Beyond Suicide Hotlines: How to Help

by Candice Ammori

Kate Spade’s and Anthony Bourdain’s deaths made many of us wonder which of our friends and family members may be silently struggling and how we can help them. We’ve seen countless well-meaning tweets and posts urging anyone suffering to pick up the phone and call a suicide hotline. But these hotlines work best when people are in immediate danger of harming themselves. Even then, we can’t always expect someone contemplating suicide to reach out for help on their own. But there are conversations you can have with your loved ones before it gets to that point.

Before you can do anything for others, challenge your own internal beliefs and stigmas around suicide

Some say suicide is selfish and morally wrong, but research shows that people who feel suicidal often have irrational thoughts that are clouded by mental illness. They may feel that they have no hope for recovery and are a burden to their loved ones. To relieve their family and friends, many believe suicide is the selfless — not selfish — thing to do at that point.,

Suicide is preventable; but you can only be effective in helping if you approach the conversation on the topic without judgment. Continuously check in with yourself to make sure that you are projecting an attitude of respect and love throughout the conversation.

Check in & listen

Check on your friends and loved ones — even the ones who seem to have it all together. No one minds a friend checking in and asking how life is going. Ask how they are doing and listen fully.

If someone you know is open about going through difficult times, follow-up with questions, like, “How are you coping with what’s going on in your life?”

Note any verbal cues that suggests they are thinking about suicide. Some are obvious: “I should just kill myself,” or “Pretty soon you won’t have to worry about me.” Some are less obvious: “If so and so happens, I’m done,” “I just can’t keep doing this,” or “You know I love you, right?”

If someone in your life seems to feel hopeless, have trouble concentrating or thinking clearly, are obsessively thinking about something, or exhibit any unusual behaviors or mood shifts, be sure to check on them. Most suicidal people communicate their intent, directly or indirectly, sometime during the week before they attempt to self-harm.



Calm before the Storm

Importantly, be wary of sudden improvements in mood. Many people who complete suicide appeared to be in much better moods in the days before their death. They have a sense of coming to peace with their decision to end their life. You should take preventative steps immediately, including the QPR intervention.



QPR (Question, Persuade, Refer) Intervention

If you notice ANY warning signs, small or big, continue with the QPRintervention below.


Know that you won’t plant the idea in their head by asking if someone is considering suicide. Asking someone directly about suicidal intent actually lowers anxiety, opens up communication, and lowers the risk of an impulsive act.

When both of you are in a comfortable, private setting, summarize to the person what they have said or done that makes you worry that they might be thinking about suicide. Then you can say something like, “You know, when people are as upset as you seem to be, they sometimes think about suicide. I’m wondering if you’re feeling that way, too?” Or simply, “I wonder if you’re thinking about suicide?”

If you feel a less direct approach would be better, you can start with something like, “Have you been unhappy lately?” You can later follow-up with “Have you been so unhappy that you’ve been thinking about ending your life?”

Be persistent, even if they look at you like you’re silly for asking. Continue to show your concern and care. If the answer is yes, ask as neutrally as possible if your friend has access to methods for self-harm. If yes, the situation may be even more pressing than you had believed.

Listen, then PERSUADE

Let your friend talk for as long as they need. Creating the space for them to express themselves without interjection or judgment. If given the chance to talk, most people with thoughts of suicide will talk themselves out of carrying it through. Listen to them.

If there is a natural space for you to say something, make your friend feel less alone by affirming their feelings, even if you can’t fully understand them. You can show compassion by saying something like, “Things must really be awful if you are feeling that way.” It’s even ok to say, “I don’t know what to say but I’m here to listen. I care about you.” Make sure to avoid saying anything that might dismiss feelings or prompt feelings of shame and guilt.

When it seems like they are done talking, express your concern for the person by saying something like, “I want you to live,” or “This is serious. I’m worried about you.”

Then let your friend know that you love them and think of them as an important part of your life. Offer hope by saying things like, “I’m on your side” and “We’ll get through this together.” You can mention that suicide is a permanent solution to a problem that isn’t, and that you and others are more than willing to help them discover other possibilities. Never underestimate the power of, “Not today.”


Ask any appropriate variation of, “Will you go with me to get help / let me help you get help / do you trust me to find some help?”

After finding appropriate resources, the best referral involves taking the person directly to someone who can help. This can be a therapist, walk-in clinic, or emergency room. Help them learn more about the resources that sound best to them, and which they need most at the moment. Calling a suicide prevention lifeline and staying with them while they are on the phone is also an option.

If the person refuses, you may need to get others involved. If your friend mentioned having a plan and a means for self-harm, now is the time to eliminate potential means. Make sure to remove any guns your friend has access to and throw out all prescription and nonprescription medicines that are not currently being used. If your friend is taking prescription medication, you can offer to keep it for them and give them doses as needed.

Postscript Agreement

Once the situation is not immediately urgent, make an agreement with your friend that they will tell you in advance if they are tempted to move forward with the act or will seek immediate help if they do not feel safe. Let them know what you will do for your part of the agreement, like calling for professional help or taking them somewhere. Only make commitments that you can keep for certain.

If you need more information, there are several organizations dedicated to suicide prevention to prevent suicide and help friends save their friends. I am on the Board of The Jordan Elizabeth Harris Foundation, but other organizations include The Trevor Project for LGBTQ youth suicide prevention and the American Foundation for Suicide Prevention.

Posted on June 12, 2018 .