It can be a daunting challenge for someone to bring up suicidal thoughts on their own. One study looked at 100 people who died by suicide the same day that they met with a mental health professional. Of these, only 22% discussed suicide with the professional.
Of course, many people who seriously consider suicide do confide in others. Such disclosures are a major warning sign for suicide. But there are many reasons why others keep their suicidal thoughts a secret.
Even though progress has been made, stigma still surrounds the topic of suicide. A person experiencing suicidal thoughts may fear giving the message that they are crazy.
They may have had a bad experience in the past confiding their suicidal thoughts in others. They may have been judged negatively, perhaps even met with anger. Or they may have been dismissed quickly, without being listened to or understood, with pat responses such as, “You have no reason to think of suicide” or “But you have so much to live for!”
Another possibility is that the person may be so intent on dying that they do not want to be stopped, and therefore keep their plans secret. Yet directly asking if they are considering suicide can still be useful.
Many people who want to die have ambivalence about dying. Forthrightly asking about suicidal thoughts can open the door to a discussion about their conflicting wishes to live and to die. Even people with high suicidal intent experience ambivalence and may, even against their best intentions, disclose suicidal intent with the right rapport and questions from an interviewer.
Finally, some people feel so hopeless that they do not tell anybody about their suicidal plans. They believe nobody can help them. So, they tell themselves, why bother?
Again, the type of questions a clinician asks can influence whether a person does disclose suicidal thoughts.
So, it it important not to assume that someone who feels suicidal will bring it up spontaneously. Many people do, but clearly not everyone. This is why if you suspect that someone is thinking of suicide, it is important to ask.
UPDATED: May 8, 2014
© Copyright 2013 Stacey Freedenthal, PhD, LCSW, All rights Reserved. Written For: Speaking of Suicide. Photo purchased from Fotolia.com.
I believe some people are hesitant about broadcasting their ambivalence. Their reasoning might be that, by discussing their thoughts and/or intentions, while they are obviously around to do so, discloses ambivalence they may not wish to expose.
they might be frightened of being committed. a lot of psych wards that aren’t high end, self pay places are really bad, sometimes abusive, and you come out worse than when you arrived.
The only upside to that I think is that if one is ambivalent in dying, the industry that the whole of society directs you to failing you, really cancels out any last hopes and you can proceed with your plans with a little more certainty.
I know that sounds grim but unfortunately we have too many mental health professionals saying “Don’t do it! If you say you are I’m sending you there!” and far too few advocates concerned about psych ward reform, and what happens to us when we actually do end up there. And what happens to us when we get out- PTSD, financial hardship, no follow up care, etc.