If you or a loved one are having thoughts of self-harm or need immediate support, you can contact the National Suicide Prevention Lifeline (1-800-273-8255/TALK) or Crisis Text Line by texting “NAMI” to 741-741. In a life-threatening situation, go to your nearest psychiatric emergency room or call 911.

Suicidal thoughts are common among teens and young adults. In fact, about 12% of young adults (ages 18-25) report that they’ve had serious thoughts about suicide, and about 1–2% report a suicide attempt during the prior year. These numbers are higher among high school students — nearly 20% report serious thoughts about suicide and 9% report a suicide attempt. Among young adults 15–24 years old in the U.S., the rate of death by suicide in 2019 was about 14 per 100,000 people — slightly higher than one suicide for every 10,000 people in this age group.

These numbers are frightening, but there is also hope — if we can identify and support young people who are experiencing mental health symptoms, including thinking about suicide, we have an opportunity to help prevent tragedy. There is a large gap between the number of young people thinking about suicide (about 1 in 10) and the number who die by suicide (1 in 10,000). In other words, there are 1,000 young people currently struggling with the idea of ending their life for each young person lost to suicide. Most importantly, that means that there are 1,000 opportunities to provide understanding and support to those experiencing difficulties.

Risk of suicide varies across different identity and cultural groups — in many cases, historically disadvantaged communities who experience discrimination, social/environmental stressors and limited access to care and support resources also experience higher rates of suicide.

Historically, Black Americans have died by suicide at lower rates than the general public, but the rates of suicide among Black people — particularly youth — have increased in recent years. Fortunately, this crisis is beginning to receive the necessary level of attention. The Emergency Taskforce on Black Youth Suicide and Mental Health, established in 2019 by the Congressional Black Caucus released a report outlining research, policy and practice recommendations to address the crisis of suicide in Black youth, including significant increases in National Institutes of Health (NIH) and National Institutes of Mental Health (NIMH) funding for research focused on the issue.

Indigenous communities, such as Alaskan Natives, have also had higher rates of suicide than the general population due to generational trauma, poverty and stigma, among other factors. The best way to address the dangers of suicide is to build a comprehensive, culturally competent program within the community. One example of a movement to build such programs is the Indian Country Child Trauma Center which was established to develop training, technical assistance, program development and resources on trauma-informed care to tribal communities.

Youth who identify as LGBTQI are also at a higher risk for suicide than the general population. Encouragingly, states that have passed same-sex marriage laws have seen rates of adolescent suicide drop by 7%. The association between the laws and a lower suicide risk was concentrated among students who identified as “sexual minorities” showing evidence that laws supporting the LGBTQI community also help prevent youth suicide.

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Anyone who is having serious or continuing thoughts of suicide, having impulses to self-harm or making plans for suicide needs to be connected to care and support services.

There are quite a few things that have been associated with increased risk for suicide:

  • Prior suicide attempts
  • Family history of suicide
  • History of mental health conditions such as severe depression, anxiety disorders and psychotic disorders
  • Substance misuse
  • Impulsivity or aggressiveness
  • Serious family problems
  • Breakups or other major relationship losses
  • Access to means for self-harm (unsecured firearms, prescription medications, poisons)
  • Social isolation
  • History of traumatic experiences such as sexual violence or severe episodes of racial prejudice/violence, bullying
  • Lack of access to mental health care
  • Multiple exposures to suicide in one’s community or through unsafe coverage of suicide in the media

While the risk factors noted above might increase someone’s long term risk for suicide, there are several things that might indicate that the person’s thoughts of suicide are escalating or that there is more acute risk:

  • Talking, joking or posting online about dying or life not being worth living
  • Feelings of hopelessness, shame or of being a burden to others
  • Extreme sadness, anger or irritability
  • Extreme feelings of emotional pain
  • Planning or researching ways to die
  • Withdrawal from others, saying or posting “goodbye” messages, giving away possessions
  • Erratic or disorganized behavior
  • Changes in substance use
  • Seeking means to self-harm

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There are many factors that can also help to protect someone against suicidal ideation or behavior that include:

  • Effective coping and problem-solving skills
  • Strong social and family connections
  • Access to quality mental health care
  • Support from religious or social communities
  • Lack of access to means to self-harm

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The best way to help prevent a suicide-related crisis is to seek help and support before the crisis emerges. In the last 50 years, we have made significant progress in reducing rates of people dying from heart disease; this success is largely due to health care professionals getting better at identifying and treating high blood pressure, high cholesterol and blocked arteries before people have heart attacks or develop serious heart disease. The same applies to getting better at preventing suicide; if you are experiencing thoughts of self-harm, it is essential to get mental health care as soon as the symptoms start before reaching a crisis state.

If you or someone you love begins to feel worried, but doesn’t feel in immediate danger of acting on thoughts of self-harm or suicide, then steps should be taken to find help for care and support. This help can be from a pediatrician or primary health care provider, or a mental health clinician. If the person is already receiving care, let the clinician know about what is going on. Supportive family member or friends, also need to be informed about what is going on. They can be a tremendous source of support for the youth and the family.

If contacting a clinician and alerting loved ones isn’t practical — or if you or the person you love is having urges to harm yourself — then contact should be made immediately with a crisis hotline like the National Suicide Prevention Lifeline (1-800-273-8255/TALK) or Crisis Text Line (text “NAMI” to 741-741). These and other resources are confidential, and many have options for phone, text or online chat communication.

If you feel there is immediate danger, go to the nearest hospital emergency room and explain to them what you are experiencing. If you cannot get to the hospital, call 911 (or a local crisis line) and explain your situation in detail — many communities have first responders trained to support young people experiencing a mental health crisis so they can get you the most appropriate help. If possible, let a family member or friend know as well — they should stay with you for support and help make sure your environment is safe (removing any dangerous means for self-harm).

Helpful Responses for When a Friend Is in Distress

If someone you care about is showing some of the risk factors noted above, the first thing to try is having a conversation with them to express your concern. It is best if you can do this in person — face to face — and in a quiet, private place.

Explain why you are concerned about your friend and tell them what you have observed. The more specific and clear you can be the better. For example:

“You seem sad all the time and have stopped communicating with your friends.”
“You always seem very tired and distracted.”
“You are posting really scary messages on social media.”

Tell them you are worried and let them know they can talk to you if they are experiencing a problem. It can feel awkward to ask about this, but it could be the encouragement they need to be able to open up about what they are experiencing. Remember that it is not your responsibility to try to solve their problem or fix the situation. Listening patiently and asking them to tell you more will help you understand what your friend might need.

The most urgent information to find out when you speak to a friend about their mental or emotional distress is whether they are at risk of self-harm. If they have already told you or someone else that they are thinking about hurting themselves, or posted about it on social media, then the next step is getting them connected to help.

If Your Friend Does Not Seem to Be in Immediate Risk of Harm
Once you know how your friend is feeling, ask if they have any ideas for what might help. You can ask if they are taking steps to get help from family, friends or professionals. If you are comfortable, and they are open to it, you can offer to check in again with them sometime soon to see how they are doing and whether the situation is improving or getting worse.

Think about how you might feel if you were in a similar situation and what might be helpful to you. Remember that you don’t need to solve the problem. Often, just being open to listening and being supportive is helpful.

If Your Friend Tells You They Are Having Thoughts of Self-Harm
First, do not agree to keep it a secret — even if they don’t want anyone else to know, it is important to get help if you are truly afraid that they will hurt themselves. Getting help could involve letting their family know about the crisis, unless you have a clear reason to think that will make things worse (for example, they have shared that their parents do not support them or they have been mistreated or experienced rejection at home). If you are at college or a boarding school, let the campus crisis team, residence life staff or counseling service know you are worried about your friend.

If you feel the problem is urgent and serious, you can contact the National Suicide Prevention Lifeline (1-800-273-8255) or Crisis Text Line (“NAMI” to 741-741). If there is immediate danger to your friend or others, you should either try to take them to a local hospital emergency service or call 911.

If you can, and you feel safe doing so, try to stay with them until they have gotten help and you know they are safe. This can be especially important if your friend is dangerously intoxicated, or if they are experiencing serious mental health symptoms, like psychosis. Whatever steps you take, know that you are not alone.

Your support could make a huge difference for your friend — but in a crisis, you can count on crisis support lines, first responders, health care providers and others to manage this difficult situation together. It’s also important to let an adult you trust know what is going on so they can help you support your friend.

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National Suicide Prevention Lifeline
The National Suicide Prevention Lifeline (the Lifeline) at 1-800-273-TALK (8255) has crisis workers to support you and are available 24/7.

Crisis Text Line
You can text with a crisis counselor who is available to provide support 24/7

Local crisis services
Your city or state may have crisis services that can be available to you as well.

Navigating a Mental Health Crisis Guide
Provides important, potentially life-saving information for people experiencing mental health crises and their loved ones. This guide outlines what can contribute to a crisis, warning signs that a crisis is emerging, strategies to help de-escalate a crisis, available resources and so much more.

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