The Warning Signs of Suicide: How to Tell if Someone is Suicidal

If you're wondering how to tell if someone is suicidal, you've likely noticed some concerning comments or behavior from a loved one. While suicide tends to be an uncomfortable, even taboo topic for many, it's essential to talk about it and do everything possible to support the person.

Suicidal feelings or “suicidal ideation” is a common phenomenon, and it’s a matter of life and death. If you are feeling suicidal, there is help available. Call the 988 Suicide and Crisis Lifeline 24 hours a day to contact someone who can help.

IS PATH WARM: Warning Signs of Suicide

My friend Steve and I talked about him the last time we met for breakfast. The three of us had been college classmates, but Steve and Rich were closer in those years. A few years after graduating from school, Rich committed suicide by shooting himself. As Steve and I talked, neither of us could remember any sign or warning of his despair. He was there in our lives and then gone.

Unfortunately, my experience with my friend Rich is all too common. Many friends and family wonder, "What could I have done? How can I tell if someone is suicidal?"

Lanny Berman, Ph.D.  and Executive Director American Association of Suicidology, developed a mnemonic device to help determine if someone is suicidal. This device can help you pick up on some of the following warning signs associated with suicidal feelings.

  • I Ideation - directly or indirectly disclosed thinking of ending one’s life.
  • S Substance Use - misuse of alcohol or drugs.
  • P Purposeless - finding no meaning or value in living.
  • A Anxiety - a regular sense of being on edge; sleep problems.
  • T Trapped - thinking that there is no other solution.
  • H Hopelessness - and it will always be like this.
  • W Withdrawal - increased isolation from family, friends, and usual activities.
  • A Anger - rage at self or others.
  • R Recklessness - making risky and dangerous choices.
  • M Mood Change - endless despair or a sudden and unexplained release from it.

I've found this mnemonic helpful to identify someone, like my friend Rich, who may be struggling with mental illness, suicidal risk, and ideation. It can help friends and family offer support and keep their eyes open to a loved one who may experience suicidal feelings. While the IS PATH WARM device might not provide treatment options or help, identifying a suicide risk can help you intervene before it's too late. Once you've pinpointed the suicide risk, you can discuss it and encourage them to seek support before they attempt suicide.

Understanding Suicidal Ideation

Unfortunately, many of us have been affected by suicide in one way or another. Suicide rates show that it is a sadly common phenomenon in the United States. Whether through suicidal ideation expressed by a family member, friend, or coworker or if we've experienced our own struggles with depression, intrusive thoughts, and suicidal feelings, suicide has likely touched our lives.

Although many suicidal feelings stem from depression, they also relate to other mental health conditions, including anxiety, bipolar disorder, and OCD. Sometimes, people may have intrusive thoughts about suicide, even if they don't want or plan to attempt self-harm. Suicidal thoughts can be related to substance use disorder and addiction. In other cases, people may experience life circumstances, like legal, financial, social, or medical struggles, that can lead to impulsive acts and sudden feelings of suicidality. Facing the diagnosis of a major illness, sudden family violence, a breakup, or the loss of a job can cause a person to go into a mental health crisis. These circumstantial feelings can happen quickly, so it's important to be cognizant of a loved one's stability and health following a painful event or challenge.

By definition, suicide is death by injuring oneself with the intent or desire to die. Not everyone who experiences suicidal feelings attempts suicide, but many do. It's important to realize that suicidal ideation is dangerous and deadly. If a loved one expresses suicidal thoughts (or attempts), you should take them very seriously and encourage them to seek professional help.

In 2022, SAMHSA established the 988 National Suicide Prevention Lifeline. This nationwide service connects people with trained counselors and support 24 hours a day, 7 days per week. The line offers free, confidential crisis counseling for anyone experiencing these feelings.

The 988 Lifeline is an excellent resource for people. With one suicide every 11 minutes across the U.S., the line provides a valuable service. The Centers for Disease Control report that suicide increased by about 36% over the Covid-19 pandemic as people were more alone and experiencing social isolation. The number of people impacted by attempted suicide is much higher, with an estimated 12.3 million adults seriously contemplating suicide each year.

No demographic captures a "typical" person who experiences thoughts of suicide. These feelings can impact people of all ages, races, ethnicities, and socioeconomic statuses. However, some groups have a higher risk of suicide rates, including Native American people, veterans, those in chronic pain, people in the LGBTQ community, and people who live in rural areas.

There is also a tremendous financial toll on society, with suicide and suicide/self-harm attempts costing over $500 billion in value of life, medical expenses, work loss costs, and quality of life.

But beyond the monetary costs is the emotional toll on everyone impacted by the suicide or suicide attempt. Many friends and family members feel guilt, grief, anger, and anxiety following a loved one's suicide. There's often a great deal of self-blame and sorrow, especially when they feel they missed the signs or didn't intervene. It's important to recognize that you may also need to seek mental health assistance and support after the trauma of a loved one's suicide or suicide attempt.

Often suicidal feelings are connected to those who have experienced violence, abuse, and bullying. People who are suicidal often feel alone, isolated, and hopeless. By offering some forms of community support and assistance, people can get the more formal aid they need to address mental health and emotional challenges.

What to Do if You Suspect Someone is Suicidal

What should you do if your friend meets any of the criteria of IS PATH WARM? How do you help a friend who is suicidal?

Share the 988 Lifeline with them, tell them you value them, and express your caring and concern. For parents and guardians of adolescents, it's crucial to take their feelings seriously. If you notice signs of self-harm, depression, low self-esteem, or stress in a young person you care about, help them seek counseling and therapy to work through their feelings.

It's also important to recognize when and if suicidal ideation is escalating in young people. What is escalation, and what does it look like? It can include making plans, self-harm, drug use, saying things like, "I wish I wasn't here anymore," or other expressions of suicidal feelings. When these expressions become serious, parents and guardians may need to help therapists create an action or safety plan, lock up sharp and dangerous objects, and monitor their teens so they don't take their own life. Contact and work with a social worker or counselor to immediately help your adolescent and tell them about the suicidal behavior.

As for friends and family of older adults, in cases where you don't have medical oversight, intervention is unfortunately complicated. Without a signed, legal, medical release, you can't contact an adult’s therapist or medical provider. Even though you may leave a message to inform the provider of what you know, the medical or mental health professional won’t be able to call you back or speak to you without a signed release.

If you are extremely concerned that a suicide attempt is imminent or a friend is in immediate danger, you can contact the police and request a wellness visit. Keep in mind that most people facing suicidal ideation go through an in-between stage, where the feelings are there, but they don’t have an exact plan. They may lie to the police during a wellness check, insisting everything is fine. Watch for behavioral changes like increased use of alcohol, loss of interest in social activities, or a recent stressful experience, and encourage your loved one to seek support services.

The best thing to do for someone expressing suicidal feelings is to tell them that you care about them and offer them friendship and emotional support. Provide access to resources, like the 988 Lifeline, and encourage them to talk to a counselor or therapist for confidential support. Sometimes, simply "being there" for our loved ones can make all the difference. Express your concerns and your care for them.

To get more information about suicidal risk factors, you can visit Clancy Martin also wrote a book called How Not to Kill Yourself: A Portrait of a Suicidal Mind. The author discusses his feeling of suicidality and how he has worked through them. He had an interview on NPR, talking about the chronic disparity, his multiple suicide attempts, and how suicidality can become an obsession, a mental pattern, and an escape. He also talks about how grateful he is that his attempts have failed.

If you're concerned about your own mental health crisis or suicidal feelings, two excellent books can bolster your strength and work through feelings of despair: Endurance by Caroline Alexander and Unbroken by Laura Hillenbrand. These true stories—one of hardship and the other of wartime cruelty—are breathtaking descriptions of impossible conditions and human triumph. Sometimes, when we read and explore others who have overcome struggles, we can uncover our own strengths.

The most important thing you can do if you're feeling suicidal, or even if you have feelings and thoughts that make you sad, stressed, or uncomfortable, is to seek the guidance of a trained therapist, social worker, or mental health professional. Counseling can help you and your loved ones explore and overcome these feelings in a safe environment. If you need to talk to someone, please reach out today. Our team of licensed mental health professionals is ready to help you feel better in a supportive, judgment-free space.

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