advice | Suicidal thoughts are often hidden. Here’s how to talk about it.

As a psychotherapist and university professor, I understand how upsetting it can be when a seemingly happy person ends their life. It can make you worry that a loved one’s smile is a deceptive mask.

Almost half of people who die by suicide do not reveal or hint at their intentions beforehand. Research of people who have experienced suicidal thoughts reveals that they may fear that someone they trust will call the police and put them in the hospital. Or they may cherish their privacy, are afraid of burdening people with anxiety, are afraid of other people’s reactions or judgments, or just don’t want to be prevented from carrying out their own suicide plan.

The best way to find out if someone is having suicidal thoughts is to ask. I often meet people who are afraid to ask the question. They are afraid of giving in to the idea that someone might die by suicide. But research consistently shows that asking about suicidal thoughts does not lead to or worsen suicidal thoughts.

There is no foolproof way to get suicidal thoughts out of someone, and if someone dies after talking to them about suicide, it doesn’t mean it’s your fault. The truth is, unfortunately, that even if you do everything the experts recommend, suicide can still happen.

With these important caveats, here are some ways to increase the likelihood of disclosure.

Many people use phrases like “cut yourself” or “self-harm” as euphemisms for suicide. However, self-harm is not always suicidal, and a person with suicidal thoughts may not see the suicide as harming themselves or themselves. By using terms like “suicide,” “kill yourself,” and “end your life,” you also show that you can handle talking about suicide. It is indescribable.

If this makes you more comfortable, go general and get more specific. You can say, for example, that you notice that the person seems sad or stressed and ask how they are doing. After listening, you can ask if things are getting so bad that they wish they weren’t alive, and then after some more listening, you can directly ask about suicidal thoughts.

Normalization of suicidal thoughts

In the United States, 12 million adults annually contemplate suicide, as do 1 in 5 high school students. By calling others out, you are making it clear that suicidal ideation is not unusual. For example, “Many people who are going through what you describe feel so bad that they are considering suicide. Do you have suicidal thoughts?”

Some people ask, “You’re not considering suicide, are you?” Or the wiser cousin of the question, “You’re not thinking of doing something stupid, are you?” This type of question broadcasts the answer you’re hoping for, which can turn the person off.

Learn about jokes, innuendo, and other warning signs

Suicide is such a taboo subject that some people allude to it. It’s a good idea to ask directly about the exact signs. Possibilities include: “You’ve made a number of jokes about killing yourself. Are you having suicidal thoughts?” or “I’ve noticed that you haven’t been yourself lately. Are you feeling depressed?”

Once you ask someone about suicidal thoughts, comes the challenge of how to respond. It depends on their answer.

What do I say if a person denies having suicidal thoughts?

Be careful about expressing relief. You might be tempted to let out a sigh and exclaim, “Oh, that’s so good!” Keep in mind that half of people who have suicidal thoughts dismiss them when asked directly. If the person you’re worried about is suicidal, it may convey your relief that you don’t want to hear from them if the answer is yes. I recommend my social work students say something with less judgment about suicidal thoughts, like, “This is good for me to know.”

Ask if the person will tell you in the future. This question is quite revealing about therapy clients. Those who say no, they don’t have suicidal thoughts, often also say no to my question, “In the future if you have suicidal thoughts, will you tell me?” This gives me the opportunity to explore and understand their hesitation, which usually stems from their certainty that I will be recommended at the hospital. More than once, after explaining that I would suggest hospitalization if they were determined to end their own lives within the next day or two, they would say something like, “Oh, I’m not contemplating suicide so intensely.” We are now having a conversation about something they denied minutes ago.

What do I say if the person says they are suicidal?

Show empathy and compassion. This advice may seem obvious, but many people answer with questions to assuage their fears: “Do you have a plan?” or “When are you going to do that?” are examples. Unless it’s clear the person is in immediate danger—for example, they have a weapon or they’ve already taken an overdose—have a conversation. Say sympathetic statements like, “That must have been so hard” or “It makes sense that your mind would go to ways for you to end the pain.”

Do not judge, disprove, convince, or otherwise try to talk the person out of suicide. At least not yet. There may be time later to try and discuss the person’s thinking. At the moment, this approach is likely to close the conversation, not open it.

Do not blame the person. Some mental health professionals disagree on this. last year, psychiatrist Allen Francis tweeted It tells suicidal patients with self-blame and depression, “The people who care about you will be haunted by your death for the rest of their lives. You have to stay alive to save them.” That’s right, worrying about others keeps some people from acting on their suicidal thoughts. However, statements like this can convey that a person’s current suffering is not as important as the future pain of others. Such statements can also exacerbate feelings of guilt in people who already fault themselves for their suicidal impulses.

Help the person get help. Some psychological therapies and medications have been shown to be effective in reducing suicidal thoughts or behavior. The nationwide 988 Suicide & Crisis Lifeline, which can be reached by calling 988, can advise you on resources in your area. You can also help the person come up with a plan for how to stay safe amid suicidal urges.

Stacy Friedenthal is an Associate Professor of Social Work at the University of Denver and a psychotherapist in private practice. Her latest book isLoving someone with suicidal thoughts: What family, friends and partners can say and do. “

We welcome your comments on this column at OnYourMind@washpost.com.

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