Mental health education
Suicidal thoughts: what they can mean and when to act
Thoughts about death can happen during severe stress, grief, pain, depression, or trauma. A thought does not always mean a person plans to die. It does mean it is time to pause, ask more, and offer support.
If someone may act now, call 911.
For free, confidential crisis support, call 988 and press 1, text 838255, or use the Veterans Crisis Line chat. You do not need to be enrolled in VA care.
01 / KNOW THIS FIRST
02 / WHAT IT MEANS
THOUGHTS OF DEATH AND SUICIDE, IN PLAIN LANGUAGE
Not every thought means a person plans to die.
A person may wish to escape, disappear, or not wake up without planning to end their life. These thoughts can happen during deep distress. They are concerning, but they are not all emergencies. Common does not mean unimportant. Risk is higher when thoughts grow stronger or more frequent, or when the person has a plan, access to a lethal method, and intent to act.
THREE HYPOTHETICAL EXAMPLES
Veteran Stone
Says, “Sometimes I wish I would not wake up.” Stone has no plan or intent and says they can stay safe. A loved one checks in, listens, and helps Stone connect with a clinician soon.
Veteran Tarantino
The thoughts are happening more often. Tarantino feels trapped and is not sure they can stay safe. A loved one stays nearby and calls 988, then presses 1, for help now.
Veteran Ullman
Has a plan, access to what they would use, and expects to act soon. This is an emergency: call 911 and do not leave Ullman alone.
03 / HOW A PSYCHOLOGIST THINKS ABOUT IT
Some thoughts are concerning, but not always an emergency
A brief wish to escape or not wake up can be a sign that life feels unbearable. It does not always mean the person intends to die. Ask more. Notice whether the thought is new, stronger, more frequent, or joined by changes such as pulling away, saying goodbye, giving things away, or using more alcohol or drugs.
Ask four plain questions
Ask: “Are you thinking about suicide?” “Do you have a plan?” “Do you have access to what you would use?” “Do you think you might act today?” Asking does not cause suicidal thoughts. A “no” does not end the conversation if the person’s words or actions still worry you.
When should you call 988?
Call 988 and press 1 when thoughts are growing, the person feels trapped or hopeless, warning signs are increasing, or you are not sure the person can stay safe. Veterans and loved ones may call. A trained responder can listen, check safety, and help choose the next step. You do not need to wait for the situation to become an emergency.
When should you call 911?
Call 911 when the person may act now, has a plan and access to what they would use, has begun an attempt, or cannot stay safe. Stay with the person. If you can do so safely, put space between the person and firearms, medicine, or other lethal items. Do not put yourself in danger.
What can a loved one do?
Stay calm. Listen more than you talk. Do not argue, shame, lecture, or promise to keep a suicide plan secret. Help the person connect with care. If you are unsure what to do, you may call 988 and press 1 yourself. The Veterans Crisis Line also helps family members and friends who are worried about a Veteran.
What is a safety plan?
A safety plan lists warning signs, coping steps, people and places that can help, crisis contacts, and ways to make the setting safer. It is made with the person before or during a crisis. It is more than a promise not to act.
How can suicidal thoughts come up in a VA evaluation?
A mental health evaluation may ask about thoughts of death, suicidal thoughts, past attempts, current safety, and daily life. Answer plainly. You do not need to make symptoms sound better or worse. Dr. Bell may pause the evaluation to check safety and help connect urgent support. A claim can wait. Safety cannot.
04 / WHAT TREATMENT MAY LOOK LIKE
05 / KEEP LEARNING