Suicidal thoughts and suicidal crisis: getting help in the UK

NHS inform says that suicidal thoughts can happen to any of us, at any time. They are often noticed after a traumatic or stressful event, but sometimes there is no obvious trigger. The Royal College of Psychiatrists says the thoughts and feelings can last for several days or weeks, or can come and go, even several times in one day, and that they are not your fault.

People describe them in different ways. The college lists examples such as not being able to cope with the pain, not seeing any solutions, wishing to disappear, or not wanting to die but needing the things that are happening to stop. Some people are also frightened of dying at the same time. How it feels is unique to each person, and being unsure is fine.

A suicidal crisis is the point at which the thoughts become intense or there is a risk of acting on them, so that immediate safety and urgent assessment are needed. It is a medical situation, not a character flaw, and it can happen with or without a known mental health condition.

The NHS and NHS inform give a clear order of response. Call 999 or go to A&E if you have taken an overdose, have seriously harmed yourself, feel you cannot keep yourself or someone else safe, or someone's life is at risk. Call 111 and choose the mental health option if you are feeling suicidal or in a state of despair, and 111 will tell you the right place to get help. You may be able to speak to a trained mental health professional by phone. If you have a mental health team or crisis team, contact them directly.

Other options listed by the NHS include asking for an emergency GP appointment, using free listening services such as Samaritans, and, for under-19s, Childline. NHS inform adds the Campaign Against Living Miserably (CALM) for men, Switchboard for LGBT+ people and, in Scotland, Breathing Space. The NHS also lists the text service Shout, open at all hours.

If you go to A&E, the NHS says staff should treat you with respect, look after immediate physical and mental health needs and refer you to a liaison psychiatry service or a local crisis resolution and home treatment team. The team in charge of your care will assess you, and care usually involves support at home.

The NHS and NHS inform offer short, practical suggestions for coping right now: focus on getting through today, stay away from drugs and alcohol, get yourself to a safe place such as a friend's house, and be around other people. The NHS adds doing something you usually enjoy, such as spending time with a pet.

The Royal College of Psychiatrists adds that if you might be in danger of harming yourself you can remove items you could use, including medicines, or ask someone to remove them, and move to a safer place. It suggests simple grounding steps such as counting exercises, calming breathing, a warm shower or bath, or contacting someone you feel comfortable with. It also suggests limiting time on a phone if you have been seeing upsetting content.

The Royal College of Psychiatrists says there are many reasons, often linked to feeling unable to cope with an overwhelming situation. Difficult current events include bereavement, relationship breakdown, bullying, discrimination, domestic abuse, losing a job, financial worries or debt, housing instability and being diagnosed with a physical illness. Things that happened in the past can also be involved, as can a mental health condition. Not everyone with a mental health condition has suicidal thoughts, but some do.

Alcohol and drugs can play a part. The college notes that alcohol can act as a depressant and lower mood, and that drugs can negatively affect mental health, which is why a GP will ask about substance use and why honesty helps.

The Royal College of Psychiatrists says that no matter how bad suicidal thoughts are, or how long they have lasted, it is important to get support from a healthcare professional, and that the best time to seek help is before things reach crisis. A GP should explore how you are feeling and what is going on in your life, and look for contributing factors such as a mental health condition or substance use. If you have not been diagnosed, a GP may ask you to complete a screening questionnaire to check for a condition that could be contributing.

Treatment depends on what lies behind the thoughts, for example support and treatment for depression or another mental health condition, help with alcohol or drugs, and practical support with housing or money. The NHS says it may help to make a safety plan to use if you need it, and points to the Staying Safe website, which has video tutorials and templates, and to Mind's information on planning for a mental health crisis.

The NHS says that if you are worried about someone, try to get them to talk to you. Ask open-ended questions such as how they feel about things, and do not worry about having the answers. Just listening and taking what they say seriously can be more helpful than advice. You can also call the helplines for advice for yourself about someone else.

If someone has seriously harmed themselves or you do not think they can keep themselves safe, the NHS says to call 999. Rethink Mental Illness and Samaritans publish further advice on supporting someone who is having suicidal thoughts.

Suicidal crises are usually temporary, even when they feel as though they will last forever. NHS inform says that whether you have just started to notice the thoughts or have had them for a long time, you can change things for the better. The Royal College of Psychiatrists encourages people to look after themselves in the longer term by understanding what lies behind the thoughts, talking to someone they trust and keeping a plan for what to do if they return.

Follow-up is a normal part of care, whether through the GP, a community mental health team or talking therapy. If thoughts come back after a period of feeling better, that is not failure. It is a reason to use the plan and contact the same people again.