How to talk about suicide
Asking about suicide saves lives but it can be hard to know where to start or how to help. Below are some example conversation starters if you are worried about someone. The practitioners Wakelet also provides examples of conversations starters from Papyrus. It can be scary, hard or painful to talk about suicide – but we need to. Suicidal feelings don’t have to end in suicide. Many young people feel really isolated with their thoughts of suicide and do not feel that they are able to tell anyone. Evidence shows that talking about suicide does not make it more likely to happen – it reduces the stigma and is often the first step in a person’s recovery.
Ask them directly:
- ‘Are you thinking about suicide?’ By using the word suicide, you are telling the young person that it’s OK to talk openly about their thoughts of suicide with you.
- “Sometimes, when people are feeling the way you are they think about suicide. Is that what you’re thinking about?”
- “Are you telling me you want to kill yourself? End your life? Die? Die by suicide?” “It sounds like you’re thinking about suicide, is that right?” “It sounds like life feels too hard for you right now and you want to kill yourself, is that right?”
If someone is suicidal, listen to them and allow them to express their feelings. They may feel a huge sense of relief that someone is willing to hear their darkest thoughts:
- “It sounds as though things are really hard at the moment…. Can you tell me a bit more?”
- “Things must be so painful for you to feel like there is no way out. I want to listen and help.”
- “Take your time and tell me what’s happening for you at the moment.”
- “I am so sorry you’re feeling this way. Can you tell me more about how you are feeling?”
- “Can you tell me more about why you want to die?
- “What has brought you to this place/to feel this way?” “It’s hard and scary to talk about suicide but take your time and I will listen.”
Reassure them that they are not alone and you can look for support together. You can refer to the children and young persons Wakelet to help you do this.
- “It’s not uncommon to have thoughts of suicide. With help and support many people can work through these thoughts and stay safe.” “There are organisations that offer support like PAPYRUS HOPELineUK, I can help you find their contact details.”
- “You’ve shown a lot of strength in telling me this. I want to help you find support.”
- “There is hope. There is help available and we can find it together”.
Unless things have reached a critical level, your concern for the young person and interest in their well-being are likely to have reduced some of their distress and sense of isolation. By offering to see the young person again within a specified time frame, you show that you have time for them and can be approached if the situation deteriorates. Make sure that the plans you put in place actually happen; for example, check they have been contacted/seen by the service you have connected them with, or have seen their GP.
Working with Young People and their families
Young people and their families may have different views and feelings regarding the risk of suicide and may struggle to understand each other’s experience. For the professional trying to help it is often difficult to achieve a balance and support everyone involved. Don’t feel you need to manage this by yourself. It is not unusual for more than one person to provide support to the young person and their family. Risk of suicide within families can make people feel scared and helpless and it is therefore important to help them to explore these feelings in a safe way. It is important for all involved to remain open-minded, non-judgmental and to respect the views of all family members in order to reduce feelings such as blame, guilt or shame being directed at any one individual.
It is important that family members have a sense of urgency in terms of understanding the triggers to the young person’s risk of suicide and doing what they can to address these issues. At the same time, it is important to convey a sense of hope that if everyone works together then these issues can be successfully addressed, and change is possible.
Not all parents/carers have the knowledge, resources, or emotional capacity to offer support and guidance. They may also ignore or minimise concerns. Children might not always feel able to communicate openly with their parents due to fear of judgment or misunderstanding. If assessment indicates that parents/carers are not a protective factor, alternative strategies and support systems must be considered to ensure the young person’s safety and well-being. It is also worth remembering that siblings may be affected as well and their needs should also be considered.
There is a useful Wakelet for parents and carers which you may find helpful in your conversations with the parents and carers to support them to identify the right support.
If there is already multi agency support in place for the child or young person then it is important to consider how this concern is integrated alongside any other information. It may be that existing supports are enough to address any contributing factors identified in your conversations with the child or young person.
Deciding what information to share: confidentiality and consent
Explain the limits of confidentiality, emphasising that their safety is the priority and that you may need to inform parents/carers to ensure they get the support they need. Inform them that due to legal requirement you may need to inform parents/carers if their safety is at risk.
Risk Assessment
In terms of talking to a young person who may be having suicidal thoughts and feelings much of the advice in the previous section is relevant. However, when entering into a dialogue, it can be helpful to gather information on the following areas in order to accurately assess risk and share information, as required.
Thoughts: Have they ever thought about suicide? How often do these thoughts come into their mind? Are these thoughts that they can ignore? Are there things that they can do to take their mind off these thoughts? Do they ever hear these thoughts as voices telling them to harm themselves? Do they feel hopeless about their future?
Intent: Do they feel that they would act on these thoughts? Are they worried that they might act on them? Do they feel safe right now? What stops them from acting on these thoughts?
Planning: Have they ever made any plans to take their own life? What did they plan to do? Do they have a plan at this time? Have they thought about when this might happen? Have they ever researched methods or spoken to anyone else about ways to die?
Access to lethal means: Do they have anything that they would use to harm themselves such as pills etc.? Where are they kept?
History: Have they ever tried to kill themselves in the past? What happened? What stopped them? Did they go to someone for help? Do they feel the same right now?
What to do next: If suicidal thinking is fleeting, with no clear intent or planning and is contextual to a wider issue, consider access to primary support e.g., school nurse, counselling service or Primary Mental Health Workers. Are parents aware? If not, what are the young person’s concerns about telling them? If there is clear risk, you will need to inform them. If you are unsure about the level of risk or how to make sense of the information you have gathered, it is important that you seek appropriate consultation. When considering next steps, returning to the five GIRFEC questions will help contextualise the risk and support your next steps. Where clear risk is apparent, you need to consider your safety plan.
- What is getting in the way of the child/young person’s wellbeing?
- Do I have all the information I need?
- What can I do to help?
- What can my agency do to help?
- What additional help may be needed?
Refer to the GIRFEC national practice model for further information.
