What should you know when someone you care about is suicidal, and how can you support someone feeling this way?
- Understand the difference between active and passive suicidal feelings
- Don’t be afraid to ask questions
- Make sure that they feel supported
- Understand why they might not want to get help
- Know where to go for help
1. Understand the difference between active and passive suicidal feelings.
One of the biggest reasons people avoid reaching out is a fear of being sent to the hospital or held against their will.
If the person you care about is at credible risk of hurting themselves, call 911 immediately. However, there are two different types of suicidality: active and passive. The ability to understand and differentiate between them is crucial, as it helps decide what to do next.
Being actively suicidal means wanting to end one’s life and explicitly having a plan, intention, or “goal” in mind.
Being passively suicidal means wanting to end one’s life yet not having any intent or motivation whatsoever to carry out a plan.
If someone you know is passively suicidal, treating the situation like a crisis can sometimes make them feel worse. So, let’s take a closer look at the similarities and differences between active and passive suicidal thoughts.
What may these two types of suicidality have in common?
- Suicidal ideation
- Coming and going nature
- Self harm urges
Firstly, both active and passive suicidality include suicidal ideations (SI), which is a clinical term used to describe a “range of contemplations, wishes, and preoccupations with death and suicide.” SI is associated with Major Depressive Disorder, Borderline Personality Disorder, Trauma, and other mental health struggles. In one study, people who had SI and “agoraphobia and poor perceived social support” were more likely to actively attempt suicide.
Secondly, suicidal ideations (passive or active) often “present in a ‘waxing and waning manner.’” In other words, an individual is more likely to have episodes where they feel suicidal rather than feeling that way all the time. This can happen with both passive and active suicidality.
“Coming and going” suicidal thoughts aren’t always less concerning than constant ones. On the other hand, if someone is chronically and consistently suicidal, it should be brought to the attention of a mental health practitioner immediately–whether it’s active or not.
Lastly, those having passive or active suicidal thoughts may both have self harm urges. Self harm exists on a spectrum, ranging from neglecting one’s health to suicidal self-injury (SSI). In between those two extremes, many who self-harm partake in non-suicidal self-injury (NSSI) like cutting or hitting themselves. As Crisis Text Line states, “Usually, when people self-harm, they do not do so as a suicide attempt. Rather, they self-harm as a way to release painful emotions.”
Self harm requires attention
Whether the person you know is actively suicidal or not, self harm is always cause to help a friend access professional crisis intervention. However, if their self harm is clearly suicidal (if they are about to or have self harmed in a way that could kill them), emergency action is required. Seek medical attention immediately by dialing 911.
Self harm is concerning in its own right, but can’t always tell you how actively suicidal someone is. What can?
Key distinguishing features
The main difference between being actively or passively suicidal is the severity of one’s intentions. A person who is passively suicidal will have much less intention to hurt themselves than a person who is actively suicidal.
The main difference is that those who are passively suicidal do not have a set plan or intention to end their life. Those struggling with active suicidality do have a specific plan to end their life.
Signs of being actively suicidal include…
Know the signs of active suicidality so you can recognize when someone you care about needs help.
- Expressing they are a burden to others
- Talking about feeling trapped, having no way out, or being afraid of what they might do
- Researching ways to kill themselves
- Expressing a strong desire to hurt themselves
- Hurting or putting oneself in harms way intentionally
- Giving away prized possessions
- Talking about feeling hopeless or near their breaking point
- Suddenly appearing happy or calm after a long period of sadness or depression
If you notice any of these signs, try to ask more questions before taking emergency action–you want the other person to know that you care and respect their autonomy. But, be prepared to intervene if they shy from seeking help.
Signs of being passively suicidal include…
- Increasing alcohol use or drug use
- Ceasing to take care of oneself (starving yourself or developing severe hygiene struggles)
- Engaging in risky behaviors without considering the consequences
- Excessive consumption of sad content
- Existential dread
- Not planning ahead (personally, vocationally, and/or academically)
- Having thoughts of getting into an accident
These signs are also important, but don’t require emergency, crisis attention. If a loved one is passively suicidal, they still need support, but you can be a little more gentle about it.
Another difference between active and passive suicidality is the intensity of treatment required. Someone who is actively suicidal is much more likely to be placed in an inpatient, residential, or partial-hospitalization setting compared to those who are passively suicidal, who tend to utilize less acute outpatient treatment.
2. Don’t be afraid to ask questions.
Instead of jumping to conclusions about the level of crisis, you can ask questions to determine whether your loved one is actively or passively suicidal.
- On a scale of 1-10, how are you feeling mentally? (1 being calm, 10 being unbearable distress)
- If you and I weren’t talking, what would you be doing about these feelings?
- Do you feel as if you can keep yourself safe?
- Do you feel as if you have reasons to live?
- Have you made any plans to act on your suicidal thoughts?
- Have you reached out for trained help with these feelings?
- Is there something stopping you from asking for help?
- Is there anything that might help you feel better?
If they are actively suicidal, ask them to call the confidential suicide crisis line, 988. If they are in immediate danger of hurting themselves, or have already attempted, call 911. Consider being with them physically until they can get professional, emergency support. If they need inpatient (hospital) care, consider going with them to the emergency room or crisis center.
On the other hand, if your loved one is passively suicidal, consider how you can help them feel loved and listened-to until they can speak with a mental health professional.
Know that passive suicidality can turn active at a moment’s notice. Just because they’re not in danger now, doesn’t mean you should stop caring.
3. Make sure that they feel supported.
Actively listen when someone you care about tells you that they are suicidal. Even if they also reach out for professional help, your attention is an important piece of the puzzle.
The type of response you may give will vary depending on your relationship with the person, and you can’t plan responses ahead of time as they are case-by-case. You may not always know how to best respond, but listening to and validating the other person’s feelings and experiences is always appreciated.
Aside from responding to their expressions of distress, also consider a proactive approach:
- Make a plan to regularly spend quality time together (even if it’s brief–like a 15 minute phone call once a week)
- Send a daily check-in text (even if it’s just an emoji or a picture)
- Let them know what you like about them
- Make future plans with them
- Help them find reasons to keep going (like getting a job they care about, or adopting a pet)
- Show them stories from people who thought about suicide but didn’t do it
4. Understand why they might not want to get help.
If someone you care about is actively suicidal, it’s important that they get professional support. But fear and real-world complications can make people avoid seeking help.
If a person shares with a professional that they are in danger of hurting themselves, they might reasonably worry about:
- Being hospitalized
- Losing their job
- Missing their rent payment
- Taking care of pets or dependent children
- Being judged by important people in their life
Don’t minimize these very real concerns, but do emphasize why getting help is the #1 priority. Yes, you might get put on a “psych hold,” but if you are not alive, then you won’t have a job. Your pets or children may end up without care–permanently. If someone would judge you for preventing your own death, then they don’t deserve to be in your life–their opinions don’t matter. Will people judge you more for seeking help, or for carrying out your suicidal thoughts? Probably the second option.
While acknowledging their concerns, insist that your friend to seek some kind of professional support. That could be 911 or anonymous crisis services for someone who is actively suicidal. If they’re passively suicidal, consider directing the other person to resources for finding therapy through insurance or even suggesting a provider.
It’s ok to hold their hand and make sure they get an appointment on the books.
5. Know where to go for help.
- At risk of attempting suicide or already engaged in suicidal self harm? Call 911 immediately
- Actively suicidal? Call 988 or chat with the National Suicide and Crisis Lifeline
- Passively suicidal or self harming? Contact Crisis TextLine: Text NAMI to 741741 (text message support)
- At risk of attempting suicide or self harm? CARE: (800) 345-9049 (crisis hotline for those with Medicaid)
- Feeling suicidal due to LGBTQIA+ issues? Contact The Trevor Project: (212) 695-8650
- Outside the US? Browse international resources.
No matter how you choose to seek help, make sure you prioritize your loved one’s needs and safety. Make an effort to figure out how “active” their suicidal thoughts are, and consider alternative options before reaching out to 911 (such as contacting their existing mental healthcare professionals or physically staying with them during difficult times).
And as a final consideration: don’t expect the other person to immediately thank you. They may be angry with you and even feel betrayed if you ask them to get help. However, their safety is more important than temporary conflict.