Recognizing the Signs of Potential Suicide and Starting the Conversation
Sometimes the warning sign is not "I want to die."
It is quieter than that. It sounds like:
"You'd be better off without me."
"I can't do this anymore."
"I just want everything to stop."
Sometimes there are no words at all. Someone starts giving away things that matter to them. They say goodbye in a way that feels a little too final. They pull away from the people who love them most.
September is Suicide Prevention Month, and it is a good moment to say something we tell families all year: most people who are struggling show signs before they tell anyone directly. You do not have to be certain someone is suicidal before you ask. If something feels different, or something is nagging at you, that is reason enough to pay attention.
What are the common warning signs of suicide?
One sign on its own does not mean someone is suicidal. We become more concerned when several signs show up together, or when they represent a real change from how that person usually is.
Things you may notice:
Talking about wanting to die, disappear, or not wake up
Feeling like a burden to the people around them
Saying that others would be better off without them
Growing hopelessness, or a sense of being trapped with no way out
Pulling away from friends, family, or activities they normally enjoy
Giving away valued possessions, or making arrangements that seem unexpected
Writing letters, saying goodbye, or putting affairs in order
Increased alcohol or drug use
Reckless or self-destructive behavior
Significant changes in sleep, appetite, or mood
A sudden sense of calm after a stretch of intense distress, especially if they have been having thoughts of suicide
That last one surprises people. A person who seems suddenly settled after weeks of anguish may be feeling relief, and that is worth noticing rather than assuming the worst has passed.
Why we take every mention of suicide seriously
Whether someone speaks plainly about wanting to die, hints at feeling hopeless, talks about being a burden, or says something that leaves you replaying it later and wondering what they meant, it deserves your attention.
We do not treat these statements as someone "just looking for attention." Talking about suicide is a sign of real distress, and it is an opening. It is a chance to connect a person with support before things get harder.
How do you ask someone if they are thinking about suicide?
You do not need the perfect words. You need to be willing to ask.
You can say something as simple as:
"I've noticed you've seemed really overwhelmed lately. Are you thinking about suicide?"
Asking directly does not plant the idea in someone's head. This is one of the most persistent myths about suicide prevention, and it keeps people quiet when speaking up would help. What asking actually does is open a door. It tells the person that you can hear the answer, whatever it is.
If they say yes, resist the urge to fix it in that moment. Listen first.
What to do if someone tells you they are having thoughts of suicide
1. Ask directly. Find out what they mean and whether they are thinking about suicide. Vague concern is hard to act on. A clear answer gives you both something to work with.
2. Listen before you reassure. The instinct to argue someone out of it, or to start listing reasons to live, comes from love. It also tends to end the conversation. Start by understanding what is happening for them.
3. Reduce access to lethal means of suicide. When someone is having thoughts of suicide, putting distance between that person and the means to act on those thoughts is one of the most protective things anyone can do. Timing is a large part of why. Many suicide attempts happen with very little planning, in the middle of a short-term crisis, so what is within reach during those hours can determine whether a person survives them. The Means Matter campaign at the Harvard T.H. Chan School of Public Health has a clear, non-judgmental guide written for families on what to secure, how to store it, and how to raise the subject without it turning into a fight: Means Matter, for families. This is worth doing with support rather than alone, and 988 or a mental health professional can help you think it through for your specific home.
4. Stay connected. If you believe someone is in immediate danger, do not leave them alone. Help them reach a therapist, a crisis line, or emergency care.
5. Get support for yourself, too. Holding this for someone you love is heavy. Talking with a professional about it is not an overreaction. It is how people keep going.
When should you call 988?
You can call or text 988 if you are worried about yourself or about someone else. You do not have to wait until you are certain it is an emergency.
The 988 Suicide & Crisis Lifeline can help you sort out what is happening and what to do next, which is often exactly what people need when they are not sure whether their worry is warranted. If someone is in immediate danger, or has already seriously harmed themselves, call 911 or go to the nearest emergency department.
How DBT helps with suicidal thoughts
Dialectical Behavior Therapy was developed specifically for people who experience suicidal thoughts, self-harm urges, and emotions that feel impossible to survive. That history matters, because it means the treatment was built for exactly this, not adapted to it later.
The goal is not to tell someone to stay safe and hope for the best. It is to teach them what to actually do when emotions get so intense that no other way through is visible. In DBT, clients learn concrete skills for getting through a crisis, managing intense emotions, tolerating distress without making things worse, and asking for help effectively.
Alongside those skills, we build a safety plan together. A good safety plan names the person's own early warning signs, the things that help them get through a hard moment, the people they can reach out to, and the steps that make their environment safer.
Skills are only useful if they show up in real life, so DBT also includes between-session coaching. When a client is struggling at 9 p.m. on a Tuesday, that is when the skills need to be available.
And when a crisis does happen, we look at what led up to it together. What was going on? What made it harder? What might work differently next time? The goal is never blame. It is learning.
Does talking about suicide mean you will be hospitalized?
This is one of the biggest reasons people stay quiet, so it deserves a direct answer. No. Telling a clinician that you are having thoughts of suicide does not automatically mean a hospital stay.
There are situations where inpatient care is the right call, and if we believe someone is in immediate danger, we will say so plainly and help arrange it. But that is not the default, and it is not how DBT approaches suicidality. In DBT, suicidal thoughts and urges are something we treat directly in outpatient care rather than something we hand off.
There is a practical reason for that. Skills have to work in the place where the urges actually happen, which is your own home, your own school, your own relationships, at the hours when no one is on duty. That learning happens in outpatient treatment and between-session coaching, in the middle of real life.
The transition home is a high risk moment
If someone you love is coming home from an inpatient stay, a partial hospitalization program, or an intensive outpatient program, this is worth knowing: the period right after stepping down from a higher level of care is one of the highest risk times for suicide.
This is one of the better established findings in the field. A systematic review and meta-analysis in JAMA Psychiatry, drawing on five decades of studies, found that suicide rates in the first three months after discharge from a psychiatric facility were roughly 100 times the global suicide rate, and close to 200 times higher among people who had been admitted because of suicidal thoughts or behavior. A later analysis by the same research group found the risk concentrated most heavily in the very first week home. The same review also found that rates stayed meaningfully elevated for years afterward, which led the authors to argue for suicide prevention that extends well beyond the discharge window rather than stopping at it.
Numbers like that are hard to read, and they are not a prediction about any one person. What they tell us is where to put support.
It makes sense when you look at it closely. The person returns to the same environment and the same stressors, usually with far less structure and far less contact than they had inside, and sometimes without having learned skills that transfer to home.
We treat that transition as its own phase of treatment rather than as the end of one. If you or your teen is stepping down from a higher level of care, that is a moment to have outpatient support already in place, not a moment to wait and see how things go.
For teens, the family is part of treatment
When an adolescent is having thoughts of suicide or is self-harming, parents and caregivers are often frightened, exhausted, and unsure of what they are allowed to say.
In our adolescent DBT program, family members learn the skills alongside their teen. Parents learn how to respond in the difficult moments, how to support skill use at home, and how to communicate when everyone's emotions are running high.
We are not asking parents to become their child's therapist. We are giving the whole family more tools than they had before.
You do not have to figure this out alone
At Turn the Mind, we use DBT skills, collaborative safety planning, individual therapy, family involvement, and between-session coaching to help clients get through periods of crisis and build a life that feels more manageable.
If you are worried about yourself or someone you love, you do not have to wait until you are certain something is wrong.
Start the conversation. Ask the question. Get support.
We provide in-person therapy in Glen Rock, New Jersey, serving Bergen County and surrounding areas, along with virtual therapy across New Jersey, New York, and PSYPACT states.
If you are not sure whether this is the right time, or the right program, that is a normal place to start from. The first step is a free 15-minute consultation call with one of our clinicians. It is a conversation, not a commitment. We will ask what has been going on, talk through what DBT would actually look like for you or your teen, and help you find the next step even if that step turns out to be somewhere other than here.
If you are looking for DBT treatment for yourself or your adolescent, schedule a free 15-minute consultation. We would be glad to help.
Laura Richardson, Ph.D., is a Licensed Clinical Psychologist and the Clinical Director of Turn the Mind, LLC. She is a DBT-Linehan Board of Certification, Certified Clinician™ and an EMDRIA™ Certified EMDR Therapist.
Crisis resources: 988 Suicide & Crisis Lifeline (call or text 988) · Crisis Text Line (text HOME to 741741) · The Trevor Project for LGBTQ+ young people (call 1-866-488-7386 or text START to 678-678) · Veterans Crisis Line (call 988, then press 1)
References
Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide rates after discharge from psychiatric facilities: A systematic review and meta-analysis. JAMA Psychiatry, 74(7), 694–702. https://doi.org/10.1001/jamapsychiatry.2017.1044
Chung, D., Hadzi-Pavlovic, D., Wang, M., Swaraj, S., Olfson, M., & Large, M. (2019). Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation. BMJ Open, 9(3), e023883. https://doi.org/10.1136/bmjopen-2018-023883
