What Is Know The Signs?

It is a California statewide suicide prevention social marketing campaign built on three key messages: Know the Signs. Find the Words. Reach Out. This campaign is intended to educate Californians how to recognize the warning signs of suicide, how to find the words to have a direct conversation with someone in crisis and where to find professional help and resources. 

Know the Signs

Pain isn't always obvious, but most suicidal people show some signs that they are thinking about suicide. If you see even one warning sign, step in or speak up. Take the time to learn what to do now, so you're ready to be there for a friend or loved one when it matters most.

Some examples of warning signs include: Increased drug and alcohol use, reckless behavior, anger, no sense of purpose, talking about wanting to die or suicide, changes in sleep, putting affairs in order, giving away possessions, anxiety, sudden mood changes, feeling hopeless, withdrawal, neglect of personal appearance. To learn more about the warning signs visit: www.suicideispreventable.org

Find the Words

"Are you thinking of ending your life?" Few phrases are as difficult to say to a loved one.  When it comes to suicide prevention, no phrase is more important. Here are some ways to get the conversation started.

1.  Start the Conversation

  1. Mention the signs that prompted you to ask about suicide. This makes it clear that you are not asking "out of the blue," and makes it more difficult for the person to deny that something is bothering them.
  2. Ask directly about suicide. Talking about suicide does NOT put the idea in someone's head and usually they are relieved. Asking directly and using the word "suicide" establishes that you and the person at risk are talking about the same thing and lets the person know that you are willing to talk about suicide.
  3. “Are you thinking of ending your life?” You may phrase the question in a different way, and that’s ok. If they answer "yes" to your direct question about suicide stay calm, and don't leave the person alone until further help is obtained. Call 9-1-1 or the National Suicide Prevention Lifeline at 1-800-273-8255.

2.  Listen, Express, Concern, Reassure

  1. Listen to the reasons the person has for both living and dying. Validate that they are considering both options and underscore that living is an option for them. "I can imagine how tough this must be for you. I understand when you say that you aren't sure if you want to live or die. But have you always wanted to die? Well, maybe there's a chance you won't feel this way forever. I can help.”
  2. Let the person know you care. Letting them know that you take their situation seriously, and you are genuinely concerned about them, will go a long way in your effort to support them.
  3. "I'm deeply concerned about you and I want you to know that help is available to get you through this."

3.  Create a Safety Plan

  1. Ask the person if they have access to any lethal means (weapons, medications, etc) and help remove them from the vicinity. (Another friend, family member or law enforcement agent may be needed to assist with this.)  Do not put yourself in danger; if you are concerned about your own safety, call 911.
  2. Create a safety plan together. Ask the person what will help keep them safe until they meet with a professional. “Is there someone you can call if you think you may act on your thoughts of suicide?"
  3. Ask the person if they will refrain from using alcohol and other drugs or agree to have someone monitor their use. "Will you promise me that you will not drink or at least have someone monitor your drinking until we can get you help?"
  4. Get a verbal commitment that the person will not act upon thoughts of suicide until they have met with a professional. "Please promise me that you will not harm yourself or act on any thoughts of suicide until you meet with a professional."

4.  Get Help

  1. Provide the person with the resources you have come prepared with. Call the National Suicide Prevention Lifeline anytime at 1-800-273-8255.
  2. If you feel the situation is critical, take the person to a nearby Emergency Room or walk-in psychiatric crisis clinic or call 9-1-1. "I understand if it feels awkward to go see a counselor. But there is a phone number we can call to talk to somebody. Maybe they can help?"

Reach Out

You are not alone in helping someone in crisis. There are many resources available to assess, treat and intervene. Crisis lines, counselors, intervention programs and more are available to you, as well as to the person experiencing the emotional crisis. 

Please visit our Resources page  to help you find available national and local resources.

Risk Factors for Suicide

Risk factors are often confused with warning signs of suicide, and frequently suicide prevention materials mix the two into lists of “what to watch out for.” It is important to note, however, that factors identified as increasing risk are not factors that cause or predict a suicide attempt. Risk factors are characteristics that make it more likely that an individual will consider, attempt, or die by suicide. Protective factors are characteristics that make it less likely that individuals will consider, attempt, or die by suicide.
  • Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders and certain personality disorders
  • Alcohol and other substance use disorders
  • Hopelessness
  • Impulsive and/or aggressive tendencies
  • History of trauma or abuse
  • Major physical illnesses
  • Previous suicide attempt
  • Family history of suicide
  • Job or financial loss
  • Loss of relationship
  • Easy access to lethal means
  • Local clusters of suicide
  • Lack of social support and sense of isolation
  • Stigma associated with asking for help
  • Lack of health care, especially mental health and substance abuse treatment
  • Cultural and religious beliefs, such as the belief that suicide is a noble resolution of a personal dilemma
  • Exposure to others who have died by suicide (in real life or via the media and Internet)

Protective Factors for Suicide

  • Effective clinical care for mental, physical and substance use disorders
  • Easy access to a variety of clinical interventions
  • Restricted access to highly lethal means of suicide
  • Strong connections to family and community support
  • Support through ongoing medical and mental health care relationships
  • Skills in problem solving, conflict resolution and handling problems in a non-violent way
  • Cultural and religious beliefs that discourage suicide and support self-preservation
[This was adapted from "Understanding Risk and Protective Factors for Suicide” and “Risk and protective factors for suicide" by the Suicide Prevention Resource Center.]