“Are you okay?” is a question many of us ask almost automatically when someone seems quieter than usual, withdrawn or simply not themselves. And just as automatically, the answer is often, “Yes, I’m fine.”
Sometimes this is true. However, for someone experiencing significant emotional distress or thoughts of suicide, saying what is really going on for them is often incredibly difficult. They may be afraid of worrying people, ashamed of how they are feeling or uncertain about how someone will respond. They may believe they are a burden, or they may not even have the words to describe what is happening.
This can leave those of us around them in a difficult position. We may feel that something is wrong without knowing what it is. We might worry that asking more questions will feel intrusive, make things worse or push someone further away. So we accept “I’m fine”, even when something tells us the person might not be.
There is no perfect question that will suddenly make someone feel able to talk, and no conversation comes with a guarantee, but we can hold space when we notice something has changed, ask a little more often when we are concerned, and make it ok for someone to give an honest answer.
Normalising conversations about suicide is important and should not only be broached by mental health professionals. They should happen between partners at the kitchen table, between friends, within families, at work and in communities, and knowing how to begin those conversations, and what to do when someone tells us they are struggling, gives more of us the confidence to respond when things are tough. And that means going beyond, “Are you okay?” and accepting a “Yes, I’m fine” when we believe it’s not.
Suicide Does Not Always Look the Way We Expect
There is no single signpost that alerts us to what a person experiencing suicidal thoughts looks like, and outward appearances can tell us very little about the level of distress someone may be experiencing. A person may continue going to work, meeting up with friends, caring for their children, laughing and participating in everyday life while privately struggling with thoughts and feelings everyone around them knows nothing about.
However, changes in behaviour or circumstances may indicate someone is struggling and needs our attention. These can include:
- Becoming increasingly withdrawn or isolated
- Changes in sleep or behaviour
- Increased use of alcohol or drugs
- Expressions of hopelessness or feeling trapped
- Talking about being a burden to others
- Giving away possessions
- Saying goodbye to people in a way that feels out of character
These signs can give us pause, but it can be equally important to consider what has changed for that person, especially when several changes occur together or represent a noticeable departure from their usual behaviour.
Someone who normally calls every week may stop answering their phone, while a colleague who is usually engaged may gradually withdraw from those around them. A person who rarely drinks may begin drinking heavily, or a friend may start making comments that suggest they believe other people’s lives would be easier without them. None of these changes, in isolation, tells us that somebody is suicidal, but they can alert us to a potential problem and provide a reason for us to reach out first rather than waiting for them to ask for help.
The purpose is not for us to interpret every behavioural change as evidence of suicidal thinking, but to become more attentive to the people around us and more willing to respond when something feels significantly different. We may not know exactly what somebody is experiencing, but noticing that change can start a conversation that gives them an opportunity to tell us.
Going Beyond “Are You Okay?”
This question can be answered almost automatically, especially when the person isn’t ready to talk or doesn’t know how to explain what they are feeling. So, rather than simply asking whether someone is okay, we can acknowledge that they haven’t seemed like themselves recently, ask how they’re really doing, or mention that they’ve become more withdrawn and ask what’s been happening for them.
The purpose is not to interrogate, make assumptions, or pressure them into disclosing more than they are ready to. It’s about letting them know we have noticed something is off, and we are here and ready to listen. If there is genuine concern, the conversation may need to become more direct. Asking, “Are you thinking about suicide?” can understandably feel daunting, particularly when there is a fear that raising the subject might introduce the idea or somehow increase the likelihood that the person will act on it. However, research has not found evidence that asking about suicidal thoughts increases suicidal ideation or behaviour, and asking directly can provide an opportunity for someone to openly acknowledge thoughts they may have been afraid to disclose.
If the answer is yes, it can be frightening to hear, and our instinct may be to reassure them, tell them why they shouldn’t feel that way or immediately start looking for solutions. However, reassurances such as telling someone things are not as bad as they seem, reminding them what they have to be grateful for, or insisting things will get better can unintentionally minimise the distress they are trying to communicate. Instead, we can give them the opportunity to talk, listen carefully, and take what they are telling us seriously.
Their immediate safety is the priority, and what happens next will be shaped by the level of risk and the support they already have around them. We may be able to help them contact someone they trust or access appropriate professional support, without taking responsibility for managing the situation ourselves. However, if there appears to be an immediate danger to life, we should stay with the person if it is safe to do so and seek urgent emergency assistance.
Suicide Prevention Is Everyone’s Business
Suicide prevention is sometimes spoken about as though the discussion belongs exclusively with mental health professionals, but the environments in which we live and work can also influence whether someone feels able to say, “I’m not okay” and know that people will listen. As families and friends, we can make difficult conversations possible and notice when someone begins to withdraw; within workplaces, we can create cultures where mental health difficulties can be discussed without fear or judgement; and within our communities, we can continue to challenge the stigma surrounding suicide and mental illness.
None of this means we have to become somebody’s therapist; it just requires us to be more observant, ask questions when we are concerned, listen without making assumptions and help someone connect with appropriate support when they need it.
Suicide is complex, and there is rarely one cause, one missed conversation or one person who should have known what to do, and someone experiencing suicidal thoughts may not show recognisable signs and may conceal the extent of their distress even from those closest to them.
We can ask questions, offer support and seek professional help, and still not be able to control what ultimately happens, which is why suicide prevention must become everyone’s business and include accessible healthcare for everyone, effective crisis services, appropriate treatment and wider systems that can respond when someone needs help. Additionally, while compassion is essential for those experiencing suicidal thoughts, it must also extend to the families, friends and communities affected, without placing responsibility or blame where it does not belong.
It’s Ok to Keep Asking
Being available and continuing to make space for open conversations can remind someone they don’t have to try to cope with what they are experiencing alone. If someone tells us they are thinking about suicide, we can encourage them to seek professional help by contacting their GP, an existing mental health professional, NHS urgent mental health services or a crisis support organisation, and if they appear to be in immediate danger or have attempted suicide, we should call 999 or go to the nearest A&E department.
In England, anyone experiencing a mental health crisis can call NHS 111 and select the mental health option for urgent support. Samaritans are also available 24 hours a day on 116 123, free from any phone in the UK and Ireland or via their website.
“Are you okay?” will always have its place, but sometimes we need to go a little further, and if the reply is difficult, we do not need to have all the answers ourselves. We just need to be willing to listen, take what we hear seriously and help someone find the support they need.
