Suicide: coping with suicidal thoughts

Also known as suicidal ideation

This information is a suicide prevention factsheet intended for someone who is having suicidal thoughts or feelings. It may also be of benefit to the people supporting them.

If you are whānau, family, a friend, colleague, teacher or classmate of someone who is having suicidal thoughts, please also visit Suicide: worried about someone? 

Whatever is going on for you that has led to how you're feeling right now is unique to you – but having suicidal thoughts is not. You are not alone, lots of people have thought about killing themselves and have found a way through.

Having suicidal thoughts can be overwhelming and frightening. It can be very difficult to know what to do and how to cope. You may feel very depressed or anxious or you may just feel really bad and not know what the feelings are.

You may feel like you are useless and not wanted or needed by anyone. You may be feeling hopeless about the future or powerless, like nothing you do or say can change things. You may be blaming yourself for things that have happened in your life, and you might think it would be easier for others if you weren't here.

You may not even know why you feel suicidal, and think that you have no reason to want to kill yourself. Because of this, you may feel guilty and ashamed, and start feeling even worse.

It can feel much worse if no-one knows what you are going through or how bad you feel. You don’t need to be alone. There are people who are willing, able and available to help you.

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Tell someone what you are thinking

If you are having thoughts about taking your life, it’s very important to tell someone you trust so that you can get the help you need to feel better. If you can’t immediately find someone you know to talk to, there are always people who are contactable by phone and who are willing, able and available 24 hours to help you.

If you are in a serious crisis or you need urgent help, do the following:

• Call your local mental health crisis assessment team or go to your local hospital emergency department.
• If you are in immediate danger, call 111.

Not an emergency?

Talking to someone you trust can make a real difference. They may help you calm down and offer a breathing space while you decide what to do next. They may also be able to suggest how to manage your situation. It’s often easier for other people to see how to do this, particularly if they know you well.

Here are some people you could talk to:

• members of your family, whānau, friends and support networks
• your doctor or local medical centre
• a counsellor, psychologist or psychiatrist
• phone helplines – see opposite
• church or spiritual leaders
• support groups for people going through similar things.

If your request for help isn’t heard, ask again. You may need to find someone who can help you find the right person to talk to, or who will go with you to appointments or meetings.

Asking for help from a doctor or health professional

Lots of people talk to their doctor about emotional difficulties or mental health problems, so your doctor will be used to listening to people talking about suicide.

It can be very hard to talk about having suicidal thoughts, but it's very important to share what's going on for you. If you have made a plan to hurt yourself, talk about what you are planning to do so that your doctor can understand how serious your thoughts are.

Ask any questions you’d like to about what’s happening, or ask a support person to ask for you.

So they can help you feel better, your doctor or counsellor will listen to you in private, and ask some questions about you and your situation. You might want to have some of your family, whānau, friends and support network with you. You might not. Just say what you would prefer.

If you’re very distressed, it might be suggested that you take some medication, which will help you feel calmer.

Your doctor or health professional may want to talk to your whānau, friends or family about you and your situation. They will do this with your permission but if there is serious concern that you are in danger, they may talk to others without your consent.

When you ask for help, you have the right to:

• be respected and taken seriously
• have your distress acknowledged
• speak privately to people about yourself and your situation
• be listened to
• be encouraged to recover
• have your family, whānau, friends or support network with you to help you make decisions about your care, if you choose to
• have your cultural needs acknowledged and supported, if that’s what you want.

(Source: Ministry of Health)

What you can do to feel better

When you are in emotional pain, it can be hard to believe that you will ever feel better. Others have found the following information has given them hope and helped them recover from suicidal feelings. One really useful point to remember is that you only have to cope with one day at a time. It can also help to know that as your mood has changed before, so it can change again.

Here are some ways you can take care of yourself:

• Try to remember that thoughts about killing yourself are just thoughts. You don't have to act on them, no matter how overwhelming they are or how often you have them. You won't always have these thoughts.
• Remove anything that you could use to harm yourself, or ask others to do this with or for you.
• Make a “distraction box” – fill it with things that provide comfort, remind you of the good things in your life, and help lift your mood. You can include anything meaningful and helpful to you, e.g. a book, photos, letters, poems, music, notes to yourself, a toy, perfume, jokes etc.
• Get a good amount of sleep, rest and exercise, and eat regularly.
• Try to avoid drinking alcohol or taking non prescription or recreational drugs. They can change the way you think and feel, mostly in unhelpful ways.
• If you’re taking prescribed medications for an illness (whether it be a physical illness or a mental health problem), don’t stop taking them without talking to your doctor first.
• Talk to someone you trust about what’s on your mind, whenever you need to. Keep a list of phone numbers of people you could call. If you're not sure who you can talk to, try phoning a helpline or texting a text counselling service (see numbers in the sidebar)
• Spend time with people who you like and trust.
• Take time off work if you need to. Your doctor can help arrange this.
• Write down your feelings. Keeping a journal or diary can help you understand what you're thinking or feeling, or how you’re reacting to situations in your life. It can also make it easier for you to find different solutions to any problems you’re facing.
• Think about what kind of help you may need when you feel unwell. You may want friends to visit you, or help you with the shopping or cooking. Let people know, so they can do their best to support you.
• Learn from others – reading about other people who have managed difficult times can be inspirational.
• Make a plan for recovery – write down what helps you to feel better about yourself, or what helps you when you're feeling distressed. This might include going for a walk, or talking to someone you trust. Refer back to your plan when you need to.
• Be kind to yourself  – just as your suicidal thoughts took time to appear, so it will take a while for them to fade. Live from day to day and don't expect too much of yourself. Even if you can't see a way forward now, you can be certain that the way you are thinking and feeling about things will change.

Treatment options

If you have not seen a doctor or mental health professional before, it is a good idea to do so. They will listen to you in private, and ask some questions about you and your situation. This is so they can help you and, together, you can develop a plan of action. Not everyone who is thinking about suicide is experiencing a mental illness, like depression or anxiety, but it is routine to be assessed for this so you can receive the right kind of treatment or support.

Your doctor will explain there are several treatments that can help, including:

• assessment for depression or other mental health problems
• counselling/therapy
• medication
• self-help through support groups and education (self-help books and videos).

Therapy, such as talking therapies

Talking therapies or psychotherapy has helped many people who have had thoughts of ending their lives. Talking about your situation can help you to make sense of what you are going through and explore different ways to cope and recover. Your doctor will explain what is available locally and which type of talking treatment is most suitable for you.

Medication

Your doctor may prescribe antidepressants, anxiety treatments or other medications.  Often both medication and therapy is useful. Finding the right medication can be a matter of trial and error – there is no way to predict which will be effective for, and tolerated (have fewer troublesome side effects) by, any one person.

If you are prescribed medication you are entitled to know:

• the names of the medicines
• what symptoms they are supposed to treat
•  how long it will be before they take effect
• how long you will have to take them for and what their side effects (short and long-term) are.

If you are breast feeding no medication is entirely safe. Before making any decisions about taking medication at this time you should talk with your doctor about the potential benefits and problems.

Complementary therapies

Complementary therapies may be used in addition to other treatments and prescription medicines. Any health-related practice that increases your sense of wellbeing or wellness is likely to be of benefit. In general, mindfulness, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Complementary therapies can include using a number of herbal and other medicinal preparations to treat particular conditions. It is recommended that care is taken as prescription medicines, herbal and medicinal preparations can interact with each other. 

A word on physical health 

It is really important to look after your physical wellbeing. Make sure you get an annual checkup with your doctor. Being in good physical health will also help your mental health.