Suicidal ideation

Suicidal ideation refers to thoughts about suicide, which vary in intensity from passive ("I wish I didn't exist anymore," "it would be better if I just didn't wake up") to active (with a plan, intent, and access to means). It is a symptom — not a character trait — and needs to be clinically assessed whenever it is present.

It's important to distinguish: passive ideation (a wish to die without a plan) is far more common and less immediately dangerous than active ideation (with a plan and intent). Both deserve clinical attention, but active ideation is a psychiatric emergency.

Contrary to the myth, asking about suicide does NOT increase the risk — research shows that talking about it relieves the person's burden and opens the door to help. If you or someone close to you is experiencing suicidal ideation, call or text 988 — the Suicide & Crisis Lifeline in the US — or go to the nearest emergency room. Many other countries have their own free, 24/7 crisis hotlines.

In treatment, safety is the first priority — which can include assessing access to means (removing medications, weapons), a written safety plan, more frequent contact with the therapist, and, in severe cases, hospitalization.