If you are in the U.S. and need support, call or text 988 for the Suicide and Crisis Lifeline. If you believe someone is in immediate danger or experiencing a medical emergency, call 911.

Suicidal thoughts can feel like the loneliest place on earth. Not because you are actually alone, but because it feels like no one could possibly understand, and you do not want to burden the people you love.

That is exactly why this podcast episode matters.

In this conversation, host Terry Maguire sits down with Sara Kohlbeck, PhD, MPH, a public health researcher specializing in suicide, to talk about what most of us were never taught— how suicidal thoughts can show up on a spectrum, how to ask the question without making it worse, and what to do if the answer is “yes”.

If you have ever worried about someone, wondered what words to use, or quietly recognized parts of yourself in this topic, this episode offers a calm, human, practical guide for a scary moment.

1. What do I say to someone who is suicidal?

Ask the real question, then listen like it matters, because it does.

One of the biggest takeaways from Sara is surprisingly simple, if you have that gut feeling, ask directly. No euphemisms. Not “You are not thinking of doing anything stupid, are you?” Direct language creates clarity and safety.

Instead, try: “Are you thinking about killing yourself?” or “Are you thinking about suicide?” Those words can feel intimidating, but Sara emphasizes that being specific matters, because “hurting yourself” can mean many things, and someone may answer “no” even while feeling suicidal.

Then comes the part most people rush past, the pause.

If someone says “yes”, start with validation and gratitude: “Thank you for telling me. I’m really glad you told me.” Sara points out that for many people, being heard is not a small thing. As Dr. Sara Kohlbeck adds from her own interviews with attempt survivors, what people often needed most was to feel less alone, less like a burden, and like their pain was real and worth sitting with.

You do not need perfect words. One of Sara’s favorite lines from a colleague is basically this: an imperfect intervention is better than no intervention. Even a simple, human opener like, “What’s going on, dude?” can interrupt isolation and open a door back to connection.

What if they get angry or defensive when I ask?

Sometimes the conversation does not unfold in neat steps. Because stigma is real, someone might get defensive or mad. Sara’s advice is to avoid escalating the moment. Instead, acknowledge it and leave a clear path back.

You can say: “It sounds like you don’t want to talk about this right now, that’s okay. I’m here if you do.” That single sentence communicates care without pressure.

If it makes sense, add a gentle follow up: “I’ll check in later.” Not to interrogate, but to remind them they are not disappearing from your world.

Are there things we should never say?

When someone is in that tunnel, “fix it” energy can land as dismissive. Sara specifically warns against advice like “try yoga” or “try meditation.” Your goal is not to optimize their wellness routine in a crisis, your goal is to help them feel safe and supported in the moment.

Avoid judgment statements like “How could you be so selfish?”. Sara reframes this powerfully: many suicidal people do not feel selfish, they feel like a burden, and may believe removing themselves would help others.

Also avoid minimizing, even if the trigger seems “small” to you. If they are in pain, the pain is real. Validation sounds like, “That sounds incredibly hard.”

See: Helping Someone Who is Suicidal

2. Does asking someone about suicide put the idea in their head?

No, asking does not plant the thought, however it can decrease the danger by reducing secrecy.

This is one of the most common fears, and it stops people from speaking up. Sara is clear, research shows asking about suicide does not increase risk.

If the person is already thinking about suicide, you have given them permission to say what they have been holding alone. You have shown them you are a safe person for an unsafe feeling.

And if they are not thinking about suicide, the question still matters. You have communicated something quietly powerful: “If life ever gets that dark, you can tell me.”

The real risk is the silence. When people feel they cannot talk about suicidal thoughts, they can start to believe those thoughts are shameful, dangerous to share, or proof they are broken. Sara’s central theme is the opposite: suicidal thoughts are not uncommon, and we can talk about them, because talking about them is part of prevention.

3. What do I do if I ask someone if they’re suicidal and they say “yes”?

Slow down, thank them, then figure out where they are on the spectrum.

A key concept in this episode is that suicidal thoughts are not a simple “yes” or “no”. One helpful image they discuss is a “thermometer” of suicidality, ranging from passing thoughts, to passive wishes, to planning and intent, to attempt.

That spectrum matters because the right response depends on where someone is.

Start with the human basics: “That must have been hard to share. Thank you for trusting me.” Then, listen. Sara encourages people not to treat the next step like a scripted checklist.

Instead of immediately jumping to “Do you have a plan?”, create space for the story — when did this start, what has it been like, and what feels unbearable right now?

Then, with care, you can ask questions that help you understand urgency, like whether they have been thinking about ways to harm themselves or feel at risk of acting soon.

If you believe there is immediate danger or a medical emergency, call 911.

If there is not immediate physical danger, Sara recommends options that can be less threatening and more supportive, like calling or texting 988, or contacting a county mobile crisis team if available. She also notes that some people fear calling for help because they worry police will show up. She shares that in Wisconsin, the vast majority of 988 calls do not involve law enforcement, they are primarily supportive conversations and connection to resources.

Another surprisingly helpful question is: “What can we do to keep you safe for now?” Not forever. Not next month. Just now. When tomorrow feels impossible, “right now” is a reachable target.

See: Creating a Safety Plan

4. Why do I feel like I want to die if I’m not sad?

Suicidal thoughts aren’t always sadness— sometimes they’re anxiety, anger, numbness, or pure overwhelm.

A lot of people assume suicide is always about sadness. Sara pushes back on that box. Yes, sadness can be part of it, but for many people it is extreme anxiety, anger, or the feeling of being crushed by pressures with no way out.

They also talk about numbness, the “I don’t feel anything” state. And in some ways, numbness can be harder for other people to notice. Someone who is crying might draw concern. Someone who is flat, quiet, and going through the motions might just look tired.

This section of the conversation is a reminder to widen the lens. If you are thinking, “I’m not sad, so why am I having these thoughts?” you are not broken. You are having a human response to pain, stress, fear, or disconnection, and it deserves support.

If you recognize yourself here, Sara’s core message is simple and steady: you are not alone, you are not a burden, and the feeling can pass. You do not have to wait until it becomes an emergency to reach out. 988 is there for crisis support, and many communities also have warm lines and peer support options where the goal is simply to talk and feel less alone.

See: How to Stop Suicidal Thoughts

5. Can you be high functioning and suicidal, and how would anyone know?

Yes, people can look “fine” and still be in the tunnel.

One of the most eye opening parts of this episode is how clearly Sara describes “high functioning” suicidality. She shares her own lived experience: she kept going to work, kept parenting, kept showing up on the outside, while on the inside she was barely holding it together.

At the end of the day, she describes sinking into the couch, physically withdrawing, like her body was trying to disappear.

That disconnect is why stereotypes are dangerous. Suicidal thoughts do not always look like chaos. Sometimes they look like productivity, caretaking, and a smile that disappears the moment the door closes.

So what can you look for?

Sara mentions signs that can sometimes show up from the outside: increased substance use, hopelessness, anxiety, anger, impulsive behavior that is out of character. But, she also emphasizes that many people actively hide their distress because they do not want to be a burden.

That is why the most reliable tool is not mind reading, it is connection. Ask questions. Notice shifts. Trust the “something feels off” instinct.

How do I tell someone I’m struggling, especially if they don’t believe in therapy?

Sara acknowledges how hard it can be to tell a parent or partner you are thinking about ending your life. She recommends asking to talk privately, and being as direct as you can, because indirect hints might not land.

If your family does not “believe in mental health,” Sara suggests taking suicide out of that mental health box. Talk about the pressures and pain you are experiencing, the tunnel feeling, the overwhelm, the lack of a way out. Those experiences are real, even if someone does not have the language for therapy.

And if the person you told does not respond well, that is not the end of the road. Sara recommends a backup plan, such as reaching out to a friend, teacher, coach, pastor, colleague, neighbor, or calling 988. The most important thing is that you keep reaching until you find someone who can hold space with you.

6. What Are the Warning Signs of Suicide in Teens?

Reckless behavior can be a major red flag.

Teenagers experience many of the same suicide warning signs as adults, but there is one key difference. According to Kohlbeck, young people often show more impulsive behavior when they are struggling.

That can include reckless driving, risky sexual behavior, or taking dangerous substances without concern for the consequences. These behaviors may signal that a teen is struggling emotionally and acting without regard for their own safety.

Parents, teachers, and caregivers should pay close attention to these kinds of shifts. Sudden impulsive choices that seem out of character can be a warning sign that something deeper is happening.

Look for changes in behavior, not just mood

Teenagers are often labeled as “moody,” which can make it hard to tell when something is actually wrong. Kohlbeck suggests focusing less on labels and more on changes in behavior.

For example, if a teen who once loved sports suddenly withdraws from activities, isolates from friends, or begins using substances, those changes matter. As McGuire points out in the conversation, it is easier to notice when someone is acting differently than to diagnose psychological distress.

Recognizing these changes early can open the door to important conversations.

See: Teen Depression: 5 Ways to Recognize the Signs and Support and Support Your Child’s Mental Health

What are “invitations” when someone is struggling?

Kohlbeck introduces an interesting concept from suicide prevention training called “invitations.”

An invitation is a signal that someone may be opening the door to a deeper conversation. It might sound like:

• “I don’t see a way out of this.”
• “Everything feels like too much.”

It could also appear through actions like giving away possessions or increasing alcohol use.

These invitations do not mean someone is definitely suicidal. But they are cues that someone might need support and that it may be time to check in.

7. What Is Passive Suicidal Ideation?

Not all suicidal thoughts mean someone plans to die.

Passive suicidal ideation refers to thoughts about death or wishing life would end without actively planning suicide.

Kohlbeck explains that passive thoughts can sound like:

• “I wish I could go to sleep and never wake up.”
• “I can’t do this anymore.”

These thoughts do not include a plan or immediate intent. However, they still matter and should not be dismissed.

Understanding passive suicidal ideation helps people recognize that suicidal thinking exists on a spectrum and that support can be helpful long before a crisis occurs.

For some people, the thought itself feels like a safety valve

One of the more surprising insights in the episode is that passive thoughts can sometimes function as a kind of emotional release.

Some therapists and people with lived experience describe it as knowing an “option” exists, even if they do not intend to act on it. For certain individuals, simply acknowledging that thought can reduce the feeling of being trapped.

While this may seem counterintuitive, it highlights how complex suicidal thinking can be. What matters most is having space to talk about these thoughts openly and without shame.

What life events can increase suicide risk?

There is rarely a single cause behind suicidal thoughts. Instead, multiple life stressors often combine.

Kohlbeck highlights several situations associated with increased risk:

• Loss of a relationship
• Job loss or financial stress
• Death of a loved one
• Loss of identity or independence

She also points to something often overlooked in suicide prevention conversations, lack of access to basic needs.

If someone lacks stable housing, food, safety, or healthcare, it becomes much harder to maintain mental wellness.

See: Suicidal Thoughts and Depression: 12 Reasons You Must Tell Someone

8. Is Suicide Selfish?

From the inside, it often feels like the opposite.

One of the most powerful moments in the conversation comes when Kohlbeck addresses a common myth.

She explains that from the perspective of someone who is suicidal, suicide often feels like the opposite of selfishness.

Many people experiencing suicidal thoughts believe they are a burden to others. Researchers call this belief perceived burdensomeness, and it is a major factor linked to suicidal thinking.

In that state of mind, someone may believe that removing themselves will make life easier for the people they care about.

But, that belief is a distortion.

McGuire notes that this thinking is distorted, even though it feels real to the person experiencing it.

Kohlbeck agrees. Our brains can lie to us when we are in intense emotional pain. Someone who believes they are a burden is often deeply loved and valued, but their perspective has narrowed to the point where they cannot see it.

That is why connection matters so much.

As Kohlbeck puts it, “The antidote to pain is connection”.

Are people who talk about suicide just seeking attention?

Another common misconception is that someone mentioning suicide is only trying to get attention.

Kohlbeck pushes back strongly against this idea.

If someone is talking about suicide, it almost always means something painful is happening in their life. Even if suicide is not the ultimate outcome, the person is communicating distress.

Instead of dismissing the statement, it is better to view it as an invitation to ask questions and offer support.

9. How Long Does a Suicidal Crisis Last?

Some suicidal crises are surprisingly short.

One of the most important insights from suicide research is that a suicidal crisis can last only minutes.

Kohlbeck explains that during these moments of intense distress, the goal is not to solve every problem in someone’s life. The goal is to keep them safe right now.

She summarizes it with a simple but powerful question:

“What do we need to do to keep this person safe for now?”

Limiting access to lethal means can save lives

One evidence-based strategy in suicide prevention is reducing access to lethal means.

That might include locking up firearms, securing medications, or removing dangerous substances from the environment.

Even creating small barriers between a person and a harmful action can make a life-saving difference. Those barriers create time, and time allows the crisis to pass or for someone to intervene.

Research also shows that people usually do not simply substitute another method if one option is unavailable. This is known as means substitution, and it occurs far less often than many people assume.

What should happen after the crisis passes?

After a suicidal crisis de-escalates, support and follow-up are essential.

Kohlbeck recommends developing a safety plan, which outlines steps a person can take if they begin to struggle again.

A safety plan may include:

• Warning signs that a crisis is starting
• People to contact for support
• Reasons for living
• Coping strategies that help in difficult moments

Checking in regularly after a crisis can also help ensure someone continues to feel supported.

10. What Happens If You Go to the ER for Suicidal Thoughts?

Emergency rooms focus on safety first.

If someone goes to the emergency room for suicidal thoughts, the first step is typically a medical evaluation. Doctors want to rule out any immediate physical dangers, such as heart problems or medication complications.

After that, a mental health professional such as a psychiatrist or social worker may assess the situation and discuss next steps.

Sometimes treatment may involve medication, counseling, or connecting the person with outpatient support.

The goal is help, not punishment.

Many people fear they will be restrained or hospitalized immediately if they admit they are suicidal.

Kohlbeck acknowledges that these fears exist, but explains that in most cases the goal is to provide support and determine the safest plan for the individual.

Hospitalization is usually considered a last resort when someone is at immediate risk.

Will telling a therapist about suicidal thoughts lead to hospitalization?

Many people hesitate to talk openly with therapists because they fear being involuntarily hospitalized.

Kohlbeck emphasizes that therapists generally want to support recovery and avoid hospitalization whenever possible. Being honest about suicidal thoughts allows professionals to provide the appropriate care and support before a crisis escalates.

Avoiding the conversation can sometimes make things worse.

The Biggest Lesson About Suicide Prevention

The most powerful takeaway from this episode is that suicide prevention is a community effort.

Kohlbeck encourages everyone to ask themselves a simple question:

What can I do to create a community where people feel safe talking about suicidal thoughts?

That might mean checking in with a friend, learning the warning signs, or simply being willing to listen without judgment.

Because when people feel seen, supported, and connected, hope becomes easier to find.

And sometimes that connection can make all the difference.

If you or someone you know is struggling with suicidal thoughts, support is available. In the United States and the UK, you can call or text 988, the Suicide and Crisis Lifeline, for free and confidential support 24 hours a day.