This checklist is provided to help assist you assessing risk and opening up the lines of communication with your loved one. The most important thing to do is make sure you approach them gently, lovingly and with care and concern. Do not let your words or your tone suggest judgment or intolerance or condescension. Treat them with kindness and respect and all of your focus and attention.
Good luck.
EVALUATE RISK
Examine your loved one’s history, actions, and behaviors to assess risk.
Are they or do they have:
OBSERVE
Are they:
LISTEN Do you hear them talking about feeling hopeless or having no reason to live? Are they hinting or speaking openly like:
Do they express frustration or sadness by talking about feeling trapped or extreme emotional pain?
Ate they expressing their feelings about being a burden to others?
PREPARE
Asking tough questions is hard but the way communicate is just as important as the questions themselves. Prepare yourself to use the following techniques.
Paraphrasing: This includes repeating what the person said in a much shorter format, in your own words, while also making sure not to minimize what the person has experienced.
Reflecting/Mirroring: When the person is finished speaking, reflecting and mirroring involves repeating the last few words the person said. If the person concluded by saying, “…nothing has worked,” you would say, “Nothing has worked?” This helps confirm with the speaker that you are listening and understand what is being said.
Using “I” messages helps demonstrate how you feel based on what the person has said or done. For example, you could say, “I feel worried when you say life is pointless because I am not sure what you are going to do.” This provides a “timeout” or reality check to the other person, letting them know you are concerned. Make sure to be aware of your tone, so as to not to do this in a way that sounds aggressive or creates an argument.
Minimal Encouragers: Further establish the building of rapport by using simple verbal cues like, “Mmm,” “Okay,” and “I see,” as well as nonverbal gestures like head nodding, to subtly invite the person to continue speaking. This also shows that you are paying attention.
Emotion Labeling: It is important to acknowledge the emotions of the person speaking. Identifying the person’s emotions validates what they are feeling, instead of minimizing it. During a suicidal crisis, people act with their emotions rather than operating from a more rational perspective. By labeling and acknowledging their emotions, you can help restore the balance.
Note that in the examples above, you are demonstrating that you understand what the person is feeling, rather than simply saying, “I understand.”
Summarize: Summarizing is an extended version of paraphrasing in which you wrap up everything the person has said, being sure to include the elements important to the person as well as acknowledging their emotions. Summarizing validates for the person that they have been heard and understood. This is critical to do, because it can help bring a sense of relief to the person, and reduce the possibility of their taking actions solely dictated by their emotions.
Ask Open-ended Questions: Asking open-ended questions encourages the person to speak longer. This can help diffuse the tension, as well as provide you with valuable information and insight into their perspective.
Silence/Effective Pauses: Expert hostage and crisis negotiators listen much more than they speak. Part of this sort of expert listening includes utilizing silence, and pausing before taking your turn to speak. Silence allows the other person to continue speaking. Pausing prior to speaking helps calm the situation.
Using these different micro skills together increases their effectiveness. For example, try using an emotional label, and then follow it up with an open-ended question. (“You seem sad. What’s happening?”)
Source: American Foundation for Suicide Prevention
QUESTION
Are you thinking about suicide? Do you want to end your life?
When did you begin to experience these thoughts and feelings?
How frequently have you had these thoughts and feelings?
Have you ever thought of how you might kill yourself and if so, are you thinking about that now?
Have you ever made plans?
Have you told anyone that you are thinking about taking your life or are planning to do this?
Do you have the means for suicide (do you have access to pills, insecticide, firearms...)?
Do you think you might hurt yourself and if so, how can I help you because I really care?
Do these thoughts intrude into your thinking and activities? Can you describe them?
Can you stop yourself from having them by distracting yourself with an activity or other more positive thoughts?
Have you ever acted upon these thoughts?
If you have not acted upon them, how close do you feel you came to acting?
Have you ever started to act on your self-harm or suicidal thoughts, yet stopped before actually doing it? For example, did you hold a bottle of pills in your hand to take them all but stopped, or go out on a ledge to jump but then stopped?
What stopped you from acting on them?
Do you think you might act on these thoughts of self-harm or suicide in the future?
What might help you from acting on them?
Do you have methods available to you to take your life, such pills, guns, knives or proximity to a balcony, bridge or subway?
Is there any available support (family, friends, carers...)?
How strong is the feeling? If they can’t explain ask them to rate it on a scale from 1 (being worst feeling ever) to 10 (being not strong at all)?
Have you prepared for your death by writing a note, making a will, practicing the plan, putting your affairs such as your finances in order, or ensuring privacy such that you would unlikely be discovered?
ENGAGE
TAKE ACTION
Help them call a hotline
Take them to an emergency room
Make an appointment for crisis counseling
Help them be safe
Tell them you are there for them
Be there for them
Make sure they know they are not alone
NATIONAL SUICIDE PREVENTION LIFELINE
CALL: 1-800-273-TALK (8255)
www.suicidepreventionlifeline.org
CLICK TO CHAT
Good luck.
EVALUATE RISK
Examine your loved one’s history, actions, and behaviors to assess risk.
Are they or do they have:
- History of self-harm or previous suicide attempt
- Mental or substance use disorders, especially depression
- Physical illness: terminal, painful or debilitating illness
- Family history of suicide, substance abuse and/or other psychiatric disorders
- History of sexual, physical or emotional abuse
- Socially isolated or living alone
- Bereavement in childhood
- Family disturbances
- Unemployment, change in occupational or financial status
- Rejection by a significant person (e.g. relationship breakup)
- Recent discharge from a psychiatric facility
OBSERVE
Are they:
- Talking about wanting to die or to kill themselves
- Looking for a method to kill oneself (e.g. searching online or buying a rope)
- Increasing use of alcohol or drugs
- Acting anxious or agitated; behaving recklessly
- Showing rage or talking about seeking revenge
- Displaying extreme mood swings
- Talking about having no reason for living; no sense of purpose in life
- Exhibiting increased anxiety, agitation, unable to sleep or sleeping all the time
- Withdrawing from friends, family, and society
- Stopped doing things they love like hobbies or activities?
- Canceling doctor or therapy appointments or stopped taking meds
- Going through big life changes (and sometimes, just some small ones like going on or off certain meds).
- Acting irrationally or erratically
- Having financial difficulties and showing hardship
- Gaining access to a means (guns, pills)
- Have connections to others who have died by suicide
- Creating opportunity for suicide (isolating, spending time alone)
LISTEN Do you hear them talking about feeling hopeless or having no reason to live? Are they hinting or speaking openly like:
- It’s hopeless and life isn’t worth the pain
- There is no reason for me to be here anymorE
- I wish I was never born
Do they express frustration or sadness by talking about feeling trapped or extreme emotional pain?
- I just want the pain to go away
- I feel like I’m just taking up space.
Ate they expressing their feelings about being a burden to others?
- I am just a burden to everyone
- Nobody needs me around
- I am worthless to anyone
- Your life would be so much better without me.
PREPARE
Asking tough questions is hard but the way communicate is just as important as the questions themselves. Prepare yourself to use the following techniques.
Paraphrasing: This includes repeating what the person said in a much shorter format, in your own words, while also making sure not to minimize what the person has experienced.
Reflecting/Mirroring: When the person is finished speaking, reflecting and mirroring involves repeating the last few words the person said. If the person concluded by saying, “…nothing has worked,” you would say, “Nothing has worked?” This helps confirm with the speaker that you are listening and understand what is being said.
Using “I” messages helps demonstrate how you feel based on what the person has said or done. For example, you could say, “I feel worried when you say life is pointless because I am not sure what you are going to do.” This provides a “timeout” or reality check to the other person, letting them know you are concerned. Make sure to be aware of your tone, so as to not to do this in a way that sounds aggressive or creates an argument.
Minimal Encouragers: Further establish the building of rapport by using simple verbal cues like, “Mmm,” “Okay,” and “I see,” as well as nonverbal gestures like head nodding, to subtly invite the person to continue speaking. This also shows that you are paying attention.
Emotion Labeling: It is important to acknowledge the emotions of the person speaking. Identifying the person’s emotions validates what they are feeling, instead of minimizing it. During a suicidal crisis, people act with their emotions rather than operating from a more rational perspective. By labeling and acknowledging their emotions, you can help restore the balance.
- Examples: “You sound hurt;” You seem sad.
Note that in the examples above, you are demonstrating that you understand what the person is feeling, rather than simply saying, “I understand.”
Summarize: Summarizing is an extended version of paraphrasing in which you wrap up everything the person has said, being sure to include the elements important to the person as well as acknowledging their emotions. Summarizing validates for the person that they have been heard and understood. This is critical to do, because it can help bring a sense of relief to the person, and reduce the possibility of their taking actions solely dictated by their emotions.
Ask Open-ended Questions: Asking open-ended questions encourages the person to speak longer. This can help diffuse the tension, as well as provide you with valuable information and insight into their perspective.
Silence/Effective Pauses: Expert hostage and crisis negotiators listen much more than they speak. Part of this sort of expert listening includes utilizing silence, and pausing before taking your turn to speak. Silence allows the other person to continue speaking. Pausing prior to speaking helps calm the situation.
Using these different micro skills together increases their effectiveness. For example, try using an emotional label, and then follow it up with an open-ended question. (“You seem sad. What’s happening?”)
Source: American Foundation for Suicide Prevention
QUESTION
Are you thinking about suicide? Do you want to end your life?
When did you begin to experience these thoughts and feelings?
How frequently have you had these thoughts and feelings?
Have you ever thought of how you might kill yourself and if so, are you thinking about that now?
Have you ever made plans?
Have you told anyone that you are thinking about taking your life or are planning to do this?
Do you have the means for suicide (do you have access to pills, insecticide, firearms...)?
Do you think you might hurt yourself and if so, how can I help you because I really care?
Do these thoughts intrude into your thinking and activities? Can you describe them?
Can you stop yourself from having them by distracting yourself with an activity or other more positive thoughts?
Have you ever acted upon these thoughts?
If you have not acted upon them, how close do you feel you came to acting?
Have you ever started to act on your self-harm or suicidal thoughts, yet stopped before actually doing it? For example, did you hold a bottle of pills in your hand to take them all but stopped, or go out on a ledge to jump but then stopped?
What stopped you from acting on them?
Do you think you might act on these thoughts of self-harm or suicide in the future?
What might help you from acting on them?
Do you have methods available to you to take your life, such pills, guns, knives or proximity to a balcony, bridge or subway?
Is there any available support (family, friends, carers...)?
How strong is the feeling? If they can’t explain ask them to rate it on a scale from 1 (being worst feeling ever) to 10 (being not strong at all)?
Have you prepared for your death by writing a note, making a will, practicing the plan, putting your affairs such as your finances in order, or ensuring privacy such that you would unlikely be discovered?
ENGAGE
- Reach out and touch them
- Sit down close to themso they feel your presence
- Place your hand on their arm or on their back and rub in a soothing manner
- Put your arm around their shoulders and pull them closer
- Hold their hand
- Give them a hug
TAKE ACTION
Help them call a hotline
Take them to an emergency room
Make an appointment for crisis counseling
Help them be safe
Tell them you are there for them
Be there for them
Make sure they know they are not alone
NATIONAL SUICIDE PREVENTION LIFELINE
CALL: 1-800-273-TALK (8255)
www.suicidepreventionlifeline.org
CLICK TO CHAT