Suicidal thoughts: warning signs and how to help

Thoughts of suicide are a sign that a person is in more pain than they can manage right now — not a sign of weakness, bad character or weak faith. Most people who have these thoughts do not want to die; they want the pain to stop and cannot see another way. Suicidal crises are often temporary, and they are treatable. People do come through them, and go on to live lives they are glad of.

This page is for anyone worried about someone else, and for anyone having these thoughts themselves. If that is you, the section 'If you are having these thoughts' is further down — you can go straight to it.

Talking about suicide helps

In Pakistan suicide is surrounded by silence: shame for the family, fear of what people will say, and fear of the law. That silence keeps people from asking for help. The World Health Organization identifies stigma as one of the main reasons people with suicidal thoughtsSuicidal ideationThoughts about ending one's life, from a passing wish not to wake up to active plans. They are a sign of severe distress, not weakness, and with help they can pass.Read the full definition do not seek care.

One common fear is that asking about suicide will put the idea into someone's head. It does not. A review of the research found no increase in suicidal thinking when people were asked about it — and some evidence that being asked, and being able to talk, brings relief. Asking tells the person you can hear the truth.

Warning signs

There is no single sign, but these deserve attention — particularly if they are new, or getting worse.

Risk is higher after a previous suicide attempt, with depressionDepressionA medical condition in which low mood or loss of interest lasts most of the day, nearly every day, for at least two weeks, and affects sleep, energy and daily life.Read the full definition, psychosis, bipolar disorderBipolar disorderA long-term condition with episodes of depression and episodes of abnormally high or irritable mood (mania or hypomania), usually lasting days to weeks, with more stable periods in between.Read the full definition or substance use, after a major loss or humiliation — exam results, a broken engagement, debt, the end of a marriage — and for people living with violence or abuse at home.

How to help someone

1. Ask directly. Choose a private moment and ask in plain words: 'Are you thinking about suicide?' or 'Are you thinking of ending your life?' A clear question gets a clearer answer than 'You're not going to do anything silly, are you?'
2. Listen. Let them talk. Do not argue, lecture, or tell them how much worse others have it. You do not need the right words; taking them seriously is what helps.
3. Stay with them. If they are at risk now, do not leave them alone. Ask whether they have a plan and whether they have access to the means — you need to know how urgent this is.
4. Make the home safer. Limiting access to the means of suicide saves lives, because many crises are brief. Lock away or remove stored medicines, pesticides and other household chemicals, and anything else the person has mentioned. Keep only small amounts of medicine in the house and have one family member hold them.
5. Get help. Go with them to a doctor, a psychiatry department or the emergency department. Offer to make the call or sit with them while they do.
6. Follow up. Keep checking in over the following weeks. The period after a crisis, and after leaving hospital, is a particularly risky time, so keep in touch even when things seem better.

A safety plan

A safety plan is a short, written list the person makes while calmer — ideally with a doctor, counsellor or trusted family member — to use when the thoughts return. Safety planning with follow-up contact has been shown to reduce suicidal behaviour after an emergency visit. A plan usually covers:

1. My warning signs — the thoughts, feelings and situations that mean a crisis may be coming
2. Things I can do on my own to get through the next hour (pray, walk, take a shower, go somewhere with people)
3. People and places that help me feel better or distract me
4. People I can tell that I am struggling, with their numbers
5. Professionals and services I can contact, including the nearest emergency department and 1122
6. How I will make my surroundings safer
7. My reasons for living — children, parents, faith, plans, anything that matters to me

If you are having these thoughts

If you are reading this because you feel like ending your life, thank you for still being here. These feelings can be overwhelming, but they are not permanent, even though they feel that way. You do not have to act on a thought, and you do not have to face this alone.

When the immediate crisis has passed, see a doctor. Suicidal thoughts often come with depression, anxiety, trauma, bipolar disorder or overwhelming circumstances — all of which respond to treatment such as CBTCognitive behavioural therapyA structured, time-limited talking therapy that helps you notice and change the thoughts and behaviours that keep a problem going. It is a first-line treatment for depression and most anxiety problems.Read the full definition, medicine, or practical help with the problem underneath. District (DHQ) and teaching hospitals have psychiatry departments, and online therapy with a clinical psychologistClinical psychologistA psychologist trained to assess and treat mental health problems with talking therapy and psychological testing. They are not medical doctors and do not prescribe medicine.Read the full definition is available if you cannot travel.

Faith and treatment

Many people find strength in prayer, dua and their community, and faith can be one of a person's strongest reasons for living. It works best alongside treatment, not instead of it. Imams and religious teachers who are told about someone's suicidal thoughts can do a great deal of good by listening with compassion and encouraging medical help, rather than responding with condemnation.

After a crisis or a suicide attempt

Anyone who has attempted suicide needs medical care straight away, even if they seem physically fine, followed by an assessment by a doctor or psychiatrist. Most people who survive a suicide attempt do not go on to die by suicide — research summarised by Harvard's Means Matter programme puts it at around nine in ten — which is why getting through the crisis, and getting treatment afterwards, matters so much.

• Keep the home safer for the following weeks and months, not just the first night.
• Make sure there is a follow-up appointment, and help the person get to it.
• Avoid blame, interrogation or telling relatives and neighbours more than they need to know.
• If a student is involved, talk quietly with the school or college about a gradual, supported return.
• Look after yourself too — families supporting someone after a crisis are often exhausted and frightened, and can speak to a counsellor themselves.

Where to get help in Pakistan