Crisis and Suicide Prevention

Passive Suicidal Ideation: Signs and When to Seek Help

Jim Sugel on March 15, 2024

If you or a loved one is struggling with thoughts of self-harm, suicide, and dying, it’s important to reach out and talk to a professional. That’s even true if that ideation is passive, because even if it’s not pressing, suicidal ideation is never a good sign. It’s a warning that you need help, and you need to get it before the problem becomes worse.

Passive suicidal ideation is, in short, the desire to die without having a plan to achieve that. That means you face a feeling of wanting to die, intrusive thoughts of self-harm or killing yourself, or feelings of not wanting to live. If you’re experiencing that, that is enough warning sign to seek help and to talk about it with a mental health professional. However, we’ll go more into detail on that in the rest of this article.

What is Passive Suicidal Ideation

Passive suicidal ideation is the desire to die, to kill yourself, or a lack of desire to keep living. However, it’s called “passive” because the person experiencing it hasn’t made an active or concrete plan to make these thoughts a reality. In fact, they might never do so. For many people, passive suicidal ideation is unwelcome and unpleasant. For others it’s an early warning sign of actually wanting to die and will eventually solidify into an active want to die. That change can be triggered by bad things happening, mental health getting worse, or by trauma. However, it can happen.

In either case, passive suicidal ideation is not something to just live with. It reduces your quality of life, it harms your mental health, and it can turn into active suicidal ideation over time. That means you should always look for and get help if you are experiencing it. Even talking about it with a professional can give you insight into what your coping mechanisms are, how you can redirect thoughts, and how you can work towards overcoming those thoughts.

What are the Signs of Passive Suicidal Ideation in Others

Passive suicidal ideation can take a lot of different forms. For many people, it means expressing or showing thoughts of wanting to die. Others will never voice those thoughts aloud. That can mean you’ll never notice or see suicidal ideation until it’s too late. However, you can look for signs like:

Expressing a desire to die. Even if it’s said as a joke, it is something you should take seriously, talk about, and try to figure out how real the sentiment is.
Researching or looking into how suicide works and what types of suicide methods work. Even things like knowing suicide statistics and what kinds of suicide attempts work can be a red flag. For example, if someone knows why a suicide method is the most effective, that means they’ve looked it up, and that means they had motivation to do so.

You can also look for statements like:

“I want to die”
“life just doesn’t feel worth living”
“I hope this car crashes”
“I could step in front of this bus”
“My loved ones would be better off if I were never born”
“I don’t want to be alive anymore”
“Everything is too hard to cope with”
“I just want to sleep and not have to deal with life”

These statements, and others like them, all express passive suicidal ideation.

You can also look for signs of poor mental health like:

Increased reliance on substances
Depression
Self-isolation or avoiding friends and family
Expressions of or feelings of loneliness
Changes in behavior such as self-care
Changes in sleeping patterns
Self-harm
Feelings of hopelessness

These latter symptoms can map to a very large number of mental health problems. However, they all point to the fact that this person is not doing well and probably needs help.

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Are Suicidal Thoughts Normal?

In 2021, an estimated 12.3 million Americans seriously thought about Suicide. This means that for almost 4% of the population, suicide is a normal thing to think about. At the same time, normal does not mean healthy, good for you, or something you have to live with.

People think about dying all the time. Today, someone dies by suicide almost every 11 minutes in the United States. The fact that something is normal does not mean that you should leave it alone. Instead, it means that it’s normal to need help and it should be normal to ask for that help.

Coping with Passive Suicidal Ideation

Therapy and mental health support is the best way to cope with suicidal ideation. Professional help can allow you to understand what’s underneath suicidal ideation, to find and change behavior and patterns in your life that contribute to feeling that way, and to build habits and change that improve your life so you can move past suicidal ideation and get back to enjoying your life. And, when therapy isn’t enough, a mental health professional can help you to get treatment and medication to help balance your mood so you can improve quality of life that way.

Managing suicidal ideation also means managing your life and the people in it. That means:

Managing your routines so you have structure and support
Manage energy by going to bed and getting up at the same time every day, making sure you get plenty of rest, and taking steps to ensure your quality of sleep is good
Keep your space clean by spending 15-20 minutes per day cleaning up
Take time to socialize and spend time with people who are fun and doing fun things. Consider what things you like to do and make sure you do them, even if you’re not experiencing joy in doing them right then
Make sure you have what you need to feel good. That means exercising 30-60 minutes per day most days and eating nutritious food about 80% of the time.
Minimize caffeine and alcohol intake and try to stick to recommended daily limits or less for both

Essentially, if you take steps to give yourself structure and routine, put effort into taking care of yourself, and keep your space clean, you’re giving yourself a good basis for mental health. On top of that, you should add things you like to do like hobbies (crafting, sports, games) and spending time with friends and family so that you get to enjoy things as well. That won’t make you feel “not depressed”, but it will give you a good baseline for feeling good about yourself and your life.

When Should You Seek Help?

In any case where you’re experiencing suicidal ideation, you should be seeking help. If you have recurring thoughts of death, wanting to die, not wanting to live, self-harm, or suicide, you should be talking to a mental health professional. Often, that starts with talking to your doctor who can recommend you to a therapist or to other treatment. However, you can also reach out and ask for treatment directly from a mental health clinic or center.

Suicidal ideation is always a warning that something is wrong, and it is always a good sign to reach out and ask for help. If you or a loved one is experiencing even passive suicidal ideation, the time to seek out help is now.

How to Help Someone with Suicidal Ideation

Jim Sugel on January 16, 2024

If your loved one is struggling with thoughts of self-harm, dying, or suicide, you want to help. Today, some 4.3% of the U.S. population experiences suicidal ideation at least sometimes, and 10.5 million of us will be going through it in any given year. If that’s someone in your life, you want to help them – to make it better. Unfortunately, there’s no easy way to fix other people. They have to take steps themselves. They also have to have the motivation, mental capacity, and space to get help and to accept help. That can be extraordinarily difficult to sit through when it’s your family member, your partner, your friend. At the same time, it’s important to acknowledge that you can’t fix this for them and that all you can do is be there for them.

However, there are some steps you can take to be there for your loved one. Offering support, talking, and making certain that your loved one knows that they can ask for help whenever they need it will help. And, that’s the most you can do.

Talking without Judgement

The first step to being there for someone is to be able to talk to them. That often means being able to listen. And, good listening means being able to take in whatever you hear without judgement, without having to offer advice, and with only offering care and support. What does that mean? It means learning how to listen to people talking about depression, death, self-harm, being bullied, and feeling ostracized and socially outcast without judging it. Listening to someone talking about self harm can hurt, but it’s important not to make the conversation about you.

Listening means:

Responding to what the other person is saying, not to what you are feeling
Listening without sharing your perspective or story until you’ve first acknowledged their points and made sure they feel heard.
Leaving out any concern about what other people think or why.
Leaving out any moral judgements about suicide or self-harm. If you’re morally upset about your loved one’s suicidal ideation, you should figure out how to leave that at the door when you talk to them. It won’t help and it may make things worse.
Learn to ask good questions, to get to the heart of why someone feels like they do, and to learn to say “your emotions are valid, even if I don’t think you need to feel that way. People can come to suicidal ideation through a number of ways including bullying, low self-esteem, depression, stress, and things being too much. Making them feel listened to can help a great deal.

Each of these can mean doing some significant work on yourself before talking to your loved one. You have to be able to talk about suicide and self-harm with nothing but concern for your loved one. Focusing on putting that concern first, “I care about you, and I want you to be okay” as your main message can help with that.

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Show Up and Help with a Routine

The most important thing you can do for your loved one is to show up and be there. However, if you know someone is struggling, it’s also a good idea to help in other ways. For example, you can work together on improving routine, habits, and the space you’re living in. This is easiest if you share a living space with your loved one. However, you can participate in building routine and being there through that even if you don’t live together.

Start exercising together and take an hour or two a day to walk, go to the gym, or do something else physical. That can mean stopping by and picking them up and talking to them as well.
Do chores together. Even if you don’t live together, you can stop by and help with things like laundry or cleaning – although this is a lot of effort if it’s not also your home, and you’ll have to make sure you have the energy and mental space yourself.
If you live together, try having the same bed time and wake up time at about the same time every day. This won’t help with depression but it will provide stability, which can improve things over the longer term. Taking steps to ensure your loved one gets enough sleep is also a good idea. For example, by turning off screens at least an hour before bed. Or, by moving exercise and caffeine consumption to the morning so it doesn’t keep you awake later.
Eating well. That can mean doing food prep together. It can also mean having meals together even if you don’t live together. Good eating habits, as in following the general guideline of something like MyPlate.gov can help a great deal with how you feel mentally over time. However, it’s not a short-term solution.
Make sure they spend time around others in a healthy fashion. That means ensuring that you and others spend time with your loved one in a low pressure environment, even if it’s playing a game, listening to music, or watching a movie. Ensuring that someone with depression or suicidal ideation gets regular and positive contact with other people is important for their mental health.

Eventually, all of these things are steps that you can try to take. However, you’ll need buy-in and motivation from your loved one to do any of them. It doesn’t matter how much you want to organize weekly get-togethers to hang out and watch movies, if your loved one won’t do it, they won’t do it. That’s true with every one of these steps. You can only help so far as your loved one is willing or able to help themselves, and that can be very difficult.

Get Professional Help

It’s important to be aware of what mental health resources you have available to you. That means starting by talking to your doctor. You can also call the National Suicide Hotline at 988. This hotline gives advice and resources as well as directions to professionals for people struggling with suicidal ideation and their loved ones. This means you can ask for support and next steps and get guidance on what to say or do in a situation.

Suicidal ideation is often a symptom of an underlying mental health problem. For many people, that means seeking out professional mental health treatment. For example, behavioral therapy such as cognitive behavioral therapy and EMDR are very commonly used to help people understand, cope with and move past their suicidal thoughts. That can involve months or even years of treatment and some people will never recover from suicidal ideation. However, therapy and treatment will give them tools to better manage those thoughts, so they are safer no matter what their thoughts tell them.

You can work towards getting your loved one into treatment. That means being there for them, suggesting treatment as an option, talking to them when they need it, and being someone they can trust to help. Your loved one won’t go to treatment or therapy until they are ready, however, you can work to let them know that they are worth the effort, that treatment is there, and that you want them to be better, for you and also for them. “I care about you and you deserve this help” can go a long way.

The Link Between Hallucinogens and Suicide Risk

Andrea Wagner on October 26, 2023

Hallucinogens or psychedelics have a long history of being known for exacerbating mental health problems and increasing suicide risk. Today that’s come under question, especially as multiple studies show that hallucinogens may actually reduce risk of suicide in (previously) suicidal persons.

However, in both cases, we still need more data and a better understanding of how hallucinogens work on an individual level in order to make safe judgement calls.

In 2022, an estimated 49,449 Americans died of suicide. In 2012, 12.3 million adults seriously thought about suicide and 3.5 million adults made a plan to do so. Suicide dramatically impacts every aspect of our lives – so it’s important to understand the risks before you start taking drugs of any kind. Hallucinogens are no worse than any other drug, however, it is still critical that you be aware of the risks and that you have the information to use or make decisions safely.

Do Hallucinogens Increase Risk of Suicide?

The short answer is, there is no statistically significant data showing an increase in risk of suicide for persons who take hallucinogens. The long answer is that hallucinogens interact with the brain in complex ways and on an individual level, may be extremely harmful to mental health and stability, which may exacerbate or worsen existing mental health problems.

However, for the general population, hallucinogens show no direct correlation to an increase in risk of suicide. For example, a study profiling the hallucinogen usage of persons taking ayahuasca, a psychedelic drug used in religious rituals in the Amazon Rainforest, found no significant differences in mental health or mindset between persons who took the drug regularly for rituals. In fact, there were also no statistically significant differences between persons who started the study having used just once and those who had used 5+ times – and the study followed up on a yearly basis for two years. Instead, the only statistically significant differences were regular ayahuasca users were less likely to avoid dangerous or potentially harmful activities because they were less likely to worry about the results of those activities, were less likely to experience shyness, and were more likely to be dependent on getting to feel good out of an interaction or activity. With over 200 people profiled, there were no significant changes in mental health or in suicidal ideation or depression.

A similar study tracking the results of peyote on Native populations showed that 70,000 individuals using the drug were unlikely to experience statisticially different mental health norms than control groups not using the drugs.

People With Mental Health Problems Are More Likely to Use Drugs

While hallucinogens are unlikely to cause increases in risk of suicidal ideation or depression, people with suicidal ideation and depression are more likely to use drugs. This means that populations using hallucinogens are more likely to be vulnerable to suicide or suicidal ideation because they have a mental health disorder. That’s in part because many people use drugs and alcohol to self-medicate and to feel better. That’s especially true after multiple studies were picked up by the news showing that psychedelics can actually help people to relieve symptoms of suicidal ideation and decrease suicide risk. More people opt to self-medicate and then use psychedelics as a means of temporarily feeling better.

Self-medication is always dangerous because it means that people look for quick ways to feel better. This means they don’t treat underlying symptoms. Often, drug and alcohol use also exacerbates symptoms. Sometimes that’s by causing shifts in hormone and neurotransmitter production in the brain, reducing your ability to feel and process emotions properly or creating unhealthy reliance on drugs. Often, it also results in isolation and alienation from friends and family, pushing you further away from support networks and healthy coping mechanisms. That’s less true with psychedelics than with drugs like heroin or heavy alcohol use. However, hallucinogen use can still take the place of healthy coping mechanisms like exercise and eating well – resulting in reduced mental and physical health and worse coping mechanisms.

According to one study, almost 1 in 10 persons taking hallucinogens experienced major depressive episodes. However, the most significant factor contributing to those depressive episodes were significant trauma, typically before the age of 16. During the study, almost no one developed depressive episodes or suicidal ideation close enough to taking hallucinogens for the two to be linked. In fact, most people developed these episodes before taking hallucinogens with a smaller number of people developing them 3-5 years after starting hallucinogen use.

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Drugs and Alcohol Use Increase Risks of Suicide

That’s so much the case that drugs or alcohol were involved in 58.6% of all suicide deaths. Of those, alcohol is present in 22% – with severe intoxication being the number one most common factor between all people attempting suicide. That’s most likely linked to the fact that substance use and intoxication reduces inhibitions and decreases risk evaluation skills. This means people are more likely to be impulsive and less likely to be inhibited in their behavior. Therefore, if you go to drugs and alcohol while being depressed or suicidal, you’re more likely to go through with it while intoxicated. That lack of inhibition means that even a drug that doesn’t increase suicidal thoughts or behavior can increase the risk of suicide – because it means you’re less likely to weigh the negatives or to think through your decision. Drugs like hallucinogens also greatly reduce anxiety and ability to worry (although this depends on the specific drug) meaning that persons who take them score significantly lower on harm avoidance. This means that risk of suicide is higher while intoxicated, providing the individual was already experiencing suicidal ideation or depression.

Can Hallucinogens Decrease Risk of Suicide?

Multiple studies have shown that clinical hallucinogen use of either psylocibin or LSD can result in decreases in suicidal ideation in patients already showing suicide risk. However, it’s important to note that those studies are in a clinical setting with extremely controlled doses and reactions. For example, one study reviewing the efficacy of MDMA, psilocybin, and LSD in reducing suicidal thoughts and psychological distress found that MDMA and psilocybin reduced suicidal ideation by 0.01% to 10% over the course of the follow-up year. However, LSD increased risk of suicidal thoughts in that follow-up year. In addition, the study was not able to prove if results were because of hallucinogen usage or causal based on other lifestyle changes. Other studies show that LSD can also have a positive effect, although these studies are entirely clinical with controlled doses and settings.

Eventually, hallucinogens are like any other drug and should never be used to self-medicate. This means that it isn’t safe to use psychedelics of any kind to reduce suicidal ideation or depression, because you can’t guarantee what the outcome will be. Hallucinogens can increase risks of depression and psychosis in individuals, which can make your mental health problems worse. Therefore, you should never try to treat yourself with them outside of a clinical setting where you can get medical care, medical monitoring, and follow-up treatment if something goes wrong.

Hallucinogens have a reputation for increasing risk of suicide. However, that’s unlikely to be true. Instead, it’s more likely that people with a high risk of suicide are more likely to use drugs. In addition, drugs reduce inhibitions, which can increase risks of following through on suicide ideation. And, with more people now using hallucinogens to self-medicate, those risks are higher than ever. If you or a loved one is struggling with depression or thoughts of suicide, it’s important to seek out professional mental health help rather than attempting self-treatment.