Thinking About Suicide? Here’s How to Get the Right Help

One of the first steps in finding your way out of the dark hall of despair is understanding that two things are true:

• Few people understand how to help someone who’s thinking of suicide; but
• Some people do.

It’s important to know that you are not alone. You are not alone in having reached this place; other people have been here and have found a way out. You are not alone in navigating your way out of it, either; there are people who aren’t afraid to look into the abyss with you and who can help you cross it.

If loved ones have made you feel like you shouldn’t talk about what you’re thinking or feeling, they’re wrong. It can help to understand that they’re probably afraid. They probably want to help you, but they don’t know how.

If a therapist turned you away, understand that there are specific reasons that this happened, none of which mean you can’t get the help you need. It just means that right now, you probably need a higher level of care than individual therapy sessions.

There are different levels of risk associated with different types of suicidal thoughts. You may well have reached a crisis point that requires inpatient care, or you might be a perfect candidate for therapy. You can find out which is true by learning what your risk level is.

Before we review this information, though, it’s important to understand that it’s not your job to figure out your suicide risk level. If reading this is difficult for you and you just want to talk to someone, that is a wise and valid response to your circumstances.

There are many places you can (and should) call for help (see the information box immediately below). The people who answer will listen with compassion and can help connect you with local mental health treatment options.

The first time you think about suicide, you’re more likely to think about it vaguely, in response to pain or hopelessness. For example, you might think, “Maybe I’d be better off dead.”

If you’re like many people, you’ve had such a thought, immediately followed by all the reasons you want to be alive and the reasons you wouldn’t end your own life. Just because you’ve ever had a thought like that doesn’t mean you’re in crisis now or need emergency care.

More than therapy is needed when suicidal thoughts develop two dangerous features: intent and a plan. If you’ve progressed from considering suicide to actively wanting to end your life, you’re in much greater danger than when the thoughts are vague or passive.

Your risk of acting on the thoughts is even higher if you’ve started planning how you would end your life. Using substances also increases your suicide risk by increasing your risk of acting on a sudden impulse.

The following infographic shows the risk levels associated with each kind of suicidal thinking and the recommended level of care for each:

When you’re actively considering suicide, you’re in crisis and need something more intensive than a weekly therapy session. When you’ve reached the point you’re planning to act, you need to immediately seek emergency care. If you’re not sure where to go, please call 988 or one of the other numbers listed above to connect with the care you need.

When mental health professionals evaluate your suicide risk, they also consider what they call risk and protective factors. These are aspects of your life that either increase or lower your risk of suicide.

Knowing which of these you have—and how many—can help professionals (and you) figure out what level of support and care you need right now. In general, the fewer protective factors you have, the higher level of care you need.

One of the important things to understand about depression is that it isolates you and convinces you that you’re alone because you deserve to be or because there’s something wrong with you. This isn’t true. Many more people than you’d think go through periods of isolation; they just don’t tell people how lonely it got for them.

Just like thoughts of suicide can be overcome, so can social isolation. The more connected the world becomes, the more we all learn we have a tribe out there somewhere. You can find yours and enjoy a very different quality of life than what feels possible for you now. Getting the help you need to get through a crisis is often only the first step on the journey of healing.

This may have less to do with concerns about the limitations of online therapy than it does with how much harder it is to accurately screen for suicide risk using an online form. Many times, if you select the “wrong” box, you’re automatically routed somewhere else—like this page—without the chance to explain further.

It also has to do with the importance of in-person supports for people with severe symptoms. While online therapy can be as effective as in-office therapy, there are times when it isn’t. It’s much easier for your therapist to help you create and follow a safety plan and link you with other local resources when they’re part of your local community and you see them in person.

To get the right care for your risk level, your best option is to connect with someone local—whether it’s a local therapist or a local mental health hotline. The National Suicide Prevention Lifeline (988) is also a good place to call. It’s staffed with people who understand suicidal thoughts and feelings and address them with nuance and respect.

Two ways to get mental health care immediately are to call 911 or go to a local emergency room. If you aren’t in immediate danger if you don’t get medical care right away, and you want to talk to a counselor first, you can call the National Suicide Prevention Lifeline (988) or a local crisis line.

Mental health crisis lines are part of the public mental health system in every state and typically operate 24/7 or have after-hours alternatives. There are also international crisis lines.

The people who answer crisis and suicide hotlines can give you immediate support and connect you with the care you need. If you need help right away and can’t transport yourself to an emergency room, they may be able to connect you to a local dispatcher and get first responders to come to you.

Note that once first responders become involved, you are no longer in control of all decisions about your care. If you say you’re thinking of harming yourself, then try to leave, you may be temporarily detained for involuntary treatment.

If you’ve had vague or passive suicidal thoughts, no suicide plans, and no intent to act on them, therapy can be a great place to start, especially if you have other protective factors that can help.

If you and a therapist determine that therapy is appropriate for your risk level, addressing suicidal thoughts will be an important element of your therapy plan, though probably not the only one.

Your therapist will want to understand the factors in your life that affect your mental health the most, whether those are circumstances at work or home or something else. They’ll want to learn more about the specific nature of the thoughts you’re having and develop a safety plan so you’ll know what to do if the thoughts become more intense, frequent, or specific.

As you and your therapist get to know one another better, you’ll start delving deeper and finding out what triggers your suicidal thoughts and other symptoms. You’ll work together to address these triggers and any underlying issues you may have, such as unresolved trauma, untreated depression, or unhealthy life circumstances. You’ll collaborate on an action plan for things to work on in therapy and things to do at home to improve your mental health.

You’ll engage in similar tasks in any mental health program. Higher levels of care usually include individual therapy as part of your treatment plan. Intensive and day programs work not by providing a totally different type of care, but by complementing therapy with additional interventions.

In general, higher levels of care involve spending more time each week in treatment than you would if you were seeing a therapist once a week. Intensive outpatient programs usually provide 6-8 hours of care per week, while partial hospitalization or day treatment programs meet for 8 hours a day, five days a week. Some programs offer flexible scheduling options when those are appropriate for your risk level.

In partial hospitalization and intensive outpatient programs, you usually participate in individual therapy sessions at least once weekly and sometimes as often as every day. You go to multiple group therapy sessions each week as well as instructional classes where you learn more about your condition or symptoms.

Many intermediate programs offer self-help groups where you can talk to peers without a counselor present. Depending on the program, you may also be able to participate in additional activities or therapies like art therapy or yoga.

Inpatient treatment usually involves a similar treatment schedule as partial hospitalization or day treatment programs.

The extra time you spend on an inpatient unit isn’t as much about spending more time in groups or therapy sessions as it is about having extra security and immediate care when you need it. Staff are available around the clock. If you’re in an inpatient program and wake up in the middle of the night in crisis, you can immediately connect with professional care.

Another important feature of inpatient treatment is that it removes you from circumstances that may be triggering or aggravating suicidal thoughts or other mental health symptoms. This allows you to stabilize in a safe environment and gain perspective on what you need to change at home to improve your mental health.

One of the most important things you’ll do in an inpatient program is work with your care team to develop a discharge plan to make your transition back to life at home smoother. Most people follow up inpatient care with outpatient care.

Like musicians who have explored suicide in their song lyrics, Nietzsche didn’t believe people should end their own lives. Instead, he wanted to help people find the strength to rebel against suicidal thoughts and the circumstances that produce them. Like other existentialist philosophers, he believed the only way to overcome suicidal despair was to honestly confront its reality.

Why do people have suicidal thoughts? The main reason people think about suicide is that they want to get out of an unbearable situation or end the pain they’re in. This is why Nietzsche said the thought of suicide can be a consolation—it is preferable to the thought of endless pain or torment.

Many people who have been in despair and gotten help have later found great happiness that seemed impossible at the time.

Though many people have thought about suicide at some point in their lives, it remains a taboo topic.

Even some mental health professionals are uncomfortable with the topic of suicide and refuse to meet with people who tell them over the phone that they’ve thought about suicide.

If this has happened to you, don’t lose hope. Sometimes, they’re right to refer people to a higher level of care, but sometimes they’re wrong. Sometimes they’re just not experienced enough to know what to do, and default to assuming you need a higher level of care.

There are experienced therapists who can help you if you’re not in acute crisis (if you are, please call one of the hotlines listed above), and you’re more likely to get in to see one if you can explain your symptoms in detail. You may have more luck with group practices or community mental health agencies.

You can find both kinds of therapy providers using the search tools on OpenCounseling.com.

No matter what it feels or looks like now, there is hope. You’ve been through a lot, and you’re stronger than you know. Your life has potential that’s hard to see in the dark, so please don’t give up. There are people who care and want to help. The more of them you get to know, and the more you learn about yourself, the closer you’ll be to finding your way out of the darkness.