Maybe a friend said something that did not sound like a joke. Maybe your brother has gone quiet, or a coworker gave away a guitar she loved. When something feels off, it is hard to know whether to say anything. This article walks through the signs the National Institute of Mental Health (NIMH) lists and the steps it recommends, so you have words ready if you need them.
What people may talk about
- Wanting to die
- Feeling great guilt or shame
- Being a burden to others
What people may feel
- Empty, hopeless or trapped, or as if there is no reason to live
- Extremely sad, more anxious, agitated or full of rage
- Emotional or physical pain that seems unbearable
How behavior may change
- Making a plan or looking up ways to die
- Pulling away from friends, saying goodbye, giving away important things or making a will
- Taking dangerous risks, such as driving extremely fast
- Showing extreme mood swings
- Eating or sleeping more or less than usual
- Drinking or using drugs more often
NIMH says to get help as soon as possible, especially when a behavior is new or has recently increased. Trust what you notice and act on it.
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Five steps NIMH recommends
1. Ask
Ask the question plainly: "Are you thinking about suicide?" It can feel risky to say out loud, but NIMH cites studies showing that asking does not increase suicidal thoughts or behavior.
2. Be there
Listen without judging, and try to understand what the person is thinking and feeling. NIMH notes research suggesting that acknowledging and talking about suicide may reduce suicidal thoughts. You do not need the perfect thing to say. Staying in the conversation matters more.
3. Help keep them safe
Ask whether the person has a plan. NIMH advises reducing access to highly lethal items or places, which can mean making them less available or less deadly.
4. Help them connect
Help the person reach 988 by call or text, or a trusted family member, friend, spiritual advisor or mental health professional. NIMH also points to chat at 988lifeline.org. You can make the call together.
5. Follow up
Check in after the crisis passes, or after the person leaves care. NIMH says supportive, ongoing contact plays an important role in prevention. A text the next day and a call the next week count.
If the person is you
If you recognize yourself in these lists, you are not a burden for asking for help. Call or text 988 now, or tell someone you trust tonight.
Care at Hope Behavioral Medicine
Hope Behavioral Medicine is not an emergency service, so please do not use our phone line, email or forms to report a crisis. Once the immediate danger has passed, we offer evaluation, depression care and counseling for adults in West Ashley and by secure video anywhere in South Carolina. Our FAQ covers what to do in a mental health crisis. Request an appointment.
Sources: NIMH, Warning Signs of Suicide (revised 2025); NIMH, 5 Action Steps to Help Someone Having Thoughts of Suicide (revised 2024).
This article is general information, not medical advice, and does not create a patient–provider relationship. Every situation is different, so see a provider who can evaluate yours and develop a plan of care. If you are ever in doubt about an emergency, call 911 or go to the nearest emergency room.
Frequently Asked Questions
NIMH lists talking about wanting to die, guilt or shame, or being a burden; feeling empty, hopeless, trapped or in unbearable pain; and behavior changes such as making a plan, pulling away, giving things away, taking dangerous risks and big changes in sleep or eating.
No. NIMH cites studies showing that asking directly does not increase suicidal thoughts or behavior. Ask plainly: "Are you thinking about suicide?"
Call 911 or go to the nearest emergency room, and stay with the person if it is safe. For support, call or text 988 at any hour.
NIMH recommends five steps: ask, be there, help keep them safe, help them connect with 988 or someone they trust, and follow up afterward.