25 Overview: Suicide Prevention

Editor’s Note: The information in this section is adapted from “Suicide Prevention” by the National Institutes of Mental Health.

If You Know Someone in Crisis

Call or text the 988 Suicide & Crisis Lifeline at 988 (para ayuda en español, llame al 988). You can also contact the Crisis Text Line (text HELLO to 741741). Both services provide 24-hour, confidential support to anyone in suicidal crisis or emotional distress. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency.

The Veterans Crisis Line connects Service members and Veterans in crisis, as well as their family members and friends, with qualified Department of Veteran’s Affairs (VA) responders through a confidential toll-free hotline, online chat, or text messaging service. Dial 1-800-273-8255 and Press 1 to talk to someone or send a text message to 838255 to connect with a VA responder.  You can also start a confidential online chat session at Veterans Crisis Chat.

Introduction

Suicide is a major public health concern. In 2019, suicide was the 10th leading cause of death overall in the United States, claiming the lives of over 47,500 people. People living with bipolar disorder have a 10-30 times higher increased risk of dying by suicide when compared with the general population (Dome et al., 2019). Suicide is complicated and tragic, but it is often preventable. Knowing the warning signs for suicide and how to get help can help save lives.

What is Suicide?

Suicide is when people harm themselves with the goal of ending their life, and they die as a result.

suicide attempt is when people harm themselves with the goal of ending their life, but they do not die.

Avoid using terms such as “committing suicide,” “successful suicide,” or “failed suicide” when referring to suicide and suicide attempts, as these terms often carry negative meanings.

Warning Signs

Warning signs that someone may be at immediate risk for attempting suicide include:

  • Talking about wanting to die or wanting to kill themselves
  • Talking about feeling empty or hopeless or having no reason to live
  • Talking about feeling trapped or feeling that there are no solutions
  • Feeling unbearable emotional or physical pain
  • Talking about being a burden to others
  • Withdrawing from family and friends
  • Giving away important possessions
  • Saying goodbye to friends and family
  • Putting affairs in order, such as making a will
  • Taking great risks that could lead to death, such as driving extremely fast
  • Talking or thinking about death often

Other serious warning signs that someone may be at risk for attempting suicide include:

  • Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
  • Making a plan or looking for ways to kill themselves, such as searching for lethal methods online, stockpiling pills, or buying a gun
  • Talking about feeling great guilt or shame
  • Using alcohol or drugs more often
  • Acting anxious or agitated
  • Changing eating or sleeping habits
  • Showing rage or talking about seeking revenge

It is important to note that suicide is not a normal response to stress. Suicidal thoughts or actions are a sign of extreme distress and should not be ignored. If these warning signs apply to you or someone you know, get help as soon as possible, particularly if the behavior is new or has increased recently.

Here are five steps you can take to #BeThe1To help someone in emotional pain:

Presents five steps for helping someone in emotional pain in order to prevent suicide: Ask, Keep Them Safe, Be There, Help Them Connect, and Stay Connected.
  1. ASK: “Are you thinking about killing yourself?” It’s not an easy question, but studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts.
  2. KEEP THEM SAFE: Reducing a suicidal person’s access to highly lethal items or places is an important part of suicide prevention. While this is not always easy, asking if the at-risk person has a plan and removing or disabling the lethal means can make a difference.
  3. BE THERE: Listen carefully and learn what the individual is thinking and feeling. Research suggests acknowledging and talking about suicide may reduce rather than increase suicidal thoughts.
  4. HELP THEM CONNECT: Save the 988 Suicide & Crisis Lifeline number (call or text 988) and the Crisis Text Line number (741741) in your phone so they’re there if you need them. You can also help make a connection with a trusted individual like a family member, friend, spiritual advisor, or mental health professional.
  5. STAY CONNECTED: Staying in touch after a crisis or after being discharged from care can make a difference. Studies have shown the number of suicide deaths goes down when someone follows up with the at-risk person.

Risk Factors

Suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk. Suicidal behavior is complex, and there is no single cause. The main risk factors for suicide are:

  • Depression, other mental disorders (including bipolar disorder), or substance use disorder
  • Chronic pain
  • A history of suicide attempts
  • Family history of a mental disorder or substance use
  • Family history of suicide
  • Exposure to family violence, including physical or sexual abuse
  • Presence of guns or other firearms in the home
  • Having recently been released from prison or jail
  • Exposure, either directly or indirectly, to others’ suicidal behavior, such as that of family members, peers, or celebrities

Most people who have risk factors will not attempt suicide, and it is difficult to tell who will act on suicidal thoughts. Although risk factors for suicide are important to keep in mind, someone who is showing warning signs of suicide may be at higher risk for danger and need immediate attention.

Stressful life events (such as the loss of a loved one, legal troubles, or financial difficulties) and interpersonal stressors (such as shame, harassment, bullying, discrimination, or relationship troubles) may contribute to suicide risk, especially when they occur along with suicide risk factors.

Family and friends are often the first to recognize the warning signs of suicide, and they can take the first step toward helping a loved one find mental health treatment. See the resources on NIMH’s Find Help for Mental Illnesses page if you’re not sure where to start.

Identifying People at Risk for Suicide

Treatments and Therapies

Effective, evidence-based interventions are available to help people who are at risk for suicide.

Brief Interventions

Psychotherapies

Multiple types of psychosocial interventions have been found to help individuals who have attempted suicide (see below). These types of interventions may prevent someone from making another attempt.

NIMH’s Find Help for Mental Illnesses page can help you locate a mental health provider in your area. Here are tips to help prepare and guide you on how to talk to your health care provider about your mental health and get the most of your visit.

Medication

Some individuals at risk for suicide might benefit from medication. Health care providers and patients can work together to find the best medication or medication combination, as well as the right dose. Because many individuals at risk for suicide often have a mental illness or substance use problems, individuals might benefit from medication along with psychosocial intervention.

Clozapine is an antipsychotic medication used primarily to treat individuals with schizophrenia. To date, it is the only medication with a specific U.S. Food and Drug Administration (FDA) indication for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder.

If you are prescribed a medication, be sure you:

  • Talk with your health care provider or a pharmacist to make sure you understand the risks and benefits of the medications you’re taking.
  • Do not stop taking a medication without talking to your health care provider first. Suddenly stopping a medication may lead to “rebound” or worsening of symptoms. Other uncomfortable or potentially dangerous withdrawal effects also are possible.
  • Report any concerns about side effects to your health care provider right away. You may need a change in the dose or a different medication.
  • Report serious side effects to the FDA MedWatch Adverse Event Reporting program online or by phone at 1-800-332-1088. You or your health care provider may send a report.

For the most up-to-date information on medications, side effects, and warnings, visit the FDA website.

Collaborative Care

Collaborative Care is a team-based approach to mental health care. A behavioral health care manager will work with the person, their primary health care provider, and mental health specialists to develop a treatment plan. Collaborative care has been shown to be an effective way to treat depression and reduce suicidal thoughts.

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Healthy Living with Bipolar Disorder Copyright © 2022 by International Bipolar Foundation. All Rights Reserved.

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