Suicidal Ideation: how to hear what isn’t being said

When people are feeling suicidal, they are not likely to come up to you and say, “I am experiencing suicidal ideations.” “Suicidal ideation” by the way, is the clinical term for contemplating or planning suicide.  So, what can you look for in the words or behavior of a person that sets off the alarm bells? How does suicidal ideation come to the surface?

The World Health Organization estimates that approximately 1 million people die each year from suicide. It is 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.


Your person may give you a very clear signal that they are contemplating suicide. They might:

  • express thoughts of killing or harming themselves
  • become obsessed with death or dying in general
  • Or they may seek out the tools of suicide, like weapons, drugs, or some kind of planning.

These signals are even more dangerous if the person has a mood disorder like depression or bipolar disorder, or if they suffer from alcohol or drug dependence. Certainly it is more serious if they have previously attempted suicide, or if there is a family history of suicide. But clear signals like this are not common. It is more likely you will be interpreting less obvious signs.suicidal ideation


Mortal thoughts usually rise to the surface in the form of internal struggle or existential crisis. The person experiencing suicidal ideation may communicate their pain using any number of expressions:

[These are a collection of signs found on and the National Suicide Prevention lifeline]

  1. Expressing Hopelessness – finding no reason to live, no hope for future happiness

  2. A desire to withdraw from society – wanting to be alone, to escape

  3. Talking about being a burden to others – self-loathing

  4. Sleep disturbances – too much sleep, or an inability to sleep

  5. Excessive mood swings – not just sadness, but anger, regret, intolerance, etc.

  6. Giving away their valued possessions

  7. Being in unbearable pain – e.g. chronic pain patients

  8. Increase in the use of drugs and/or alcohol

  9. Reckless behavior that increases the risk of harm to the person or their livelihood

  10. Giving up on life – “I don’t care”, “whatever”, “it doesn’t matter”

  11. Expressing rage or a desire for revenge

  12. A sudden sense of calm after a depressed period – resolute to end their ‘suffering’


The signs that a person in your life may be experiencing suicidal ideation are not always clear to see. If you think someone might be thinking about ending their life it’s better to risk an awkward conversation than to say nothing at all.

suicidal ideation

This article is part of a brief series for the National Suicide Prevention Week (September 8-14) for 2019. Other articles in this series include:

3 Important Things to do in Response to Suicidal Ideation


Suicidal Teens: What are the Signs? What do you Do?

You can also read a more indepth article written by mental health professionals from Choosing Therapy.

Jim Sliney Jr. is a Registered Medical Assistant and a Columbia University trained Writer/Editor. He createsjim sliney jr education and advocacy materials for patient support groups. Jim has worked closely with several rare disease communities. He also coordinates the patient content for PatientsRising and collaborates with other writers to hone their craft. Jim is a native New Yorker where he lives with his wife and all their cats. Twitter  Email

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