September is National Suicide Prevention Month. Recognizing warning signs and providing resources for someone in need could be life-saving.

In 2020, suicide was the twelfth leading cause of death for Americans, according to the CDC. And for people ages 10-34, it was among the top three causes of death, the agency found.

The highest suicide rates in the U.S. are among white men, according to Suicide Awareness Voices of Education. But, suicide rates also increased slightly among Black people in 2020, compared to 2019.

"We want to drill in and understand who's at higher risk because our prevention and intervention programs need to be sector specific," says Julie Goldstein Grumet, vice president of suicide prevention strategy and director of the Zero Suicide Institute at Education Development Center.

Prevention programs continue to do the work and offer resources, but it's often that the loved ones of people experiencing suicidal thoughts will be able to notice signs and intervene.

Warning Signs of Suicidal Ideation

Indicators of suicidal ideation can range from verbal cues to changes in behaviors, and some aren't as obvious as you'd think, says Goldstein Grumet. 

Voicing suicidal ideations

It won't always be as clear as "I'm going to end it all," or "I'm going to kill myself," she says, but if a loved one says those words to you, then they should be taken seriously.

If someone you know is talking about suicide, whether directly or indirectly, it's important to address it, says Goldstein Grumet. Comments to pay close attention to include:

• "People would be better off without me."
• "I wish I were dead."
• "I can't take it anymore."
• "I just can't go on."
• "You won't have to worry about me anymore."

Behavioral changes including creating a plan

Any indication that someone is coming up with a plan to harm themselves is significant as well, she says, especially if you stumble upon searches in their web history about ways to take their own life. Other indicators could be a person reading or writing about suicide, she adds.

Additionally, behavioral changes can suggest that someone is having suicidal thoughts, Goldstein Grumet says, especially not wanting to do activities that they used to like.

Changes like these are signs to look out for:

• No longer wanting to hang out with other people
• Quitting sports
• Skipping school, getting lower grades
• Having a more difficult time going to work
• Drinking or using drugs
• Sleeping more or sleeping less

"There are some people who, when depressed, also think about suicide, but sometimes that depression looks more like anxiety or irritability," Goldstein Grumet adds. "So, when we're thinking about warning signs, we would also want to think about if we're seeing things like that."

How to help a loved one having suicidal thoughts

When you suspect that someone is considering suicide, the next best step is to directly ask them if that's what they mean by their statements or if they're seriously considering taking their own life, says Goldstein Grumet.

"Asking directly does not put the idea in somebody's head," she says, "If they already have the idea or thoughts of suicide, being asked in a genuine and empathic way, actually relieves their anxiety because now they can talk about it."

You should never walk away from the situation without asking if the person truly means what they're saying, and it's imperative to refrain from being judgmental, as it could make matters worse, she notes.

"When we're having that conversation, it needs to be empathetic and compassionate with our full attention while listening," Goldstein Grumet says, "They just want to be listened to and know that they're heard."

Avoid sayings like:

• "Why would you do that?"
• "Don't do anything stupid or crazy."
• "It's not worth getting upset about."
• "Things will get better."

Aim for phrases like:

• "Is suicide something that you're telling me you're thinking about?"
• "I care about you."
• "I want to understand."
• "I'm here, and I want to help you."
• "You are not alone."

Try to get as many details as you can to determine if they truly have a plan, Goldstein Grumet adds.

You want to know if they have access to means to follow through or a day chosen to do so because it can give you a sense of how imminent and high-risk the situation is, she says. 

The 988 crisis line and other resources

Once someone has opened up to you about what they're feeling, you can begin to introduce resources and start discussing the possibility of speaking with a professional.

Remember to always follow up after a person has sought out these resources. It's important to ensure that they're doing better, plan to keep using the preventative measures and know that you support them, Goldstein Grumet says.

Here are some resources you can suggest:

• Call 988: 24/7 Suicide Crisis Lifeline
• Talk to a mental health professional. (Ask if you can take them to their appointment if that is more comfortable)
• Speak to your primary care doctor or physician

"Suicide prevention is everybody's business and everybody's job," Goldstein Grumet says. "It's a public health issue. It takes community, faith, schools, workplaces, home, neighborhoods, healthcare and everybody to play a role in identifying people at risk."

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