Suicide is not the answer. Help is available.

September 18, 2023 Swedish Behavioral Health Team


In this article:

  • Suicide is one of the leading causes of death in the United States.
  • In 2022, more than 49,000 people in the United States died by suicide.
  • Suicide is preventable. Be proactive by learning risk factors and warning and protective signs to reduce the risk of suicide for yourself or a loved one.
  • 988 Lifeline is the free national crisis intervention hotline for those experiencing a mental health or substance abuse crisis.

Suicide is a topic that’s not easily discussed. As difficult as the conversation can be, it serves as an important reminder about the reality of mental health struggles and the need to check in with ourselves and our loved ones. 

September Suicide Prevention Awareness Month. We spoke with behavioral health expert, Rachel Ebeling, PsyD, clinical psychologist at Swedish about suicidal ideation, strategies for managing a mental health crisis and resources for support and education.  

Experts are very clear about the power of connection, says Dr. Ebeling, and on a practical level, it is often easier to gain perspective or face a problem with support from a friend or trusted family member.

“Never underestimate the power of a good relationship,” shares “When you’re struggling, reach out to your family and friends and let them know what’s going on. Take time to check in on someone you’ve noticed struggling or who has just been dealing with a bad hand lately.

“It’s so easy for us, as humans, to brush off our problems with a quick ‘I’m fine’ response. Opening up, sharing what’s on your mind and asking for help can go a long way to help you or someone else manage feelings of anxiety, depression and even thoughts of suicide or self-harm,” Dr. Ebeling finishes.

Be gentle with yourself

The last few years have been a challenge for all of us. We’ve gone through a pandemic and a seemingly unending news cycle of violence, political upheaval, racial injustice and social inequities.

“Many of us are suffering from crisis fatigue. Our emotional capacity has been worn then by this constant barrage of unsettling and worrying news stories,” states Dr. Ebeling. “And when that happens, we become more irritable, more anxious, are more likely to experience depression and have little energy to engage with others or enjoy our favorite activities.”

Fortunately, there are ways to help break this cycle and rebuild your emotional capacity. Dr. Ebeling recommends two specific tips:

  • Talk to a behavioral health professional. A therapist or psychologist can help you cope with anxiety, depression and other mental health issues before they become an emergency.
  • Take care of yourself. This one is easier said than done, but self-care is a vital way to help our bodies and minds recharge. “Like a car or plant, we need to monitor how we are doing and feeling and make adjustments needed so that we can do the best we can.” That may be walking a few times a week, getting better sleep or scheduling time to connect with loved ones.

“While the treatment for suicidal ideation remains mostly the same, we are working hard to identify people in emotional distress much earlier,” says Dr. Ebeling. “Most suicides are occasioned by a “catalyst” event: the breakup of a relationship, losing a job, or learning of bad news. Misconceptions arise when we mistake one of these isolated events for the cause of the suicide. Instead, it is more likely to the last event in a series of distressful experiences for that person.  With our depression response initiative and touching base with patients’ who score high on their PHQ-9, or Patient Health Questionnaire (which is used to assess degrees of severity of depression), we can see patients much earlier in their emotional distress and help them with resources and treatment much quicker.”

You are not alone

If you’re struggling with a mental health illness or having thoughts of suicide or self-harm, please remember that you are not alone. In fact, millions of people in the U.S. experience the same types of thoughts, emotions and feelings that you may be having right now.

Reach out and ask for help. It can be a vital step in stopping the cycle and, more importantly, heling quiet your thoughts of suicide or self-harm.

Warning signs and risk factors for suicide

One of the best things you can do for yourself and loved ones is become familiar with the warning signs and risk factors for suicide. The National Alliance on Mental Illness (NAMI) and the National Institute of Mental Health (NIMH) list the following:

Risk Factors

  • A family history of suicide.
  • Known history of suicide attempts.
  • Known mental health condition (such a depression).
  • Substance use.
  • Access to firearms.
  • A serious or chronic medical illness.
  • A history of trauma or abuse.
  • Prolonged stress.
  • A recent tragedy or loss.
  • Feeling isolated or not having social support.
  • Work or financial concerns.

Warning Signs

  • Increased alcohol and drug use.
  • Aggressive behavior.
  • Withdrawal from friends, family, community. 
  • Feeling like a burden to others.
  • Dramatic mood swings.
  • Impulsive or reckless behavior.
  • Talking about death, dying, or suicide.

Take action

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 988 to reach the Suicide & Crisis Lifeline:

  • 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.

How to help yourself, loved ones

“The good news is suicide is preventable,” reminds Dr. Ebeling. “On the opposite side of risk and warning signs, there are also protective factors to help reduce the risk of suicide or self-harm.”

A protective factor is a proactive step in recognizing and preventing suicide or self-harm. Typically, we only watch for those warning signs, which may indicate it’s too late to help – or may be harder to get someone the help they need.

Instead, focusing on protective factors helps create a toolbox of sorts so that when negative or suicidal thoughts begin to occur, an individual can better cope with and overcome those situations.

Protective factors include:

  • Coping and problem-solving skills.
  • Reasons for living.
  • Sense of cultural identity.
  • Supportive relationships (family, friends, romantic partners).
  • Sense of community.
  • Cultural, religious, or moral objections to harming yourself.
  • Limited access to lethal means.

One of the most important protective factors to reduce the risk of thoughts of suicide and self-harm is the availability and consistent quality of healthcare and behavioral health services.

“Please don’t hesitate to reach out for professional support if you or a loved one are struggling with a mental health issue,” encourages Dr. Ebeling. “We are here to offer effective and safe suggestions to manage your experience and help you feel like yourself again.”

Create a crisis plan

Just like school children practice fire drills and all families should discuss how to get out of the house in an emergency, a suicide crisis plan can help you or a loved one navigate distressing thoughts.

“When we are experiencing a high moment of distress, it’s like having tunnel vision. It’s extremely difficult to think outside of that scope,” Dr. Ebeling explains. “A crisis or safety plan lists out what is helpful so you can use it immediately without having to come up with something on the spot.” 

A crisis plan should include:

  • Warning signs. The things that we do, feel, types of situations, images or thoughts that precede or accompany suicidal urges.
  • Coping skills. Ideas or strategies that have helped us feel a bit better in the past. This may include things like meditation, exercise or watching a funny TV show.
  • Trusted contacts. Keep a list of people you feel comfortable sharing your honest thoughts and feelings. This may include friends, families, teachers, coaches and your mental health provider.
  • Phone numbers. Always have the contact information for national and local resources that can help, including 988 or 911. 988 is the new, free nationwide suicide and crisis lifeline. You can call or text 988 or visit

Offering support for a loved one

It can be overwhelming and difficult to see someone you love struggle with mental illness. Just remember, what they need more than anything is an open and non-judgmental space.

“It’s okay to reach out to someone that may be having thoughts of suicide or self-harm,” encourages Dr. Ebeling. “You don’t need to know what to say or what to do. Just be a compassionate listener. Reflect their feelings and summarize their thoughts, instead of telling them what to do or that it’s all going to be okay.”

Here are some tips that are helpful when talking to someone with suicidal thoughts:

  • Keep your voice calm.
  • Avoid overreacting.
  • Express concern and support.
  • Be patient.
  • Allow them space.
  • Ask how you can help.
  • Offer options instead of telling the person what they should do.
  • Ask them if they have a plan for ending their life and what it is.
  • Encourage them to seek help that they are comfortable with, such as help from a doctor or counselor or support through a crisis line.
  • Follow up on any commitments that you agree to.
  • Make sure someone is with them if they’re in immediate danger. 
  • Call 988 for additional support or information if you or a loved one is experiencing a mental health crisis.
  • Call 988 if the situation seems life-threatening.

Understanding self-harm

Self-harm is not the same as attempting suicide. However, it is a symptom of emotional pain that should be taken seriously. If someone is hurting themself, they may be at an increased risk of feeling suicidal. It’s important to find treatment for the underlying emotions. 

If you are worried about a family member or friend that might be hurting themself, ask them how they're doing and be prepared to listen, even if it makes you uncomfortable. This may be a hard subject to understand. One of the best things is to tell them that while you may not fully understand, you can be there to be a support for them.

There is help

If you are in a crisis, reach out to someone or contact 988 or 911. You do not have to take this burden alone. There are people who can help. 


The 988 Lifeline is an easy number to remember. It connects you with trained professionals experienced in crisis intervention. Help is available 24 hours, 7 days a week – every day of the year. Counselors can offer support, reassurance and connect you with the resources you or a loved one needs. 988 is available to anyone experiencing:

  • Mental health crisis
  • Thoughts of suicide
  • Substance abuse crisis
  • Emotional distress

Family and friends can also call 988 if they are worried about a loved one who may need crisis support.

National Resources

NAMI offers a great guide to navigating a mental health crisis that is free to download for more detailed information on what to expect in a crisis, crisis plan, best approaches and what to expect for treatment.

Navigating a Mental Health Crisis

Other resources include:

Local resources

Local resources in Washington state include:

  • Crisis Connections: 24-hour crisis line at 866-427-4747. The primary source for connecting residents to emergency mental health services in King, Pierce, Clark, Skamania, Klickitat, Grant, Okanogan, Chelan and Douglas counties.
  • Teen Link: Text, chat or call 866-833-6546

If you know someone in crisis, or you are having suicidal thoughts yourself, call one of the resources above or 9-8-8 or 9-1-1. Do not hesitate to get help and reach out for support.

Words of advice, encouragement

We asked Dr. Ebeling to share a few words of encouragement for young adults, females and males struggling with mental illness or thoughts of suicide or self-harm.

For young adults

“If you need help, please reach out. Licensed mental health professionals work in confidentiality and will let you know what those limits are before diving into things. We are here to help you, not to try to get information out of you. Speaking to a school counselor, campus counseling center, a trusted adult, or crisis responder can help you get connected to services if you’re in need.”

For people who identify as female

“There is a lot of societal expectation to juggle everything effortlessly and be ‘superwomen.’ No one can live this way, or at least it cannot last forever. If you feel like you are not yourself or you’re not able to engage in life like you used to, that’s a good sign to speak to someone. It’s more than okay to make time for yourself. You’re not being selfish; you are taking care of yourself, so you can engage in your life fully again.”

For people that identify as male

“There is a toxic social expectation to take things how they are and ‘to be a man’ or ‘man up.’ This keeps people from opening up and can make you feel increasingly isolated when suffering from mental health. Know that you are not alone. It may be hard to do at first, but speaking to someone can help relieve a lot of the stress that you are holding in. Do not hesitate to reach out.”

If you are bereaved by the suicide of a friend or loved one

“Guilt is a very common for survivors of suicide and overcoming it can be a challenging barrier healing. Guilt can become a survivor’s worst enemy because it creates a false accusation towards themselves. Survivors are not responsible for their loved one’s suicide in any way, shape, or form. No one should or has to go through this alone,” Dr. Ebeling advises. “There are many people who understand what survivors are experiencing and are willing to help.  Therapy, specialized groups, and books are great resources to help people on their journey of healing.”

Where survivors can go for help

Support Groups


Healing After the Suicide of A Loved One by Ann Smolin and John Guinan, published by Simon & Schuster

Life After Suicide: A Ray of Hope For Those Left Behind by E. Betsy Ross, published by Insight Books

“Death will impact our lives at one point or another. However, with suicide it is different. The person you have lost seems to have chosen death, and that makes a world of difference for those left to grieve. Suicide survivors face all the same emotions as anyone who grieves a death, but they also endure somewhat unique set of painful feelings on top of their grief.  These emotions include stigma, guilt, disconnection, and anger towards their loved one,” Dr. Ebeling says. “Time heals, but time alone cannot heal the suicide survivor. Suicide survivors must use that time to heal themselves and lean on the help and support of others.”

Learn more and find a provider

If you are struggling with your mental health have questions about behavioral health services, Swedish is here for you. To schedule an appointment, contact Swedish Behavioral Health. Whether you require an in-person visit or want to consult a doctor virtually, you have options.

Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instructions and follow up as needed. If you need to find a provider, you can use our provider directory.

Join our Patient and Family Advisory Council.

Additional resources

After his family’s tragedy, a Swedish caregiver logs miles to save lives

What’s 988? What you need to know about the new national mental health crisis hotline

Understanding mental health counseling

Recognize and manage the signs of mental health struggles

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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About the Author

Whether it's stress, anxiety, dementia, addiction or any number of life events that impede our ability to function, mental health is a topic that impacts nearly everyone. The Swedish Behavioral Health Team is committed to offering every-day tips and clinical advice to help you and your loved ones navigate mental health conditions.

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