September is Suicide Prevention Awareness Month, which gives us an important reason to talk openly about something many people are still understandably uncomfortable discussing. When we picture someone who is suicidal, we often imagine an obvious crisis: a person saying they want to die, making a plan, or reaching a visible breaking point. In reality, suicidal distress does not always announce itself that clearly.

Someone can go to work, take care of their children, answer texts, make plans for next weekend, and still struggle with thoughts about whether they want to keep living. Some people experiencing suicidal thoughts do not even think of themselves as “suicidal,” particularly when their thoughts sound more like wanting relief, wanting to disappear, or feeling exhausted by the effort it takes to keep going.

Understanding that distinction matters. It helps us recognize emotional pain earlier, respond without panic, and have conversations about suicide before someone reaches a crisis point.

Suicidal Thoughts Can Take Different Forms

Suicidal thinking can take different forms, and not every thought about death means someone has a plan or intends to act. A person may find themselves thinking, I wish I could disappear, Everyone would be better off without me, or I don’t want to die, but I can’t keep feeling like this. Clinicians sometimes describe thoughts such as wishing not to wake up as passive suicidal ideation, while active suicidal ideation involves thoughts of intentionally ending one's life.

Those distinctions can be clinically useful, but suicide risk is more complicated than placing someone into a passive or active category. A person's current thoughts, intent, planning, access to lethal means, previous suicide attempts, substance use, recent stressors, mental and physical health, and protective factors can all contribute to understanding risk. Risk can also change, sometimes quickly.

This is why statements about death or wanting to escape deserve curiosity rather than dismissal. You do not need to assume the worst, but you also do not need to decide whether someone “really means it” before taking them seriously.

Warning Signs Aren’t Always Dramatic

Some warning signs are relatively recognizable. Someone may begin talking about wanting to die, feeling hopeless or trapped, experiencing unbearable emotional or physical pain, or believing other people would be better off without them. They may withdraw from people they care about, increase their alcohol or drug use, sleep much more or less than usual, behave recklessly, give away important possessions, say unusual goodbyes, or begin researching or planning suicide.

Changes from a person's usual behavior can be especially important. Someone who becomes increasingly isolated, hopeless, agitated, impulsive, or preoccupied with death may need additional support, particularly when several changes are happening at the same time.

At the same time, there is no perfectly reliable list of warning signs that allows us to predict suicide. Some people conceal their distress extremely well, while others may not fully understand what is happening themselves. Suicide prevention should never become another way for grieving families to look backward and blame themselves for something they believe they “should have seen.”

It’s Okay to Ask Directly About Suicide

Many people hesitate to ask someone whether they are thinking about suicide because they worry that saying the word might somehow put the idea into the person's head. Research does not support that fear.  Asking directly can actually create an opening for someone to talk about thoughts they may have been frightened or ashamed to disclose.

You might say, “You’ve seemed really overwhelmed lately, and some of what you’re saying worries me. Are you thinking about suicide?” It can feel uncomfortable to ask, but direct language is often kinder than making someone who is already struggling figure out how to bring the subject up themselves.

If they say yes, you do not need to immediately find the perfect words or convince them that everything will be okay. Listen without judgment, take what they are saying seriously, and help them connect with appropriate support. If they tell you they intend to kill themselves or appear to be in immediate danger, stay with them and seek emergency help.

One response to avoid is guilt. Telling someone, “Think about what that would do to your kids,” may be intended as a reason to stay alive, but a person experiencing suicidal distress may already believe they are a burden to the people they love. Connection is generally much more useful than shame.

Why Does Someone Become Suicidal?

There is rarely one simple explanation. Suicide risk can be influenced by many interacting factors, including previous suicide attempts, depression or other mental health conditions, substance use, trauma, chronic pain or illness, significant losses, relationship problems, financial or occupational stress, isolation, and access to lethal means. Having one or several of these risk factors does not mean someone will attempt suicide.

It is also important not to reduce suicide to depression. Suicide is a complex mental-health and public-health issue influenced by individual, relational, community, and societal factors. Sometimes several pressures accumulate until the person cannot imagine circumstances changing, even when possibilities exist that they cannot currently see.

For some people with trauma histories, suicidal thoughts can become connected to a desperate need for relief from emotional pain that feels inescapable. Someone may feel trapped by memories, shame, grief, chronic nervous-system activation, or circumstances they cannot imagine changing. Understanding what is underneath that despair can become an important part of therapy, but immediate safety always comes first.

What Actually Helps?

Suicide prevention is much bigger than telling someone to call a hotline. Connection matters, but so do practical interventions such as appropriate mental-health treatment, collaborative safety planning, follow-up after a crisis, support from trusted people, and reducing access to highly lethal means during periods of elevated risk.

A safety plan is more than asking someone to promise that they will not hurt themselves. A collaborative plan may identify personal warning signs, coping strategies, people and places that provide support or distraction, professionals and crisis resources to contact, and steps that can make the person's environment safer when suicidal thoughts intensify.

Sometimes prevention begins much earlier, before anyone is in immediate danger. It may start when someone notices a change and asks, “You haven’t seemed like yourself lately. How are you really doing?” Then comes the harder part: being willing to hear an honest answer without immediately trying to fix it.

Where Does EMDR Therapy Fit?

EMDR therapy can be helpful when unresolved trauma, traumatic loss, shame, painful memories, or deeply held negative beliefs are contributing to someone's emotional distress. A person may carry beliefs such as I’m trapped, I’m a burden, I’m powerless, or Nothing will ever change, and those beliefs may have histories attached to them.

EMDR is not a crisis intervention for acute suicidality, and trauma processing is not automatically the appropriate next step simply because someone has a trauma history. When suicide risk is elevated, assessment, stabilization, safety planning, psychiatric or medical evaluation when appropriate, crisis resources and coordination of care may need to come first.

Once someone has sufficient stability for trauma-focused work, EMDR may become one part of a broader treatment plan. The purpose is not to convince someone that painful experiences were insignificant or simply replace a negative thought with a positive one. Instead, EMDR can help the brain process experiences that continue to make the present feel as if the past is still happening.

You Don’t Have to Wait Until Things Become Unbearable

In 2024, nearly 49,000 people died by suicide in the United States, and millions more adults seriously considered suicide. Behind those statistics are people whose experiences of despair, trauma, illness, loss, isolation, or overwhelm may have developed over months or years.

We do not need to wait until someone has developed a suicide plan before their suffering counts. Therapy, medical and psychiatric care when appropriate, supportive relationships, practical problem-solving, substance-use treatment, trauma treatment, community connection, and crisis resources can all become part of a larger support system.

Suicide Prevention Awareness Month is an opportunity to make conversations about suicide less frightening and more human. We cannot prevent every tragedy by asking exactly the right question at exactly the right moment, but we can make it easier for people to tell the truth about how badly they are hurting and help them find support before they have to carry that pain alone.

If you or someone you know is experiencing suicidal thoughts or an emotional crisis, call or text 988 to reach the Suicide & Crisis Lifeline. If there is an immediate life-threatening emergency, call 911 or go to the nearest emergency department.

About the Author

Andrea “Andi” White, MC, LPC, CCTP-II, EMDR-Certified Therapist, is a trauma therapist and founder of EMDR Counseling Collective in Arizona. She specializes in working with complex trauma, PTSD, and acute and recent traumatic experiences using advanced EMDR approaches, EMDR intensives, and Ketamine-Assisted EMDR Therapy™.