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When You're Worried About Suicide

A practical guide for the moment a family member's worry crosses from "they are struggling" to "they might not survive this." How to ask, what to do, who to call, what not to do.

If your loved one is in immediate danger — has a plan, has the means, or has tried — call 911 or take them to the nearest emergency room. If you're not sure, call or text 988 (the Suicide and Crisis Lifeline). They will help you think through it.

So, addiction and suicide overlap more than most families realize. Substance use raises suicide risk. Withdrawal — especially from stimulants — raises it. Shame, isolation, and "I'm a burden" thinking are part of the addiction landscape, not the exception.

If you're reading this, you're already worried. Trust that.

Warning signs that mean pay closer attention

  • Talking about wanting to die, being a burden, or not being here.
  • Giving things away, "putting affairs in order," saying goodbye.
  • Sudden calm after a long stretch of distress (sometimes a sign a decision has been made).
  • Increased substance use, especially alone.
  • New access to means — a gun in the house, a stockpile of pills.
  • Pulling away from people they used to lean on.
  • A recent loss, breakup, job loss, legal problem, or major shame event.
  • A previous attempt. Past attempts are the strongest predictor.

You don't need all of these. One or two is enough to take seriously.

Ask the question

The biggest myth: "If I ask, I'll plant the idea." You won't. Decades of research are clear on this — asking directly does not increase risk. Avoiding the question doesn't keep them safe. It keeps you out of the conversation.

Ask plainly. Try one of these:

  • "Are you thinking about killing yourself?"
  • "Are you having thoughts of suicide?"
  • "Sometimes when people are in this much pain, they think about ending their life. Are you?"

Say it slowly. Look at them. Then stop talking and let them answer.

If they say yes, don't react with horror. That's the moment they decide whether to keep telling the truth or shut it down. A steady, "Thank you for telling me. I want to understand what's happening for you," keeps the door open.

What to ask next

  • Are you having thoughts of ending your life, or thoughts of being dead? (Different.)
  • Do you have a plan?
  • Do you have access to what you'd use?
  • When did this start? What's making it worse?
  • Have you felt this way before? What helped then?

You're not interrogating. You're listening, and you're getting information you may need to share with a professional.

What to do — in this order

  1. If there's any immediate danger, call 911 or go to the ER. A psychiatric hold (sometimes called a 5150, a Baker Act, or a 72-hour hold — names vary by state) is not punishment. It's a pause, in a safe place.
  2. If it's serious but not immediate, call 988. Free, confidential, 24/7, by phone or text. They'll talk with your loved one, or with you, and can help dispatch a mobile crisis team in many areas.
  3. Reduce access to means, today. This is the single most evidence-backed intervention available to a family. Guns: out of the house, ideally to a trusted friend, family member, or police-storage program. A trigger lock is not enough. Medications: locked or removed — especially benzos, opioids, sleep meds, blood-pressure meds, and anything in large quantities. Alcohol: out of the house if alcohol is part of the picture. Time and distance from a method are often the difference between an attempt and a survived crisis.
  4. Get them to a clinician within 24 to 72 hours. A psychiatric evaluation, a therapist who does suicide assessment, or a crisis stabilization unit. Don't try to manage this alone.
  5. Stay with them, or arrange someone to. Especially the first 24 hours.

What not to do

  • Don't promise to keep it a secret. You can promise care. You can't promise silence.
  • Don't argue them out of it. "You have so much to live for" lands like criticism in this moment.
  • Don't ask why they would do this to you. They aren't doing it to you.
  • Don't leave the house with means they could use, especially in the first stretch.

What to say

You don't need the perfect words. You need to be present and steady. Try:

  • "I'm not going anywhere. We're going to figure this out together."
  • "I'm scared. I love you. I want to help you stay alive."
  • "I don't fully understand the pain you're in. I want to."
  • "We don't have to fix everything tonight. We have to make it through tonight."

Take care of yourself, too

Living with a loved one's suicidal thinking is its own trauma. It compresses your nervous system into hypervigilance. Get your own therapist. Call your own support. Sleep when you can. You can't sit a long vigil if you're running on empty.

Numbers to keep close

  • 988 — Suicide and Crisis Lifeline (call or text, 24/7).
  • 911 — for immediate danger.
  • Crisis Text Line — text HOME to 741741.
  • Trevor Project (LGBTQ+ youth) — 1-866-488-7386 or text START to 678-678.
  • Veterans Crisis Line — call 988 then press 1, or text 838255.

Save these in your phone. You shouldn't be looking them up at 2 a.m.

You're not overreacting. Worried families are the reason a lot of people are still alive.

Keep going

Safety guide How to Recognize an Overdose and Use Narcan A short, plainspoken guide every family with opioid use in the picture should keep close. Recognize an overdose, use naloxone, call 911. Safety guide When Withdrawal Is a Medical Emergency Most families think withdrawal is uncomfortable. Some forms of withdrawal can kill. Here is what is safe to ride out and what needs medical detox today. Briefing What Families Need to Know About Fentanyl A short, honest briefing on fentanyl — what it is, why it is in everything, and the practical things families can do to keep a loved one alive while recovery unfolds.

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