Suicidal thoughts

If you are thinking about ending your life and feel you might act on it, please reach out immediately. You do not have to explain everything or have the right words.

• In the US, call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day
• In the UK and Ireland, call Samaritans free on 116 123, any time
• If you are in immediate danger, call 911 in the US or your local emergency number, or go to the nearest emergency department
• Elsewhere, contact your local emergency number or a local crisis line

If you can, move away from anything you could use to harm yourself, and stay near other people. Tell someone you trust how you are feeling, even if it is just a short message saying "I'm not safe right now."

These feelings can be overwhelming, but they often rise and fall. Getting through the next few minutes or hours, with support, can make a real difference.

Suicidal ideation is not one single experience. Some people have passive suicidal ideation: thoughts such as "I wish I could just disappear" or "I want to die," without an intention or plan to act. Others have active thoughts that include considering how or when they might end their life. Both deserve to be taken seriously and talked about with a professional.

Feeling suicidal often comes from a sense that pain is unbearable, that nothing will change and that you are a burden to others. These beliefs feel completely true in the moment, but they are shaped by distress, exhaustion and conditions such as depression, which narrow how you see the future.

Having suicidal thoughts does not mean you are weak or selfish. Talking openly about suicide does not plant the idea; it usually brings relief and opens the door to help.

Recognizing suicide warning signs, in yourself or someone else, can help you get support sooner. Signs that someone may be at higher risk include:

• Talking or writing about wanting to die, being a burden or having no reason to live
• Looking for ways to harm themselves or researching methods
• Withdrawing from friends, family and activities
• Giving away possessions, saying goodbye or putting affairs in order
• Sudden calm after a period of deep distress
• Increased alcohol or drug use
• Extreme mood swings, agitation, rage or reckless behavior
• Sleeping much more or much less than usual

Risk factors include depression, bipolar disorder, borderline personality disorder, substance use, previous suicide attempts, self-harm, chronic pain or illness, trauma, loneliness, relationship breakdown, bullying, financial crisis and losing someone to suicide. Easy access to lethal means also increases risk. None of these factors means suicide is inevitable; they are signals that support is needed.

If you are worried about someone, ask them directly: "Are you thinking about suicide?" Asking clearly and calmly shows you care and gives them permission to be honest. It does not make suicide more likely.

Then focus on listening:

• Stay calm and let them talk without judging, arguing or rushing to fix things
• Take what they say seriously, even if they play it down
• Ask whether they have a plan or the means to act on it
• Help them reduce access to anything they might use to harm themselves
• Encourage them to contact a crisis line, doctor or therapist, and offer to make the call with them
• Do not promise to keep it a secret if their life is at risk

If they are in immediate danger, call 911 in the US or your local emergency number, and stay with them until help arrives if it is safe to do so. Supporting someone through this is hard, so look after yourself and reach out for support too.

Suicidal thoughts can be treated, and many people find that the intensity eases significantly with the right care. Treatment usually addresses both the immediate safety and the underlying causes, such as depression, trauma or overwhelming life stress.

Evidence-based approaches include cognitive behavioral therapy focused on suicide prevention, dialectical behavior therapy (DBT), which builds skills for managing intense emotions, and brief interventions that help people build a personal safety plan. Treating conditions such as depression, bipolar disorder or substance use is also central, and a psychiatrist may recommend medication as part of that care.

A psychiatrist, clinical psychologist or licensed psychologist can assess risk and plan treatment with you. At a first appointment, they will ask directly about suicidal thoughts, how often they occur, whether you have a plan and what keeps you going. These questions are routine and asked to keep you safe. Being honest helps them offer the right level of support, which may range from regular therapy sessions to more intensive care during a crisis.

When thoughts of suicide are intense, the goal is to get through the moment safely. A written safety plan, ideally made with a professional, can guide you. It often includes:

• Your personal warning signs, such as certain thoughts, situations or feelings
• Things you can do on your own to get through, like going for a walk, taking a shower or listening to music
• People and places that provide distraction and connection
• Trusted people you can tell that you are struggling
• Crisis lines and professionals you can contact, including 988 in the US and Samaritans on 116 123 in the UK and Ireland
• Steps to make your environment safer

It can also help to avoid alcohol and drugs, which can make impulses stronger. You do not have to act on a thought, and reaching out is a sign of strength.