Talking about suicide and mental health issues

If you are hesitant about raising suicide or mental health concerns (due to fears of increasing the risk of suicide by talking about it, or of intruding, causing distress, or increasing stigma), evidence shows that:

• asking directly and respectfully about suicide does not increase risk. In fact, initiating a calm, non-judgmental, and empathetic conversation creates a safe space for patients to share their experiences, describe current stressors, and talk openly about suicidal thoughts³⁹
• the therapeutic relationship between the GP and patient is a significant protective factor in reducing suicidal ideation and self-harm. A GP’s ability to convey empathy, genuine concern, and openness to discussing emotional wellbeing can strongly influence a patient’s readiness to disclose distress.

Conversations can be introduced with clear, reassuring statements that normalise help-seeking, such as:

“Part of my role is to check in on how you’re really going. I’m concerned that things might be feeling harder for you at the moment. Would it be okay if we talked about that?

A comprehensive assessment explores multiple, interconnected risk factors, including:

• the presence and nature of suicidal thoughts
• the frequency, intensity, and intrusiveness of suicidal thoughts
• any history of suicidal behaviour or self-harm
• current plans, intent, and access to means
• the person’s overall mental state.

Understanding protective factors and supports early (such as support persons, relationships, reasons for living, coping strategies, and access to formal and informal supports), is equally important and provides a more balanced picture of risk and resilience.

When asking about a patient’s suicidal thoughts, your primary role is to create a safe, calm space where your patient feels heard and respected. It is less about saying the right thing and more about how you listen and respond.

The questions listed below will help you to understand your patient’s risk of suicide:

• Do you ever feel like giving up?
• How does your future seem to you?
• Does your life ever seem so bad that you wish to die?
• How often do you have these thoughts? How intense are they?
• Have you made any plans? If so, what have you been thinking about?
• How close have you come to doing something?
• What stops you from doing something?

When talking to a patient about stressors and suicidal ideation, the following techniques will help reinforce the therapeutic relationship.

• Use active listening. Remember that presence, posture, tone, and silence are just as important as words. To indicate that you are listening and understanding:
  • maintain eye contact
  • repeat back (or paraphrase) what they have said, without judgement
  • use non-verbal indications (eg nodding, maintaining an open posture) to confirm that you are listening
  • let them finish sentences and ideas.
• Validate their distress without trying to minimise the distress or change the patient), and acknowledge systemic trauma, stigma, and past experiences where relevant.
• Maintain the patient’s agency and remain collaborative throughout the conversation by inviting the patient to guide the conversation, asking questions, and exploring options together.
• Talk about mental health issues, mental illness and mental disorders as being separate to the person, instead of something that defines them.
• Avoid premature reassurance or a premature focus on recovery, as this can leave the patient feeling unheard, dismissed, rushed and invalidated
• Tell them that you will provide ongoing support, and share with them the next steps.
• Recognise that relapse or recurrence of suicidal thoughts can be part of a patient’s normal experience, and explain this to your patient.
• Acknowledge their courage in disclosing suicidal thoughts.

Attempting to normalise a person’s lived experience of distress (eg by saying “this happens to everyone”), can unintentionally minimise or universalise their distress, whereas validation acknowledges their experience as real, understandable, and worthy of care, without comparison or reassurance.

To put this into practice:

When a patient shares suicidal thoughts, respond with calm, attentive listening and clear validation, and remember to:

• acknowledge the courage it takes to speak openly
• avoid minimising their distress
• avoid rushing to solutions
• use supportive statements that reinforce presence and collaboration.

The focus should be on understanding the person’s experience and identifying next steps together, while maintaining their sense of agency. For example, you could say:

• ‘Thank you for trusting me with something this difficult.’
• ‘I want to be clear—I’m really glad you told me, and I’m here with you.’
• ‘These thoughts sound like they’ve been a way of coping with a lot of pain.’
• ‘You’re still the expert in your own life. My role is to support you and help look at options together.’
• ‘We don’t have to solve everything today. Let’s focus on what would feel most helpful right now.’

When talking to patients about mental health issues, the language that you use can have a significant impact on how the person thinks and feels about themselves. Therefore, always talk to and about a patient (if you have consent to liaise with other professionals and their family members) as an individual human being first and foremost, rather than defining them by their condition, illness or issue.

To put this into practice:

The large majority of people who experience mental health distress will develop ways to live meaningful and valued lives, even when symptoms recur or persist. Contemporary practice has moved away from focusing mental health care on “recovery” as an end point, to fostering hope by recognising mental health as dynamic and fluctuating, and supporting each person to define what wellbeing, safety, and quality of life mean for them.

Mental health professionals have an important role in sustaining hope by adopting a person-centred, strengths-based approach and recognising that supportive environments (such as health services, social systems, and relationships), shape outcomes over time. Rather than focusing solely on symptom resolution, you can support ongoing wellbeing by:

• recognising and affirming the person’s strengths, values, interests, and capacities
• working in genuine partnership, with respect for the person’s autonomy and lived experience
• supporting each individual to identify their own goals, priorities, and indicators of progress
• conveying a consistent belief in the person’s capacity to adapt, cope, and find meaning over time.

In this context, improvement does not necessarily mean the absence of distress or a return to previous levels of functioning. Many people reach a point where they can integrate their experiences of mental health into a broader sense of self, without being defined by them. Hope is supported through a focus on connection, purpose, agency, and dignity, alongside practical strategies that enhance safety, stability, and participation in life.

Is your patient struggling to see past their mental illness/issue/condition and thoughts of suicide?

Consider using comments such as the ones listed below to help them understand the nature of their condition and how you can support them.

• ‘What you’re experiencing feels overwhelming right now, and we can take this one step at a time together.’
• ‘This won’t always feel exactly as it does today, even if it’s hard to imagine that right now.’
• ‘You’ve found ways to cope with very difficult situations before, even it if doesn’t feel clear what might help this time.’
• ‘You’ve shown strength and persistence in getting through other challenges, and we can build on that together.’
• ‘It’s not uncommon for people to experience thoughts like these when things feel unbearable, and support can help ease the weight over time.’
• ‘You’re not alone in this – I’m here with you, and we can look at options together.’
• ‘This distress is part of what’s happening for you right now, but it doesn’t define who you are.’
• ‘There’s more to you than the pain you’re carrying – your values, relationships, and strengths still matter.’