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Mental health tips and insights

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Understanding and Addressing Suicidal Thoughts and Self Harm

Suicide is one of the leading causes of death in the United States. It is important to recognize the common signs, causes, and statistics. If you and/or a loved one is experiencing suicidal thoughts and/or self-harm, there are resources listed below for mental health support. 

If you are feeling suicidal or if you are worried about a loved one, you can call or text the National Suicide Prevention Lifeline at 988

Recognizing the Signs of Suicidal Thoughts and Self Harm

It is important to recognize that suicidal thoughts and self-harm look different for everyone. As a therapist, I’ll ask clients the question, “Is it your intent to want to hurt yourself, make yourself feel something, punish yourself, etc.?”

Suicidal thoughts can be passive or continuously active. A passive suicidal thought could be something as brief as “Wouldn’t it be crazy if I just died right now?” while enjoying a bowl of cereal in the morning. Whereas, active suicidality is “I truly wish I wasn’t alive at this moment” and it is usually met with deeper feelings of sadness, grief, pain, etc.

As a loved one, some warning signs that you could look for if you suspect someone is experiencing suicidal ideation is:

  • If they are more irritable or sad than normal,
  • If they are talking about the future as if it is not obtainable,
  • If they are giving away some of their beloved items,
  • Withdrawing from others or any special interests of theirs,
  • Talking about being a burden or how others may be better off without them

And many more. Please view this list created by the National Institute of Mental Health for a more intensive list:  Suicide Prevention – National Institute of Mental Health (NIMH).

Self-harm also has its own magnitudes. Usually when someone refers to self-harm, it is common for people to picture someone cutting themselves with a sharp object, but self-harm can be more complex than that. Self-harm could be pulling your hair, burning yourself, making yourself work extreme hours, taking EXTREMELY hot showers, etc. These aren’t uncommon, however the question is “why am I doing this? What is the intent?” For most folks, it is to ignore the pain that they are experiencing in their head.

What are Potential Causes of Suicidality?

There’s no perfect answer as to why someone may be experiencing suicidal thoughts or urges to self-harm, however there are common causes that may contribute to why your brain is allowing you to feel and do these things.

Suicidality can come from feeling that there is no other way to cope with stressors. Stressors can be bullying, conflicts arising in various environments, confrontational situations, etc. Of course, some people may experience these situations and not experience suicidal ideation. These differences may be based on how your prefrontal cortex is processing and navigating your emotional and impulsive reactions.  

In a less scientific way, sometimes I explain to clients that even if they feel like they have no reason to be suicidal, sometimes their brain just has fewer “happy chemicals”. Sometimes people think that if they have a good life and have no trauma, it means that they should not be feeling this way, which is simply not true. There are certain chemicals in your brain that lead to happiness, motivation, love, etc. For some folks, those happy chemicals aren’t as plentiful as the average human being. That is why you’ll often hear from professionals that medications and therapy is the best combination to treat majority of mental health conditions.

Some people are worried about taking medication. You know when you’re watching TV and an antidepressant commercial comes on and you hear the fast-talking warnings towards the end that says “may lead to suicidal thoughts” – you might be thinking “well why would I want to take a pill that may increase what I’m already feeling?” That’s valid, because it can be scary, and it is always a risk with any potential medication. The majority of people find relief when they are on medications, and should be monitoring any side effects closely with their prescriber.

Have you ever put on a sweater that looks SO good on the model or a best friend, and then you put it on and it looks NOTHING like how you thought it would? Medications are similar. Medications that work for some people might have a different effect on others. Some of that has to do with your brain chemistry and some has to do with how your body metabolizes and absorbs chemicals. It is can be trial-and-error process finding a medication that works for you and your fancy dancy brain chemicals, and that’s why having a prescriber you trust is important.

Philppe Courtet and Jorge Lopez-Castroman did research on the concern that antidepressants could lead to increased suicides, however they found that suicide is more likely for those who do not take any medications versus those who are on medications.

Suicide Statistics

Here are some statistics regarding who are most likely to be affected by suicide according to information gathered by the CDC in 2021:

  • Non-Hispanic American Indian / Alaska Native have the highest rates of suicide with non-Hispanic white individuals following second
  • Males are four times more likely to be affected by suicide than women
  • People ages 85+ have the highest rates of suicide
  • LGBTQIA+ individuals are four times likely to commit suicide than their peers
  • Nearly 20% of high schoolers report having serious thoughts about suicide, and 9% admit to a suicide attempt.

What Should I Do If I am Experiencing Suicidal Thoughts?

First things first: You can call or text the National Suicide Prevention Lifeline at 988. If you don’t think you can keep yourself safe in that moment, call 911 or go to your nearest emergency room to get help right away. 

Second, seek professional help from a medical provider or therapistA therapist can help you manage your suicidal thoughts and also help manage self-harm, especially if you notice it is interfering with your day to day life. If you begin to formulate a plan for your suicide, inpatient hospitalization may be more necessary for you.

The difference between inpatient and outpatient therapy is that outpatient therapy is what you envision as your “typical” therapy, like talk therapy in a therapy office. Inpatient therapy is what the kids call “grippy sock jail”, where you are hospitalized for a period of time to help manage your suicide thoughts and urges. Inpatient hospitalization can be a helpful way to meet peers who are also struggling through group therapy sessions, pausing outside stressors until you have necessary coping skills, and even medication management if necessary. That can help you feel like you’re not alone.

If you’re worried about someone that you love, check out our blog post about how to ask someone about suicide.

As a therapist, some coping skills that I teach my clients that might also be helpful for you too, (but keep in mind that seeing your own therapist and getting your own professional help is going to be the best course of action) may be the TIPP method:

T: Temperature

Temperature is a great resource for suicidal thoughts, and for any other rumination. Temperature is a part of using the senses, which can be great grounding. A tool that is often recommended as part of the temperature idea is to squeeze an ice cube in your hand, have a fan blow cold fan in your face, take a really hot or really cold shower, etc. Your goal is to distract your mind by putting pressure on your body using the senses in a healthy manner. This is similar to the idea of intense exercise. The sweat, soreness, etc., provides a great distraction.

I: Intense exercise

The I stands for intensive exercise; Pushing your body to sweat, be warm, and end up being sore is a way to “feel the burn” but in a constructive manner. The body sensations also adds to the idea that the senses are important in regulating emotions.

P: Paced breathing

Paced breathing is also a great tool for all mental health conditions. You can do box breathing by holding your breath for four seconds, breathing in your nose for four seconds, holding for four, and letting the air out of your mouth for four seconds.

P: Progressive Muscle Relaxation (PMR)

Progressive muscle relaxation means to work your way either up or down your body by squeezing all of your muscles then releasing. This process helps individuals become more aware of and release tension in their muscles, and it can counteract the body’s stress response, leading to reduced feelings of anxiety and improved overall well-being.

Suicide and Self-Harm Prevention Resources

Ellie Mental Health can be a great resource to find a therapist to help manage any suicidal symptoms you are experiencing.

If you are feeling suicidal, you can call or text the National Suicide Prevention Lifeline: 988

You can also chat online here or call the Trevor Project (866) 488-7386.

If you are worried that you can’t keep yourself safe, call 911.

Some books and blogs that may help educate you or others on suicidal thoughts or self-harm:

Other Resources and Sources:

Suicide Prevention – National Institute of Mental Health (NIMH) (

Antidepressants and suicide risk in depression – PMC (

Suicide Data and Statistics | Suicide Prevention | CDC

About the author

Amber Silva headshot

Amber Silva, LLMSW

Co-Clinical Director

Amber is passionate about creating a safe and open-minded space for all identities in their therapy. She believes the most important aspect when it comes to therapy is having it be collaborative, compassionate, empathetic, and fun! Amber has experience working with children, youth, and adults who present with anxiety, depression,… Read more