Suicide Assessment Checklist
How To Help a Suicidal Friend or Family Member
When someone you know and care about threatens to commit suicide, it's easy to feel overwhelmed and helpless. Whether you view suicide as an understandable way to eliminate unendurable pain, a cry for attention, or a coward's way out, it's likely that you want to help your friend or loved one find a path that leads away from the mortuary!
Suicide is a serious problem in the United States. It's the third leading cause of death among young adults and the tenth leading cause of death overall. Most of us will be confronted by suicide at some point in our lives. A friend, a family member, a coworker, or a neighbor will disappear from our lives suddenly and unexpectedly, and we will wonder what we could have done.
You don't have to have a psychology degree to make a difference. In this article, you'll discover practical steps to evaluate your friend's circumstances and steps you can take to help them.
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In a little while, I'll be providing you with a checklist to help you figure out how much risk is present, but in order to use it, you'll need to understand a bit about suicidal ideation. The concept of suicidal ideation is a simple one - it means that a person has thoughts of killing themselves. But ideation can have different degrees and may never involve verbal statements.
Suicidal ideation should be considered when:
- A person is clearly thinking about wanting to die. They may make statements about wanting to kill themselves or making others "sorry for the way they treated" them.
- A person takes dangerous actions that could lead to death, even if they don't plan to die. This can happen with cutting or engaging in risky behaviors that are likely to lead to death, like driving recklessly or while drunk.
- A person makes suicidal gestures. A suicidal gesture is one that appears to be a suicide attempt that did not succeed. The person who committed the act did not expect to die, and did not die, but wanted others to perceive his or her desire to die. An example of this was someone I knew who swallowed an entire bottle of Tylenol and picked up the phone to call me and tell me what she'd done.
- Suicide attempts, like suicidal gestures, happen when someone takes actions that are likely to lead to death and that the individual believes will result in death. Typically, suicide attempts fail due to errors in planning or because someone intervened. Another person I knew was discovered unconscious in his garage with the car running. He told hospital personnel and his wife that he'd been working hard lately and had just fallen asleep and wasn't trying to hurt himself. However, he was intent upon killing himself. Shortly after he was released from the hospital, he waited for a day when he had more time alone at home and killed himself by sitting in his running car with the garage door closed.
All of these are examples of suicidal ideation, and all of them should be taken seriously. While it's true that some suicidal ideations are "a cry for help," getting angry at them will not help the situation in any way. A person who doesn't get appropriate help stands a much higher chance of eventually dying by their own hand. So instead of becoming hostile toward someone who is in pain, use the steps you'll find here to rationally deal with the situation.
Would you recognize common signs of suicidal thinking?
Suicide Risk Assessment Checklist
There are many suicide evaluation tools available for professionals, but they're often designed for use in a clinical setting - a trained counselor doing a patient intake interview would be likely to ask some of the questions, but a concerned friend would be perceived as interrogating and controlling if they try to ask the same questions.
Ideally, you've already got some information about your loved one's background and history, but even if you've just met recently the most important thing you can do is show concern while you get the kind of information that will help you assess the risk.
You'll be able to get most or all of this information by simply listening without being judgmental. You might have to ask a few question, which you can word in a caring, concerned way to communicate that you are trying to understand the big picture that your friend is experiencing. Here's what to look for:
What to look for:
Some Risk is Present
Risk is More Serious
High Risk is Likely
How are they communicating threat?
Verbal statements "I want to die."
They also want to affect other people.
Their focus is vague, or on guilt/worthlessness.
How much planning have they done?
Plan is present, but not quite complete
Detailed plan about how, when, where
Can they execute their plan?
They have to get the items they plan to use.
Tools are not immediate, but easily acquired.
They have immediate access to what they plan to use.
When do they plan to execute?
In the future at some point or don't know.
Within hours or days.
How lethal is their method?
Slashing wrist, alcohol, over-the-counter drugs
Car wreck, carbon monoxide, prescription drugs
Guns, "suicide by cop," hanging
Have they attempted before?
Yes, with low lethality 1-2 times, or repeated threats.
Yes, with medium or high lethality methods, or several previous attempts.
What stress are they experiencing?
Normal stresses of daily life.
They're feeling a moderate loss or changes in life.
They feel major changes in life or a significant loss is affecting them..
Have they had lifestyle changes?
Work, friendships, etc. continue as before.
Some changes, especially in eating, sleeping, school, or work.
Major changes in functioning. May have stopped friendships, left school or work, etc.
How is depression affecting them?
Mild - others unlikely to notice.
Moderate - People notice irritability, loss of energy or concentration, sleep and appetite changes.
They feel overwhelmed and may neglect responsibilities.
What support network do they have?
Concerned friends & family willing to help.
Inconsistent or unreliable help from friends and family.
Friends and family unwilling or hostile.
How stable is their lifestyle?
Stable relationships, school/work performance, and personality
Recent changes, acting out, drug or alcohol use
Unstable personality, chronic problems with friends, family, school, or work.
Do they have any medical problems?
Short term or imagined illness.
Chronic debilitating illness, personality disorder, or untreated psychiatric problems not identified.
Evaluating Suicide Symptoms
Once you've assigned points to each answer, divide the result by three and compare results.
1-6 points: A low risk is present.
7-10 points: A moderate risk is present.
11-13 points: An immediate, high risk is present. Treat this as a crisis.
Statistics about Suicide
- Suicide Loss Research
This link provides a good overview of existing research on those who are left behind, a topic that is has not deeply explored, but affects many people.
- Suicide in the U.S.: Statistics and Prevention (National Institute on Mental Health)
A fact sheet of statistics on suicide and risk factors with information on treatments and suicide prevention.
What to Do Next
There's a good chance that you won't have this checklist printed out when you're interacting with a suicidal person. You might even find yourself getting this information over the Internet or in a phone conversation instead of face-to-face, but by taking some time to learn what to look for and how to evaluate the situation, you can make a very good educated guess at the threat level present.
Next, you'll want to consider how to respond. You don't want to be responsible for having your friend locked up for 72-hours because they were feeling a little blue, but you don't want to take a chance at not responding and have them die, either!
Let's look at the steps you can take to respond to the various threat levels.
Low Risk of Suicide
A low risk doesn't mean the risk is absent. As I mentioned earlier, a person who is very intent on suicide may try to make it look like there is little or no risk. Of course, if you've gotten enough supplemental information about the person's lifestyle, current stressors, and history, you may have a good idea whether to believe them or not.
Here are steps you can take next with a person who is contemplating suicide but doesn't appear to be an immediate risk:
- Ask them to make a verbal contract with you to not harm themselves for the next 30 days. In exchange, offer that they can call on you if they need to talk.
- Try to obtain their address, current location if they're away from home for an extended period, and a way to contact them.
- Encourage them to talk to other people they trust, especially a counselor if they have one.
- Give them reasons not to harm themselves like the ones listed below or reasons that you know are meaningful to them, such as the way it will affect their children.
- Ask them to talk to someone at the suicide prevention hotline (in the U.S., call 1-800-273-TALK) and to call you back afterward and let you know how it went. When you speak again, you'll be looking for whether they're feeling better after speaking with someone who doesn't know them and who is trained to help people find hope.
Give them Reasons to Avoid Suicide
- Everyone goes through really rough periods at some time in their lives. These times are temporary. Remind your friend that they're strong enough and courageous enough to get through it if they will keep looking for other options. They have felt bad before and overcome it, and while this time might seem bigger than before, they will be able to overcome it, too. Suicide is a permanent solution to a temporary problem, but it creates lifelong problems for the ones left behind. That's not what your loved one wants, is it?
- Tell him or her that people do care. Offer yourself as an example of someone who cares.
- Consider asking him or her to do something for you. If they experience being able to make the world a better place by being of service to others, it can help lift the feelings that are driving them to think of suicide.
- Encourage them to eat something even if they aren't hungry if they've told you they haven't been eating well. A well-nourished body is better able to deal with problems. Similarly, if they haven't been sleeping, invite them to do something that may help them get some rest, like drinking some warm milk or listening to soothing music when they lay down.
When Low - Moderate Suicide Risk is Present
This book details one woman's struggle against suicidal thoughts in a way that offers hope and help to people considering suicide. If the risk is not an immediate crisis, it may be able to help your loved one cope with those feelings and find a path that will lead to a happier outcome.
When a Moderate Risk of Suicide is Present
When a moderate risk is present, use the steps outlined above and also try to:
- Ensure that the person has supportive people around him or her regularly. This might mean stopping by to see them every day or two, asking someone to call them on the phone more often, or persuading him or her to double up on appointments with a therapist for a few weeks.
- Remove any weapons or tools that they have identified as part of their suicide plan. For instance, if they own a gun that they said they would use, ask them if they'll let you hold onto it for the next 30 days as part of their agreement not to harm themselves.
- Remind your friend or family member that medical treatment can help them feel better. Ask them to see a doctor to determine if medication might help them as they're dealing with the problems making them feel the way they do.
- Consider enlisting family members or friends who you believe will be supportive and have enough empathy to avoid judgment, as well as enough common sense to be able to find solutions.
High Risk Crisis Intervention
When the risk is immediate and high, be prepared to call in people who are better prepared to address the problems. Call the police or take your loved one to a hospital for evaluation. (This is the reason having an address and contact information as early as possible is important!)
- If the person lives in your home, temporarily lock up items that could easily be used to commit suicide. This includes belts, ropes, knives, guns, drugs, and alcohol.
- Do not leave your loved one unattended until the crisis is past. Call in other friends and family to help if necessary.
- Tell the suicidal person that you care frequently, but do not make empty promises. Reassure them that you will help them get through this.
- Do not believe them if they tell you they will be fine. They may want you to let your guard down so that they can act on their suicidal intentions. Stay alert until they're seen at a local hospital or spend time with their therapist.
- If you know who their therapist is, contact him or her to explain what is happening and ask for advice on how to best help your loved one right now.
- Do not offer any type of alcohol or drugs to your loved one.
Is Suicide Ever Acceptable?
I Hope You Won't Need It - But if Suicide has Touched You
This book provides substantial help for coping with the kind of grief that comes from losing someone to suicide.
Assisted Suicide - A Controversial Concept
Some people believe that suicide is a reasonable alternative for debilitating, chronic pain. This video highlights the issues that surround the controversy.
Whether you support the idea or not, when someone you care about is considering suicide, it's natural to want to help, especially if your loved one is not a terminally ill patient. Taking the steps above can literally be the difference between life and death. However, these steps are not a one-size-fits-all solution that works every time.
There are just a couple more things to consider about suicide prevention and your role in helping someone who is suicidal.
1. You may not succeed at preventing them from killing themselves. If this happens, please don't blame yourself! You did all that you knew how to do. Expecting more than that isn't realistic or reasonable.
2. At the very bottom of these issues, we are all responsible for ourselves. We have a duty and responsibility to provide reasonable assistance, but if "helping" someone else means harming our own lives, don't. Let others who are more qualified step in, and remove yourself from the situation altogether. Sometimes people use threats of suicide and suicidal gestures as a way to control others. Don't stay in an unhappy marriage purely to keep someone from killing themselves. Instead, offer them resources and limited support as you separate yourself. Your presence is not saving their life - it's preventing them from being a responsible person who has the strength and resources to solve his or her own problems.
Note: Google advertising has been disabled on this page due to the site's automatic filters, but it's an important topic that shouldn't be buried. Since this is one of the ways I earn a small income from writing, please consider sharing this or one of my other articles if you found this information helpful, or purchase one of the items I've highlighted if you can use one of them.
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