What if You Experience Thoughts of Suicide?
If you are in immediate crisis or having a suicide emergency, please call 911.
If you are not in acute crisis but are experiencing thoughts of suicide, please call 988, the crisis and suicide lifeline. Visiting your local emergency department may be needed, but it may not be needed. Talking with 988 should help you determine appropriate next steps and will provide you with support.
Please remember that many, many people have thoughts of suicide, without ever taking action on these thoughts. It’s important to
buy yourself time until the thoughts lessen and to remove access to means.
If anyone you know expresses thoughts of suicide, please react with compassion, kindness, and respect. After talking with 988, you may turn to doctors, nurses, counselors, and faith leaders in your community for ongoing support.
| Resources | Location | Services | Contact |
|---|---|---|---|
| 988 Suicide and Crisis Lifeline | Nationwide |
The 988 Lifeline provides 24/7, free, confidential clinical support for people in crisis and their family members. Press 1 if you are a veteran |
Phone or text: 988 Website: https://988lifeline.org/ |
| National Suicide Prevention Hotline | Nationwide | Phone: 1-800-273-8255; Teen Link: 866-833-6546 |
|
| WA Department of Health & Welfare Suicide Prevention Program | Washington State | Phone: 866-833-6546 |
What Kind of Help is Out There?
Taking steps to get help or find support can be overwhelming, especially if you do not know where to start. Below is a guide of possible places to start, seek treatment, and navigate systems of support:
Mental Health Counseling:
The Mental Health Counseling field has made significant strides in developing approaches and interventions for individuals and loved ones when someone is at risk for suicidal behavior and ideations. In addition to assisting individuals and families with broad life, behavioral, and psychological changes, counseling can help in reducing and managing suicidal behavior and thoughts. Below is a list of treatment approaches that have been found to measurably assist with anxious, depressive, or suicidal thoughts along with substance use, occupational and life experiences. Inquire with treatment providers about their experience and credentials in supporting individuals with thoughts about suicide. If they are afraid of taking you on as a patient, then they aren’t the right provider for you. It means they aren’t experienced enough in their job. In WA state, we have a law that requires training around suicide care so most providers you reach out to should feel capable of helping.
Collaborative Management and Assessment of Suicidality (CAMS)
The primary goal of CAMS is to assist clients in determining the problems that cause them to consider suicide; these are called suicide drivers. Working together collaboratively, the client and therapist will explore the roots of suicidal thoughts and behaviors while developing a plan to manage the drivers and find coping mechanisms. CAMS is also used to facilitate a discussion of risk factors, ways to reduce risk factors, and developing a stabilization plan. This plan will ultimately be intended to help individuals increase their understanding of drivers, identify support from others, and find reasons to live by increasing a person’s understanding of their relationships, drivers, and motivations for living. Overall, this approach is highly collaborative between client and counselor and involves deep work in creating /maintaining plans to stay alive, identify and monitor drivers, and find hope for the future.
Interventions Include:
- Assessment and determination of suicide risk
- Collaborative treatment planning and implementation
- Develop an understanding of suicidal drivers
- Use problem-solving to identify and work on effective interventions for drivers
- Discover and engage in reasons for living
Cognitive Behavioral Therapy (CBT) & Cognitive Behavioral Therapy-Suicide Prevention (CBT-SP)
In this modality of therapy, the counselor and client can work collaboratively to cognitively restructure the client’s thoughts about suicide. In this treatment, suicidal behavior is viewed as a maladaptive coping behavior that a person has developed in order to resolve their pain; it is not, however, viewed as a disorder or symptom of one. Using CBT and/or CBT-SP, the counselor can help a client change their automatic thoughts and start to disrupt these maladaptive thought patterns. It is a way to critically view and evaluate your thought patterns in a safe space, and instead, re-wire your brain to develop other ways of thinking, coping, and living. CBT is often used to treat depression and anxiety and is known to
significantly improve people’s automatic negative thoughts, maladaptive belief patterns, negative self-talk, and disruptive behaviors. Typically, treatment would include three main phases: Acute, Skill Building, and Continuation Post Acute.
Treatment Strategies Include:
- The cognitive restructuring of thinking, especially pertaining to suicidal thoughts and behaviors
- Critically evaluating the pros and cons of decisions to improve an individual’s ability to make decisions
- Developing coping mechanisms and helpful strategies to get through a crisis
- Creating safety plans in order to have steps to lean on during moments of crisis
Dialectical Behavioral Therapy (DBT)
DBT, a talk therapy based on CBT, is specifically designed to help individuals who experience emotions on a very intense level. “Dialectical” means combining opposite ideas, and in this modality’s case, the opposite ideas consist of helping people accept the reality of their lives and their behaviors, as well as helping them learn to change their lives, including their unhelpful behaviors. The idea here is that in an emotionally charged situation, two opposing points of view compete, and the goal of therapy is to bring the two points of view together, thereby increasing the integration of views and emotions and reducing reactivity. These dialectics include experiences such as solving a problem vs. accepting a problem, improving vs. accepting yourself as you are, regulating feelings vs. feeling what you feel, quiet and meditation vs. taking action, and being independent while understanding that sometimes one is dependent. The overall idea is that DBT aims to help a client begin to view their life as a life worth living while simultaneously learning new, adaptive skills to get through and cope with crises. Often DBT is used to treat self-harm ideations, suicidal behavior, Post-Traumatic Stress Disorder, Substance Use Disorder, eating disorders, Depression, Anxiety, and Borderline Personality Disorder.
DBT Aims to Teach:
- Problem-solving skills
- Mindfulness
- Emotional regulation and understanding
- Interpersonal effectiveness
- Distress tolerance
Prolonged Grief Therapy (PGT)
This is a form of therapy that aims to help individuals and families cope with and process a loss. Grief and loss are complicated experiences, especially if there is a presence of trauma and confusion. Sometimes, people can feel “stuck” in their grief and will find it difficult to enjoy aspects of life, heal, and move forward. When someone is experiencing prolonged, intense, and unrelenting grief, PGT can be a beneficial therapeutic process in helping them get “unstuck” and begin healing. Essentially, a therapist using PGT will help their client process their grief while simultaneously healing using a variety of techniques and treatment strategies.
The Goals of PGT:
- Learning about the processes of normal and prolonged grief
- Learning how to balance grief with coping and personal life
- Addressing trauma and loss
- Restoration and healing
Attachment-Based Family Therapy (ABFT)
This therapeutic modality was developed with the intention of reducing suicide risk among adolescents and is often used in family treatment settings. ABFT focuses on bringing empathy, perspective-taking, and problem-solving skills to families so that family attachment may grow. Ideally, increased family attachment will support an adolescent’s sense of self and will form a model for healthy relationships. In ABFT, suicidal behavior in adolescents is often viewed as a coping response to stress and difficulty regulating intense emotions. This can take place when family attachment is insecure and adolescents experience symptoms such as depression, reactivity, and disruptive emotional regulation. ABFT works to identify the feelings and situations that produce distressful family relationship patterns. In turn, individuals and families can begin to more openly discuss difficult feelings and build skills for emotional expression. Through compassionate and informative conversations, the counselor will work with the adolescent and parents separately and together in order to build a more secure, informed, and communicative family attachment.
In ABFT:
- Individual emotions and experiences, both positive and negative, are validated
- Adolescents play a role in developing a vocabulary for their emotions
- Parents get to express their emotions and experiences
- Negation and compromises are used to resolve family conflicts
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a neuro-scientifically backed therapeutic process that assists people in reducing the effects and disturbances of trauma. Through a structured process, a client will be guided through their traumatic memory while simultaneously experiencing bilateral stimulation (typically eye movement or finger tapping). The combination of these movement simulations and the memory helps the individual reduce the vividness of the emotion associated with the trauma. In essence, it is a way to process difficult memories and experiences while re-wring your brain to experience less disturbance and diminish symptoms. People often find EMDR useful as it is highly structured and typically works faster than talk therapy. While EMDR is not a method used to treat acute suicidal thoughts and actions, it has been found to be measurably helpful for those who suffer from PSTD, anxiety, depression, OCD, chronic pain, addictions, and other traumatic or distressing events.
EMDR Aims to:
- Help reduce the subjective disturbance of an event
- Decrease symptoms of PTSD
- Utilize bilateral stimulation to help de-sensitize the brain to traumatic memories
- Focus more on the bilateral stimulation and memory process than on talk therapy
Source: For more details on these methods, please visit The American Foundation for Suicide Prevention’s page on Therapy options for those struggling with loss or thoughts of suicide.
Mental Health Resources for Historically Underserved Communities
The American Foundation for Suicide Prevention provides a list of national resources that have been reviewed for accuracy, mental health and community content, and ease of use. The resources are grouped by different ethnicity groups, cultures, and communities in an effort to help each user find a group or resource that fits their needs.
https://afsp.org/mental-health-resources-for-marginalized-communities/
Ways to Find a Mental Health Counselor:
It can be difficult to know where to start when looking for a mental health counselor who will be a good fit. Fortunately, there are several resources available that can assist in this process. When starting your search, it can be helpful to use a search database to narrow down criteria such as a therapist’s specialty, their location, which insurances or payment methods they take, and other areas that are important to you. Remember to trust your gut; if you do not end up connecting well with a therapist, it is okay to find someone who will be better suited for you and your journey.
A great place to start your search is Psychology Today. This extensive search engine allows you to search for Therapists, Psychiatrists, Treatment Centers, and Support Groups by location. You can also filter for a variety of categories, such as telehealth or in-person sessions, type of therapy or specialty, gender, age, price, insurance, ethnicity, language, faith, and sexuality. Once you have selected the criteria that fit your preferences, a list of matches will appear. Here, you to click on each profile, and view pictures, bios, and websites for all available therapists. This resource allows you to get a good idea of what is out there, who will fit your needs, and how to go about narrowing down your perfect fit.
Additionally, Healthline published a reviewed article on different modalities and considerations for finding a therapist. They include step-by-step processes for defining your goals, consulting insurance and identifying financial questions, exploring community and peer resources, using a variety of databases, identifying helpful organizations, and navigating online therapy options.
Finally, the other tabs on this page have many linked resources for group and individual support programs/organizations for suicide loss survivors, law enforcement, first responders, and the general community.
Alternatives or Additions to Mental Health Counseling:
Therapy is a great resource for many people regardless of what they are going through. However, some may find that they would like alternative options or options that can be used in addition to mental health counseling. Below are several options, all of which should be extensively discussed and assessed with a qualified professional to determine if they fit an individual’s needs.
Medication:
When using medication to treat mental health, it is vital that one works with a qualified professional, such as a psychiatrist, to ensure they are getting their needs met while properly weighing risks and benefits. This discussion should cover details on a person’s experience, how their condition/symptoms impact their life, and the different options for treatment that exist. Despite potential risks and side effects from taking medication, choosing not to treat symptoms, like suicidal thoughts, can also come with its own set of risks. For many, medications can assist with suffering, medical comorbidity, chronic pain, autoimmune conditions, and risk of suicide. Ultimately, it is up to you and your doctor to decide the best course of action for you. The American Foundation for Suicide Prevention goes further into detail about the process of exploring medication as an option, including a list of medications that have been found to measurably assist with depression and suicide prevention.
Transcranial Magnetic Stimulation (TMS):
This is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain, resulting in the alleviation of some of the symptoms of major depression. TMS is often used for those who have found talk therapy and/or medication to be ineffective in treating depression, smoking, migraines, and obsessive-compulsive disorder. Currently, TMS is approved for use by the U.S. Food and Drug Administration (FDA) and the full extent of the method’s abilities to help various conditions (such as epilepsy) is still being studied. TMS is essentially performed by placing an electromagnetic coil against the client’s scalp. The coil then delivers pulses that stimulate the brain’s mood control region, typically stimulating areas that experience decreased activity due to depression. For more information on TMS, its uses, outcomes, and side effects, you can view the Mayo Clinic’s review of the treatment.
Ketamine / Esketamine Treatment:
In 2019, the FDA approved a nasal spray called Esketamine, a derivative of Ketamine, as an alternative approach to helping with treatment-resistant depression. While it is in the fairly early stages of research, scientists have found certain treatments that involve Ketamine can measurably help fight major depression. For more information on the treatment, please visit Yale Medicine or The National Institute of Mental Health.
Other Alternatives:
Outside of the above-listed resources, there are a variety of other options for helping to treat depression and suicidal ideations. For example, researchers are beginning to discover that a method known as The Stellate Ganglion Block (SGB), an injection of medication into nerves at the base of your neck for chronic pain conditions, has been found to help with mental health conditions such as depression and PTSD. For more information, please visit the Cleveland Clinics page on SGB.
Additionally, there are many holistic options that researchers have found measurably improve quality of life and can pair well with any of the aforementioned approaches. Here is a list developed by the Cleveland Clinic on holistic alternatives and additives to therapy/medication.
Brief Interventions:
While mental health counseling, medication, and other previously listed treatments can be very effective in reducing and eliminating suicidal thoughts and actions, sometimes an individual needs a brief, more immediate approach. When someone is in crisis, coping becomes extremely difficult and their usual methods of managing stress or utilizing flexible cognition may feel strained. In order to live through a high-risk suicidal crisis, it is less effective for a person to tackle the root of their pain and attempt to solve their problem than it is to help them find alternative options for suicidal behavior in the present moment. If you or someone you are close to is prone to moments of crisis like this, it can be extremely helpful to create a plan using one or more of the methods below. That way, if a crisis occurs, you already have a list of steps you can turn to.
Safety Planning:
A safety plan is personal and looks different for everyone. It is typically constructed between an individual and a mental health care provider or someone who is a trusted source. The goal of a safety plan is to help individuals identify the thoughts or feelings that occur before a decline in mental health so that they can fall back on a variety of options for coping.
According to The American Foundation for Suicide Prevention, a safety plan will include:
- Warning signs that a suicidal crisis may be developing
- Specific things — activities and/or places — that will distract a person’s attention away from suicidal thoughts
- People who can help an individual distract themselves
- People with whom they can discuss their distress and suicidal thoughts and feel heard or supported
- Professionals available for consultation
- Emergency contacts such as the 988 Suicide & Crisis Lifeline (988) and the Crisis Textline (text ‘TALK’ to 741741) and other relevant helplines
- A plan to reduce access to lethal means in the home or immediate environment
- The person’s unique hopes for the future and reasons for living
Lethal Means Counseling (LMC):
LMC aims to help individuals, peers, and families in reducing the means that a suicidal person has for committing suicide. When someone is in suicidal crisis, things can escalate very quickly, they can develop tunnel vision from pain, and whether or not they are near lethal means such as weapons or substances can play a determining role in the act of committing suicide. LMC can help families and individuals in removing lethal means from important environments, like home, in order to help someone make it through a crisis. Research shows that if people can make it through these moments of painful crisis, they are more likely to be able to consider other coping strategies.
The American Foundation for Suicide Prevention defines the steps LMC as:
- Expressing concern for the patient’s safety
- Letting them know what they can do to create a safe environment
- Removing or securing any type of lethal means from the home (or work) environment
- This can include items such as firearms, medications (prescribed and over the counter), toxic substances like cleaning supplies, sharp objects
- Explaining how lethal means safety works
- During moments of acute risk, need to reduce access to lethal means they have honed in on
- People usually don’t switch quickly to a different method since thinking is less flexible in that moment
- If an attempt does occur, other methods are likely to be less lethal