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Are you thinking about killing yourself?

Have you decided how you would kill yourself? Do you have a plan?

Have you decided when you would do it?

Have you taken any steps to secure the things you would need to carry out your plan?

MH First Aid USA, p. 137

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NATIONAL
1-800-SUICIDE (784-2433)

1-800-273-TALK (8255)

1-800-799-4TTY )for hearing & speech impaired)

LOCAL
211 or 740-345-4357

Under 17: 614-722-1800

18 & older: 614-276-2273

TEXT 4HOPE to 741741

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American Foundation for Suicide Prevention

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Let's say you're having an open, honest conversation with someone about mental health - you can find tips on how to do that - and they feel comfortable enough with you to reveal that they're having thoughts of suicide. You probably feel an immense amount of pressure. How should you respond? What can you do to connect them to help?

First of all, realize that someone opening up in this way is a positive thing, because it's an opportunity to help. Here are some ways you can respond.
Let them know you're listening
First of all, reassure them you hear what they're saying, and that you're taking them seriously.

"I'm so glad you're telling me about how much has been going on, and how you're feeling. Thank you for sharing this with me."
Show your support
In your own way, make sure they know you're there with them, and that you care.

"I'm right here with you."

"Nothing you're going through changes how I feel about you, and how awesome I think you are."

"I love you no matter what, and we're going to get through this together."
Encourage them to keep talking - and really listen
Let them know you want to hear more about how they're feeling, and what they're going through. Listen actively by expressing curiosity and interest in the details.

"Wow - that situation sounds really difficult."

"How did that make you feel when that happened?"
Ask them about changes in their life and how they are coping
Find out how long it's been that the person has been feeling this way, and any changes it's caused in their life.

"How long have you felt this way? When did these feelings start?"

"Have these thoughts led to any specific changes in your life, like trouble sleeping, or keeping up with work?"

"Have you been getting out as much as before? Are you isolating yourself?"
Be direct if you suspect they're thinking about suicide
If you think someone's thinking about suicide, trust your gut and ask them directly. Research shows it will not put the idea in their head, or push them into action. Often, they'll be relieved someone cares enough to hear about their experience with suicidal thoughts.

"Are you thinking about killing yourself?"

"Does it ever get so tough that you think about ending your life?"

Make sure not to sound like you're passing judgment ( DON'T say: "You're not thinking of doing something stupid, are you?") or guilt-trip them (DON'T say: "Think of what it would do to your parents.")

Instead, reassure them that you understand and care.

"I really care about you, and I want you to know you can tell me anything."
What can you say if they tell you they're thinking about killing themselves?
Stay calm - just because someone is having thoughts of suicide, it doesn't mean they're in immediate danger. Take the time to calmly listen to what they have to say, and ask some follow-up questions.

"How often are you having these thoughts?"

"When it gets really bad, what do you do?"

"What scares you about these thoughts?"

"What do you need to do to feel safe?"

Reassure them that help is available, and that these feelings are a signal that it's time to talk to a mental health professional.

"The fact that you're having these thoughts tells me something significant is going on for you right now. The good news is, help is out there. I want to help you get connected to resources that can help."
Follow their lead, and know when to take a break
This is a tough conversation to have, so make sure the other person knows they can stop if it feels like talking about it is too hard for them at the moment.

"Are you okay with continuing to talk about this?"

"I want to support you, and I'll be here if you want to talk more later."
How to suggest they could benefit from professional help
You are being a great person in having this supportive conversation - but you're not a mental health professional. If the person you care about has told you they're thinking of suicide, it's a warning sign that they should speak with a mental health professional. Here's how you can broach the subject.

"I hear you that you're struggling, and I think it would really be helpful for you to talk to someone who can help you get through this."

"You know, therapy isn't just for serious, "clinical" problems. It can help any of us process any challenges we're facing - and we all face serious stuff sometimes."

"I really think talking to someone can help you gain some perspective, and keep things from getting worse."

"You're in good company: the highest-performing executives and elite athletes lean on mental health professionals to hone their performance. Reaching out for professional guidance and therapy is a strong thing to do, and it can make all the difference."
Help them connect
Sometimes making that first moment of contact to professional help can be the hardest. Offer to help them connect in whatever way you're comfortable with.

"I could call your insurance with you, or go online to find a mental health professional or substance use program. Or I could sit with you while you do it. We can figure it out together."

"I could drive or walk you to your appointment. Then we could have coffee afterwards."
If they're concerned about privacy
If the person is worried about others finding out that they're getting treatment, let them know their worries are mostly unfounded.

"Mental health treatment actually has even greater confidentiality safeguards than physical health treatment."

"Most people realize that mental health is an extremely important, valid part of health in general - and we all have various kinds of health issues. People who get support for their mental health are seen as strong, smart and proactive."

If they ask you not to tell anyone, tell them you want to help them get the support they need - and that that may involve enlisting the help of others. Encourage them to be part of the conversation that happens in reaching out for help, and reassure them you'll be as discreet as possible in your effort to keep them safe.
What if they refuse?
Not everyone is ready right away. If someone you know is struggling refuses your suggestion of professional help (and if they aren't in immediate danger, i.e. that they are not presently self-harming or about to), be patient and don't push too hard.

"It's okay that it doesn't sound like you're ready yet. I really hope you'll think about it. Just let me know if you change your mind, and I can help you connect with someone."

"I know you're going through a lot, and I really believe it can make a big difference for your life, and your health. Just consider it for later, and know I'm here to help."

"If you're not ready to go in and meet with someone in person, you could call the National Suicide Prevention Lifeline at 1-800-273-8255, or if you don't feel like speaking, just text TALK to the Crisis Text Line at 741741. They can tell you more about what it might be like to work with a doctor, counselor or therapist."

You can also offer to speak with their primary care provider as a gentle next step - family and friends can provide information to health care providers without expecting a call back or for the HCP to provide any confidential health information back.
When the convo's winding down...
End the conversation by reiterating that you are so glad for the chance to connect on this deeper level about such meaningful things in life. Remind them that we all have challenges at times, and that you'll continue to be there for them.
* If they're in immediate danger Check out (and share) our other AFSP #RealConvo Guides: How to Start (and Continue!) a Conversation About Mental Health: A #RealConvo Guide from AFSP Reaching Out for Help: A #RealConvo Guide from AFSP How to Talk to a Suicide Loss Survivor: A #RealConvo Guide from AFSP

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If Someone Tells You They're Thinking About Suicide: A #RealConvo Guide from AFSP

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Let's say you're having an open, honest conversation with someone about mental health - you can find tips on how to do that - and they feel comfortable enough with you to reveal that they're having thoughts of suicide. You probably feel an immense amount of pressure. How should you respond?

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https://www.mentalhealthfirstaid.org/cs/wp-content/uploads/2014/05/Youth-Mental-Health-First-Aid-Overview.pdf