish I was dead” or “I wish I wasn’t here.” Other warning signs can be less clear.

• New or increased alcohol and drug use
• Aggressive behavior
• Withdrawing from friends, family or activities that previously brought joy
• Dramatic mood swings
• Impulsive or reckless behavior
• Giving away possessions
• Unintentional weight loss
• Low energy
• Self-harm
• Lack of sleep
• Negative self-talk

Being aware of changes in a person’s behaviors and actively listening to a person can alert you to potential warning signs.

“Putting your phone away and having a conversation is a great gesture,” said Hoffmann, who teaches classes on suicide intervention. “You want to hear what’s going on. Life is hard, and we want to know what’s going on. Things build upon things.”

How Do You Ask Someone If They Are Having Suicidal Thoughts?

Talking about possible suicidal thoughts with another person admittedly can be uncomfortable.  Expressing support and concern about any changes in behaviors or life changes may be able to begin the conversation.

“We can’t stop life from happening to other people,” Hoffmann said.

Hoffmann encourages using compassion and empathy throughout the conversation, and speaking without judgement about the person’s choices or past actions.

“One of the first things I tell someone is ‘I care for you, maybe more than you can care for yourself right now,” she said. “I’m going to ask a hard question: Are you suicidal?’”

It’s important to be direct in asking about suicidal thoughts. Knowing the answer can help you support them in a positive way and potentially help them redirect from a decision to kill themselves.

“There’s really no downside other than it’s uncomfortable to us,” Hoffmann said. “I’m not going to be mad about you for caring about me.”

How To Turn A Conversation From Suicidal Thoughts To Thoughts Of Life?

If they’re still here, some part of them wants to still be alive, Hoffmann said. But finding the reasons why can be challenging.

Actively listening to the person and repeating back to them key comments can help a person identify what’s keeping them from making the choice for suicide.

“Any hope or uncertainty is sufficient to keep them alive,” she said. “It’s about them staying safe and identifying an option or reason to continue living. Ask them, ‘Is this important enough for you to stay safe for now?’ It boils down to ‘I care, I understand, and I’ll help.’”

How Can I Get Training On Suicide Prevention?

Franciscan Health is working to save lives through free courses designed to help professionals and the public recognize suicidal ideation and prevent death by suicide. These programs include:

• Question, Persuade, and Refer (QPR) Suicide Prevention Course, a free, two-hour training that equips participants to recognize the warning signs of a suicide crisis and how to question, persuade and refer someone to help.
• LivingWorks’ Applied Suicide Intervention Skills Training (ASIST), a free two-day workshop designed for all caregiver communities.

“You don’t have to be a physician or a skilled nurse to perform CPR and save a life, and you don’t have to be a psychologist or mental health clinician to save a life with these programs,” said Cathy Cinko, LCSW, CEAP, lead therapist for Franciscan Health’s Employee Assistance Program.

Role-playing in suicide-prevention classes helps normalize these conversations.

“My goal is to make people realize it’s not about fixing or solving but having empathy, listening and showing care,” Hoffmann said.

Stacy Zembala, BS HCM, community health improvement and community benefit coordinator for Franciscan Health Munster, Dyer and Crown Point, said she’s thankful for the opportunity to teach the courses.

“It feels like an honor to teach people how to save someone’s life, to share that knowledge in a safe environment where they can ask questions and express their feelings,” she said. “If we save one life, we know we’ve been successful.”

Listen Now: How To Ask Someone About Suicide 

Don’t wait for the “perfect moment” to ask about suicide; that moment will never come. Ask anyway. Because suicide is too important to keep secret. Franciscan Health QPR and mental health first aid instructor Tina Hoffman shares how to start the conversation about suicide.

10 Things To Say To Someone Considering Suicide

“How you ask about suicide matters,” Hoffmann added. “Be calm and be honest. It’s about us sitting and hearing their story that they might not have ever told before.”

Ten things you might ask a person considering suicide to help them share their story:

1. “What has changed for you in the last weeks or months?”
2. “It sounds to me like you need to talk about this.”
3. “I understand you’ve been through a lot.”
4. “What I heard you say was”
5. “It sounds like”
6. “Do you have anyone to talk to or share with?”
7. “Do you have a plan for how you would kill yourself?”
8. “Have you tried to hurt yourself?”
9. “You’re still here – and that says a lot. Can you stay safe for now and we can look for things that can support you?”
10. “How can I help you stay safe for now?”

Avoiding judgment matters. Avoid statements that add guilt such as “Suicide is wrong,” You don’t want to kill yourself,” or “That’s not a reason.”

“Their reason for thinking about suicide is important to them, even if it’s not important to you. Suicide for some people is impaired problem solving.”

However, solving the person’s problems is not the goal of suicide intervention; simply it’s helping the person stay safe for now.