Suicide: What To Do When A Friend Waves Red Flags

Aren’t we all at risk for suicide? A risk factor for suicide is exposure to suicide. What do you do when a friend or family member feel hopeless, helpless, and wants to die?

Every 12 minutes, someone dies from suicide, over 120 people each day.

Every minute someone attempts suicide. For every suicide, there were 12 attempts.

Suicide takes twice as many lives as homicides in the US.

In 2016, suicide took the lives of 44,965, and homicides took 19,362 lives.
Suicide was the second leading cause of death in Americans aged10-34 behind unintentional injuries, and the fourth leading cause of death in those aged 35-54. White males accounted for 7 out of 10 suicides. Data from 2017 show suicide claimed the lives of 47,173 and remained the 10th leading cause of death.

Ninety percent of those who succumb to suicide have a DSM V underlying mental illness. Over 50% of those with mental illness have major depression, and about 75% have both major depression and alcoholism. Nearly half of all suicides, 50%, are due to firearms followed by suffocation and overdoses

Who is at risk for suicide?

Teens, young adults, older adults, and white males have the highest suicide rates. Women are more likely to attempt suicide, while men are more likely to be successful. The following groups are at higher for suicide than the general population:

  1. People with a history of suicide attempts
  2. People with a family history of suicide
  3. People who know someone who committed suicide
  4. Seniors living alone who have lost a spouse
  5. People with a history of abuse
  6. People with a history of mental illness
  7. People with a history of addiction or alcoholism
  8. People recently discharged from an inpatient psychiatric admission
  9. People with chronic pain or terminal illness
  10. People on medications that increase suicide risk
  11. People who work in certain professions, such as medicine.
  12. People who feel hopeless, helpless and a burden
  13. People who feel disconnected and talk about death and dying
  14. People with traumatic brain injury
Photo by Yuri Catalano on Unsplash

A co-worker who committed suicide puts you at risk. Copycat suicides or suicide clusters suggest you don’t need to know the person to be at risk. Physicians, by the nature of our jobs, are at high risk. Unsurprisingly as suicide rates increase, the rate among doctors is at an all-time high.

One risk factor for suicide not often appreciated or mentioned in medicine is medications. There is a slew of drugs that increase suicide risk. Those include antidepressants and other psychiatric medications used to treat major depression and other mental illness after suicide attempts. Some of these medications cause depersonalization and changes that lead to suicidal ideations, attempts, and deaths.

What is Suicide?

According to Edwin Schneidman, who created the field of Suicidology, suicide is psychache. Suicide is the outcome of a perceived, painful life. It’s a permanent solution to an often temporary problem. People with a high sense of well-being don’t commit suicide! When someone confides suicide is their only viable solution, they are in despair. Listen with compassion and empathy.

Not all suicides are the same. Suicide in children and young adults tend to be impulsive often with less than an hour between the final decision and the act. The trigger is usually a breakup, loss, or trauma. In older people, suicide is planned. Older people commit suicide when the quality of life deteriorates due to illness or the loss of a spouse. Their suicide is frequently masked by chronic medical problems that can lead to underreporting.

It’s paramount to diagnose and treat the underlying mental illness or substance abuse problem that accompanies patients with suicidal ideations or attempts. Remember the brain of young adults, in particular, the frontal lobe that controls impulse, isn’t fully developed until age 25-30.

Older patients benefit from treatment when there is underlying depression or mental illness but are less likely to exhibit red flags or reach out to others about their intent. For them, it comes down to the quality of life where chronic illness affects their ability to function and appreciate life.

Source of image: Google
Source of image: Google

What are the red flags of suicide?

About 70-75% of suicidal patients wave red flags. These can be subtle changes in behavior. A co-worker, friend or family member withdraws, becomes reckless or becomes preoccupied with death. A once gregarious friend now is quiet, unfriendly or unforgivingly pessimistic. That friend once the life of the party is no longer around. Another red flag is a friend who suddenly gives away treasured items or a cautious friend who now participates in unprotected sex or other risky behaviors. Red flags could be as subtle as increased unexplained irritability or sleeping more.

Red flags overlap with normal behavior or normal behavior. One could easily conclude that your easily agitated co-worker is a jerk. Investigating red flags means resisting the urge to pass judgment. I believe that’s one reason many people feel guilty when a close friend or family member commits suicide. They recall the lost opportunities to intervene.

“You unconditionally walk with them.” Photo by Jon Tyson on Unsplash

What do you do if you think your friend or relative is suicidal?

That’s tricky! I don’t think one answer fits all and a reason context is critical.

However, the following advice by Roald Michel, a psychologist, is the best response.

You unconditionally walk with them. This means: No advice, no lame stuff like, “to morrow will be a better day”, no “why?”Example? A young woman desperately wanted to end her life. Everybody resisted. Didn’t help. Finally she succeeded in taking the pills. She was rushed to the hospital. They pumped her stomach. As soon as I heard, I went to the hospital as well. On arrival she just was carried to a recovery room. I took her hand, and said: “Shit, Mary (not her real name), now you have to start all over again!” The way she squeezed my hand, and the way she looked at me at that moment was carved unto my soul. We saw each other, we were connected, and nothing else was more important than that to the both of us.

If you notice changes in a friend’s behavior, particularly after a loss or traumatic event, investigate. Don’t assume or confabulate (fill in the gaps) with your explanations. Engage the person and find out. Try not to be judgemental and add to your friend’s stress or back him in a corner. That friends change in attitude could be a reasonable response, but it could be a red flag that this person is suicidal. How do you tell? By observing and engaging the person without judgment always in context.

For people of color, I would be cautious in calling 911 or the police — the police usually respond along with the EMTs on many such 911 calls. There are too many videos of cops finishing the job rather than assisting in transporting patients of color to the hospital for proper medical care to recommend any intervention involving them.

I believe it’s dangerous and risky to tap into the 911 system when concerned about an acutely suicidal or mentally ill black person. I recall a former friend calling 911 then provided misleading information to ensure a response. What followed was a SWAT team at my door that forced themselves into my home then tackled my son to the floor and handcuffed me. My right shoulder has never been the same. That call could have resulted in not only my death but the death of my son. Society rewards cops who respond like this to POC.

If you are a parent, hide all medications even over the counter ones, firearms, knives, and sharp objects as well as street drugs. I’d also maintain a 24/7 watch until your child sees the doctor. Call your PCP who will advise going to the ED. If possible, Black people should transport themselves rather than call 911 since the outcome of the latter could be fatal.

The US healthcare delivery system is not set up to provide acute care. There are huge gaps in care, especially if you are without health insurance or a person of color. Without health insurance, you will most likely spend hours if not days in the ED and be discharged with minimal if any help. Or you may be transported to jail where you may or may not receive mental health care. If you felt psyache before your interaction with the healthcare system engaging with the system without an advocate will often validate your pain. I mention this to prepare you not to diss the system.

Fortunately, not every person who is suicidal requires a visit to the ED. It’s more important to engage and listen. Most acutely suicidal patients actually want to live, but they are in pain and often can’t feel or see anything but pain and suffering. Knowing someone will listen without judgment can do more to talk a person down than a hostile encounter with 911 and the cops or a denigrating experience in the ED or spending days in jail. As Roald Michel eloquently stated, “You unconditionally walk with them.”

The National Suicide Prevention Lifeline is available at 1–800–273–TALK (8255), 24 hours a day, seven days a week. The deaf and hard of hearing can contact the Lifeline via TTY at 1–800–799–4889. All calls are confidential. ” I’ve never called them. Based on patient experience, I believe that’s an excellent place to start.

Suicide haunted my personal and professional lives. I struggle with feelings of not wanting to live and often feel hopeless and helpless. What prevents me from killing myself is my children. They keep me grounded by connecting me to life when I think my life has no value. Regardless, there are times I want the pain and suffering to end and convince myself it would be in their best interest.

My father committed suicide when I was nine years old. I’ll never forget the tears and painful faces at his funeral. At that time, I promised myself I would never inflict that kind of pain on anyone. I haven’t so far, and that’s not because of the promise but rather my children. My husband also committed suicide, subjecting my children to a similar trauma. He was an alcoholic who would not face his demons. His suicide was inevitable and unavoidable since he denied his problems and had a network of enablers who supported his denials.

As someone with multiple risk factors at high risk for suicide, it’s best to listen to the acutely suicidal person despite your personal views. Unconditionally walk with them! If that person trusts you enough to be vulnerable and reveal their feelings don’t betray that trust because the person mentioned suicide. That is a common mistake people frequently make instead of using common sense. Sometimes I needed to reveal my feelings to relieve the urge. The last thing a person in despair needs is a lecture or a biblical lesson about the sins of suicide or dismissal of their feelings. Summon your empathy and humanity to connect with a person asking for your help.

“Happy” people don’t kill themselves, but stressed people do or people with a low sense of well-being. Could the cure for suicide reside in the hands of society? Could a culture of inclusivity where people feel connected reduce suicide? Since the environment vastly affects outcomes, what is the impact of imprisoning suicidal patients even if it’s the only alternative they have for mental health care? Poor and homeless people are the most affected.

These are essential questions to explore and research to eliminate the most preventable cause of death in our children.



Author: Angela Grant

Angela Grant is a medical doctor. For 22 years, she practiced emergency medicine and internal medicine. She studied for one year at Harvard T. H Chan School Of Public Health. She writes about culture, race, and health.

16 thoughts on “Suicide: What To Do When A Friend Waves Red Flags

  1. Re: “What to do………” You know my take on this already. I was in that position several times. Maybe you forgot? The short version? You unconditionally walk with them. This means: No advice, no lame stuff like, “to morrow will be a better day”, no “why?”
    Example? A young woman desperately wanted to end her life. Everybody resisted. Didn’t help. Finally she succeeded in taking the pills. She was rushed to the hospital. They pumped her stomach. As soon as I heard, I went to the hospital as well. On arrival she just was carried to a recovery room. I took her hand, and said: “Shit, Mary (not her real name), now you have to start all over again!” The way she squeezed my hand, and the way she looked at me at that moment was carved unto my soul. We saw each other, we were connected, and nothing else was more important than that to the both of us.

    Re: “Ninety percent of those who succumb to suicide have an underlying mental illness………” Says who? And….um….”mental illness”? What’s that?

    Re: “Happy people don’t commit suicide!” Crap. Mainstream babble.

    1. Thank you, Roald. I appreciate your feedback. Your story of “Mary” touched my soul. You showed empathy and made an immediate connection with her. Perhaps if she had revealed her feelings to you instead of others, she would not have attempted.

      It’s that damn training compelling me to report mainstream babble; I feel the article would be incomplete without it but maybe not.

      1. Re: “……if she had revealed her feelings to you……..” She did. I once visited her, and saw her sitting there in tears with a handful of pills ready to swallow. I sat with her, holding her in silence. Nobody spoke. After a while she stood up, and threw the pills away. But sometimes it’s simply too much, too heavy, too overwhelming, and too unbearable.

        The sad thing is, that many people who truly want to die, lack the knowledge of how to make their final exit less desperate, less painful, less horrible.

        1. It is unbearable! I hate it when friends or family in trying to help minimize or ridicule the pain instead of quietly holding your hands.

          As an ER doc, I had a weird sense of humor. I often mused of writing a book on how to do it effectively and without pain.

  2. Angela your article is very informative about the causes of suicide and what a person can do to help a relative or friend! Especially appreciated info about thinking twice about going to the ED and Black people calling 911.

    1. Hi Rudy, thank you. I am glad you noticed the info geared for POC. What works for white culture does not necessarily work for black culture. I am writing from the vantage point as a person of color. 🙂

  3. I know what’s missing. Brevity! It’s too long for me to read or edit at one sitting. I need to cut 50% since it is close to 2000 words or split it into two parts or a combo. With the latter, I can add another part later. Hmmm, I may need to change the title.

    1. Long story short: Brevity is for sufferers from FUFA disorder

      When genuinely interested in the subject, I don’t give a rats’ ass about brevity. Authenticity and content is what I seek.

  4. This was a great article. I will admit that I did get some bad flashbacks from my past when it came to that issue. It’s good that you care about that issue and noting so many of the red flags.

    1. Thank you, Curtis. I’m going to do a post about treatment since ECT is gaining ground as treatment and not as a last resort. I need to talk with people in the field. My first response to ECT is regret for sending patients to psyche who received it but that was a while ago. Perhaps patients no longer appear lost or brain dead after ECT.

    2. Hi Curtis, thank you. I believe suicidal thoughts are more normal than we admit. If we learned more about managing those thoughts suicide rates would decrease.

      My interest in suicide dates back years. It was why I considered a career in public health.

      1. No problem, Angela. I find it believable that those thoughts are more normal than people give credit for.

        It’s good you’re doing the research about this issue. I’ll be looking forward to that post about ECT.

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