My best friend has depression and was put on suicide watch. I'm trying my absolute best to be there for him and help him through this issue. It just seems that I don't feel like I'm helping. Any thoughts for me?

This is a challenging situation for anyonefriends, families, and mental health professionals. But there are some things that are generally helpful.

First, don’t be afraid to talk about suicidal thoughts and feelings.We often avoid talking about frightening or disturbing things like suicide, but avoiding them doesn’t make them go away—and sometimes makes them more dangerous. It is a myth that talking about suicidal thoughts will prompt suicide or increase the risk.  It is important to send a clear message that, “I want to know if and when you are in danger, and I’ll do my best to help.”

Second, make the environment as safe as you can. While suicidal thoughts can be persistent, acting on those thoughts is often impulsive. People are more likely to act on those impulses if the tools or means (like pills or firearms) are easy to find. Of course, we cannot eliminate all dangerous things from the environment, but we can certainly create speed bumps to increase the time and space between impulse and action. So you can ask your friend if they think about specific means of self-harm—such as pills, firearms, or knives. Ask if they will agree to move those dangerous things out of their home—at least until this crisis passes.

Third, encourage your friend to get treatment that works. Treatment of specific mental health conditions, like depression or anxiety, can reduce the pain that often lies behind suicidal thoughts. We now know that specific counseling or therapy approaches can help people cope with suicidal thoughts, and thus reduce the risk of suicide attempts. Those counseling approaches emphasize specific skills to cope with intense emotions and crisis situations.

Fourth, try to empathize with your friend’s suicidal thoughts—but still politely disagree with them. All feelings are “true,” but not all predictions about the future are true. So you can say things like, “I know you feel that things will never improve, and that is very painful. But I don’t agree with your prediction about the future. I’ve seen you pass through really bad times before, and I believe things will improve.” Or, “I know you feel like you are a burden to everyone, but I don’t think you are a burden to me.”

About the Doc

About the Doc

Greg Simon, MD, MPH, is a psychiatrist and researcher at  Kaiser Permanente Washington Health Research Institute in Seattle. His research focuses on improving the quality and availability of mental health services for people living with mood disorders, and he has a specific interest in activating consumers to expect and demand more effective mental health care.