Crisis Interventions for Suicidal Ideation: A Family and Consumer Guide
Phyllis M. Connolly PhD, RN, CS
8/9/95, Revised 1/97

Suicidal ideation and gestures are frequently outcomes of mental disorders. Various factors
which are involved in mental disorders increase the risk (potential) of suicidal ideation (thoughts)
and gestures (acts). Hallucinations, delusions, recent stressors, increased feelings of
hopelessness, and severe depression increase the likelihood that a person will have suicidal
thoughts and often act on those thoughts. The use of alcohol and/or illegal drugs are found in the
majority of completed suicides. At least 70% of persons who commit suicide give some clue
before making an attempt.
Having a positive supportive and helpful relationship with a mental health
provider may reduce the risk of suicide.
Case finding, seeing clients more often, and relationship maintenance may decrease the incidence
of completed suicides. Educating families and consumers regarding the potential for suicide and
having a plan to intervene may prevent successful suicides. Positive outcomes (i.e. prevention of
suicide) has been the result of the author’s professional experience in educating families and
consumers in the area of suicide prevention. The following guidelines provide families with the
“how to” during a suspected suicidal ideation episode.
YOU SHOULD HAVE AN EMERGENCY PLAN FOR HANDLING A SUICIDE
GESTURE OR IDEATION, JUST AS YOU HAVE FOR HANDLING A HEART
ATTACK VICTIM OR ANY OTHER MEDICAL EMERGENCY (e.g. INSULIN
REACTION OR SEIZURE).
STEP 1: Check out your concerns regarding the persons suicidal thought.
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THOUGHTS (Ideation)
Validate your concerns regarding the person’s suicidal thoughts. It's OK to ask someone if
they are thinking about suicide.
 Example: "Are you thinking about hurting yourself?"
 If the person responds "yes," stay CALM
You may need to take a deep breath. You need to say to yourself, this person is probably
very frightened. They need someone to tell them that they will be safe and that they are not
alone.
Crisis Intervention: Family and Consumer Guidelines: Suicidal Ideation 2
Phyllis M. Connolly PhD, RN, CS

If possible, ask the person what their thoughts are like (you want to know if they are hearing
voices which may be giving them commands to kill themselves).
 If "yes," get the person to the suicide crisis center or emergency
psychiatric services immediately.
STEP 2: If there are no voices, ask for details about how they expect to kill (hurt) themselves.
This helps establish if there is a plan.

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What exactly do they intend to do?
 For example, do they intend to use a gun (firearms account for 60% of all suicides
across all ages).
Does the person have access to a gun or medications, whatever the method?
How specific is the person’s plan?
 Do they intend to use the method today or is the plan to use the method only if a
social security check does not arrive by Friday, and today is Monday?
If the person’s plan is lethal, concrete, specific, and available, get the person to the suicide
crisis center or emergency psychiatric services.
STEP 3: If the person has no plan or if it is not specific, available, or immediate, then proceed
with the following questions about medications.

Ask about what medications and the dosage which may have been taken in the last 24
hours. This will help determine if the suicidal ideation (thoughts) might be related to a drop
in the therapeutic level of a prescribed medications or possibly to an interaction between a
prescribed medication and an over the counter medication.
STEP 4: The person should be seen by a mental health professional as soon as possible. If
possible, the person should be seen by their primary therapist. If not, call the SUICIDE &
CRISIS HELP LINE 408-279-3312 (in Santa Clara County, CA) or your local CRISIS
HELP LINE.
As in any other EMERGENCY, someone should stay with the person at all times. Generally, the
person is experiencing very strong feelings of abandonment, loneliness, guilt, and hopelessness.
Crisis Intervention: Family and Consumer Guidelines: Suicidal Ideation 3
Phyllis M. Connolly PhD, RN, CS
ASSESSMENT AT THE CRISIS CENTER
PRIMARY THERAPIST
Hospitalization

Depending on the outcome of the assessment of the crisis staff or therapist the person may
need a brief hospitalization. The person may be placed on a 5150 (72 hour hold) (California)
if they are assessed to be a grave danger to themselves or others. In some situations, the
person may voluntarily admit themselves to an inpatient unit.
In Home Support

Depending on the person's suicide risk and the community resources available, they may be
sent home. If the person is not hospitalized they should not be left alone.
Someone needs to be available at all times. The person most likely will be asked to agree to
let their support person and therapist know if the suicidal thoughts are increasing or if they
feel that they cannot control a suicidal gesture.
Establishing a Support System

Friends, church members, family members, and roommates can often be enlisted to provide a
supportive environment.
Medications

Medications may be prescribed to control the suicidal thoughts. Most likely only small
amounts will be dispensed so the person does not have access to use extra medications in an
overdose attempt. This may not even be an intentional overdose; frequently, people are
confused and disoriented and actually forget how much medication they took or if they took
their medications at all.
Identifying Precipitating Factors

It's important once the person is safe and secure to attempt to find out if there were recent
stressors such as changes, losses, or anticipated losses that could be related to the increase in
suicidal ideation/gestures. The mental health professional will assess additional factors such
as an impending relapse, an increase in depression, nutritional imbalances, medications,
physiological changes, or medical conditions.
Adaptive Problem Solving

Frequently persons who express suicidal ideation and/or gestures have reduced basic problem
solving skills. It's imperative to assist the person with basic problem solving. This begins
with the basics: Where are they living? Do they have food and basic survival needs? What
has worked in the past for this person? The person may need support and direction with
handling activities of daily living. Family can be instrumental and provide a basic critical
component in reestablishing the person's equilibrium.
Crisis Intervention: Family and Consumer Guidelines: Suicidal Ideation 4
Phyllis M. Connolly PhD, RN, CS
Competency and Efficacy
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Facilitate the person's sense of competency and efficacy
Set short term goals which can be met
 Example: establish a verbal or written contract that the person will not act on the
suicidal thoughts for 24 hours
Encourage and give positive feedback for meeting that goal
Family and support persons are critical in identifying and giving the person positive
reinforcement for those actions which the person is able to do. This may mean praising the
person for seeking help, accepting the help, and agreeing to stay with family for support.
Facilitate Feelings of Hope
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Provide a supportive climate
Facilitate hopeful perception
Help the person to restructure the situation
Assist the person in making plans
Assist the person in taking action, and establishing goals for living


Get the person to the nearest hospital emergency department.
Follow your emergency plan, call 911.
SUICIDE GESTURES(Acts)
If at all possible stay with the person at all times, unless somehow you have been
targeted as the person who may have failed to meet the suicidal person's
expectations or needs. This may be an actual or a distorted perception of the
suicidal person.
Treatment from this point will depend on the nature and seriousness of the suicide gesture. The
person will need tremendous support. If the person has actually been unsuccessful in their
attempt to end their life, their depression, hopelessness, and possibly anger may be very intense.
STAY CALM. GET SUPPORT AND COUNSELING FOR YOURSELF AFTER THE
PERSON HAS BEEN STABILIZED.
YOU CAN GET SUPPORT FROM AN ALLIANCE FOR THE MENTALLY ILL (AMI)
CARING/SHARING MEETING OR YOUR OWN COUNSELOR. 800-950-6264
Crisis Intervention: Family and Consumer Guidelines: Suicidal Ideation 5
Phyllis M. Connolly PhD, RN, CS
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