How to Talk About Suicide With Your Clients

When you work in mental health care, talking about suicide with clients is often part of the job -- but that doesn’t mean it’s an easy one. Whether you’re hesitant to say the wrong thing or simply looking for the right tools to help your client’s unique situation, it can be a challenging conversation to navigate.

Here, we spoke with Aimee Keith, PsyD, clinical manager at Eating Recovery Center and Pathlight Mood & Anxiety Center (ERC Pathlight), about how to handle these conversations around suicide and suicidal ideation with clients, including issues impacting marginalized communities.

Helping clients with emotion regulation

All day long, we, as humans, use something called “emotion regulation.” It’s the process of managing your emotional state for a specific context.

“For example, when being chased by a bear, the emotion of fear is helpful to your survival, but if you are about to take a math test, that same emotional anxiety is counterproductive,” Dr. Keith explains. “Anger that is used to stand up for yourself can be beneficial, but anger that causes you to engage in self-destructive behaviors would be maladaptive.” 

Being able to regulate our emotions means being able to harness them when they’re helpful and cope with them when they’re not. Thus regulation is in itself a coping skill. There are a myriad of other coping skills out there to use -- some helpful, some less so.

Helping clients through suicidal ideation

“Suicidal ideation often functions as a way for someone to regulate their emotions. Feelings of overwhelm and fear may be quelled by the promise of relief,” Dr. Keith explains. “Death is the ultimate avoidance, and fantasizing about or even planning for it makes sense when we look at it in this context. The problem is that it is also a very permanent avoidance.”

If your client has expressed suicidal ideation, you can help them recognize this ideation as a coping mechanism. From there, “we can help the person understand the contexts in which it arises and how to help them intervene before they feel so desperate and drawn in by that feeling that they want to act on it,” Dr. Keith says. “Non-suicidal self-injury is also often utilized to regulate emotions. Many people have reported that they feel it is the only way to ‘get control’ over their emotions.”

An important next step when working with clients is to teach new relaxation techniques and coping skills so that their brain can access feelings of safety and security instead of moving toward suicide for perceived safety or relief.

“For people who are chronically feeling suicidal, those thoughts often have become the quickest way to obtain a sense of ‘safety’ and emotional regulation, and losing the option can feel very dysregulating,” Dr. Keith says. “These people can also benefit from a recalibration of their nervous system over time by utilizing relaxation techniques daily.”

Helping clients who are feeling isolated

There’s a direct link between loneliness and suicidal ideation.

“Loneliness lights up the same area of the brain as physical pain. We know that isolation can cause destruction in a person’s mind,” Dr. Keith says. “When we aren’t connected with another, when we can’t share our vulnerabilities, we feel unsafe. Feeling unsafe can become unbearable after a period of time and lead to feelings of despair.”

Research shows that reducing loneliness may reduce the likelihood of suicide, and one of the greatest way to reduce loneliness is to foster connection and belonging.

“Humans are designed to be social creatures. Before we were easily able to go to the grocery store or take shelter in our homes, we lived in communities. Therefore, our brains feel safe when we are connected to other humans,” Dr. Keith says. “Many of the patients I work with find that connecting with others lifts their mood and is integral to their recovery plan. Connection with other human beings makes life more tolerable, shares the burden of stress and gives us a reason to hold on.”

What’s more, connection with others can deter people from suicide because they don’t want to cause others pain or trauma, Dr. Keith says.

Anyone looking to build community with other people who are going through something similar can join one of our free support groups.

Suicidal ideation in marginalized communities

Suicide rates in the U.S. are on the rise, particularly among people with marginalized identities, according to a 2023 study from the Centers for Disease Control and Prevention. Specifically, rates have risen by 5% in people ages 25-44, with even higher percentages among Black, Hispanic, multiracial and Alaska Native communities.

Why this disparity?

“I could speculate that the weight of bias, systemic oppression and so on causes a large amount of cumulative stress over a lifetime. We know that bias in medical settings can lead to gaps in medical care and can increase avoidance of medical settings, including the therapist office,” Dr. Keith says.

Transgender people also face a higher risk of suicide, according to decades of health data.

“For the LGBTQ+ community in particular, we know that gender- and person-affirming care is suicide prevention,” Dr. Keith adds. “Imagine feeling trapped in a body that does not match your gender. Wouldn’t you feel hopeless and desperate for release? Imagine that the government is continually outlawing your existence and you cannot rely on the rights so many take for granted. You might feel alienated, too.”

Read more about the importance of culturally affirming care here and gender-affirming care here.

Learn more about suicide prevention with other mental health professionals

We’d love to invite you to “Connecting the Dots,” a comprehensive one-day event aimed at shedding light on the underlying causes of suicide in marginalized communities, with a specific focus on the profound impact of loneliness.

The event includes:

• Four informative sessions covering various marginalized groups, including the trans community, the Black community and college-aged young adults
• Open discussions with like-minded professionals 
• Q&A sessions with knowledgeable speakers and panelists

By addressing the specific needs and experiences of marginalized communities, the event seeks to break down stigmas, promote inclusivity and provide tangible support to those who are most vulnerable. Participants will leave with increased awareness, practical tools for prevention and a renewed commitment to actively address loneliness and its consequences in their own lives and communities.

RSVP HERE