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Have you been worried about a friend, roommate, or classmate who is increasingly withdrawn, behaving recklessly, or hinting at self-harm? Joining a college campus means joining a community—and within that community, it is likely that someone you know will be seriously affected by mental illness or will contemplate suicide. In an anonymous survey of 29,000 students, 1 in 10 said they had seriously considered suicide in the past 12 months (NCHA, 2015). Two out of three college students who disclose suicidal thoughts tell a peer first (Professional Psychology: Research and Practice, 2009). Most students want to help others but often aren’t sure how, SH101 surveys show. So here’s how.

Three steps to helping a friend who may be suicidal

1. Notice something is wrong

Warning signs indicate an immediate risk for suicide. Mental health professionals or emergency responders should be contacted quickly. Warning signs can include:

• A threat to self-harm
• Hopelessness
• Increasing alcohol or drug use
• Dramatic mood changes
• Seeking access to a firearm, pills, or other lethal means

2. Choose to respond

Your concerns are probably valid. It’s appropriate to empathize, listen, and help connect your friend to other supports. Suicidal thoughts are far more common than suicide attempts; your friend may feel relief when you raise the issue.

Reach out to mutual close friends to see if they share your concern, and strategize about how to help. “It’s not gossip if the intention is to coordinate help for a friend,” says Charles Morse, associate dean for student development and director of counseling at the Worcester Polytechnic Institute, Massachusetts.

When seeking help for another person, what’s the deal with privacy?

By Marian Trattner, MSW, suicide prevention coordinator at the University of Texas at Austin, and Charlie Morse, MA, LMHC, associate dean for student development at Worcester Polytechnic Institute, Massachusetts

When the professional is a licensed mental health professional:

• If Student A talks to a licensed mental health professional about Student B, privacy is guaranteed in almost all circumstances. Because of confidentiality laws, the mental health professional can’t reach out to the student of concern. Exception: The professional can contact Student B if there seems to be an immediate threat to Student B or others.
• Counselors might ask for information about Student B but will not reveal what they know about that student: “Occasionally we do ask for names of students, as it might help us strategize as to how to best approach the situation (for instance, when we know the student is already in counseling),” says Charles Morse. “Students understand that we will never share confidential information, even something as ‘simple’ as whether a student has been seen in counseling before. Unless we are concerned about a student’s well-being, we will not try to take the situation out of their hands.”

When the professional is not a licensed mental health professional:

• If Student A talks to a student affairs professional who is not a licensed mental health professional, seeking advice about Student B, then that student affairs professional could and should reach out to Student B. Student A can ask that their name be kept out of the conversation.

3. Take action

Your support can be either or both of these:

• Direct: i.e., talking to the person you’re worried about
• Indirect: i.e., talking to or involving another person or resource

Direct action

Suicide risk factors, warning signs, and what to do

Is it a warning sign or a risk factor?
Suicide risk factors suggest a person may be at higher risk for suicide in the long term (not immediately). For example:

• An alcohol or drug use problem
• A previous suicide attempt
• A mood disorder (e.g., depression)
• Access to a firearm, pills, or other lethal means

Action: Call 911 or seek immediate help from a mental health provider
When you hear or see any one of these behaviors:

• Someone threatening to hurt or kill themselves
• Someone looking for ways to kill themselves (e.g., seeking access to pills or weapons)
• Someone talking or writing about death, dying, or suicide

Action: Contact a mental health professional or call 1-800-273-TALK for a referral
When you witness, hear, or see anyone exhibiting any one or more of these behaviors:

• Hopelessness
• Rage, anger, seeking revenge
• Acting reckless or engaging in risky activities, seemingly without thinking
• Feeling trapped, like there’s no way out
• Increasing alcohol or drug use
• Withdrawing from friends, family, or society
• Anxiety, agitation, unable to sleep, or sleeping all the time
• Dramatic mood changes
• No reason for living; no sense of purpose in life

Adapted from table #2: Rudd, D. M., Berman, A. L., Joiner, T. E., Nock, M. K., et al. (2006). Warning signs for suicide: Theory, research, and clinical applications. Suicide and Life-Threatening Behavior, 36(3), 255-262.

How to talk to someone who may be having suicidal thoughts

• Think this through in advance and role-play your conversation.
• Talk about behaviors, not labels: Avoiding labels like “depressed” or “alcoholic” helps take judgment and stigma out of the conversation.
• Talk about being concerned, not worried. “‘Worried’ potentially conveys that it’s the friend anxiety that is the issue,” says Charles Morse.
• Ask open-ended questions about your friend’s situation.
• Ask your friend about suicide directly, in a nonjudgmental way. Worried that raising the issue may give them the idea? This concern is outweighed by the risk of not raising it.
• Stay supportive. It’s OK that you don’t have all the answers. Refer them to a helpful resource.

Indirect intervention

Sometimes you are not the best person to intervene, and that’s OK. You can take these helpful actions:

• Involve another helper, such as a friend or resident assistant.
• Consult with the counseling center; the counselors can help figure out how to support your friend and when to involve outside resources.
• Report an online post that hints at suicide to the relevant social media network; they can connect the poster to the National Suicide Prevention Lifeline.
• Share urgent concerns about another student’s safety with the dean’s office, or call 911; you should do this immediately if you feel a student is in danger.

Take care of yourself too

Being an active bystander involves recognizing your limits. Take care of yourself, and seek guidance from professionals as needed.

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