Suicidal Crisis – How to Recognize When Someone Needs Help

Suicide remains one of the most serious public health problems worldwide. According to the World Health Organization, more than 720,000 people die by suicide each year, while suicide attempts are many times more common. Suicide is also the third leading cause of death among people aged 15 to 29. A previous suicide attempt is a particularly important risk factor. A history of suicide attempts should always be taken seriously when assessing a person’s current mental state.

A suicidal crisis does not have one characteristic presentation. A person at risk of suicide does not necessarily cry, openly say that they want to die, or appear to be experiencing a severe mental health crisis. They may go to work, meet other people, joke, carry out their daily responsibilities, and give the impression that everything is fine. There is also no single type of person who may experience such a crisis. Factors associated with increased risk include depression and other mental disorders, substance use disorders, previous suicidal behavior, chronic pain, serious illness, experiences of violence, loneliness, the loss of a loved one, relationship conflicts, and financial difficulties. Suicide is a complex phenomenon and usually cannot be fully explained by a single event.

Differences between women and men are also important. Globally, suicide deaths are more common among men. This does not mean that women rarely experience suicidal crises. Suicidal behaviors occur in both sexes, although their characteristics, frequency, and fatality may differ. This is one reason why suicide risk should always be assessed individually rather than on the basis of stereotypes about what a person at risk of suicide is supposed to look like.

Suicidal thoughts do not always begin with an explicit statement such as “I want to kill myself”. Sometimes a person may say, “I wish I could go to sleep and never wake up”, “I don’t have the strength to keep living”, “everyone would be better off without me”, or “I just want all of this to end”. They may not have a specific intention to take their own life, but may increasingly think about death or feel that it would be better not to exist. Such statements should not be dismissed simply because there is no specific suicide plan. As the crisis deepens, suicidal thoughts may become more active and the person may begin taking preparatory steps. Warning signs may include saying goodbye to loved ones, giving away important possessions, putting personal affairs in order, withdrawing from relationships, talking about being a burden, expressing a lack of hope for the future, or believing that there is no way out of the current situation. A sudden and marked change in behavior or mood may also be significant.

One of the most persistent myths is the belief that a person should not be asked directly about suicide because doing so might “put the idea into their head”. Available research does not support this belief. Asking directly about suicidal thoughts does not increase the risk of suicidal behavior. Instead, it may open a conversation with someone who has never told anyone what they are really experiencing. If you are concerned about someone close to you, you can calmly ask, “Do you ever think that you don’t want to live anymore?” or more directly, “Are you thinking about suicide?” You do not need to be a psychiatrist or psychologist to ask this question.

What happens next is equally important. A person in crisis should first of all be listened to without judgment and without immediately trying to convince them that “everything will be fine”. Statements such as “other people have it worse”, “pull yourself together”, “you have a family”, or “think about what this will do to your loved ones” may increase feelings of guilt, being misunderstood, and isolation. The belief that someone who talks about suicide is merely “seeking attention” is also false. Every statement expressing a desire to die should be taken seriously. Even if such words are primarily an attempt to communicate a need for help, they indicate a level of suffering that the person may no longer be able to cope with on their own.

At the same time, experiencing suicidal thoughts does not mean that a person will inevitably take their own life. The intensity of a suicidal crisis may fluctuate. What seems like a situation with no way out at the most difficult point of the crisis may be perceived very differently after appropriate help has been received. This is why ensuring safety during periods of greatest risk is so important. One important element of suicide prevention is reducing a person’s access to potentially dangerous means or locations. This can provide valuable time to obtain professional help and allow the intensity of the crisis to decrease.

If someone says that they intend to take their own life, is taking preparatory steps, or their behavior indicates an immediate risk, they should not be left alone. You should also not promise to keep suicidal intent secret. When there is an immediate threat to life, safety takes priority. In Poland, call 112 or 999, or seek help at a facility providing 24-hour psychiatric care or at the nearest hospital emergency department. Not every crisis, however, requires calling an ambulance. Recurrent thoughts about death, feelings of hopelessness, loss of meaning in life, or the belief that loved ones would be better off without you are sufficient reasons to seek professional help. There is no need to wait until a specific suicide plan develops.

World Suicide Prevention Day reminds us that suicide can and should be talked about. Sometimes the first step is neither making a diagnosis nor finding the perfect words. It may simply be noticing a change, staying with another person, and asking a straightforward question: “I can see that things have been very difficult for you lately. Are you thinking about suicide?” A conversation does not replace professional help, but it can be the first step towards receiving it. Asking this question does not put the idea of suicide into someone’s mind. It may, however, mean that a person who has been experiencing their crisis alone no longer has to face it alone.

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