How to Recognize Suicidal Ideation in Your Clients

Suicidal ideation is a touchy topic – a stigmatized topic.

Unfortunately, there’s a good chance suicide will impact us in either our personal or professional lives. The research across Canada tells us that one in every 20 people has thoughts of suicide at any given time – it’s not a rare issue.

This is true for everyone from age nine through to adults and seniors. Of course, this number is going to look different depending on a variety of geographic, social, and cultural factors, as shown by the statistics collected by the Government of Canada.

How common is suicidal ideation?

Although suicidal ideation is common, there’s still a lot of stigma around the subject. This may be because many of us still carry a fear that if we talk about suicide, it could put the idea into someone’s mind. Among the many myths around suicide, it’s also a difficult subject to talk about – but I would like to challenge that thought.

As a therapist whose core work is with suicidal ideation, I believe there is hope when we truly understand suicide and are ready, willing, and able to talk about it with our clients. But in order to do that, we need to consider if we are contributing to the stigma, and work against any tendencies we may have to avoid the subject.

What does the prevalence of suicidal ideation mean for us as therapists?

Short answer: We need to start talking about suicide a lot more.

The research tells us that talking about suicide with someone who is struggling is one of the most protective things we can do. If we as therapists brush it off or push it away – or if we avoid the conversation – we are strengthening the stigma around suicide.

Talking about suicide with someone who is struggling is one of the most protective things we can do.

What are the signs of suicide?

Sometimes even therapists miss things. Maybe we don’t ask the right questions or fear the answers; or maybe we’re not sure what we’re looking for.

What are the red flags or indicators we need to be aware of? Sometimes we avoid these indicators because we’re too scared to have the conversation, we’re too busy, or we’re on to the next thing.

As a therapist, have there been times when you’ve avoided that hard conversation, even when your client has clearly said they are thinking about dying? I have often heard about this happening from clients, and this reaction often increases feelings of shame and furthers their thoughts of not wanting to be a burden.  

Below are some potential indicators that someone is thinking about suicide. These signs should not be ignored:
  • Giving away possessions
  • Engaging in more high-risk activities
  • Using or misusing drugs or alcohol
  • No longer wanting to do things they used to love
  • Changes in their physical appearance
  • Gaining or losing a significant amount of weight
  • Sleeping too much or too little
  • Complaining about aches, pains, and headaches, or generally feeling
When supporting someone who is struggling with suicidal ideation, it’s also important to consider what emotions they’re experiencing:
  • Are they hopeless?
  • Are they helpless?
  • Are they sad or lonely?
  • Do they feel guilty about something?
  • Are they angry?
Four key areas to watch for:
  • What actions look different for them?
  • What’s happening with their physical appearance?
  • What words and statements are they saying?
  • What feelings are they putting out there?
Suicide is a heart decision, not a head decision. It comes from a place of big, heavy, hard, tough emotions. Individuals who are struggling often say things like: 
  • “I don’t want to live the way I’m living.”
  • “I want things to look different.”
  • “I want my relationship back.”
  • “I want to leave a relationship.”
  • “I want my job back.”

If we are hearing, seeing, sensing, or learning that an individual may be struggling in one or multiple areas of their life, this is a great time to ask, “Are you thinking about suicide?”

The grief and loss we feel when someone dies by suicide is often very different from when someone who is elderly passes away by natural causes. The good news is there are supports and resources for individuals who have lost someone to suicide.

The grief and loss we feel when someone dies by suicide is often very different from when someone who is elderly passes away by natural causes.

Please reach out for support for yourself or your clients if you are struggling with a loss to suicide.

For more RESOURCES on this topic and others, visit our free resources page.  If you found this blog helpful, you may be interested in Suicide Ideation: 5 Myth-Busting Facts. Click here to download Suicide Warning Signs, one of our many free printable handouts offered on our website


Shelly Qualtieri

MA, RSW – Trainer, Crisis & Trauma Resource Institute

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