Suicidal Ambivalence & How to Support Loved Ones in Crisis

CW: Mentions of suicidal ideation.

As a crisis counselor for the 988 Suicide & Crisis Lifeline, I supported a diverse range of individuals facing challenging and distressing situations. Help-seekers with suicidal ideation (the desire to die by suicide) that reached out to the hotline expressed something called ‘suicidal ambivalence’. Though many of these individuals had a plan for how they would end their lives, some even having a timeline, the fact that they reached out for support showed that some part of them wanted to live. 

Suicidal ambivalence is the concept of both wanting to live and wanting to die. Most people with suicidal ideation also have ambivalence. When an individual reaches out for support, has plans for the future, or has loved ones that they confide in, this often means that they are not ready to take their own life. 

When conversing with a loved one who is expressing suicidal thoughts, many people find it difficult to say the right thing. Though it can be anxiety-provoking, it is not as hard as you may think. The most important thing that the person in crisis needs is time. Time to talk about what they are experiencing. Time to distract themselves from these negative thoughts. In the moment, thoughts of suicide can feel impossible to combat, but it is essential for these individuals to return to a space where these thoughts are not overpowering. Offer a safe space for them to share their feelings without fear of judgment.

Third-party callers reach out to the 988 Lifeline daily, seeking advice for someone in their life in crisis. It can be overwhelming for a person with suicidal thoughts to reach out for help or they may feel that they do not want to be helped. The support system of this individual can be trained to cope with these crises. 

If someone in your life expresses the intent to take their own life, there are some ways to keep them out of danger. 

If they have already taken action to harm themselves or have an immediate plan: it is highly suggested that you call emergency services or take the individual to a hospital if possible.

 If they are safe for the moment: the third party has more options. Anyone can assess risk for the individual in crisis by asking if they have a plan, timeline, intent, and access to the means that they plan to use to end their life. If they feel that their loved one is at imminent risk, they should seek emergency services. While involving emergency services is crucial, stay with the person if it is safe to do so until help arrives.

It is important to note that emergency services are not the only option for individuals experiencing a mental health crisis. Being faced with an armed emergency service officer can be traumatizing for individuals in need of support. There is another option called a psychiatric mobile response team (PMRT). This is a group of mental health professionals that will evaluate the individual and assess what next steps will benefit them. Though PMRT is an incredible resource, it may take much longer than emergency services to arrive. Check with your local health services to see if a PMRT is available in your area. It is helpful to weigh out the pros and cons of each option before making this decision. If the third party does not feel comfortable with making these decisions or de-escalating their loved one, they can call 988 for support through this process. 

Other resources such as suicideispreventable.org and suicideisdifferent.org provide additional information on warning signs, how to talk about suicide, and guidance. 

If you or anyone you know is struggling with substance use or an emotional crisis, help is available. Text or call 988 or chat 988lifeline.org to speak with a caring counselor 24/7.