Warning signs are the behaviors and visible changes that may indicate that a person is thinking about or planning suicide. When we know and are able to notice the warning signs of suicide, they can help us identify those at risk. The more risk factors and warning signs exhibited, the higher the risk that the person is attempting suicide.

It is common for people to exhibit some of these signs at different times, especially when they are in distress. Nonetheless, it is best to err on the side of caution and discuss with the person immediately to check how they are doing and whether they are thinking about suicide.

Warning signs of suicide might include the following:

• Hopelessness or feeling that one has no hope for the future. The person might be saying things like “I can’t see the future” or “I don’t know how things are going to be for me”
• Feeling isolated and lonely
• Being aggressive and irritable (e.g. wanting to be left alone, easily frustrated)
• Having access to and/or owning the means to commit suicide (e.g. medication, weapons, tools)
• Seeing themselves negatively (e.g. feeling worthless, “ugly”, unworthy of support/being alive)
• Significant alterations in mood and behavior
• Talking about death and suicide regularly
• Engaging in self-harming behaviors (e.g. cutting themselves)
• Engaging in risk-taking actions (e.g. willing to try anything and “dare” to die)
• Preparing for funeral
• Giving away personal possessions (clothes, expensive gifts) – “When I’m gone, I want you to have this”.
• Substance abuse
• Feeling and seeing themselves as a burden to other people

Responding to warning signs

If you notice you are having suicidal feelings and have some of the warning signs, you are encouraged to talk to someone about your feelings.

Thinking about suicide and death can be frightening and distressing. You may or may not have thought about it before, or it could be fleeting thoughts that seem to be always in the back of your mind. You may feel apprehensive and ashamed talking about it, and unsure of how others will react. Nonetheless, it is beneficial to talk to someone you can trust and you feel comfortable with (e.g. a family member, friend, teacher, doctor, counsellor or other health professional).

Once you have decided to talk to someone about it, try to treat it as a typical conversation. It is better for you to be direct and clear about what has been going on for you, your feelings and the support that you need.

Furthermore, be mindful and prepare yourself for their response – it is not uncommon for them to feel shocked and emotionally overwhelmed. Continue your conversation together to work things out and find the best solutions. Encourage your support person to also seek help themselves. It is important to remember that once you have disclosed your suicidal thoughts to your support person, they may need to access further support for you in order to keep you safe.

One thing that is important to do when you are struggling with suicidal thoughts is making sure that you are safe. Try to develop your own safety plan with the support of people you can trust and/or health professionals. Your personalized safety plan can be used to guide you in taking the actions that you need to help you feel safe again. Some things that you can consider to help you stay safe:

• Thoughts are just that: they are thoughts and you do not have to act on them. Our brain is designed to think, and many thoughts (ranging from positive to negative, realistic to unrealistic, helpful to unhelpful) can spur at any moment in time. Your thoughts are not permanent either – it could stay for only a period of time, and your mood might be different later on.
• Give yourself as much time as you can to access the support that you need.
• Get rid of anything in your environment (e.g. your house) that you could potentially use to harm yourself
• Save crisis phone numbers or internet links in your mobile phone so they are easy to access when you need to
• Get someone to be with you until your suicidal thoughts lessen in intensity (avoid being by yourself!)
• Stay away from substances such as drugs and alcohol that could potentially heighten your suicidal feelings and cloud your judgment
• Some hospitals and mental health facilities in Indonesia provide suicide watch support, where you can voluntarily admit yourself when feeling highly suicidal

If you are worried that someone might be having suicidal feelings, talk to them. Expressing your concern and talking to someone about their suicidal feelings does not mean that you are putting ideas into their head. On the contrary, by showing them your concern and opening up the conversation, the suicidal person may now have the chance to disclose their feelings, making them feeling less isolated, and could decrease their risk of suicide.

You can start the conversation by asking how they are doing in general and/or pointing out what has been different about them lately (i.e. what made you worried about them?). You can then continue to ask what kind of support that you can do for them (that they need). It will be helpful to emphasize to the person that you do want to help them and that you will be available for them if they want to talk (so they will not feel pressured to talk there and then). There are several questions that can be asked to determine if a person might be suicidal:

• Do you intend to take your life?
• Do you have a plan to take your life?
• Do you have access to the means to carry out your plan?
• Do you have a timeframe for taking your life?

Last but not least, always encourage them to seek support. You can help the person who is suicidal to find the best support that they can access. Websites such as beyondblue.org.au and headspace.org.au (for youth and people working with youth) have a lot of helpful resources for mental health and suicide support in general.

Unfortunately, no suicide crisis phone line is available in Indonesia. Nonetheless, a local organization called Into The Light Indonesia that specializes in education and prevention of suicide does provide vast resources (articles and programs) for suicide support and mental health care in Indonesia. (kes)

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This article can also be read on The Jakarta Post