[6 mn read]
In this article:
- Read this blog. It could help you save someone's life. Or your own.
- If you're having suicidal thoughts and feel like you may act on them, call 988, the National Suicide Hotline. You can also call 911 or go to your local ER right away.
- A Providence Swedish behavioral health experts shares guidance for supporting those in crisis, including what NOT to do and say; how social media can be a tool for suicide prevention; and ways to communicate with your doctor if you're having suicidal thoughts.
According to the U.S. Centers for Disease Control and Prevention (CDC), suicide was the 11th leading cause of death in the United States in 2021, with over 48,000 individuals losing their lives. Washington State, like many other states, has also experienced the profound impact of suicide, reporting approximately 1,200 deaths in the same year.
For people who may be contemplating suicide, it is crucial to understand that there is hope and help available. To learn more, we spoke with Providence Swedish behavioral health expert, Janarthan Sivaratnam, Ph.D, a psychologist with Providence Swedish South Lake Union Primary Care, who offered a wealth of guidance for anyone struggling with thoughts of suicide as well as for friends and family, for any time a friend of loved one comes to us in crisis.
Together, professional help and personal support networks can create a powerful safety net, underscoring that no one has to face their struggles alone.
What should we do if we find ourselves having even occasional suicidal thoughts?
Don't go through it alone! Reach out to professional help.
- Talk to someone you trust a friend, family member, mentor, or anyone who makes you feel safe. You don't need to explain everything at once or even talk about your concerns – sometimes interacting with others can help us feel more grounded.
- Reach out to professional help such as therapists or counselors. Many are trained specifically to help with suicidal ideation. Doctors or psychiatrists can help, too, if it’s related to depression or another mental health condition, they can provide treatment options.
- Use crisis resources: in the U.S. call or text 988 (the suicide and crisis lifeline) 24/7.
If you're in immediate danger or feel like you might act on those thoughts, call 911, go to the ER or call a crisis line right away.
Understand that the thoughts may just be thoughts. Suicidal thoughts can often come from pain or feeling overewhelmed.They’re your brain’s way of saying, “I need help.” That pain can be treated. Things can and often do get better with support.
What if a friend or colleague shares their thoughts with us? What are some best practices and some things NOT TO DO?
Things TO DO include, but are not limited to:
- Stay calm and listen without judgment
- Let them talk.
- Use active listening: “That sounds incredibly painful. I’m really glad you told me.”
- Accept their emotions, even if they scare you.
- You don’t need to “fix” their feelings — just be present and stay open.
- Take it seriously. Every time
- Ask directly about risk. Research shows that asking does NOT increase risk, in fact, it can reduce it.
- Encourage professional help such as talking to their medical doctor or seeking therapy/psychiatry).
- Know emergency steps in case the person has a plan or is in immediate danger.
- Avoid leaving them alone.
- Call a local emergency number or crisis team.
- If you’re unsure what to do, calling the crisis number yourself can be a good place to start to get some initial recommendation.
AVOID doing the following:
- Minimizing the other person’s feelings.
- Promising total secrecy – you can explain to them that you’ll do everything you can to keep the information protected but also be transparent and share that if you are imminently concerned you might need to get help.
- Avoid panicking/overreacting: one can take the information seriously without necessarily having to sound “all the alarms” so to speak.
- Do NOT take on the role of a therapist: you can support them, but you're not expected to solve this alone. Help them access professional help.
Is there a difference between suicidal ideation and depressive feelings of wanting to disappear? What feelings, thoughts or actions make us more vulnerable to suicidal thoughts?
Feelings that can make us more vulnerable to suicidal thoughts can include:
- Overwhelming sadness or numbness.
- Intense loneliness or isolation.
- Persistent anxiety or panic.
- Unresolved trauma or grief.
- Emptiness or emotional exhaustion.
- Anger turned inward.
Thoughts that can make us more vulnerable can include:
- Hopelessness: Believing nothing will ever get better.
- Black-and-white thinking: Seeing life as "all bad" or "all good" with no in-between.
- Self-criticism or self-hate: Harsh inner dialogue like “I’m a burden,” “I’m worthless,” etc.
- Feeling like a failure or a deep sense of shame.
- Belief that others would be better off without you.
These are not facts; they’re distorted thoughts often fueled by depression, anxiety, trauma or stress.
Behavioral warning signs:
- Withdrawing from friends, family, or usual activities.
- Giving away possessions or saying goodbye.
- Sudden calm after a long period of distress.
- Increased risky or reckless behavior.
- Talking or joking about death or suicide.
- Looking for means (e.g., researching methods, acquiring tools).
What are some regular practices we can put in place to keep these feelings at bay?
In general, some things to keep in mind as a part of your general day-to-day practice that can help keep these feelings at bay can include:
- Feeling connected to others (even one person).
- Access to mental health care.
- A sense of purpose or future goals.
- Spirituality or belief systems that value life.
- Healthy coping skills like journaling, exercise, therapy, etc.
- A safety plan or crisis tools.
In terms of actions you can take if you notice any of the earlier vulnerabilities can include:
- Talk about it, not to fix it, but to reduce isolation.
- Normalize help-seeking, such as therapy, support groups, crisis lines.
- Track your moods and triggers. Self-awareness helps.
- Build protective routines such sleep, connection, small joys.
- Have a plan for hard days including a list of people, activities, or calming tools.
What specific signs should parents be aware of that might indicate their child is experiencing suicidal thoughts or behaviors?
Emotional and psychological signs
- Persistent sadness, hopelessness, or despair.
- Sudden mood swings — especially if a child becomes very calm or happy after a period of deep sadness (this can indicate a decision to end their life).
- Excessive guilt or worthlessness.
- Increased anxiety or panic attacks.
- Withdrawal from friends, family, or activities they used to enjoy.
- Children may not always say “I feel hopeless,” but may show it through a loss of interest or statements like, “What’s the point?” or “No one cares anyway.”
Behavioral Changes
- Changes in eating or sleeping — too much or too little.
- Drop in academic performance or loss of concentration.
- Giving away possessions or talking about not needing things anymore.
- Increased risk-taking, such as reckless driving, substance use, unsafe sex, etc.
- Self-harm, such as cutting, burning, etc.
- Sudden isolation, locking themselves in their room, avoiding eye contact.
Verbal Cues
Direct statements:
- “I want to die.”
- “I don’t want to be here anymore.”
Indirect statements:
- “You won’t have to worry about me much longer.”
- “I wish I could disappear.”
- “Everyone would be better off without me.”
Digital and social media clues:
- Searching for or posting about death, suicide, or hopelessness
- Following or engaging with dark, depressive content
- Saying goodbye in texts or posts
- Deleting social media accounts or digital footprints suddenly
Sometimes these may sound like drama or attention-seeking — but they’re always worth taking seriously.
What are some effective strategies for parents to start a conversation with their children about mental health and suicide prevention?
While exact conversations will vary depending on each child and their age, some general things to keep in mind include the following:
- Normalize talking about emotions. Create a family culture where it’s safe to talk about feelings — before a crisis ever happens – can be an effective strategy to validate feelings early on and to foster a space where things can be talked about before they become more serious later on.
Example: “I’ve been thinking about how important it is to talk about mental health — just like we do with physical health. How have you been feeling lately?”
- Use open-ended, non-judgmental ouestions. This can allow a child to elaborate in a way that is comfortable for them while at the same time allowing conversations to occur and you learning more about how they’re actually doing.
- Be direct (but kind) about suicide. Asking directly does NOT increase risk. It shows your child you’re strong enough to hear the truth — and that they’re not alone. Keep your tone soft and matter-of-fact.
- Stay calm, even if the answer is yes. Listen fully and validate their feelings. If your child opens up, don’t jump in with solutions (particularly if there is not an acute/immediate danger) or minimize their experience. Just be present. Creating a safe place where your child can be seen/authentic, even if authenticity includes some heavy topics, can be immensely therapeutic.
How can technology and social media be utilized positively to support youth mental health and suicide prevention initiatives?
Use social media to promote mental health literacy and connection
- Share age-appropriate mental health content, coping tips, and encouragement.
- De-stigmatize mental health struggles through relatable stories or influencers.
- Learn more about mental health apps designed for youth.
- Use and connect with 988, the national suicide prevention hotline.
Example: A teen-focused Instagram account sharing daily affirmations, signs of burnout, or where to get help can normalize help-seeking behavior.
How can communities better support marginalized groups, such as LGBTQ+ individuals and racial minorities, who may be at increased risk for suicide?
Marginalized groups, including LGBTQ+ individuals and racial or ethnic minorities, often face higher suicide risk — not because of who they are, but because of systemic inequality, discrimination, and lack of access to culturally responsive care. When people feel safe to be fully themselves, suicide risk drops significantly.
Learn more about culturally and identity affirming safe spaces that are inclusive environments in schools, community centers, and clinics where LGBTQ+ and BIPOC individuals feel respected, protected, and celebrated.
Thease include, but are not limited to:
- Gender-neutral restrooms.
- LGBTQ+ youth support groups.
- Culturally rooted healing spaces or affinity groups.
Many marginalized youth avoid help because they fear judgment, misunderstanding or discrimination from providers. Support peer mentors, youth advisory boards and community leaders who reflect those most affected.
How can we start a conversation with our healthcare provider if we feel ashamed or afraid to share mental health struggles and suicidal thoughts during appointments?
- Write it down first, then read or hand it over.
If speaking feels too hard, prepare a short note ahead of time. You can read it out loud during the appointment or hand it to the provider. This takes pressure off and ensures nothing gets left unsaid.
Use simple, honest language. You don’t need to explain everything perfectly. Start with something small.
- “I’ve been feeling really low lately — worse than usual.”
- “I’ve had some thoughts about not wanting to be here.”
- “I think I need help with my mental health, but I’m scared to talk about it.”
Bring someone you trust.
- If you feel that writing or speaking is too much, but feel comfortable having someone else you trust share with you, that is okay. Having someone else can help you feel more comfortable and also take the pressure off of you to speak, if it’s uncomfortable at first.
Remind yourself that this is caring for you and part of your doctor's job.
- Doctors, nurses, and therapists hear about suicidal thoughts regularly. It’s not shameful, and you won’t be judged — they want to help. A common statement I hear is that “there are people worse off than me that need or deserve the help more than I do.”
Please remember that doctors and your care teams are here for you and want to see you early so we can help reduce the likelihood of you feeling worse. Preventative medicine is medicine!
Learn more and find a physician or advanced practice clinician (APC)
If you are looking for help managing holiday stress or learning to deal with holiday stress, support is available at Providence Swedish Behavioral Health. Whether you require an in-person visit or want to consult a doctor virtually, you have options. You can also connect virtually with your provider to review your symptoms, provide instruction and follow up as needed. And with Swedish ExpressCare Virtual you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections, and more. You can use our provider directory to find a specialist or primary care physician near you.
Information for patients and visitors
Related resources
988, the free national mental health hotline, has connected with millions in crisis
Let glimmers of meaning bring shine to your life
Choosing a therapist: identifying your mental health goals and what to keep in mind
Anchor yourself: tips for managing big feelings in turbulent times
This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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