Recognize, respond, refer

The signs of experiencing suicidal thoughts will vary from person to person. Some individuals might not show any outward signs at all. Anytime you’re concerned for a student, it’s important to take that concern seriously and offer support as you are able. See the Respond section for information on how to check-in with a student. It is always better to check-in with the person and find that they are alright than to miss an opportunity to offer support when it is needed.

Below is a list of common warning signs which could help identify a person experiencing distress. You may notice that some of these warning signs are vague and could apply to forms of distress other than thoughts of suicide. It’s important to check-in directly about suicide if the student exhibits any warning signs. You may find the student is having thoughts of suicide or experiencing other kinds of distress with academics or a relationship for example. In either case, the Respond and Refer sections will help you to respond and find further support.

Keep in mind mental illness and suicide are not the same. Just because a person has a mental illness, does not mean they experience thoughts of suicide, and vice versa.

• Changes from person’s usual mood or speech (more depressed or hyperactive)
• Strange or bizarre behavior
• Odd or out of character emotional reactions
• Increased sleep/sleepiness
• Increased use of alcohol or drugs
• Giving away personal belongings

• Swollen eyes
• Weight gain or loss
• Changes to personal hygiene or dress

• Verbal or written references to suicide or death.
  • This can be direct, such as, “I’ve decided to kill myself,” “I wish I were dead,” or “If (such and such) doesn’t happen, I’ll kill myself.”
  • And it can be indirect, such as, “I’m tired of life; I just can’t go on,” “My family would be better off without me,” or “Who cares if I’m dead anyway.”
• Talking about being a burden to others
• Expressing feelings of hopelessness or helplessness
• Seeking out things that could be used in a suicide attempt, such as weapons and drugs

• Not showing up for meetings, class, or work
• Repeated requests for additional time
• Disruptive or avoidant behavior
• Lowered self-esteem, self-efficacy
• New or heightened interpersonal difficulties with peers, faculty, staff, or family members
• Isolation or disconnection from friends

The warning signs listed above can help you identify when a student diplays warning signs of suicide. These signs will vary widely from person to person, and some people will show no outward signs. Anytime you are concerned for a student, respond as you are able. The below sections, Respond and Refer, will help you do so.

There are risk and protective factors which impact students’ suicide risk (likelihood they will die by suicide or experience suicide ideation). See the Suicide Prevention Resource Center for more information on risk and protective factors. Understanding risk and protective factors informs suicide prevention, as we can seek to reduce aspects of our campus environment which increase suicide risk and promote factors which protect students from suicide.  However, if risk factors apply to a student, this does not mean that they are inevitably going to experience thoughts of suicide or attempt suicide.

One example of a protective factor relevant to our campus is sense of belonging. Our campus environment makes it more difficult for students with identities underrepresented and marginalized to benefit from this protective factor while at UW–Madison. Students of identities historically underrepresented and marginalized within our campus community–such as students of color and LGBTQ+ students–were more likely to describe experiences in which they did not feel they belonged or connected to UW–Madison (Healthy Minds Study, 2017). It is all of our responsibility to change our campus climate so that all students can experience the protective factor of sense of belonging. We must also support students who are currently excluded from this protective factor. Consider the way a students’ identity intersects with mental health when being a link in their chain of support as you Recognize, Respond, and Refer.

If you have further questions about your concerns or want to talk with another person before taking action, you can call any number of suicide hotlines including the National Suicide Prevention Lifeline at 800-273-8255 and the UHS 24/7 Mental Health Crisis Services
at 608-265-5600 (option 9). 

As important as it is to respond to someone in distress, it can also be intimidating. There are a number of barriers that can keep us from intervening. These can be personal barriers, such as being uncomfortable with having a conversation; relationship barriers, such as not wanting to be intrusive; and general barriers, such as thinking if no one else is concerned about it, it is probably not a big deal. These barriers can often lead us to ignore what we recognize and prevent us from responding. We must each be aware of which barriers impact our own abilities to respond to someone, and work to overcome these barriers to intervention.

Showing a person experiencing thoughts of suicide that you are open to talking directly about suicide and distress can reduce stigma, provide relief, and could even prevent a suicide attempt. While the language you use is important, the most important thing is demonstrating that you are available to listen and be there to support them. Keep in mind, showing that you care, demonstrating that you are available to listen, and being present for the person are the most important things you can do. It is not about saying exactly the right words. Remember, you are not expecting to resolve their concern, but you can work to get them to the next link in their chain of support.

Ways to start the conversation

• “I wanted to check in with you because you’ve been drinking more in the last few months.”  Focusing on concrete, observable behaviors which caused your concern can be a good way to start.
• “I felt like that argument you got into with Anthony got pretty intense.” Using “I” statements can help soften your observations.
• “I noticed you missed class last week and I am concerned about you. How are you doing?”  It is important to express that you care about the person. Try to avoid judgement.

Asking about suicide

A central part of responding to the person is asking directly about suicide by asking, “Have you had any thoughts about killing yourself/suicide?” Many people believe asking this question will put the idea in someone’s head. Research shows this is not true. Asking directly shows that you are ready to listen to their feelings and support them through anything.

Other questions you can ask

•         How can I best support you right now?
•         Have you considered talking to someone about this?
•         When did you begin feeling like this?

Tips for responding

1. An important aspect to offering support is do not be sworn to secrecy. You need to feel comfortable reaching out for help if necessary. Remember that you are a link in that person’s chain of support—be a good link, but know your limits. Feel free to consult with the UHS Mental Health Crisis Line, and if your friend is in immediate danger, accompany them to the nearest emergency room or call 911. If you call 911, you need to stay with that person under any circumstances.
2. Speak with the individual in a private, comfortable place.
3. Express concern openly and honestly. Think of specific behavior examples that caused concern, such as “I didn’t see you in class this past week. How have you been doing?”
4. Maintain a tone of voice and body language which communicates you are there to help. Avoid a tone which is judgmental or confrontational.
5. While you may feel compelled to convince the person to seek help by lecturing about the value of life, this can be more harmful than helpful. Avoid saying things like, “You have so much to live for,” or “Your suicide will hurt your family.”
6. Do not try to minimize their situation by saying, “Look on the bright side,” “I know how you feel,” or “Try not to worry about it.”

Ways to start the conversation

•         I have been concerned about you lately.
•         Recently, I have noticed some differences in you and wondered how you are doing.
•         I wanted to check in with you because you haven’t seemed yourself lately.

What you can say that helps

•         “You are not alone in this. I’m here for you.”
•         “I may not be able to understand exactly how you feel, but I care about you and want to help.”
•         “You are important to me.”
•         “I am here for you. We’ll get through this together.”

Things that are more harmful than helpful

•         “You’ve been acting weird lately.” It is important to avoid unspecific, negative labels like “weird,” as this may make the person                     defensive.
•         “It’s all in your head. You’ll be fine – stop worrying.”
•         “We all go through times like this.”
•         “You have so much to live for – why would you want to die?”
•         “Just snap out of it. Look on the bright side.”
•         “Here’s my advice…”

Additional Support

If you’re unsure how to respond or need support, contact the UHS Mental Health Crisis Line at 608-265-5600 (option 9). They can provide consultations for those who are concerned about the mental health of a student. The Dean of Students Office can also consult and assist with situations involving students who may be struggling. The dean on call is available at 608-263-5700.

After holding space for the person to share what is going on, inform them that there are opportunities to seek additional help. Let them know they can book an Access Appointment with UHS Mental Health Services by using their online MyUHS or by calling 608-265-5600 (option 2). An Access Appointment is a 20- to 30-minute appointment over the phone or in person during which a UHS mental health provider will connect you with services and resources both at UHS and within the larger Madison community for support specific to your situation.

There are other campus and community resources which may be useful. Explore this list of resourcesSuicide Prevention Resources before talking with a student, and with the student if they are willing.

If the person is not in immediate danger, the decision to seek help is entirely up to that person. You should not force or manipulate the person into using one of these resources, even if you feel strongly that it would benefit them. All you can do is let them know you are willing and able to have the conversation if/when they are ready.

General tips for referring a student to help:

• Do not attempt to trick or manipulate someone into counseling. Except in dangerous emergencies, the decision whether or not to accept a referral to counseling is the individual’s.
• Get help together. Offer to accompany the student in distress to the counseling center, call a crisis line with them, or make them an appointment. If the person is in immediate danger accompany them to the nearest emergency room or call 911. If you call 911, you need to stay with that person under any circumstances.
• Never leave a suicidal person alone. Remove any means that the student could use to harm themselves or others such as weapons or medications.
• Keep the distance in your relationship with the person the same as it was before you recognized, responded, and referred. If you were close before this, be just as close. If they were just an acquaintance, don’t suddenly try to be their best friend, as this could be overwhelming and uncomfortable for the person.

Asking for help while you are referring someone is always an option. If you are ever unsure what to do, call:

UHS 24-hour Crisis Line: 608-265-5600 (option 9)

National Suicide Prevention Lifeline: 800-273-TALK (8255)