Gauge and Respond to Suicidal Risk

It takes courage to talk to a man about suicide, but having the right conversation at the right time could save his life

Understanding a man’s risk for suicide begins with looking out for the factors that can increase risk, as well as those that might offer some protection (i.e., mitigate risk). These include:

  • Personal History: Personal background, health, family history, social relationships
  • Behaviours: Social withdrawal, issues with sleep, self-harm, falling behind on things, impulsiveness
  • Desires: Comments indicating active (directly mentioning wishing he were dead) or passive (wishing he were gone or could escape) suicidal thinking
  • Intent: Displaying intentions or making plans to act on suicidal thoughts, or seeming to get things in order as if planning to not being around (e.g., sorting out his will, selling or getting rid of his belongings)
  • Means: Possessing the means to attempt suicide or having plans to acquire them
  • Protective Factors: Social network, positive relationships, future goals, healthy lifestyle

For an expanded description of these factors, see Assess Suicide Risk (we recommend reading this page before continuing on below).

Risk Levels

Understanding someone’s risk level, though not an exact science, is helpful in determining how you engage with/support him.

Note that a person’s risk of suicide can fluctuate, which is why it’s important to regularly check in with him.

Low Risk

Keep in mind that even if a guy is considered low risk, it doesn’t necessarily mean that he’s completely out of danger or not needing our support.

Key signs:

  • No expressed or suggested suicidal desire
  • No suicide intent/plan
  • May have some risk factors (e.g., poor sleep, living alone), but has several protective factors

What you can do:

  • Continue to support him
  • Keep in regular contact with him
  • Engage him in conversation (and practice active listening)
  • Draw on any resources/protective factors that he may have access to

Next Steps:

See our pages on Start a Conversation and Provide Ongoing Support.


Medium Risk

Key signs:

  • May have voiced suicidal or escapist thoughts/desires but they’re not repetitive
  • No intent/plan
  • Several risk factors, but also has a moderate number of protective factors

What you can do:

  • Respond with the steps listed for “low risk” and…
  • Suggest that he connect with a family doctor or mental health professional, offer to accompany him
  • Provide him the number to a crisis line and encourage him to reach out “just in case”
  • Brainstorm coping strategies with him
  • Suggest that he join a men’s support group (offer to help him find one)

Next Steps:

See section below on how to start a conversation and the Provide Ongoing Support tips on our Manage Suicide Risk page.


High Risk

Key signs:

  • Clear and repetitive suicidal desire
  • Signs of intent (e.g., sorting out wills or getting rid of belongings)
  • May have voiced future intent (e.g., “If things don’t get better by next month, I’m gonna do it”)
  • May have a general suicide plan, or even a clear plan
  • May have access to means of taking one’s life (e.g., guns, large amount of rope)
  • Several risk factors present
  • Few to no protective factors or he may have existing protective factors but they don’t appear to be diminishing the impact of his risk factors

What you can do:

  • Respond with the steps listed in low and medium risk and…
  • Strongly urge him to connect with a doctor or mental health professional (help him make an appointment with a doctor or therapist)
  • Ask if, together, you can brainstorm a crisis safety plan (e.g., if he has the urge to hurt himself or others or attempt his plan, he agrees to call or text you first)
  • Speak to others in his life, with his permission, who may be able to support him as well
  • Remove, restrict, or impede his access to any obvious means of taking his life (if possible)

Next Steps:

See section below on how to start a conversation, the Provide Ongoing Support tips on our Manage Suicide Risk page, and our Help in a Crisis page.


Imminent Risk

This level of risk requires our intervention to protect someone’s life.

Key signs:

  • Clear and repetitive suicidal desire
  • Has a suicide plan
  • Plan is relatively specific (may have mentioned a date, time, location, or his preferred means)
  • Protective factors, if any, have not reduced the impact of his risk factors
  • Has the means or can quickly access the means that would be used e.g., pills, firearm, lives near train tracks that he mentioned previously.
  • Has stated intent to act on his plan either right now or very shortly

What you can do:

  • Address the issue clearly and directly with him, while being calm, empathic, and compassionate
  • Remain with him (on the phone or in person, if possible)
  • If he’s willing, take him to the hospital or his health care provider immediately
  • If he’s not willing or you can’t reach him, call 911 (if in Canada or US), 999 (if in UK), 112 (if in Europe) or whatever your local emergency number is right away

Next Step:

See our Help in a Crisis page.


More Active Engagement with Increasing Risk Levels

At higher levels of risk (generally, from the medium risk level onward), more active engagement on our part is required. This means having more open and upfront discussions about suicide, which include finding out whether he has any sort of plan.

Start A Conversation

If we suspect that a man in our lives may be thinking about suicide, we need to voice our concerns. This can be a challenging talk to have; one that requires courage. Many people falsely presume that discussing suicide will make things worse – this couldn’t be further from the truth. If we are concerned, we need to speak up – it could save someone’s life.

Keep in mind that thinking about suicide has nothing to do with a person being selfish, having a weak character, or lacking effort. Instead, when someone is thinking about suicide, it reflects the deep level of pain and despair that they are suffering, and a lack of hope.

Key Points:

  • Talking to a guy about his darkest thoughts requires privacy and patience
  • Be as calm and composed as possible
  • Be empathetic and receptive to what he has to say. Sometimes a guy just needs to know that it’s OK to talk about things he is struggling with
  • Avoid being judgmental

TIPS AND EXAMPLES OF WHAT YOU CAN SAY

Ask About Suicide

With some men, a direct question is best; with others, a softer approach may be better. Start with what you feel comfortable asking and go from there.

 

What you can say:

  • “You seem especially down recently, how are you doing these days?”
  • “Do you sometimes wish that you could escape from life and be rid of all this?”
  • “Are you thinking about hurting yourself”
  • “Earlier, you said that you just want to escape from everything, so I’m wondering if you’ve been having suicidal thoughts?”
  • “Have you been thinking about suicide?”

If he tells you that he’s been thinking about suicide, it’s important to ask him directly if he has a plan for suicide, and if so, what his plan entails.

 

What you can say:

  • “Do you have a plan about how you want to end your life?”
  • “Since you’re having these thoughts, I’m wondering if you’ve thought of a way to end your life?”
  • “Can you tell me about your plan?”

Encourage Him to Be Honest

Encourage the guy to talk about what’s going on and to be honest.

 

What you can say:

  • “I want to support you, but it’s hard for me to do that if you don’t talk to me about things. I can support you best if you’re honest with me about how you’re doing. That way I know how I can help.”
  • “What type of thoughts have you been having?”
  • “Tell me about it – we’ve got time, I’m here to listen.”
  • “Lay it on me. I want you to be really open and honest about this.”

Offer Supportive Comments

Reassure him that, as painful as things may feel right now, depression is treatable. Let him know that you are there to help him through this.

 

What you can say:

  • “Just know that you aren’t alone and I’m here whenever you need me.”
  • “I know it’s hard to believe now, but many guys have gotten better from depression and thinking about ending their lives.”
  • “I know how strong you are. You can do this, and I’m not going anywhere, so we can do this together.”

ASK TO REMOVE MEANS

If you’re worried about a guy and he currently has a means for suicide in his home, express your concern to him and ask if you can remove or prevent access to these items by offering to keep them at your place, or getting him to put them somewhere that makes it harder for him to access (e.g., a safe or a roommate’s room).

By removing, reducing, preventing, or impeding his access to lethal means, we’re creating an inconvenient roadblock in his plan that may reduce his desire or capability to follow through.

Try to Help Limit Alcohol or Substance Use

When someone is having suicidal thoughts, they are in a tremendous amount of pain. He may turn to alcohol or other substances to numb his pain, but these substances can make depression worse and dangerously lower his ability to fight suicidal thoughts. As much as possible, try to limit his access to alcohol or other substances if he is struggling with thoughts of suicide.

Next Steps:

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