A conversation I have with many of my clients is about suicidal ideation. For some people, it is something we check in about regularly. For others, the conversation happens less often—perhaps when depression deepens, circumstances change, or something has made life significantly harder. I am comfortable asking the question and I want my clients to know that it is okay to answer honestly.
Talking about thoughts of suicide does not automatically mean that everyone needs to panic. Sometimes being able to say those thoughts out loud, to someone who can stay present and listen, gives us an opportunity to better understand what is happening and what kind of support is needed. That does not mean we minimize suicidal thoughts or assume that everything will be okay. It means we make room for an honest conversation.
Asking about suicide does not put the idea in someone's head
One of the fears I sometimes hear is that asking someone directly about suicide might somehow make things worse. Research and suicide-prevention organizations are clear that asking about suicide does not put the idea into someone's mind. In fact, asking directly can give someone permission to talk about something they may already have been carrying quietly.
Talking about suicide outside of therapy matters too. If you are a friend, family member, partner, colleague, or someone else who is worried about a person you care about, it can feel frightening to ask: “Are you thinking about suicide?”
Part of that fear may come from not knowing what you will do if the answer is yes. But you do not need to have every answer before you are willing to listen. Sometimes the first step is simply being able to hear what the person is actually saying.
Not every conversation needs to begin at the worst moment
One of the reasons I believe these conversations matter is that they give us an opportunity to talk about what happens before someone reaches their most difficult moment. When suicidal thoughts can be discussed openly, we can begin noticing patterns. What tends to happen when things are becoming harder?
- Perhaps sleep deteriorates.
- Maybe someone begins withdrawing from people they normally talk with.
- Hopelessness may increase.
- Thinking may become more rigid.
- Suicidal thoughts may become more frequent, more intense, or more specific.
Sometimes there are changes the person themselves has learned to recognize. Those observations can become part of a plan.
We can ask:
- Who could you contact if things become worse?
- Is there a friend or family member who knows what has been happening?
- When would you contact your therapist or another health-care provider?
- When would calling or texting 9-8-8 be appropriate?
- What would tell you that going to the emergency department is necessary?
- What would you want someone close to you to know if you were having difficulty keeping yourself safe?
Having these conversations ahead of time means fewer decisions need to be made during a moment when distress may already be affecting the person's ability to think clearly.
Sometimes one of the most helpful things is not panicking
People often worry that they need to say exactly the right thing when someone tells them they are thinking about suicide. There is no perfect sentence. What matters most is our capacity to stay present long enough to understand what the other person is trying to tell us. That does not mean ignoring risk. It does not mean promising secrecy when someone's immediate safety is at risk. It means listening before rushing to reassure, problem-solve, argue, or tell someone all the reasons they should want to live.
For a friend or family member, your role is also not to become that person's therapist.
You may not be able to provide all of the support they need—and you should not have to. What you can sometimes provide is connection. You can listen. You can take what they are saying seriously. You can help them reach someone who is able to provide the level of support they need and sometimes you can stay with them while they make that call.
Why I ask about sleep
There is another question I ask frequently when someone is struggling:
“How have you been sleeping?”
Years ago, a psychiatrist said something that stayed with me. He told me that sometimes one of the greatest gifts he could give someone who arrived at hospital in crisis was a good night's sleep.
I think about that comment often.
Sleep does not solve the circumstances that brought someone to a crisis point. A good night's sleep does not make trauma disappear, repair a relationship, resolve financial stress, or treat depression on its own.
But sleep matters.
When we are severely sleep deprived, coping can become harder. Thinking can become less flexible. Emotions may feel more difficult to manage. Problems that already feel overwhelming can become even harder to navigate.
Sleep disturbance is also associated with suicidal thoughts and behaviour, which is one reason health-care professionals often ask about changes in sleep when assessing how someone is doing.
So when your therapist asks:
“How are you sleeping?”
it really is an important question. Sometimes improving sleep is one part of creating enough stability for someone to begin dealing with everything else.
What if I am worried about someone?
You do not need to conduct a clinical assessment.
You can ask directly.
You might say:
“I've noticed that things seem really difficult right now. Are you thinking about suicide?”
If they say yes, listen.
Ask what has been happening.
Take them seriously.
If they are willing, help them connect with additional support.
In Canada, anyone can call or text 9-8-8, 24 hours a day, seven days a week. You can contact 9-8-8 if you are experiencing suicidal thoughts yourself, or if you are worried about someone else.
There are also times when the level of support needs to change urgently.
If someone believes they may act on suicidal thoughts, cannot keep themselves safe, or there is immediate danger, additional emergency support is needed. In those circumstances, call 9-1-1 or go to the nearest emergency department.
We can talk before things become a crisis
September is Suicide Prevention Month, but conversations about suicide need to be possible throughout the year.
Perhaps part of changing the way we respond to suicide is making room for these conversations before someone reaches their worst moment.
- We can ask.
- We can listen.
- We can take what someone tells us seriously without treating them as though they have suddenly become frightening or fragile.
- We can talk about what makes things worse and what helps.
- We can make a plan for what happens if tomorrow becomes harder than today.
And sometimes, being able to say something difficult out loud to another person who does not panic can create just a little more room for support, connection, and another possibility.
If you or someone you know needs support
In Canada, call or text 9-8-8 for the Suicide Crisis Helpline, available 24 hours a day, seven days a week.
If someone's immediate safety is at risk, call 9-1-1 or go to the nearest emergency department.
Healing Paths Psychology provides counselling for adults experiencing trauma, depression, grief, neurodivergence, relationship concerns, and other mental-health challenges. Counselling can also include ongoing conversations about suicidal thoughts, safety planning, and identifying supports before a crisis develops.
