Suicide Prevention

If you are in crisis, text "SOS" to 741741 or call 800.273-TALK (8255). If you are in extreme crisis, call 911 while you're looking in the front of your local yellow pages for the number of the local suicide prevention hotline. If you can't get through to either of those, click on Emergency Numbers. Also visit which contains conversations and writings for suicidal persons to read, gay youth suicide at and youth: suicide at .

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Awkward Silence

Suicide prevention must be transformed by integrating injury prevention and mental health perspectives to develop a mosaic of common risk public health interventions that address the diversity of populations and individuals whose mortality and morbidity contribute to the burdens of suicide and attempted suicide. Emphasizing distal preventive interventions, strategies must focus on people and places—and on related interpersonal factors and social contexts—to alter the life trajectories of people before they become suicidal. Attention also must be paid to those in the middle years—the age with the greatest overall burden. We need scientific and social processes that define priorities and assess their potential for reducing what has been a steadily increasing rate of suicide during the past decade. - American Public Health Association

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Suicide Prevention

How to Help Someone who is Suicidal and Save a Life

Suicide prevention

A suicidal person may not ask for help, but that doesn't mean that help isn't wanted. People who take their lives don't want to die—they just want to stop hurting. Suicide prevention starts with recognizing the warning signs and taking them seriously. If you think a friend or family member is considering suicide, you might be afraid to bring up the subject. But talking openly about suicidal thoughts and feelings can save a life.

If you are suicididal, Text "SOS" to 741741 or call
800-273-TALK (8255) in the US. To find a suicide helpline outside the U.S., visit

Understanding suicide

The World Health Organization estimates that approximately 1 million people die each year from suicide. What drives so many individuals to take their own lives? To those not in the grips of suicidal depression and despair, it's difficult to understand what drives so many individuals to take their own lives. But a suicidal person is in so much pain that he or she can see no other option.

Suicide is a desperate attempt to escape suffering that has become unbearable. Blinded by feelings of self-loathing, hopelessness, and isolation, a suicidal person can't see any way of finding relief except through death. But despite their desire for the pain to stop, most suicidal people are deeply conflicted about ending their own lives. They wish there was an alternative to suicide, but they just can't see one.

Common misconceptions about suicide

Myth: People who talk about suicide won't really do it.

Fact: Almost everyone who attempts suicide has given some clue or warning. Don’t ignore even indirect references to death or suicide. Statements like "You'll be sorry when I'm gone," "I can't see any way out," — no matter how casually or jokingly said, may indicate serious suicidal feelings.

Myth: Anyone who tries to kill him/herself must be crazy.

Fact: Most suicidal people are not psychotic or insane. They must be upset, grief-stricken, depressed or despairing, but extreme distress and emotional pain are not necessarily signs of mental illness.

Myth: If a person is determined to kill him/herself, nothing is going to stop them.

Fact: Even the most severely depressed person has mixed feelings about death, wavering until the very last moment between wanting to live and wanting to die. Most suicidal people do not want death; they want the pain to stop. The impulse to end it all, however overpowering, does not last forever.

Myth: People who die by suicide are people who were unwilling to seek help.

Fact: Studies of suicide victims have shown that more than half had sought medical help in the six months prior to their deaths.

Myth: Talking about suicide may give someone the idea.

Fact: You don't give a suicidal person morbid ideas by talking about suicide. The opposite is true—bringing up the subject of suicide and discussing it openly is one of the most helpful things you can do.

Source: SAVE - Suicide Awareness Voices of Education

Warning signs of suicide

Take any suicidal talk or behavior seriously. It's not just a warning sign that the person is thinking about suicide—it's a cry for help.

Most suicidal individuals give warning signs or signals of their intentions. The best way to prevent suicide is to recognize these warning signs and know how to respond if you spot them. If you believe that a friend or family member is suicidal, you can play a role in suicide prevention by pointing out the alternatives, showing that you care, and getting a doctor or psychologist involved.

Major warning signs for suicide include talking about killing or harming oneself, talking or writing a lot about death or dying, and seeking out things that could be used in a suicide attempt, such as weapons and drugs. These signals are even more dangerous if the person has a mood disorder such as depression or bipolar disorder, suffers from alcohol dependence, has previously attempted suicide, or has a family history of suicide.

A more subtle but equally dangerous warning sign of suicide is hopelessness. Studies have found that hopelessness is a strong predictor of suicide. People who feel hopeless may talk about "unbearable" feelings, predict a bleak future, and state that they have nothing to look forward to.

Other warning signs that point to a suicidal mind frame include dramatic mood swings or sudden personality changes, such as going from outgoing to withdrawn or well-behaved to rebellious. A suicidal person may also lose interest in day-to-day activities, neglect his or her appearance, and show big changes in eating or sleeping habits.

Suicide warning signs

Talking about suicide – Any talk about suicide, dying, or self-harm, such as "I wish I hadn't been born," "If I see you again..." and "I'd be better off dead."

Seeking out lethal means – Seeking access to guns, pills, knives, or other objects that could be used in a suicide attempt.

Preoccupation with death – Unusual focus on death, dying, or violence. Writing poems or stories about death.

No hope for the future – Feelings of helplessness, hopelessness, and being trapped ("There's no way out"). Belief that things will never get better or change.

Self-loathing, self-hatred – Feelings of worthlessness, guilt, shame, and self-hatred. Feeling like a burden ("Everyone would be better off without me").

Getting affairs in order – Making out a will. Giving away prized possessions. Making arrangements for family members.

Saying goodbye – Unusual or unexpected visits or calls to family and friends. Saying goodbye to people as if they won't be seen again.

Withdrawing from others – Withdrawing from friends and family. Increasing social isolation. Desire to be left alone.

Self-destructive behavior – Increased alcohol or drug use, reckless driving, unsafe sex. Taking unnecessary risks as if they have a "death wish."

Sudden sense of calm – A sudden sense of calm and happiness after being extremely depressed can mean that the person has made a decision to attempt suicide.

Suicide prevention tip 1: Speak up if you’re worried

If you spot the warning signs of suicide in someone you care about, you may wonder if it’s a good idea to say anything. What if you’re wrong? What if the person gets angry? In such situations, it's natural to feel uncomfortable or afraid. But anyone who talks about suicide or shows other warning signs needs immediate help—the sooner the better.

Talking to a person about suicide

Talking to a friend or family member about their suicidal thoughts and feelings can be extremely difficult for anyone. But if you're unsure whether someone is suicidal, the best way to find out is to ask. You can't make a person suicidal by showing that you care. In fact, giving a suicidal person the opportunity to express his or her feelings can provide relief from loneliness and pent-up negative feelings, and may prevent a suicide attempt.

Ways to start a conversation about suicide:

"I have been feeling concerned about you lately."

"Recently, I have noticed some differences in you and wondered how you are doing."

"I wanted to check in with you because you haven’t seemed yourself lately."

Questions you can ask:

"When did you begin feeling like this?"

"Did something happen that made you start feeling this way?"

"How can I best support you right now?"

"Have you thought about getting help?"

What you can say that helps:

"You are not alone in this. I’m here for you."

"You may not believe it now, but the way you’re feeling will change."

"I may not be able to understand exactly how you feel, but I care about you and want to help."

"When you want to give up, tell yourself you will hold off for just one more day, hour, minute—whatever you can manage."

When talking to a suicidal person


Be yourself. Let the person know you care, that he/she is not alone. The right words are often unimportant. If you are concerned, your voice and manner will show it.

Listen. Let the suicidal person unload despair, ventilate anger. No matter how negative the conversation seems, the fact that it exists is a positive sign.

Be sympathetic, non-judgmental, patient, calm, accepting. Your friend or family member is doing the right thing by talking about his/her feelings.

Offer hope. Reassure the person that help is available and that the suicidal feelings are temporary. Let the person know that his or her life is important to you.\

Take the person seriously. If the person says things like, “I’m so depressed, I can’t go on,” ask the question: “Are you having thoughts of suicide?” You are not putting ideas in their head, you are showing that you are concerned, that you take them seriously, and that it’s OK for them to share their pain with you.

But don’t:

Argue with the suicidal person. Avoid saying things like: "You have so much to live for," "Your suicide will hurt your family," or “Look on the bright side.”

Act shocked, lecture on the value of life, or say that suicide is wrong.

Promise confidentiality. Refuse to be sworn to secrecy. A life is at stake and you may need to speak to a mental health professional in order to keep the suicidal person safe. If you promise to keep your discussions secret, you may have to break your word.

Offer ways to fix their problems, or give advice, or make them feel like they have to justify their suicidal feelings. It is not about how bad the problem is, but how badly it’s hurting your friend or loved one.

Blame yourself. You can’t “fix” someone’s depression. Your loved one’s happiness, or lack thereof, is not your responsibility.


Tip 2: Intervention: Respond quickly in a crisis

If a friend or family member tells you that he or she is thinking about death or suicide, it's important to evaluate the immediate danger the person is in. Those at the highest risk for suicide in the near future have a specific suicide PLAN, the MEANS to carry out the plan, a TIME SET for doing it, and an INTENTION to do it.

The following questions can help you assess the immediate risk for suicide:

  • Do you have a suicide plan? (PLAN)
  • Do you have what you need to carry out your plan (pills, gun, etc.)? (MEANS)
  • Do you know when you would do it? (TIME SET)
  • Do you intend to take your own life? (INTENTION)

Level of Suicide Risk

Low – Some suicidal thoughts. No suicide plan. Says he or she won't attempt suicide.

Moderate – Suicidal thoughts. Vague plan that isn't very lethal. Says he or she won't attempt suicide.

High – Suicidal thoughts. Specific plan that is highly lethal. Says he or she won't attempt suicide.

Severe – Suicidal thoughts. Specific plan that is highly lethal. Says he or she will attempt suicide.

Editor's note: The analysis of Crisis Teext Line texts indicates that mentioning ibuprofen, Advil, Tylenol, or Aspirin is a clear indication that they have a plan.

If a suicide attempt seems imminent, call a local crisis center, dial 911, or take the person to an emergency room. Remove guns, drugs, knives, and other potentially lethal objects from the vicinity but do not, under any circumstances, leave a suicidal person alone.

Tip 3: Offer help and support

If a friend or family member is suicidal, the best way to help is by offering an empathetic, listening ear. Let your loved one know that he or she is not alone and that you care. Don't take responsibility, however, for making your loved one well. You can offer support, but you can't get better for a suicidal person. He or she has to make a personal commitment to recovery.

It takes a lot of courage to help someone who is suicidal. Witnessing a loved one dealing with thoughts about ending his or her own life can stir up many difficult emotions. As you're helping a suicidal person, don't forget to take care of yourself. Find someone that you trust—a friend, family member, clergyman, or counselor—to talk to about your feelings and get support of your own.

Helping a suicidal person:

Get professional help. Do everything in your power to get a suicidal person the help he or she needs. Call a crisis line for advice and referrals. Encourage the person to see a mental health professional, help locate a treatment facility, or take them to a doctor's appointment.

Follow-up on treatment. If the doctor prescribes medication, make sure your friend or loved one takes it as directed. Be aware of possible side effects and be sure to notify the physician if the person seems to be getting worse. It often takes time and persistence to find the medication or therapy that’s right for a particular person.

Be proactive. Those contemplating suicide often don't believe they can be helped, so you may have to be more proactive at offering assistance. Saying, “Call me if you need anything” is too vague. Don’t wait for the person to call you or even to return your calls. Drop by, call again, invite the person out.

Encourage positive lifestyle changes, such as a healthy diet, plenty of sleep, and getting out in the sun or into nature for at least 30 minutes each day. Exercise is also extremely important as it releases endorphins, relieves stress, and promotes emotional well-being.

Make a safety plan. Help the person develop a set of steps he or she promises to follow during a suicidal crisis. It should identify any triggers that may lead to a suicidal crisis, such as an anniversary of a loss, alcohol, or stress from relationships. Also include contact numbers for the person's doctor or therapist, as well as friends and family members who will help in an emergency.

Remove potential means of suicide, such as pills, knives, razors, or firearms. If the person is likely to take an overdose, keep medications locked away or give out only as the person needs them.

Continue your support over the long haul. Even after the immediate suicidal crisis has passed, stay in touch with the person, periodically checking in or dropping by. Your support is vital to ensure your friend or loved one remains on the recovery track.

Risk factors

According to the U.S. Department of Health and Human Services, at least 90 percent of all people who die by suicide suffer from one or more mental disorders such as depression, bipolar disorder, schizophrenia, or alcoholism. Depression in particular plays a large role in suicide. The difficulty suicidal people have imagining a solution to their suffering is due in part to the distorted thinking caused by depression.

Common suicide risk factors include:

  • Mental illness, alcoholism or drug abuse
  • Previous suicide attempts, family history of suicide, or history of trauma or abuse
  • Terminal illness or chronic pain, a recent loss or stressful life event
  • Social isolation and loneliness
Antidepressants and suicide

For some, depression medication causes an increase—rather than a decrease—in depression and suicidal thoughts and feelings. Because of this risk, the FDA advises that anyone on antidepressants should be watched for increases in suicidal thoughts and behaviors. Monitoring is especially important if this is the person's first time on depression medication or if the dose has recently been changed.
The risk of suicide is the greatest during the first
two months of antidepressant treatment.

Suicide in teens and older adults

In addition to the general risk factors for suicide, both teenagers and older adults are at a higher risk of suicide.

Suicide in teens

Teenage suicide is a serious and growing problem. The teenage years can be emotionally turbulent and stressful. Teenagers face pressures to succeed and fit in. They may struggle with self-esteem issues, self-doubt, and feelings of alienation. For some, this leads to suicide. Depression is also a major risk factor for teen suicide.

Youth Suicide Warning Signs

Is your friend:

1. Talking about wanting to die, be dead, or about suicide, or are they cutting or burning themselves?

2. Feeling like things may never get better, seeming like they are in terrible emotional pain (like something is wrong deep inside but they can't make it go away), or they are struggling to deal with a big loss in their life?

3. Or is your gut telling you to be worried became they have withdrawn from everyone and everything, have become more worried or on edge, seem unusually angry, or just don't seem normal to you?

How to Respond:

1. Ask them if they are okay and listen to them like a true friend.

2. Tell them you are worried and concerned about them and that they are not alone.

3. Talk to an adult you trust about your concerns and direct them to this website

Other risk factors for teenage suicide include:

  • Childhood abuse
  • Recent traumatic event
  • Lack of a support network
  • Availability of a gun
  • Hostile social or school environment
  • Exposure to other teen suicides

Warning signs in teens

Additional warning signs that a teen may be considering suicide:

  • Change in eating and sleeping habits
  • Violent or rebellious behavior, running away
  • Drug and alcohol use
  • Unusual neglect of personal appearance
  • Persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork
  • Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc.
  • Not tolerating praise or rewards

Source: American Academy of Child & Adolescent Psychiatry

Suicide in the elderly

The highest suicide rates of any age group occur among persons aged 65 years and older. One contributing factor is depression in the elderly that is undiagnosed and untreated.

Other risk factors for suicide in the elderly include:

  • Recent death of a loved one, isolation and loneliness
  • Physical illness, disability, or pain
  • Major life changes, such as retirement or loss of independence
  • Loss of sense of purpose

Warning signs in older adults

Additional warning signs that an elderly person may be contemplating suicide:

  • Reading material about death and suicide
  • Disruption of sleep patterns
  • Increased alcohol or prescription drug use
  • Failure to take care of self or follow medical orders
  • Stockpiling medications or sudden interest in firearms
  • Social withdrawal, elaborate good-byes, rush to complete or revise a will

Source: University of Florida

Related HelpGuide articles

Resources and references

General information about suicide

Understanding Suicidal Thinking (16 page PDF) – Learn about preventing suicide attempts and offering help and support. (Depression and Bipolar Support Alliance)

Suicide in America: Frequently Asked Questions – Find answers to common questions about suicide, including who is at the highest risk and how to help. (National Institute of Mental Health)

Suicide and Mental Illness – Facts on the link between suicide and mental illnesses such as depression, substance abuse, schizophrenia, and bipolar disorder. (

Suicide and Preventing Suicide – Suicide fact sheets answer questions about who's at risk and what friends and family can do to prevent suicide. (The National Alliance on Mental Illness).

About Suicide – Information on suicide warning signs & risk factors, statistics, and treatment. (American Foundation for Suicide Prevention)

Helping a suicidal person

What Can I Do To Help Someone Who May be Suicidal? – Discusses possible warning signs of suicidal thoughts and ways to prevent suicide attempts. (

Handling a Call From a Suicidal Person – How to handle a phone call from a friend or family member who is suicidal. Features tips on what to say and how to help. (

Suicide crisis phone and text lines in the U.S.

National Suicide Prevention Lifeline – Suicide prevention telephone hotline funded by the U.S. government. Provides free, 24-hour assistance. 1-800-273-TALK (8255).

Crisis Text Line - Free, confidential, national, 24/7 Text "SOS" to 741741 for anyone in any kind of crisis.

National Hopeline Network – Toll-free telephone number offering 24-hour suicide crisis support. 1-800-SUICIDE (784-2433). (National Hopeline Network)

The Trevor Project – Crisis intervention and suicide prevention services for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. Includes a 24/7 hotline: 1-866-488-7386.

SAMHSA's National Helpline – Free, confidential 24/7 helpline information service for substance abuse and mental health treatment referral. 1-800-662-HELP (4357). (SAHMSA)

txt4life – Suicide prevention resource for residents of Minnesota. Text the word "LIFE" to 61222 to be connected to a trained counselor. (

Suicide crisis lines worldwide

Crisis Centers in Canada – Locate suicide crisis centers in Canada by province. (Canadian Association for Suicide Prevention)

IASP – Find crisis centers and helplines around the world. (International Association for Suicide Prevention).

International Suicide Hotlines – Find a helpline in different countries around the world. (

Befrienders Worldwide – International suicide prevention organization connects people to crisis hotlines in their country. (Befrienders Worldwide)

Samaritans UK – 24-hour suicide support for people in the UK and Republic of Ireland (call 116 123). (Samaritans)

Lifeline Australia – 24-hour suicide crisis support service at 13 11 14. (Lifeline Australia)

Coping after a suicide attempt

After an Attempt (PDF) – Guide for taking care of a family member following a suicide attempt and treatment in an emergency room. (National Suicide Prevention Lifeline)


Using awkward silences for potentially life-saving conversation about depression

"Seize the Awkward" is part of a new ad campaign from the American Foundation for Suicide Prevention and the Ad Council. (Provided)

Two teens sit awkwardly together in a drab living room. They are silent, and then a man emerges from the space between them on the couch. “An awkward silence can be a great thing,” he says. “Like Kelly here is about to demonstrate.”

“Kelly” tells her friend that she’s noticed she’s been down lately and wants to see if she’s OK.

It’s part of a new ad campaign developed by the Jed Foundation, the American Foundation for Suicide Prevention and the Ad Council, called “Seize the Awkward.” The ads encourage teens and young adults to talk to their friends about depression.

“This campaign gives young people tools to recognize the risks and warning signs and shows them how to have a conversation — and most importantly how to be there for a friend who may be struggling,” said Stephanie Coggin, the vice president of communications at the American Foundation for Suicide Prevention. “With the help of this campaign, we are empowering teens to reach out and create a safe space for their friends to open up.”

“You hear about heart disease, cholesterol, cancer, and all these other ailments that take people’s lives” but not suicide or depression, said Eddie Tully. Tapped by the American Foundation for Suicide Prevention as “lifesaver of the year,” Tully will be honored at a March 9 gala.

Tully has devoted himself to anti-bullying and suicide-awareness campaigns since the suicide of his brother Chris two years ago.

The Awkward campaign reminds Tully of his brother’s legacy as a teacher.

As a popular and award-winning educator in Bucks County, Chris Tully didn’t shy away from making himself look awkward to help kids understand a difficult concept. But privately, he struggled to open up.

“My brother definitely felt shame for what he was going through, especially because he was a very well-liked and respected teacher across the country, and even in other parts of the world,” said Tully.

Chris Tully would have benefited from the new campaign, said his brother. And he’s hopeful the campaign will help others know that they’re not alone — and that good help is available.

“Seventy-six percent of young adults will turn to a peer when they are looking for support,” Coggin said, noting that suicide is the second-leading cause of death among young adults.

“By trusting their gut instincts when something is off with a friend and saying something — even if it’s awkward or messy or imperfect — can prevent something much worse from happening,” she said.

Why youth who have a cell phone should know and memorize 741741

Research shows that over 90% of teens in crisis will not call a suicide helpline. They don't even talk on their cell phones, they text. 741741 has been around since August of 2013 and works basically the same wway as the national suicide phone line but it's counselors are especially knowledgable about texting, Both are 24/7, confidential, free and staffed by trained counselors. (See "Extra Benefits")

The Benefits of Teaching Suicide Prevention in Schools

According to the Centers for Disease Control and Prevention, 1 in 12 teenagers attempted suicide in 2012. By the next year, 8% of all high school students had actually acted on their suicidal thoughts. When students learn suicide prevention in school, they’re given the resources they need to address their own suicidal feelings, or those of a friend. As such, proper education could lead to a dramatic decrease in suicidal thoughts and attempts amongst teenagers.

Unfortunately, however, most students are not adequately taught about suicide prevention in school or at home. This means that the majority of teenagers are unable to properly handle suicidal feelings.

Why Suicide Risk is High Among Teens

As many of us know, one’s teenage years can be tumultuous. What many don’t fully understand is what could lead teenagers to consider or attempt suicide. The answer to this, however, can be complex, and often involves both environmental and emotional factors.

  • Depression: Up to 20% of teenagers report incidences of depression. This can include feelings up worthlessness, hopelessness, loneliness, or helplessness. Often, teens feel that the only way to end these feelings is through death.
  • Stress and Anxiety: Much like depression, teens experience stress and anxiety at high rates, and cannot find healthy coping mechanisms.
  • Mental Illness or Family History: Teens who experience mental illness or have a family history of mental illness are more likely to attempt suicide.
  • Physical Illness: Teens with physical illnesses often see themselves as different from their peers, which can be devastating during youth, leading to suicidal thoughts and actions.
  • Brain Development: The human brain is still developing during teenage years. As such, many students do not have the capacity to handle feelings of sadness, depression, anxiety, rejection, or hurt.
  • Bullying: With the rise of social media and technology, bullying has become more prevalent than ever. Teens who experience bullying often see no way out of the situation other than suicide.
  • Abuse, Neglect, or Trauma: Teens who experience parental abuse or neglect, or those who have experienced trauma at home (such as the death of a loved one) are more likely to commit suicide.
  • Substance Abuse: Often, substance abuse, other mental illness, and suicide go hand in hand in the teenage community.
  • Access to Means: Teenagers with the means to commit suicide (including access to weapons) are more likely to actually make an attempt.

How Suicide Prevention Programs in Schools Can Help

Proper access to resources is key to preventing and treating any disease, whether physical or mental. As previously stated, teenagers’ brains and bodies are still in development, and as such, they need guidance and counseling to properly cope with negative feelings, emotions, and situations.

Whether students are experiencing a poor home life or an undiagnosed mental illness, a suicide prevention program could help guide them in the right direction. Important aspects of any suicide prevention program should include:

  • Risk factors associated with suicide;
  • Resources for help;
  • Facts and statistics about suicide; and
  • How help yourself or a loved one.

With this knowledge, students and teachers alike can learn how to identify warning signs, whether within themselves or those around them. Once these signs are recognized, students and staff will have the skills and knowledge they need to reach out for help. When suicide prevention resources are enabled, the risk of suicide amongst teens will decrease.

Teens are a vulnerable population of individuals and to maintain proper health, both physically and mentally, they must be given the proper resources. By adding suicide prevention to a school’s curriculum, students are better able to handle and address suicidal thoughts or intentions. Prevention can save lives, especially those of younger populations who are at higher risk.

Preventing Suicide: Guidelines for Administrators and Crisis Teams

School personnel have a legal and ethical responsibility to recognize and respond to suicidal thinking and behavior. Schools must have clear policies and procedures for what to do, as well as trained school-employed mental health professionals and crisis response teams. Although many suicidal children and adolescents do not self-refer, most show some warning signs. Never ignore these signs. Suicide prevention should be an integral component of a multi-tiered system of mental health and safety supports.

Assembling a Crisis Team

A trained school safety and crisis response team is essential to being able to identify and intervene effectively with students who are at risk of suicidal behavior. At a minimum, the team should include an administrator, school-employed mental health professional, school security personnel, and other appropriate school personnel. Each crisis response team member needs to have clearly defined roles and responsibilities.

The crisis response team is responsible for developing and implementing suicide risk assessment, intervention and postvention policies and procedures. Sometimes these policies are developed at the district level by a district crisis response team.

The crisis response team should assign one or more individuals as a "designated reporter" to receive and act upon all reports from teachers, other staff and students about students who may be suicidal. This individual should be a school-employed mental health professional (e.g., school psychologist, counselor, nurse or social worker).

All school crisis response teams should have a representative from local law enforcement. If a student resists, becomes combative or attempts to flee, assistance from law enforcement is essential. In some jurisdictions, law enforcement can also be of help to obtain a "72-hour hold," which will place the youth in protective custody for psychiatric observation and treatment. In other jurisdictions, the community mental health center, child protective services, and/or calling 911 is required if the youth needs to be placed in protective custody and parents are unable to safely transport and/or are uncooperative. It is important to know the procedures for your jurisdiction.

All staff should receive training annually on the warning signs and referral procedures for students who display signs of suicidal thinking and behavior. Students should also receive instruction about risk factors, warning signs, and how to get help for themselves or a friend. This training can be part of the curriculum or a comprehensive suicide prevention program, but should be delivered by qualified credentialed educators.

Prevention Measure

Providing a safe, positive, and welcoming school climate; and ensuring that students have trusting relationships with adults serves is the foundation for effective suicide prevention efforts. Schools should have mental health supports that are explicitly connected to both school safety and learning outcomes. Ideally they also should implement a comprehensive empirically supported suicide prevention program [e.g., Signs of Suicide (SOS)]. Schools should make use of a well-publicized tip line for students to call or text with any concerns.

Bullying and suicide-related behaviors have a number of shared risk factors including mental health challenges (e.g., depression, hopelessness, and substance use/abuse). Thus, schools would be well served by adopting an integrated approach to violence prevention with both peer-directed and self-directed violence addressed in the design and implementation of programs, policies, and procedures. Youth who report frequently bullying others and those who report being frequently bullied are at increased risk for suicidal thoughts and behavior. Bully-victims (those who report both bullying others and being bullied) are at the highest risk for suicidal thoughts and behaviors. Keep in mind the relationship between bullying and suicide is more complex and less direct than it might appear. While bullying may be a precipitating event, there are often many other contributing factors, including underlying mental illness.

Prevention efforts should also address non-suicidal self-injury (NSSI or "cutting"). While the behavior is typically not associated with suicidal thinking, it is a red flag that someone is distressed and does increase the risk for suicidal thinking and behaviors. It is important that school staff learn to recognize the signs of NSSI, including cuts, burns, scratches, scabs, and scrapes, especially those that are recurrent and if explanations for the injuries are not credible. Suicide risk assessment should always be a part of intervention with the student who displays NSSI.

Identification and Intervention

Early identification and intervention are critical to preventing suicidal behavior. When school staff become aware of a student exhibiting potential suicidal behavior, they should immediately and escort the child to a member of the school's crisis response team for a suicide risk assessment (i.e., the "designated reporter"). They should not "send" the student on their own. If the appropriate staff is not available, 911 should be called. Typically, it is best to inform the student what you are going to do every step of the way. Solicit the student's assistance where appropriate. Under no circumstances should the student be allowed to leave school or be alone (even in the restroom). Reassure and supervise the student until a 24/7 caregiving resource (e.g., parent, mental health professional or law enforcement representative) can assume responsibility.

Designated members of the school crisis team should conduct a suicide risk assessment. The purpose of the assessment is to determine the level of risk and to identify the most appropriate actions to ensure the immediate and long-term safety and well-being of the student. This should be done by a team that includes a school-employed mental health professional.(See NASP's handout on ,a href="/resources-and-publications/resources/school-safety-and-crisis/preventing-youth-suicide/preventing-suicide-guidelines-for-administrators-and-crisis-teams#" >threat assessment for guidance on this topic.)

Caregiver notification is a vital part of suicide prevention. The appropriate caregiver(s) must always be contacted when signs of suicidal thinking and behavior are observed. Typically this is the student's parent(s); however, when child abuse is suspected protective services should be contacted. Even if a child is judged to be at low risk for suicidal behavior, schools may ask caregivers to sign a form to indicate that relevant information has been provided. Regardless, all caregiver notifications must be documented. Caregivers also provide critical information in determining level of risk. Whether a student is in imminent danger or not, it is strongly recommended that lethal means are (i.e. guns, poisons, medications, and sharp objects) are removed or made inaccessible.

Refer to community services if warranted. Suicidal thinking and behaviors can also occur outside of school hours. Thus, referral options to 24 hour community-based services should be identified in advance. It is best to obtain a release from the primary caregiver to facilitate the sharing of information between the school and community agency and it is highly recommended the school contact the agency to share critical information. School districts have an obligation to suggest agencies that are non-proprietary or offer sliding scale of fees.

Help the student to develop a safety plan. Generally speaking no-suicide contracts have been shown to be ineffective and are no longer recommended. However, helping the student to develop a written list of coping strategies and sources of support that can be of assistance when he or she is having thoughts of suicide (i.e., a safety plan) is recommended. Suicide prevention hotlines (e.g., 800-273-TALK), Crisis Text Line 741741 and the app MY3 ( can be helpful elements of such a plan.

Schools are legally responsible for documenting every step in the assessment and intervention process. Such documentation ensures that protocols were followed. Every school district should develop a documentation form for support personnel and crisis response team members to record their suicide intervention actions and caregiver communication. Student information must be kept confidential but there are exceptions to FERPA when safety is of concern. Staff responsible for the safety and welfare of the student should be provided with the information necessary to work with the student and preserve the safety. School staff members do not need clinical information about the student or a detailed history of his or her suicidal risk or behavior. Discussion among staff should be restricted to the student's treatment and support needs.

Keep tabs on the rumor mill (including social media). If you hear or see something credible, refer the student to a school-employed mental health professional or crisis response team member. At the same time, gossip about particular incidents and students should also be discouraged. For more information on conducting a suicide intervention, see handout "A Suicide Intervention Model."


Following a suicide, school communities must strike a delicate balance. Students should have an opportunity to grieve, but in a way that does not glorifying, romanticizing or sensationalizing suicide, which may increase suicide risk for other students.

Confirm facts. Confirm the facts related to the death with the family and/or police. Inform other schools in the district with students related or close to the deceased. Contact the family to offer condolences, ask what the school can do to help, offer resources, and to discuss communication with the school community. Protect and gather the personal effects of the deceased for the family and/or the police. Pay close attention to other students (and staff) who may also be at risk of suicidal behavior.

Resources needed. In some situations, schools may have adequate resources to handle the aftermath of a suicide. However, it is critical that schools assess the impact of the suicide on the school community to determine the level of postvention support needed. Factors to consider include how well known the student was, if the suicide was public (i.e., occurred at school), and/or if the deceased had shared his/her suicidal intentions with others (particularly to large numbers of other students via social media). These factors generally increase the impact and thus the potential postvention needs of members of the school community.

Contagion. Suicide contagion occurs when suicidal behavior is imitated. The effect is strongest among adolescents: they appear to be more susceptible to imitative suicide than adults, largely because they may identify more readily with the behavior and qualities of their peers. Guilt, identification, and modeling are each thought to play a role in contagion. Sometimes suicide contagion can result in a cluster of suicides. Studies indicate that 1-5% of all suicides within this age group are due to contagion (100-200 teenage cluster suicides per year).

Suicide postvention strategies designed to minimize contagion include avoiding sensationalism or giving unnecessary attention to the suicide, avoiding glorifying or vilifying of suicide victims, and minimizing the amount of detail about the suicide shared with students.

If there appears to be contagion, school administrators should consider taking additional steps beyond the basic crisis response, including stepping up efforts to identify other students who may be at heightened risk of suicide, collaborating with community partners in a coordinated suicide prevention effort, and possibly bringing in outside experts.

Memorials. Memorials in particular run the risk of glamorizing suicide and should thus be implemented with great care. Living memorials are recommended such as making donations to a local crisis center, participating in an event that raises awareness about suicide prevention, or providing opportunities for service activities in the school that emphasize the importance of student's taking care of each other.

Care for the caregiver. It is important that administrators and crisis team members not underestimate the potential impact that a suicide can have on school staff members. School leaders should promote a culture in which both the students and the adults in the building feel comfortable asking for help and/or to take a break. Providing contact information and encouraging staff to meet their own mental health needs is an important first step in ensuring that staff are adequately supported.

Media. In general, news media outlets will not cover suicide as a news story unless the death occurs in public or the victim is a public figure. If a suicide is reported by news media, reporters should simply inform their audience of the death without sensationalizing it. Pictures of the deceased and the use of the word suicide in the headline are discouraged. News stories should note that most people who die by suicide have mental health challenges and exhibit warning signs, and these should be included in the story or in a sidebar. Suicide should be portrayed as a public health issue and the story should offer both hope and information about available suicide prevention and mental health resources available in the community.


Keep Suicide Prevention Fresh With Classroom Activities

Teaching high school and middle school students, especially when you are dealing with sensitive topics, requires quite a bit of creativity. The SOS program recognizes this and offers schools some uniquely engaging and interactive lesson plans beyond the traditional program. Everything you need for the lesson plans is included in the program’s implementers’ guide. While some are specifically for middle school and others for high school, you can feel free to mix them up -- they both work for the different age groups.

Each of the games requires the students’ participation, and encourages discussion. They teach students about the signs and symptoms of depression and suicidal ideation and the best ways to respond and do so in an engaging, non-threatening way.

Middle School: The Categories Game

This game takes about 30 minutes, and involves breaking up the class into groups of four to six students, and the task of the students is to determine what a list of things has in common. The facilitator will read a list with items such as:

  • Tell them to snap out of it
  • Keep it a secret
  • Leave the person alone

These are all, of course, things you should not do when someone expresses symptoms of depression or suicidal thoughts. There are five different categories and each category has six lists, so there is enough to fill an entire 30-minute lesson block.

Middle School: Connections Game

This game is similar to Apples to Apples, and allows the facilitator to play the game as a whole class, or by breaking the class up into teams of four to six students. Students receive descriptor cards and the person in the group serving as the judge (or the class facilitator) chooses a noun card, and each of the players choose descriptor cards that they think matches best. For example, a facilitator may say the term “text messages,” and the students playing choose from their cards the most applicable descriptors that match the noun. The idea is that there are no right or wrong answers, but that the students defend their choice and explain how their descriptor matches the noun. This is a great way to encourage dialogue about the topics at hand.

Middle School: Lights, Camera, ACT

This game involves role playing and presents a selection of scenarios that students can act out. The goal of the exercise is to help students develop and practice effective ways to handle situations that involve being concerned for a depressed or suicidal friend. The implementation guide includes “Do’s and Don’ts” to tell the students before the roleplaying, so that you start them off in the right direction. Below is one scenario.

It’s the end of the school day, and Shawn is talking to Marcus about the upcoming weekend. They usually make plans to hang out and play basketball on Saturdays with some other guys, but Marcus hasn’t shown up for the last couple months. Shawn asks Marcus about it, but he becomes annoyed and angry and tells him to just back off. Shawn thinks it’s strange considering Marcus is typically energetic, happy and always is always up for shooting hoops.

High School: Scripts for Suicide Prevention Hotline

These scripts are a really fun activity, and are especially helpful because students can really apply what is going on in their own community. After facilitators teach the students about the warning signs of depression and suicidal thoughts, and the ACT acronym (acknowledge, care, tell), pairs of students create scripts and talk out a call to a suicide prevention hotline. As your students hear the warning signs, it’s a great way to reinforce the lessons they have already learned.

High School: Myths and Facts Quiz

This quiz is very powerful and really challenges students’ beliefs about suicide and depression among teens. You can involve the students in any way you want, whether you discuss the myths and facts included in the implementers’ guide, or you pass out sheets and students read them and choose whether something is a myth or fact.

Of course, every school and community is different. If you have an SOS program and have any questions or comments about the games, feel free to contact us at anytime at

The Role of the School Board in Suicide Prevention

Students at risk for suicide are an unfortunate reality in every school at every grade level. While classroom curriculums can certainly encourage students to be alert to personal signs of suicide risk and reinforce strategies for help-seeking, effective suicide prevention in a school must begin at the top – with understanding, support and commitment from the elected officials on the Board. A Board’s concern is not just articulated but clearly reflected in both its priorities and the steps it takes in policies and procedures to insure the well-being of students and faculty alike.

How can you, as a Board Member, assess your district’s competence and readiness to deal with an ever-increasing population of students at risk for suicidal behaviors? Here are a few suggestions to get you started:

Check out your policies and procedures

How comprehensive are they- do they cover the range of suicide risk from ideation to attempts and completions?

When were they revised? Do they include incorporate current evidence-based standards of school suicide prevention?

When was the last time one of the district schools used the policy? Was there a formal evaluation of its effectiveness?

How often are local mental health referral resources reviewed? How effective is their collaboration with the district on at-risk students?

How up-to-date is your parental notification policy?

Do you have specific procedures for using web-based resources for parental notification in the event of sudden, traumatic death in the school?

Are there specific guidelines for interactions with the media? Do they incorporate Centers for Disease Control recommendations for suicide reporting?

Review suicide awareness training for faculty and staff

Is the training compliant with the two hour legislative mandate?

Who provides the training? Is it based on ‘best practices’ or evidence based standards?

Is training available for ancillary staff- administrative staff, cafeteria and maintenance workers?

Is any type of training provided for bus drivers? Remember, they observe students in an informal setting and are often one of the best sources of information about student behavior

Finally, do your homework.

Review the data in your district. Find out how many suicide attempts have been reported over the last 3 to 5 years. Has there been a change over time? What is the profile of students who have made attempts? Are you noticing more attempts in younger students?

See what information this data gives you about your population of at-risk students. Familiarize yourself with current information about youth suicide risk. Check out recommended web-sites and stay on top of how this information relates to your schools and students.

Click to download the PDF Handout version of this resource!

Developing Comprehensive, Integrated Approaches to Suicide Prevention

The Injury Control Research Center for Suicide Prevention (ICRC-S) has released an online presentation on developing comprehensive, integrated approaches to suicide prevention. This 43-minute presentation is delivered by Eric Caine, co-director of ICRC-S and the University of Rochester Center for the Study and Prevention of Suicide (UR-CSPS). Dr. Caine discusses the rationale for a comprehensive and highly coordinated approach to suicide prevention and the role that public health can play in this approach. Yeates Conwell, professor and vice chair of the University of Rochester Department of Psychiatry, moderates the session and describes a comprehensive approach being implemented in Colorado.

Surgeon General Announces National Plan for Suicide Prevention

U.S. Surgeon General Satcher unveiled the National Plan for Suicide Prevention. The Plan acknowledges that males are four times more likely to die from suicide than are females. The federal government is finally beginning to recognize the problem of suicide among men.


  • Promote Awareness that Suicide is a Public Health Problem that is Preventable
  • Develop Broad-based Support for Suicide Prevention
  • Develop and Implement Strategies to Reduce the Stigma Associated with Being a Consumer of Mental Health, Substance Abuse, and Suicide Prevention Services
  • Develop and Implement Suicide Prevention Programs
  • Promote Efforts to Reduce Access to Lethal Means and Methods of Self-Harm
  • Implement Training For Recognition of At-Risk Behavior and Delivery of Effective Treatment
  • Develop and Promote Effective Clinical and Professional Practices
  • Improve Access to and Community Linkages with Mental Health and Substance Abuse Services
  • Improve Reporting and Portrayals of Suicidal Behavior, Mental Illness, and Substance Abuse in the Entertainment and News Media
  • Promote and Support Research on Suicide and Suicide Prevention
  • Improve and Expand Surveillance Systems

If you want to contact the Surgeon General about the Plan, here is his address: David Satcher, MD, PhD, Surgeon General, 200 Independence Ave., SW. Washington, DC 20201 The full plan can be found at this address:

Suicide Prevention

Each year in the United States, more than 650,000 attempt to commit suicide. Of these, more than 30,000 die. In an effort to educate the public about suicide and ways to prevent it, May 6 through 12 has been designated as National Suicide Prevention Week. This falls during National Mental Health Month.

Dr. Satcher and colleagues have set forth 11 goals with 68 measurable objectives to help reduce this number and save lives. He says, if we are successful, not only will it stop senseless deaths, but also will put on end to the harmful after-effects these acts have on families and communities. The program is the result of work done by advocates, clinicians, researchers and survivors. The program strives to change the most basic attitudes about suicide in an effort to change, the judicial, educations, social service, and health care systems.

Some of the objectives set forth include:

  • Increasing the number of states that require health insurance plans to cover mental health and substance abuse care on par with coverage for physical health care.
  • Increasing the availability of comprehensive support programs for survivors of suicide.
  • Increasing the number of professional and volunteer groups as well as faith-based communities that integrate suicide prevention into their ongoing activities.
  • Increasing the number of television programs and movies that accurately and safely depict suicide and mental illness.

About half of the states have begun efforts to enact their own suicide prevention strategies.


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Ending the Stigma: Programs Create Conversations about Mental Health in Arizona Schools

Arizona schools are trying to get their students talking about mental health. While the state does not have a mental health education requirement, some schools are implementing programs that aim to raise awareness of mental health issues. For example, the National Alliance on Mental Illness (NAMI) Ending the Silence program has been rolled out in several Tucson area school districts. The program is designed to change negative perceptions of mental illness by introducing middle and high school students to positive role models who have experienced mental health challenges. The NAMI Southern Arizona affiliate recently received a grant to evaluate the program and possibly expand it across the state. Ending the Silence presenter Lisa Cole hopes that describing her history of mental health issues might help encourage students to reach out for help. “The earlier a problem is addressed the more likely someone is to find the appropriate resources and get better,” she said.

The Suicide Rate Just Rose Again. What Does That Mean for Prevention?

Although the overall rate of suicide increased in 2018, there is reason for hope.

A newly released report from the Centers for Disease Control and Prevention shows that while overall life expectancy in the United States rose in 2018 for the first time in 3 years, the rate of suicide increased as well, continuing a 20-year trend. In this podcast, EDC’s Jerry Reed and Kristen Quinlan break down the new data and offer their perspectives on the current state of suicide prevention initiatives in the United States. Reed leads EDC’s work in suicide, violence, and injury prevention. Quinlan is the lead epidemiologist for the Suicide Prevention Resource Center.

On why suicide rates have been rising

Jerry Reed: I think we may be getting better at determining a suicide death at the medical examiner’s or coroner’s office, so we may be calling a suicide a suicide, when in previous decades, we may not [have]. . . . And I think truly we do have some emotional distress in the country on behalf of many, many people who may not have employment or may live in rural areas where there is no economic opportunity that may be leading them to consider a tragic decision.

On the impact of suicide prevention efforts

Kristen Quinlan : One of the things that we noticed [in the data] is that suicide rates remained the same between 2017 and 2018 for youth and young adults between the ages of 15 and 24. And I think this is important because . . . we are putting some really significant investment particularly in preventing youth suicide. And when we see that leveling out of a rate of suicide among the population where we are placing the biggest investment, I think that speaks to the efficacy of our efforts.

On how we can reduce rates of suicide in the United States

Reed: We need to treat suicide as the public health challenge that it is. It is the 10th leading cause of death, so our investment in research, our investment in practice, our investment in programs needs to be commensurate with [that fact]. Secondly, I think we need to acknowledge that when you talk about an issue, and when you invest in an issue, and when you measure and track an issue, then people get the message that there’s something we can do about the issue . . . the public health community needs to respect the fact that this is not an inevitable form of death, but it is indeed a very preventable form of death if we all come together.



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We can't tear out a single page from our life,
but we can throw the whole book into the fire. - George Sand