How to talk to a loved one about suicide

When someone you care about seems withdrawn or overwhelmed, or is acting differently than usual, it's natural to worry. It’s not always easy to tell whether they’re just going through a rough patch or struggling with a more serious mental health concern.

Yet family and friends often hesitate to ask because they fear saying the wrong thing or making the situation worse. But a caring conversation can be an important first step toward helping someone in need.

"The only way to know whether someone is having a difficult time coping with life's challenges is to ask them," says Mary Heineke, a licensed marriage and family therapist at Sharp Grossmont Hospital for Behavioral Health. "Being attentive to changes in behavior, mood or the way they express themselves can provide important clues. These conversations can feel uncomfortable, but trust your instincts.”

Reaching out and starting the conversation, particularly if someone may be considering self-harm, can make a meaningful difference.

Asking could save a life

In 2024, an estimated 14.3 million adults in the U.S. seriously thought about suicide. Additionally, suicide claimed the lives of nearly 49,000 people.

One persistent myth is that asking someone about suicide increases the likelihood they’ll act on those thoughts. Heineke notes that research has consistently found that asking doesn’t cause suicide or put the idea in someone’s head.

In fact, rather than increasing risk, research from the Centre for Suicide Prevention emphasizes the importance of asking direct, compassionate questions if there are concerns.

Heineke says avoiding the conversation can reinforce stigma, and simply asking could save a life. “Many of my patients have shared that because someone asked them if they were thinking of taking their life, that’s what got them to the hospital and why they’re alive today,” she says.

Warning signs to watch for

Even when someone isn't asking for help, there are often signs. Heineke encourages people to watch for changes in mood, behavior and daily routines. Someone may also seem unusually irritable, angry, sad or anxious, or withdraw from friends, family and activities they normally enjoy.

Other warning signs can include changes in sleeping or eating habits, neglecting personal hygiene, increased alcohol or drug use, or having difficulty keeping up with responsibilities at work, school or home. They may also seem unusually tired, emotionally reactive, or less responsive to calls, texts and other communication.

Someone could also start giving away valued belongings. A serious or life-threatening health diagnosis may also increase risk, especially in older adults.

Starting the conversation

Because individuals who are struggling don't always ask for help or share what they're going through, it’s even more important to check in.

Heineke offers these tips:

When in doubt, reach out

Heineke says it's worth checking in when someone’s behaviors seem out of character. If you're worried someone may be considering suicide, seek help right away.

Call or text 988 for immediate support and guidance from a trained crisis counselor. If the person becomes threatening, the crisis is escalating, or there is an immediate risk of harm, call 911. Tell the dispatcher that you're facing a mental health-related emergency and ask for the psychological response team for immediate help.

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