Suicide Prevention

It can be frightening if someone you love talks about suicidal thoughts. It can be even more frightening if you find yourself thinking about dying or giving up on life. Not taking these kinds of thoughts seriously can have devastating outcomes, as suicide is a permanent solution to (often) temporary problems.

 

Suicide is a major public health concern. Over 48,000 people died by suicide in the United States in 2018; it is the 10th leading cause of death overall. Suicide is complicated and tragic, but it is often preventable. Knowing the warning signs for suicide and how to get help can help save lives.

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Immediate

Help

Call 911 if you or someone you know is in immediate danger or go to the nearest emergency room.

 

National Suicide Prevention Lifeline

Call 1-800-273-TALK (8255); En Español 1-888-628-9454
The Lifeline is a free, confidential crisis hotline that is available to everyone 24 hours a day, seven days a week. The Lifeline connects callers to the nearest crisis center in the Lifeline national network. These centers provide crisis counseling and mental health referrals. People who are deaf, hard of hearing, or have hearing loss can contact the Lifeline via TTY at 1-800-799-4889.

 

Crisis Text Line

Text “HELLO” to 741741
The Crisis Text hotline is available 24 hours a day, seven days a week throughout the U.S. The Crisis Text Line serves anyone, in any type of crisis, connecting them with a crisis counselor who can provide support and information.

 

Veterans Crisis Line

Call 1-800-273-TALK (8255) and press 1 or text to 838255
The Veterans Crisis Line is a free, confidential resource that connects veterans 24 hours a day, seven days a week with a trained responder. The service is available to all veterans, even if they are not registered with the VA or enrolled in VA healthcare. People who are deaf, hard of hearing, or have hearing loss can call 1-800-799-4889.

 

Disaster Distress Helpline

Call 1-800-985-5990 or text “TalkWithUs” to 66746

The disaster distress helpline provides immediate crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster. The helpline is free, multilingual, confidential, and available 24 hours a day, seven days a week.

 

Symptoms

Suicidal behaviors are a psychiatric emergency. If you or a loved one starts to take any of these steps, seek immediate help from a health care provider or call 911:

  • Collecting and saving pills or buying a weapon

  • Giving away possessions

  • Tying up loose ends, like organizing personal papers or paying off debts

  • Saying goodbye to friends and family

If you are unsure, a licensed mental health professional can help assess.

Here are a few other warning signs of suicide:

  • Talking about wanting to die or wanting to kill themselves

  • Talking about feeling empty, hopeless, or having no reason to live

  • Making a plan or looking for a way to kill themselves, such as searching for lethal methods online, stockpiling pills, or buying a gun

  • Talking about great guilt or shame

  • Talking about feeling trapped or feeling that there are no solutions

  • Feeling unbearable pain (emotional pain or physical pain)

  • Talking about being a burden to others

  • Using alcohol or drugs more often

  • Acting anxious or agitated

  • Withdrawing from family and friends

  • Changing eating and/or sleeping habits

  • Dramatic mood swings

  • Showing rage or talking about seeking revenge

  • Taking great risks that could lead to death, such as driving extremely fast

  • Talking or thinking about death often

  • Displaying extreme mood swings, suddenly changing from very sad to very calm or happy

  • Giving away important possessions

  • Saying goodbye to friends and family

  • Putting affairs in order, making a will

 

Treatment

Brief Interventions

 

Psychotherapies
Multiple types of psychosocial interventions have been found to help individuals who have attempted suicide (see below). These types of interventions may prevent someone from making another attempt.

  • Cognitive Behavioral Therapy (CBT) can help people learn new ways of dealing with stressful experiences through training. CBT helps individuals recognize their thought patterns and consider alternative actions when thoughts of suicide arise.

  • Dialectical Behavior Therapy (DBT) has been shown to reduce suicidal behavior in adolescents. DBT has also been shown to reduce the rate of suicide in adults with borderline personality disorder, a mental illness characterized by an ongoing pattern of varying moods, self-image, and behavior that often results in impulsive actions and problems in relationships. A therapist trained in DBT helps a person recognize when his or her feelings or actions are disruptive or unhealthy, and teaches the skills needed to deal better with upsetting situations.


Medication

 

Collaborative Care

Collaborative Care has been shown to be an effective way to treat depression and reduce suicidal thoughts. A team-based Collaborative Care program adds two new types of services to usual primary care: behavioral health care management and consultations with a mental health specialist.

The behavioral health care manager becomes part of the patient’s treatment team and helps the primary care provider evaluate the patient’s mental health. If the patient receives a diagnosis of a mental health disorder and wants treatment, the care manager, primary care provider, and patient work together to develop a treatment plan. This plan may include medication, psychotherapy, or other appropriate options.

Later, the care manager reaches out to see if the patient likes the plan, is following the plan, and if the plan is working or if changes are needed to improve management of the patient’s disorders. The care manager and the primary care provider also regularly review the patient’s status and care plan with a mental health specialist, like a psychiatrist or psychiatric nurse, to be sure the patient is getting the best treatment options and improving.

 

Medication

Guide

Some individuals at risk for suicide might benefit from medication. Doctors and patients can work together to find the best medication or medication combination, as well as the right dose. Because many individuals at risk for suicide often have a mental illness and substance use problems, individuals might benefit from medication along with psychosocial intervention.

Clozapine is an antipsychotic medication used primarily to treat individuals with schizophrenia. To date, it is the only medication with a specific U.S. Food and Drug Administration (FDA) indication for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder.

If you are prescribed a medication, be sure you:

  • Talk with your doctor or a pharmacist to make sure you understand the risks and benefits of the medications you're taking.

  • Do not stop taking a medication without talking to your doctor first. Suddenly stopping a medication may lead to "rebound" or worsening of symptoms. Other uncomfortable or potentially dangerous withdrawal effects also are possible.

  • Report any concerns about side effects to your doctor right away. You may need a change in the dose or a different medication.

  • Report serious side effects to the FDA MedWatch Adverse Event Reporting program online or by phone at 1-800-332-1088. You or your doctor may send a report.


Other medications have been used to treat suicidal thoughts and behaviors, but more research is needed to show the benefit of these options. For basic information about these medications, you can visit the NIMH Mental Health Medications webpage. For the most up-to-date information on medications, side effects, and warnings, visit the FDA website.

 
 

Additional

Resources

Support Programs

Blogs

  • The Kim Foundation: A supportive resource for lives touched by mental illness and suicide

Books

Articles

Websites

  • National Suicide Prevention Lifeline

  • Lifeline - 24-hour crisis support and suicide prevention services.

  • S.A.F.E. ALTERNATIVES - Committed to helping you and others achieve an end to self-injurious behavior

  • Stigma-Free Society - A resource for parents, guardians, and caregivers to talk to their teens about mental wellbeing

  • The Mighty - A community to share and interact with others going through mental health issue

  • ReachOut - An Australian site dedicated to providing self-help information, peer-support program and referral tools for those suffering with a mental illness or having a tough time

  • You Are Not Alone from NAMI - A forum for users to read and share their personal stories

Podcasts

Handouts

Apps

  • MindDoc - Monitoring and self-management app for promoting emotional well-being and coping

  • Headspace - Guided meditations, animations, articles, and videos