Suicide Assessment Checklist

Be ready to help a suicidal friend or loved one before you need to. Suicide affects thousands of people every year - including those left behind. This photo is a re-creation of a movie scene and is not an actual event.
Be ready to help a suicidal friend or loved one before you need to. Suicide affects thousands of people every year - including those left behind. This photo is a re-creation of a movie scene and is not an actual event. | Source

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.

Your Experience

Have you known someone who threatened suicide?

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Has someone you knew committed suicide?

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Have YOU ever thought about taking your own life?

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Suicidal Ideation

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?
Vague plan
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.
Right now.
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?
No.
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?
None known.
Short term or imagined illness.
Chronic debilitating illness, personality disorder, or untreated psychiatric problems not identified.
Assign 1, 2, or 3 points for each answer. (1 for "Some risk is present," 2 points for "More Serious," and 3 for "High Risk.") See scoring below.

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.

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

How I Stayed Alive When My Brain Was Trying to Kill Me: One Person's Guide to Suicide Prevention
How I Stayed Alive When My Brain Was Trying to Kill Me: One Person's Guide to Suicide Prevention

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

Understanding Your Suicide Grief: Ten Essential Touchstones for Finding Hope and Healing Your Heart (Understanding Your Grief)
Understanding Your Suicide Grief: Ten Essential Touchstones for Finding Hope and Healing Your Heart (Understanding Your Grief)

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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Comments 12 comments

NornsMercy profile image

NornsMercy 3 years ago from Charlotte, NC

This is a great hub. Suicide is really common so people just joke about it and it's not funny. I know several people who killed themselves and the signs were there in the beginning but hindsight is 20/20. Voted up and useful.


jellygator profile image

jellygator 3 years ago from USA Author

Thank you, Norns. Both of the people I mentioned in this article certainly gave signs. One went on to kill himself and the other never attempted again as far as I know, but I took her to the hospital immediately after she called me, and I got into an argument with a family member who claimed she was just doing it for attention. I will always wonder whether my response - that if she needed attention, then withholding it wasn't going to help - made any difference.


AdviceUnhinged profile image

AdviceUnhinged 3 years ago

I love this. I am a counselor who specializes in working with families of those who've committed suicide and am a suicide survivor myself. I just started a hub myself for the first time today where in the future I will be talking about this topic ( today I introduced counseling from the perspective of the "unhinged" counselor). I think it's great you mention that anyone can recognize these symptoms and help.


jellygator profile image

jellygator 3 years ago from USA Author

Thank you, AdviceUnhinged. I learned about evaluating these things years ago when I was volunteering at a detox center, and the knowledge has certainly come in handy a few times.


GoodLady profile image

GoodLady 3 years ago from Rome, Italy

Man this is a tough subject. My husband committed suicide but he had been desperate for years. He didn't threaten suicide, he just took his life because he couldn't get sober. Addicts have a hard time staying alive and unless they get into a twelve step program, they're on the edge always.

There is not a lot a family member can do but take care of themselves, with their own twelve step program. I believe in all that a lot.

My husband just would not stay with a 12 step program.

I wouldn't know about other suicide indications, but someone who talks about it and who is depressed needs a friend (and then some help if that's possible).

Good hub. Thanks.


jellygator profile image

jellygator 3 years ago from USA Author

I'm sorry that you lost your husband to suicide, Penelope. I can imagine that in your husband's case, you had a lot of conflicting emotions to endure as you recovered. I agree that the 12-step principle is amazing for helping people who want to improve their lives - even people who aren't alcoholic. I use many of the principles I've discovered in them every day of my life.


teaches12345 profile image

teaches12345 3 years ago

Jelly, you have hit all the high marks on this one. What a wonderful post and so educational. I know this is going to be very useful to many people in helping others. Applause, applause! Voted up+++


jellygator profile image

jellygator 3 years ago from USA Author

Thank you, Teaches! I hope it does make a difference for someone!


FromtheOtherPerspective 3 years ago

Whelp. I'm high risk. I knew that though, there's no way in hell I'm letting anyone else know. Bad idea? Yes, probably. I have screwed up and told people, but they fall for "I'm fine," and I don't have the energy to get my hopes up anymore that they won't. I will say it hurt to read through the things for high risk because I know no one would do any of that for me. I don't deserve it or matter anyway. I have a date but I still can’t figure out a foolproof plan. The best I could come up with is to do everything; pills then choking (scarf/belt) then slash my wrists. I kind of want my body to not scar whoever finds it as well. I actually have access to most of these, but I still kind of hope somebody would notice or something will change. Just because I don’t have the energy doesn’t mean my idiot brain doesn’t do it. (I have been depressed for 10 years, and suicidal for 7. I’m 17, and I really can’t see it getting better except for being able to drink at 21 and being able to do nothing if I can’t function. I’m bull-crapping my way through life right now just to appear okay.)

I feel crappy for posting on here because I don't want people to care about me at this point, too late, but I wanted to let you know that most of this (especially the high risk things) would actually help someone who just wants the pain to end (like me). I don’t know if it would help someone who wants to die as revenge. I actually don’t blame anybody for not trying to help because it’s my problem and I should be able to deal with it. (Technically, suicide is dealing with it.) But also they have their own lives and problems and I don’t deserve to bother them. I have finally learned that. So please don’t bother with me.

But here are a few things I thought might be helpful for people who want to help, from a perspective similar to that of the people you’re trying to help. Telling somebody it's just temporary... I'll tell you now that I would nod along to that and smile and pretend like that's such a great thing (I have done this) and well... no. Being there and making sure they know that is the best thing. The absolute WORST thing is to tell them you'll be there and then not be there. Judgment is another bad thing, don't tell them about all of the people who would love not to be dying and here they are wishing they were dead. All that does for me is to make me feel guilty on top of everything else because that doesn't do a thing to help me not want to die. Also, asking them to do something for you ... the way I feel is that I am already sticking around here now for everyone else. I'm still functioning so I don't hurt people. Also, personally, I can’t call the help-lines. I have a problem with phones and just saying this stuff out loud. I’m sure I’m not the only one. There are supposed to be help centers where typing is an option, but I haven’t found one that works like they say it should. (Plus at this point I’m beyond words to describe most of it and other people’s words have lost meaning.)


jellygator profile image

jellygator 3 years ago from USA Author

FtOP, I'm so sorry to hear that you're in so much emotional pain that you don't feel like your life is valuable. I get it, and I know how hard it can be to reach out when you feel like nobody cares enough to see through the fake smiles.

You say that you've been feeling depressed for ten years and suicidal for seven. Since you're just 17 now, this makes me think you may have gone through something traumatic before your depression set in, such as abuse or the loss of a loved one. If this is not true, there is also the possibility that you may have a mood disorder. I don't want you to post publicly if you're not comfortable with it, but I DO want you to know that you do not have to go through your life feeling bad, and it doesn't require taking your life to get relief!

If someone mistreated you, I hope you will recognize that your feelings of worthlessness and apathy just gives them power over how you feel. Anyone who hurts a young child does NOT deserve that kind of influence in your life!

If you cannot pinpoint a traumatic before your depression started, then you may have imbalances in your brain chemistry that make your "pleasure centers" feel numb or absent, and let emotional pain take control of the wheel. This is something that's not so difficult to treat if you can get to a decent doctor! It might take several weeks to start feeling better, but antidepressants or mood stabilizers can make a world of difference. They can help you regain the way you felt before these depressions set in!

I realize that you may have trouble seeing a doctor for this if you're afraid of how family members might react, but you're so close to being able to make your own decisions on things like this that I hope you'll let yourself wait at least that long...

I can tell from what you have written that you are capable of loving others. You say you don't want to hurt them and that's why you smile and pass things off like everything is fine. So please take a moment and think about something for me: If you don't want them to hurt, then killing yourself is NOT the way to protect them from feeling pain!! Did you know that family members and friends who survive after a person commits suicide are more likely to blame themselves the rest of their lives? To have years of depression the same way you've been feeling all these years? Wouldn't it be kinder to let them feel scared and be hurt just once... for a little while... when you tell them how you feel and that you need help to move past this horrible way you're feeling?

Because you DO matter to them. You've given helpful information on this page, and what you've said here MATTERS to the people who will be reading this today, tomorrow, a year from now, ten years from now.

So I have one request that I'd like to ask of you. Before you act on your plan, will you please tell one doctor that you've been thinking of hurting or killing yourself? Fake "woman problems" if you have to, but please talk to just ONE medical professional and get their opinion on whether medication can help you reclaim joy in your life! Would you be willing to do this and then get back to me? (You can send a private email to me at kathybatesel (at) gmail .com now or afterward - or both.)


FromtheOtherPerspective 3 years ago

I'm glad I have given helpful information. I know it's hard to understand the thinking unless you've experienced and even then, it's different than dealing with it then. I remember one of my friends from ninth grade who started cutting and I couldn't understand it. (That was when I had the person I was during the day who was fine and the person I really was who never slept at night. They got put into one person last year which was not a fun process.)

And I don't mind sharing here. If someone else like me finds this, it might help them.

I was abused by both parents when I was younger. My dad was the instigator and I can’t count how many wooden spoons he broke “disciplining” me. My mom was similar, but she pretends she wasn't and isn't like that. I had a little brother, but he never went through any of it because mom protected him by blaming me. Literally everything was my fault until I moved into a residential school last year and the only one it could really be is my brother, who is now being reprimanded for his misbehavior. (He's at least not getting beaten, it's just discipline for him.) (I actually still get blamed for things that happened at home and I had no control over sometimes though.) I haven’t been physically abused since my mom and dad separated. I live with my mom and step-dad now. I haven’t talked to my dad at all in 3 years now. My step-dad actually does try, but he takes my mom’s word for things. I still get threats from my mom that she’s going to use the belt and I still flinch when anyone has their hand near my head suddenly. I tried to run away 3 or 4 times. The last time, I got taken to the hospital and was diagnosed with depression and subsequently told by my mother to “just get over it.” I have had a therapist for 7 years, because of the divorce originally, but then because of continued outbursts. (I used to blame everybody else, but now I just blame myself.) I have been put on meds before and am on meds now which do nothing, or at least nothing I can perceive. I actually did tell my therapist I’m suicidal, but that was about a year ago … and even she fell for “I’m fine.” (It was how I got the medication I have which isn't really for severe depression, it's for stress.) Or appeared to and has made no effort since to ask about it. I asked her not to tell my mom, but she may have still since I’m a minor. It would explain some weird reactions from my mom. (Especially considering how she waited until I was back from summer camp to confront me about not eating, and all she did was tell me I should eat.) And I already hurt myself. I can't cut because that's obvious, but there are many more ways than cutting or burning.

On the subject of self-harm, telling the person to stop will most likely just make them hide it better. One way to get them to see it from your perspective might be to tell them if they want to, they have to do it to you. Another way is to tell them to come to you if they feel like it and talk instead. After a certain point it's a habit and it's also become a coping method and the feeling is addictive. It even stops being because you're hurt, or whatever the original reason was. (I've been hurting myself since I was extremely young, 6 definitely, and the reason I remember is because I deserved it, the pain felt like it let other pain out, and I was fascinated with blood. The only reason I haven't cut now is because I promised one person, which matters less than the other reason, which is that I don't think I could hide it.) It could work to have them promise you not to do it, but that can cause guilt when relapse happens. (and it will happen) It depends on the kind of harm, how long they've been doing it, and the person.

You actually stated the argument that’s keeping me here. I don’t want to hurt them and have them blame themselves. That’s why I’m still hoping it’ll get better somehow. I am giving it seven months from Monday; it’s a pretty important day. (That would actually be giving it until I could make my own decisions.) If I feel like I can make it a little longer, then I’m waiting until after graduation so I can “go to college” and never come back. (If it gets way better, then I've been keeping up with everything enough that I could bounce back if that ever happened.) But nothing really matters at all but keeping up appearances, and that matters very little. I’m supposed to be heading off to college next fall, and I’m basically thanking the God’s that I have a provisional acceptance because it no longer matters and if I still can’t be gone by then my parents are kicking me out anyway. Eating doesn't matter, class, school, not really anything. I’m blessed in one way in that even at the school I’m now at (supposed to be and is the best school I could be going to) I don’t have to apply myself to get good grades. So as long as I go to class, I’m good there if I’m fine with B's and I am. I find myself wondering what I could do if I still had the energy and drive I did before when I was two different people.

I really wish I didn't have to affect people, because one thing I’m painfully aware of is how much other people depend on my presence and look forward to seeing me every day. That makes no difference at night when I’m lying in bed, as my roommate falls asleep, falling apart. I have had to master crying silently and without any sign other than water leaking out of my eyes. (I’d get extra for crying out.) I keep a journal of sorts on my iPod since I won’t let myself tell anyone again, not anyone who actually knows me. (It hurts worse when nothing changes.) Nighttime is when I question everything. I have written so many suicide notes, because I keep giving it one more chance to get better. It still hasn't.

Thank you though. You don’t need to worry about me though. I’ll either get better or die trying. (I feel like I got on a tangent towards the end, sorry.)


grand old lady profile image

grand old lady 4 months ago from Philippines

This is a very helpful and informative article. I appreciate that you point out that celebrities and John Nash had schizophrenia, but they touched and changed the world. The video of the suicide packs was kind of scary, but altogether, you have examine the topic from all angles, which I want to thank you for.

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