There are questions we avoid because we are afraid of the answer.

“Are you thinking about suicide?” might be one of the hardest.

We worry we will offend someone. Embarrass them. Make things worse. We worry they’ll get angry. That they’ll think we’re being dramatic. That asking will somehow put the idea in their head.

And maybe the part we don’t say out loud is this:

What the hell do I do if they say yes?

I understand that fear.

I also know there are questions that are much harder to live with when you can no longer ask them.

Suicidal thoughts are more human than we like to admit

We talk about suicide as though there is a clean line between people who are suicidal and people who are not.

Human suffering is rarely that tidy.

Sometimes people don’t want to die. They desperately want the pain to stop.

Sometimes thoughts of suicide show up and frighten the person having them.

I think we forget that part.

We are so frightened of hearing the answer that we don't always consider how frightening it might be to be the person carrying it.

Asking doesn't create the thought.

Sometimes asking gives the thought somewhere to go.

Sometimes there is ambivalence.

Sometimes there is planning.

Sometimes someone is functioning. Going to work. Parenting. Laughing. Making dinner. Answering emails.

This is part of what makes suicide so difficult to talk about. We expect suffering to look like suffering.

It doesn’t always.

Research has not found evidence that asking about suicide increases suicidal thoughts or behaviour. In a review of 13 studies involving adolescents and adults, including both general and at-risk populations, none found a statistically significant increase in suicidal ideation as a result of being asked about suicidal thoughts (Dazzi et al., 2014). The Canadian Mental Health Association also encourages people to ask directly and explains that asking about suicide does not increase the risk.

So why are we still so afraid to ask?

Because research can tell us that asking is safe.

It cannot make asking comfortable.

Sometimes the signs don’t look like signs

I think this is something we don’t talk about enough.

Sometimes what we understand differently afterward looked positive while it was happening.

More connection.

Sentimentality.

Taking pictures.

Expressing appreciation that hadn’t been expressed before.

Wanting to spend time together after being more isolated.

Sometimes it looks like someone doing better and smiling more deeply.

And sometimes that is exactly what it is.

Sometimes it isn’t.

I know something about the distance between those two possibilities.

There were moments that gave me pause.

And there were explanations.

He’s doing better.

He’s functioning.

He’s not suffering the way he was before.

He would tell me.

That last one is difficult to write.

Because sometimes people don’t tell us.

Sometimes they don’t know how.

Sometimes they are afraid of what happens once they say it out loud.

And sometimes we have to be brave enough to ask.

I was afraid asking would cost me the connection

I worried about making someone angry.

I worried about pushing too hard and having them pull away.

I worried that asking would feel like judgment.

I worried I would hear yes and not know what to say next.

Those fears are deeply human too.

But here’s the thing I wish I could make people understand:

You do not need the perfect words.

You need to be willing to tolerate the answer.

Depending on the person and the relationship, I might ask:

“Are you having some dark thoughts?”

“Have you thought about dying or hurting yourself?”

Or I might say:

“Sometimes when people are hurting this much, they start having thoughts about suicide. Has that ever crossed your mind?”

And then I stop talking.

Because asking the question isn’t an interrogation.

It is an opening.

What if they say yes?

Stay.

Listen.

You don’t need to immediately convince them that life is wonderful. You don’t need a speech about everything they have to live for. You don’t need to become their therapist.

And you do not have to carry this alone.

Help them connect with support. In Canada, call or text 9-8-8 for suicide crisis support. You can also contact 9-8-8 when you're worried about someone else and aren't sure what to do next. If there is immediate danger, call 9-1-1 or go to the nearest emergency department.

Kids Help Phone provides free, confidential support for young people across Canada, and Hope by CAMH can help someone create a suicide safety plan.

And learn what to do before you’re standing in the moment trying to figure it out.

Take an ASIST suicide-intervention training.

Ask your workplace why psychological first aid isn’t treated with the same seriousness as physical first aid.

We certify people in CPR because we accept that ordinary people may one day find themselves beside another human being who needs help staying alive.

Why would mental health be different?

Ask anyway

September is Suicide Prevention Month.

There will be graphics.

There will be statistics.

There will be reminders to “check on your people.”

I want to ask something harder.

If something in you pauses around someone you love, don’t be so quick to talk yourself out of it.

You may be wrong.

I hope you are.

They may roll their eyes. They may tell you they’re fine. They may even be irritated that you asked.

You can survive an uncomfortable conversation.

And if they say yes, you don’t have to know exactly what comes next. Stay with them. Listen. Get help. Call someone who does know what comes next.

I once thought asking the question might cost me the connection.

There are things I understand differently now.

Never getting to ask can haunt you.

So I would spare you that experience if I could.

Ask.

References

Dazzi, T., Gribble, R., Wessely, S., & Fear, N. T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361–3363. https://doi.org/10.1017/S0033291714001299

Canadian Mental Health Association. (n.d.). Talking about suicide.

Government of Canada. (n.d.). 9-8-8: Suicide Crisis Helpline.

Centre for Addiction and Mental Health. (n.d.). Hope by CAMH.

LivingWorks. (n.d.). Applied Suicide Intervention Skills Training (ASIST).

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