Suicide prevention may begin long before a person reaches a crisis point sometimes with noticing that someone is no longer behaving like themselves.
For Dr Linet Kendi, a consultant psychiatrist, lecturer and mental-health advocate, one of the most important lessons in suicide prevention is that distress does not always have an obvious face.
“Someone may still be going to work, attending university, raising children, laughing with friends or meeting deadlines, yet internally they may be struggling profoundly,” she says.
This, she argues, is why families, friends, colleagues and communities must learn to look beyond appearances.
There is no single way a person experiencing suicidal thoughts will behave. Some may openly express hopelessness or say they no longer want to live. Others may become withdrawn, unusually quiet, agitated or emotionally overwhelmed.
Changes in sleep, appetite, alcohol or drug use, relationships and performance at work or school can also signal that something is wrong.
There may also be behavioral changes such as giving away valued possessions, saying unusual goodbyes or suddenly putting personal affairs in order.
But sometimes the signs are far less obvious.
“In clinical work, people do not always say, ‘I am suicidal.’ They may say things like, ‘My mind is just filled with thoughts,’ ‘I need my meds,’ or ask to be taken back to the clinician who has helped them before,” Dr Kendi says.
Such statements, she explains, can be attempts to communicate distress when a person may not have the words to fully explain what they are experiencing.
For families, the starting point is often simple: know the person and notice what has changed.
Has someone who normally communicates freely become withdrawn? Has a sociable person stopped interacting with others? Has someone stopped caring about activities that previously mattered to them?
Dr Kendi warns against interpreting these changes as simply bad behavior.
“A young person becomes withdrawn and we call them disrespectful. Someone cannot get out of bed and we call them lazy. Someone begins drinking heavily and we focus only on the alcohol without asking what they may be trying to numb.”
Instead, she recommends a compassionate conversation.
Rather than immediately criticizing the behavior, a family member could say: “You haven't seemed like yourself lately. What is happening?”
Ask directly
One of the biggest misconceptions about suicide is that asking someone whether they are thinking about suicide will put the idea in their head. Dr Kendi says this is not the case.
“Ask clearly, calmly and compassionately,” she advises.
A person can ask whether someone has been thinking about hurting themselves or whether they have been thinking about suicide.
The important thing, she says, is to listen to the response without judgment.
Avoid responses such as telling someone they have “so much to live for”, comparing their problems with those of other people or telling them to simply be grateful.
Instead, Dr Kendi recommends starting with: “I’m glad you told me.”
“Silence does not protect people,” she says. “A compassionate conversation can create an important pause between distress and action.”
Take every disclosure seriously
When someone says they want to die, the safest response is to take them seriously rather than dismissing the statement as attention-seeking.
If there is immediate danger, Dr Kendi advises seeking urgent professional help and ensuring the person is not left alone.
“Safety comes before secrecy when someone's life may be at risk,” she says.
Suicidal distress can emerge from several pressures coming together. These may include mental-health conditions, previous suicidal behavior, severe hopelessness, bereavement, relationship breakdown, financial difficulties, unemployment, chronic illness, trauma, violence, academic difficulties, isolation and substance use.
Dr Kendi cautions against reducing suicide to one event.
“Suicide is rarely caused by one thing,” she says. “I often describe suicide risk as an accumulation rather than a single event.”
Stigma can keep people silent
For many people, seeking help remains difficult because of fear of being labelled weak, unstable, dramatic or attention-seeking.
Young people may fear disappointing their parents, while men may have been taught that expressing emotional pain is a sign of weakness.
The result, Dr Kendi says, is that some people learn to “perform wellness” appearing functional while struggling internally.
“We need to stop waiting for somebody to completely fall apart before we consider their suffering legitimate,” she says.
Early intervention can create more opportunities to address distress before it becomes overwhelming. Treatment can involve psychotherapy, psychiatric care, and family support, treatment for substance-use problems, management of physical illness and addressing social or workplace difficulties.
Hope can return
For someone who has lost hope, Dr Kendi says the immediate goal does not have to be solving their entire life.
“The way you feel at this moment is real, but it does not have to become the final truth about your life.”
She says psychological pain can narrow a person's ability to imagine a different future. But that inability to see another possibility does not mean one does not exist.
“You do not have to solve your entire life today,” she says. “For now, the task may simply be to stay.”
Her message is ultimately one of connection.
“Stay through this hour. Tell somebody. Allow another person to carry part of what has become too heavy for you.”
And when hope feels out of reach, she says, people can temporarily rely on those around them to help carry it.
“So if hope feels unavailable, borrow hope from the people around you until you can feel it again for yourself. Your life deserves that time.”
