12/23/2025
The holidays are not a joyous time for everyone, please educate yourself on self-harming behavior. Suicidal symptoms, no the signs. Determine if and how often the loved one is having suicidal thoughts. Ask the loved one: “In the past few weeks, have you been thinking of self-harming behavior?” Depression: “In the past few weeks, have you felt so sad or depressed that it makes it hard to do the things you would like?” Ask about killing yourself? If yes, ask: “How often?” (once or twice a week, daily, several times a day, a couple of times a week, etc.) “When was the last time you had these thoughts?” “Are you having thoughts of killing yourself right now?” (If “yes,” the loved one requires an urgent/STAT mental health evaluation and cannot be left alone. A positive response indicates imminent risk.) Anxiety: “In the past few weeks, have you felt so worried that it makes it hard to do the things you would like to do or that you feel constantly agitated/on edge?” Impulsivity/Recklessness: “Do you often act without thinking?” Hopelessness: “In the past few weeks, have you felt a lack of motivation, helplessness, hopeless that life will improve?” Su***de plan: Assess if the loved one has a su***de plan, regardless of how they responded to any other questions (ask about method and access to means). Ask the loved one: “Do you have a plan to kill yourself? Please describe.” If no plan, ask: “If you were going to kill yourself, how would you do it?” Isolation: “Have you been keeping yourself more than usual?” Irritability: “In the past few weeks, have you been feeling more irritable or grouchier than usual?” Substance and alcohol use: “In the past few weeks, have you used drugs or alcohol?” If yes, ask: “What? How much?” Note: If the loved one has a very detailed plan, this is more concerning than if they haven’t thought it through in great detail. If the plan is feasible (e.g., if they are planning to use pills and have access to pills), this is a reason for greater concern and removing or securing dangerous items (medications, guns, ropes, etc.). Other concerns: “Recently, have there been any concerning changes in how you are thinking or feeling?” Past behavior (Strongest predictor of future attempts): Evaluate past self-injury and history of su***de attempts (method, estimated date, intent). Ask the patient: “Have you ever tried to hurt yourself?” “Have you ever tried to kill yourself?” If yes, ask: “How? When? Why?” and assess intent: “Did you think [method] would kill you?” “Did you want to die?” Ask: “Did you receive medical/psychiatric treatment?” Support & Safety: Support network: “Is there a trusted person you can talk to? Who? Have you ever seen a therapist/counselor?” If yes, ask: “When and for what purpose?” Safety question: “Do you think you need help to keep yourself safe?” (A “no” response does not indicate that the loved one is safe, but a “yes” is a reason to act immediately to ensure safety.) Reasons for living: “What are some of the reasons you would NOT kill yourself?”