ABOUT SUICIDALITY 

Misconceptions About Suicidality 

There are many myths about suicidality. One is that people who talk about suicide won’t actually attempt it. The truth is the opposite: talking about suicidal thoughts is often a warning sign. Another myth is that suicide is usually planned out far in advance. Research shows that most suicide attempts are impulsive, often happening within five minutes of the decision. Another misconception is that suicidal thoughts are always about attention. In reality, suicidality is about pain, hopelessness, and feeling unable to cope.

Passive vs. Active Suicidality 

Passive suicidality involves thoughts like, “I don’t want to be here anymore” or “life feels too heavy,” without the intent to act. Active suicidality involves making plans, preparing for an attempt, or being unable to stay safe. 

Both passive and active suicidality matter, and both require care and attention.

Why Suicidality Happens 

Suicidality can occur as part of several mental health conditions. These include depression, PTSD, bipolar disorder, borderline personality disorder, complicated grief, psychotic disorders, and substance use disorders.

Suicidality happens when the brain and body feel overwhelmed. It can come from unbearable emotional pain, hopelessness, or the belief that things will never get better. Sometimes people feel like a burden to others. For some, chronic suicidality becomes a coping mechanism—a way of imagining an escape when life feels too hard. For others, suicidality appears suddenly during moments of crisis.

The Neuroscience of Suicidality 

Suicidality is linked to changes in how the brain regulates emotions, impulses, and decision-making. The prefrontal cortex, which helps with judgment and planning, can become less active during times of high stress. At the same time, the amygdala, which detects threat and fear, becomes overactive. This imbalance can make suicidal urges feel overwhelming and immediate. 

Most suicide attempts are impulsive, not carefully planned, which is why fast access to support is so important.

Chronic vs. Acute Suicidality 

Chronic suicidality can last for months or years. It often becomes a mental habit that the brain uses to release tension, even if there is no intent to act. Someone with chronic suicidality might wake up every morning with the same thought: “I don’t want to be alive.” They may go to work, take care of family, and continue with daily life while silently carrying those thoughts.

Acute suicidality feels different. It can come on suddenly, often triggered by conflict, loss, or overwhelming stress. The intensity builds quickly, and within minutes someone may shift from struggling to making an attempt. Acute suicidality is especially dangerous because of how fast it escalates, and because the window for intervention is short.

Treatment Approaches 

Treatment for suicidality depends on what else is happening alongside it. For depression, therapy and medication can help. For BPD, Dialectical Behavior Therapy (DBT) is effective at reducing suicidal behaviors. For trauma, treatment may focus on safety and stabilization before processing painful memories.

No matter the cause, treatment always includes building safety, creating a plan for crisis moments, and learning new ways to manage overwhelming emotions. Therapy, psychiatry, and group support all play important roles.

Levels of Care for Suicidality 

Sometimes suicidality requires urgent or 24/7 support. Inpatient or residential care is needed if someone cannot keep themselves safe or is in immediate danger.

At HighTide Mental Health, our Partial Hospitalization Program (PHP) provides daily structure, including therapy groups, individual therapy, psychiatry, and support in a safe environment. For people experiencing suicidality, PHP offers close monitoring and the chance to practice coping skills throughout the day.

Our Intensive Outpatient Program (IOP) is designed for people who are stable enough to be at home but still need consistent support. Clients attend several sessions each week while returning to school, work, or family life. IOP focuses on using safety skills in real situations, while continuing therapy and psychiatric care.

Supportive Tools 

Two skills can help when suicidal thoughts become overwhelming:

• Urge Surfing: Suicidal urges rise like waves. They peak and then fall. The skill is to notice the urge, ride it without acting, and remind yourself that it will pass.
• DBT TIPP Skill: Change your body’s chemistry quickly. Splash cold water on your face or hold ice, do a burst of intense exercise, slow your breathing, or tense and release muscles. These fast changes help bring the nervous system back into balance.

These tools are not a replacement for treatment, but they can help during intense moments.

Coercive vs. Non-Coercive Interventions 

There are different ways suicidality is treated in crisis. Coercive interventions include involuntary hospitalization or calling emergency services when someone does not want help. These can sometimes save lives, but they can also be traumatic. Non-coercive interventions include collaborative safety planning, voluntary admission, and peer or family support. Many people prefer non-coercive approaches because they preserve trust and dignity, but both approaches have a role depending on the level of risk.

Closing 

Suicidality is a sign of pain. It can be chronic and long-lasting, or it can come on suddenly and feel overwhelming. Both need care. With treatment, suicidal thoughts can become less frequent and less intense, and people can learn skills to survive the hardest moments. 

If you or someone you love is struggling, reach out for help. Safety and healing are possible.