If this is an emergency
Call or text 988. The 988 Suicide & Crisis Lifeline is free, confidential and open 24/7, everywhere in Maryland, Washington, D.C. and Ohio. In immediate danger, call 911 or go to the nearest emergency department. Everything else on this page can wait until you are safe.
Warning signs worth acting on
According to the National Institute of Mental Health, warning signs include talking about wanting to die or being a burden, withdrawing, giving away possessions, increased substance use, and dramatic mood shifts, including a sudden calm after despair. The list above covers more. None of them proves what is coming; all of them justify a direct question and a call.
Two actions are consistently protective: asking directly (it does not plant the idea. It relieves the secrecy), and reducing access to means during a dark period, from medications to firearms. Neither requires training. Both have saved lives.
What raises risk
Suicidal thinking is a symptom, and it has recognised contributors. Knowing them is useful for one reason: nearly all of them are treatable or addressable.
- Mental health conditions: depression above all, and also bipolar disorder, PTSD, psychotic illness and anxiety, particularly when untreated.
- Alcohol and drug use, which raise risk in two ways: they deepen despair over time, and they remove the pause between an impulse and an action.
- A previous attempt, which is the single strongest predictor there is, and precisely why follow-up care after one matters so much.
- Recent loss or upheaval: bereavement, a relationship ending, job loss, financial crisis, legal trouble, or public humiliation.
- Chronic pain or a serious physical illness.
- Isolation, and a sense of being a burden to the people you love.
- Family history of suicide, and exposure to another person’s.
- Access to lethal means, which converts a survivable moment into an unsurvivable one.
And what protects: connection to other people, being in treatment and staying in it, a written safety plan, reduced access to means, and reasons for living that have been named out loud rather than assumed.
The moments that need extra care
Risk is not constant. Certain windows are known to be higher, and they are the ones where booking the next appointment matters most:
- The days and weeks after leaving an emergency department or a hospital stay. This handover is one of the highest-risk periods in all of psychiatry, and one of the most preventable.
- Early in treatment for depression, when energy and initiative can return before mood does. Being told about this in advance is part of good care, not a reason to avoid treatment. Say so immediately if it happens.
- A sudden calm after a long darkness. It can be relief, and it can be the peace of a decision made. It always deserves a direct question.
- Anniversaries, court dates, discharge dates and other things that were being waited for.
If you are worried about someone
You do not need training or the right words. You need four things, in order.
- Ask, using the word. “Are you thinking about suicide?” Not “you’re not thinking of doing anything silly, are you?”. That phrasing asks for reassurance rather than the truth.
- Listen without fixing. Do not argue them out of it, list their blessings, or react with panic or anger. Being heard without alarm is the intervention.
- Reduce access to means, now. Lock up or remove medications, firearms and anything else specific to their plan. This is the single most effective practical action a family member can take, and it does not require their agreement to be worth raising.
- Connect them to help, and stay while it happens. Call or text 988 together. Go with them to the emergency department if the danger is immediate. Then follow up tomorrow, and next week, the crisis passing is the beginning of the treatment, not the end of the risk.
Do not promise to keep it secret. It is the one promise you cannot safely keep, and saying so honestly at the start protects both of you.
What we do, and when to come to us
We are follow-up care, not a crisis line: the treatment that addresses what the thoughts grow from. After an evaluation, that usually means treating the underlying condition: depression, trauma, substance use, with therapy and medication as fits, plus a written safety plan: your warning signs, your reasons, your people, your numbers, made before the next dark night rather than during it. DBT skills help many people ride out surges of pain without acting on them.
If you have recently left an emergency department or a hospital stay, that handover window matters enormously: book the follow-up now, while the discharge papers are still on the counter.
For the people alongside
Loving someone through this is frightening and exhausting, and you are allowed support too, 988 takes calls from worried families, and so do we. You do not have to be the whole safety net. You just have to help them reach the rest of it.