One winter evening in early 2019, I relaxed on a blue sofa as about six people trickled into a dimly lit room for that night’s peer support meeting, which I was leading. After greeting each other and grabbing coffee or flavored seltzer, everyone joined the circle of comfy couches and chairs.
I began the session reflecting on how when we mention our suicidal thoughts, people often see us differently. “They typically ask a checklist of questions about plans to kill ourselves, even when that’s not our intention,” I remember saying. “We’re often coerced into situations that make our lives worse, like being locked in the hospital, having belongings taken away, and being mandated to take drugs.”
Others interjected with stories of police being called on them, their medication being altered without their consent, and being forced into sedation and restraints.
I reassured them nothing like that would happen here. The collective sigh of relief was audible.
Normalizing discussion of suicide is the key idea behind Alternatives to Suicide (Alt2Su), peer-led groups intended for adults who have suicidal thoughts or identify as survivors. It’s one of the only peer-to-peer support groups of its kind. Four years ago, I participated in a three-day training to become a facilitator, which involved engaging in debate, roleplay, and discussion, and leading practice sessions. I’ve both led and participated in groups ever since.
Founded in 2009 by Sera Davidow, director of the Wildflower Alliance in Massachusetts, Alt2Su has evolved and grown, with dozens of groups popping up around the U.S. and Australia. “We’re often the first place that asks, ‘Hey, did something happen before [these thoughts] started for you?’ ” Davidow said. Answers range widely, and often involve traumatic experiences such as abuse or loss.
Many suicide prevention efforts are based on false beliefs such as the chemical imbalance myth, which makes it harder to engage in a robust examination of the countless, complex reasons someone could be feeling the way they do. As Davidow explained, “When assumptions are present about what the cause is, curiosity disappears, and that inhibits the space to discuss, to explore, to make meaning of [our thoughts].”
Caroline Mazel-Carlton, director of training for the Wildflower Alliance and a group facilitator with a decade of experience, describes Alt2Su as a place where people ask, “How are you?” and actually tell the truth. “Just having that dialogue creates a human connection that’s real and authentic and that can help us stick around in the world,” she said.
There’s a persistent myth that it’s dangerous to talk about suicide. People fear saying the wrong thing or falsely assume talking will make someone more likely to act on their thoughts. What opening conversation actually does is eliminate silence, shame, and social isolation, which has a huge positive impact on someone’s life and may reduce, rather than increase, suicidal thinking.
It’s common to hear that any mention of suicidal thoughts is a warning sign that someone should speak with a mental health professional—but professionals don’t have all the answers, either. According to the American Foundation for Suicide Prevention, there are no national guidelines that require education in how to treat someone with suicidal thoughts, either during certification or a career in mental health. Since many practitioners are trained to worry about liability, some people find they’re able to have more open, honest conversations with nonclinicians.
According to Igor Galynker, a professor of psychiatry and director of the Suicide Research and Prevention Lab at Mount Sinai, more than half of people who die by suicide do not have a mental health diagnosis, and they may not have a clinician to speak to about suicidal thoughts. That makes it even more important for everyone to be able to discuss this topic.
It can be scary when someone shares suicidal thoughts, especially if you don’t know how to react. But you don’t need a perfect response: The best place to start is simply by being open to listening.
A 2020 survey found that an estimated 12.2 million adults in the U.S. had serious thoughts of suicide in the previous year. “I don’t feel safe talking to most people about this stuff,” Sherry, who’s participated in Alt2Su for three years, told me via email. “I imagine they would be alarmed, and I’d be in a position to have to soothe them.”
When someone discloses suicidal thoughts, you may be the only one they feel comfortable enough to open up to. If you panic and they have to use all their emotional energy to reassure you, they’ll likely wish they never reached out to you in the first place.
Likewise, they’re not talking to you so you can fix things. Listen without taking responsibility for solving their problems, removing their pain, or saving their life—none of which are possible for you to do. That means you shouldn’t jump to a barrage of questions like, “Did you take your meds?” or “Have you called your therapist?” or “Should we go to the ER?” This type of reaction can discourage someone and lead to frustration. The conversation is not about you or what you should do to help.
David Reed Jr., a survivor and participant in Alt2Su, expressed relief at having a place to reflect on his feelings without judgment. “My suicidal ideation is not about another person. It’s about my feelings at that time,” he told me in an email. “Sometimes I feel loved ones put too much pressure on themselves when they have nothing to do with the problem.”
What most people want is to tell you what they’re going through while you listen calmly. It can help to ask open-ended questions like, “How long have you felt this way?”, “What’s making it most difficult to be here right now?”, or “Are there certain times when you don’t feel this way?” If you can’t think of a question, you can always say, “Tell me more.”
Vered Brandman, who’s lived with thoughts of suicide since age 10, told me via email, “No clinician I’ve ever worked with has actually sat with me and explored the topic [of suicide], [they’ve] just escalated my level of care until I’ve stopped talking about it long enough. It’s so liberating to know there’s a space where I can talk about [suicide] openly.”
Alt2Su groups are successful because their goal is connection, not predicting or controlling behavior. When we try to control people, we’re less likely to be supportive. We also don’t learn much by asking yes or no questions such as, “Do you have a plan?” or “Do you have lethal means?” You’ll hear considerably more of that person’s story by focusing on building your relationship with them through genuine dialogue.
Another reason the peer-support approach works is because members treat each other with respect and curiosity. They would never shut someone down with, “Don’t say that,” or guilt-trip each other with, “What are you sad about? Your life is great,” or “Think of your family.” Shaming the person for feelings they can’t control is counterproductive. Instead, let them know you’re listening by validating what they say (“That sounds really hard”), keeping the conversation about them, and encouraging them to talk more.
Elise, a survivor and group facilitator, said that when they’re talking to a friend, they personally don’t need much from the listener. They often preface discussions by saying, “I don’t want you to do anything about this. I just want to be heard.” If they wanted a response, they’d ask—though they said it could be helpful to get reassurance that it’s okay if they don’t have the energy for their usual responsibilities.
Brandman wants her loved ones to make time for her and if necessary, to connect with each other to coordinate her care. “Last time it got bad,” she said via email, “my partner and my best friend came over with comfort foods and just … sat with me.” Enhancing family and social support and communication are key elements of suicide prevention treatment, according to Galynker and other researchers.
Anna (a pseudonym) is a former clinician who spent four years volunteering for an anonymous crisis hotline. She suggested that listeners “show in some small way that you care, whatever that means.” For her, that would mean someone making sure her cat is OK. She pointed out that loneliness was a repeated theme of the crisis line calls she answered. “They wanted that human connection,” she said, “to know someone cared enough to take time to really listen, no matter what.”
Of course, while guidelines can serve as a basis for these conversations, experiences are individual and suicidal thoughts don’t come in cookie-cutter shapes. Even in a crisis situation, there is no one-size-fits-all response. It’s important to look at each case separately and figure out what someone needs by asking what’s been helpful and unhelpful for them in the past. You may be able to support that person on your own, or you may want to work with them to look into other options.
What matters most is your willingness to listen. Be present and sit with them in the darkness.
“Good support is mostly very simple,” said Elise. “Not necessarily easy, but simple.
It requires believing and trusting.”