If it’s an emergency or you feel that you’re in immediate danger, call a suicide prevention hotline. (The number for anywhere in the United States is 988.) If you feel that it’s not an emergency, talking with a trusted physician or getting mental health counseling from a trained therapist, psychologist, or psychiatrist can be a lifesaving step that can help you feel good again, says Doreen Marshall, PhD, vice president of mission engagement at the American Foundation for Suicide Prevention (AFSP). “We know from people who’ve gone through treatment and gotten to the other side of feeling suicidal that when they look back, they’re surprised to realize they were in such a dark place. In the intensity of that pain, it’s hard to see a world outside it,” Dr. Marshall says. Talking to someone about it is worth it, she says. “Treatment is worth it.” And though such thoughts can feel isolating, they come up more commonly than you may think, Marshall says. According to the American Psychological Association (APA), 44,800 Americans died by suicide in 2020. But the number of people who had serious thoughts about taking their own lives in 2020 was 12.2 million, according to estimates from the federal government’s Substance Abuse and Mental Health Services Administration. According to Mental Health America (MHA), estimates suggest more people are reporting having suicidal thoughts than in years past. Breaking the ice to talk about it can be difficult. “There’s a stigma around mental health problems and especially around admitting you have suicidal thoughts,” says Sterling N. Ransone Jr., MD, a family physician in Deltaville, Virginia, and president of the American Academy of Family Physicians (AAFP). But know that your healthcare providers have effective ways of helping and can connect you with those resources, Dr. Ransone says. “Seeing someone you trust to talk about it is an important step.” People going through this may feel hopelessness, helplessness, and despair first, says psychologist Daniel J. Crampton, PsyD, cofounder of the Colorado-based organization Status Code 4, which provides mental health services, crisis counseling, and suicide prevention help to first responders. Suicidal thoughts may come along with intense feelings of guilt, shame, feeling you’re a burden to others, feeling trapped and empty, extreme sadness, extreme rage, and unendurable emotional or physical pain, according to the National Institute for Mental Health. “We want people to know that talking about it makes all the difference, and you don’t have to wait until you see no other options,” Crampton says. “You can get back to all the good stuff that we as human beings love, value, and find enjoyable in life.” So how do you start the conversation with your doctor or another healthcare professional? We’ll walk you through it.
How Do I Know if I’m Having Suicidal Thoughts?
The American Psychological Association defines suicidal ideation (another term for suicidal thoughts) as “thoughts about or a preoccupation with killing oneself, often as a symptom of a major depressive episode.” Other definitions are less succinct. “As there is no ‘typical’ suicide victim, there are no ‘typical’ suicidal thoughts and ideations,” according to a review published in 2022 in StatPearls. Suicidal thoughts come in various levels of intensity, Marshall says. They may be passing thoughts that are a warning your brain is trying to find a way out of a temporarily stressful or overwhelming situation, or you may have more frequent yet usually passive thoughts that don’t involve planning to take your life. Any thoughts, even if they’re fleeting or infrequent, that life isn’t worth living or about how you will end your life are suicidal thoughts, Marshall says. All of those thoughts are worth seeking help for, Marshall says. According to Mayo Clinic, other signs that can be signs you’re struggling with your mental health or suicidal thoughts that warrant seeking help include:
Talking about suicideGetting the means to take your own life (such as buying a gun or pills that could be lethal)Isolating yourself from friends, family and things you once enjoyedUsing sleep or substances like drugs or alcohol as an escapeThinking a lot about dyingFeeling trapped or hopelessDramatic personality changes, such as being severely agitated or anxious
Mental health conditions, such as depression, anxiety, substance abuse disorders, bipolar disorder, and schizophrenia, can increase risk of having suicidal thoughts, according to the American Foundation for Suicide Prevention. Having a serious medical condition (like chronic pain, a traumatic brain injury, or another chronic illness) or history of childhood abuse and trauma can also increase risk of having suicidal thoughts. Coping with an ongoing stressor (such as bullying, harassment, relationship troubles, or job loss), a death of a loved one, divorce, or a financial crisis can also increase risk, as can exposure to another person’s suicide or to media reports of suicide. A family history of suicide or your own previous attempts also increase risk. In addition, research shows that people taking certain medications may also face higher odds for experiencing suicidal risks.
Where to Turn for Immediate Help if You’re Having Suicidal Thoughts
If you feel you’re in a crisis, extreme distress, or at immediate risk for taking your own life, get help right now by dialing 988 (from anywhere in the United States) or visiting 988lifeline.org. This connects you to the toll-free Suicide and Crisis Lifeline (formerly called the formerly known as the National Suicide Prevention Lifeline) for people in suicidal crisis or emotional distress. You can also text 741741 or visit crisistextline.org to reach a trained volunteer crisis counselor at the nonprofit Crisis Text Line. Or go directly to your local emergency room.
9 Things You Should Know About How to Talk With Your Doctor About Suicidal Thoughts
If you need help but aren’t sure whether it’s an immediate crisis, talking to someone at a hotline, such as the ones above, can help you sort out what you need and how urgent your situation is, Marshall says. Additionally, talking to any medical professional you see is an option. Depending on what you’re struggling with, they may not be able to address all of your needs, but doctors and other healthcare providers are trained to help connect you with the resources you need — and that includes for mental health care, says Marshall. This could include a specialist you see for a chronic health condition, your ob-gyn or another practitioner. “Any touch point in the healthcare system can get you the help you need,” Ransone says. And remember that discussing these and other mental health concerns with your doctor is common; they’ve heard things like what you’re going through before, Marshall says. Though you might be feeling guilt and shame around having these feelings, your healthcare providers are not judging where you’re at, they’re your allies. And most of the time, these thoughts don’t require emergency treatment; more often treatment starts with counseling, medications, building a support system, learning stress management strategies, and more so you can get back to enjoying your life, Marshall says. Here’s some advice on reaching out and starting the conversation:
1. Start With a Provider You Know
Talking about suicidal thoughts can be a difficult conversation. Starting it with a healthcare provider you know and have an ongoing relationship can be a good place to start, Ransone says. They can be an important mental health ally for you, he adds. And a healthcare provider you’ve seen before may be more accessible to you than a mental health professional. Research shows that about 62 percent of people who attempt suicide never see a mental health practitioner, but most see their primary-care doctor for some reason in the month or so before an attempt.
2. Your Doctor May Ask You About Your Mental Health — if Not, Bring It Up
Routine visits for an annual physical or other exam likely won’t include questions about suicidal thoughts. But many providers, as recommended by the United States Preventive Services Task Force for primary care visits, will ask if you’ve had any signs of depression. If you say yes, your provider will likely ask more questions about your mental health, and those should include ones about suicidal thoughts. Even if a provider doesn’t ask about depression or mental health, bring it up, Ransone says. If you’re struggling with how to broach the topic, he suggests: “I’ve been having these thoughts that are concerning to me. What do you think and is it something that should worry me?”
3. Remember There’s No Wrong Way to Start the Conversation
It can certainly be a difficult conversation to start, Ransone says. “There’s a certain amount of stoicism. There’s a stigma around mental health issues that keeps people isolated and thinking they can tough it out.” But remember that there’s no right or wrong way to have the discussion, Ransone adds. Bringing it up and having the conversation is the right way, he says. “We can’t help you if you don’t bring it up.”
4. Expect to Feel Vulnerable
Be open. “It just takes a little vulnerability,” says Caitlin Caviness, a licensed professional clinical counselor and program coordinator for Pikes Peak Suicide Prevention Partnership in Colorado. You can mention you’ve noticed you’re having a decline in your mental health that you’d like to take care of, she says.
5. Writing Down Notes Ahead of Time Can Help
It may be helpful to write down key information ahead of time, such as symptoms, how your thoughts and feelings affect your life, any events in your life that seem to contribute to your current situation, and medical information including all medications you take and all medical conditions you have, the AAFP recommends. You’ll find a printable list of questions you can ask yourself with spots for filling in important details before your appointment on the AAFP website. The American Foundation for Suicide Prevention (AFSP) has printable guides with steps you can follow for talking with a loved one or a practitioner, too.
6. If You Need to See a Mental Health Care Provider, Your Doctor May Help You Find One
If you live in an area with a shortage of mental health providers or long waiting lists for an appointment, your family doctor may also be able to help you get an appointment sooner if needed, Ransone says. Your primary care practitioner or specialist physician may be able to refer you to a nearby mental-health practitioner who accepts your health insurance. If not, or if you want to look further, try the Substance Abuse and Mental Health Services Administration’s online treatment locator services tool.
7. Your Family Doctor (or Another Specialist) May Take Steps Right Away That Can Help
After telling a healthcare provider about suicidal thoughts, he or she may refer you to seek additional mental health counseling. But other steps that that provider may take may start to immediately address the problem, such as evaluating whether you have a physical condition or are using medication that may be affecting your mental health. If appropriate, a doctor might prescribe medication that can help. Your doctor may also recommend lifestyle steps that help relieve anxiety and stress and ways to use your support system such as family and friends, Ransone says.
8. Looping in All Your Healthcare Providers Can Help
Ransone says it’s also important to tell your family doctor and other specialists if you’re already receiving mental health counseling or other treatment so he or she can help keep tabs on your mental health, and so your doctor can rule out health conditions or medications that may be contributing to or triggering an emotional health issue. “It’s important for a primary care provider and mental health provider to work as a team,” he says. Your family doctor and other specialists will help assess whether you have any physical health conditions or are taking medications that may be contributing.
9. Ask a Friend or Family Member for Help
Talking with your doctor or a mental health practitioner as soon as you realize you’re feeling depressed, anxious, overwhelmed, or burned-out can stop your thoughts and emotions from spiraling further, says Ann Rush, PhD, a counselor and co-founder of Status Code 4. Don’t be afraid to ask a friend or family member for support as you seek help — or to accept support if someone close to you asks how you’re doing, she says. “It’s easy to think everyone else is feeling wonderful except you, but it’s not true,” she says. “You don’t have to feel isolated and alone. Social support can help.”
