3 Ways to Prepare for Conversations about Self-Harm & Suicide

Asking if someone is suicidal won’t give them ideas, but it may help them feel less alone. A 2014 meta-analysis (that’s a study that gathers and measures data from other studies to create really robust evidence about a hypothesis) by researchers Dazzi et al. at Cambridge University supports this. But how can we get better at these really hard conversations? Read on to learn some practical tips:

Image of a cell phone on a blue background with a pink banner across the middle of the screen. The phone screen has a contact pulled up for Sad Friend with a button to call or text on the bottom of the screen. On the banner is written, "Asking if someone is suicidal is ok." Underneath the phone is written, "Brave conversations save lives."

Why Asking Someone About Suicide and Self Harm Is Hard

Crisis – whether it’s our own or someone else’s- can shift our brain into trauma response. Instead of thinking clearly, planning, and responding well, brains in a trauma state default to Fight or Flight (or, as researchers have discovered, Fawn or Freeze). To make these conversations easier, there are a few ways we can prepare:

1. Get Used to the Word “Suicide”

A first step towards diffusing the terror of conversations that acknowledge suicide can be to simply aim to compassionately say the word in a conversation this week. It might be a life line- or, it might just be a tiny step towards creating a safe space for someone in your world to say “I’m scared how much I want to hurt myself. Help?”

2. Practice Having Conversations about Suicidal Thoughts

When we enter these brave conversations, our pulse may spike, we may stumble on words, and we may even want to escape the conversation. Here’s a tip to stay present: literally practicing saying the words can help.

To practice, pair up with a friend or partner and rehearse what it’s like to say things like:

  • “Sometimes when people are struggling with stuff like this, they have thoughts about suicide, are you having those thoughts?”
  • “I’m really concerned about you and I wonder if you feel like you can keep yourself safe right now?” or
  • “I want you to know that if you ever feel suicidal, I’m here for you. Call me and we’ll figure out together how to keep you safe.” ⁠

Most people’s inclination is to avoid words like “suicide,” “death,” or “kill,” but there’s strong evidence1,2 that being explicit, clear, and direct in our questions can result in more honest conversations.

Getting used to saying these emotionally-charged words and statements now can help us show up and speak bravely when the chips are down.

A small study in the UK in 20163 found that incremental approaches (i.e. asking about general thoughts and feelings before building to more serious questions) appeared most effective in the study that included only children and teens. Those same researchers found that the interviewer’s sense of confidence in asking were also associated with more honest disclosures.

3. Create and Know How to Create Safety Plans

As a clinician and human, I love safety plans. Done well, a safety plan can be a comfort to someone struggling with mental health and those who care about them. It’s a way to plan what to do, where to go, and who to talk to when things are Very Bad, so when that day comes we don’t have to start from scratch deciding who to reach out to or how to do it.

You can download a free safety plan template and read more about making one in my article on safety planning. Alternately, to get really cozy with safety planning, check out a mug, poster, or pillow with this crisis plan design.

⁠Gentle reminder that Instagram is not therapy and my resources are educational, not therapeutic. If you need help, reach out to the #crisistextline (click here to start the conversation) and ask to be connected with resources. If you need help urgently, call 911 or local mental health emergency services. (In Seattle, that is crisis connections at 206-461-3222.) Or find treatment options through SAMHSA.

Download a Printable PDF of this Resource:

Suicide among teenage girls is following a concerning trend, with the CDC reporting an increase of over 50% (and in several states over 70%) between 2007 and 2018 (source). We can all help. Connect, mentor, or financially support youth art, youth music, and youth mentorship.

If you are suicidal, know there is hope. Tell someone. If they don’t take you seriously tell someone else. Call a hotline. It might not be the first, second, or seventh one you try, but I promise there is a resource, health care provider, or therapist who can find you in that dark place.

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Image Description for Screen Readers:

Image of a cell phone on a blue background with a pink banner across the middle of the screen. The phone screen has a contact pulled up for “Sad Friend” with a button to call or to text on the bottom of the screen. On the banner is written, “Asking if someone is suicidal is ok. Underneath the phone is written, Brave conversations save lives.” Image was created by @LindsayBraman.

  1. Fiedorowicz, J. G., Weldon, K., & Bergus, G. (2010). Determining suicide risk (hint: a screen is not enough). The Journal of family practice59(5), 256–260. []
  2. Morgan, G., Buckley, C., & Nowers, M. (1998). Face to face with the suicidal. Advances in Psychiatric Treatment, 4(4), 188-196. doi:10.1192/apt.4.4.188 []
  3. O’Reilly, M., Kiyimba, N. and Karim, K. (2016), “This is a question we have to ask everyone”: asking young people about self-harm and suicide. J. Psychiatr. Ment. Health Nurs., 23: 479-488. https://doi.org/10.1111/jpm.12323 []

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