By: Amy Marschall, PsyD

If you or someone you care about is struggling with their mental health, help is available. 988 offers free and confidential support anywhere in the United States. Minnesota residents can find local crisis and mental health support at the Minnesota Department of Human Services website, with support for adults and children available. Your safety is important, and you deserve support.

According to Suicide Awareness Voies of Education (SAVE), suicide is currently the eleventh leading cause of death in the United States, and more than 48,000 Americans died from suicide in 2021. Worldwide, someone dies from suicide approximately once every 40 seconds. In 2001, the Center for Disease Control estimates that 12.3 million Americans seriously contemplated suicide, 3.5 million made a plan to end their life, and 1.7 million had a suicide attempt.

There is a good chance that the person reading this has had thoughts of suicide, and it is almost certain that they know and love someone who has experienced suicidal thoughts. Even though suicide is incredibly common, it is still considered taboo, and many feel they cannot talk about their experience.

Education is essential in breaking down stigma around mental health and suicide. Learn more about suicide and how to seek support.

Suicidal Thoughts

Thoughts of death and suicide can be intense and scary, and some may feel afraid to share that they are having these thoughts. It can help to understand why someone might have these thoughts and how to intervene safely.

First, not everyone who experiences suicidal thoughts is a danger to themselves. For example, some people with obsessive-compulsive disorder experience intrusive and unwanted thoughts that they might hurt themselves on purpose or attempt suicide. For many of these individuals, these thoughts are upsetting and scary, and they want the thoughts to stop. A person who suffers from intrusive thoughts is not likely to act on those thoughts even if they feel very real.

Similarly, thoughts do not always accurately reflect our desires. Sometimes feelings of overwhelm can manifest as thoughts like, “I wish I wasn’t here anymore.” Children especially sometimes make statements when they are escalated that they do not mean. That being said, we must always take suicidal statements seriously. It is better to assume that someone is suicidal when they are not than to assume they do not mean what they said. This simply means that someone can experience these thoughts without wanting to act on them.

Some might also have thoughts of death or suicide that they do not intend to act on. Again, these thoughts should be taken seriously, and someone experiencing these thoughts deserve support and treatment for their mental health. However, they might not be a danger to themselves.

Some might engage in reckless and dangerous behavior without specific suicidal intent. They may feel like they do not care either way if they live or die, and while they are not specifically making a plan to end their life, they choose activities that they know to be unsafe without regard for the risks. In this case, even if they deny active suicidal ideation or intent, they may still pose a danger to themselves or others.

Suicide and Self-Harm

A common misconception in mental health is that suicidal ideation and self-harm are the same thing. Self-harm refers to behaviors that intentionally self-inflict injury. This can include (but is not limited to) cutting, scratching, or banging one’s head.

According to the American Psychological Association, approximately 17% of adolescents have engaged in self-harm behavior on at least one occasion. By definition, an individual who is self-harming does not intend to end their life with the behavior. However, some self-harm behavior can be lethal. For example, someone who deliberately takes too much of a medication without suicidal intent could overdose by accident.

A person who self-harms might also experience suicidal ideation, but not everyone who self-harms is also suicidal. Similarly, not everyone who experiences suicidal thoughts or attempts has a history of self-harm behavior. Not everyone who self-harms requires a psychiatric hospitalization or can be considered a danger to themselves.

Talking to Mental Health Professionals About Suicide

Many people feel hesitant or afraid to talk to a mental health professional about their suicidal thoughts. They might have concerns about being hospitalized against their will, which can result in huge medical expenses, missed work, or questions about their capacity to parent. These concerns are valid and real, and people deserve supportive and affirming spaces when they seek support for their mental health.

All mental health professionals are ethically required to have specific policies around reporting and referring clients they worry may be in danger. We have an obligation to take steps to protect our clients if they might be unsafe. This means it is possible for a therapist to refer you to the hospital if you tell them you have plan and intent for suicide.

This does not mean that you will automatically be sent to the hospital if you walk about suicide with your therapist or disclose that you self-harm. As this article has described, many people experience suicidal thoughts but are not a danger to themselves.

At the same time, many therapist training programs focus on protecting liability and encourage erring on the side of hospitalization. You can ask your therapist what their policy is for hospitalization and mandated reporting, including how they assess risk and what specific criteria they use to determine when you might be a danger to yourself.

If you are looking for a therapist, some therapist directories allow you to filter providers based on whether they have expertise and specialization in treating clients who experience suicidal thoughts. Inclusive Therapists and Therapy Den both have this setting.

In order to prevent deaths from suicide, people who experience ideation need access to support and treatment without judgment or barriers. Remember that, regardless of what your thoughts try to tell you, you deserve the help you need.