Spotting the silent signals: Suicide prevention starts with awareness

Suicidal thoughts and mental health crises often present in subtle ways. Friends, colleagues and family members may notice behavioral or emotional changes, though these signs are not always obvious. While you are not expected to be a mental health professional, your awareness and support can make a critical difference in preventing suicide.

To help us better understand these signs and how to respond, Denise Gregory, MD, a psychiatrist with Trinity Health Medical Group – Grand Rapids, offers insight into what to look for and how to act with compassion and confidence.

Behavioral changes to monitor

Changes in behavior can be early indicators of emotional distress or suicidal ideation. These shifts may be gradual or sudden and often reflect internal struggles.

“When someone begins pulling away from things they once loved — whether it’s a hobby, a job or friends — it’s often a sign they’re experiencing emotional pain that they don’t know how to talk about,” says Dr. Gregory. “These changes may seem small at first, but they can be the beginning of a deeper crisis.”

Common behavioral signs include:

• Loss of interest: Withdrawal from hobbies, work or school activities once enjoyed
• Risk-taking behaviors: Increased recklessness, such as unsafe driving or substance misuse
• Declining attention to personal care: Reduced focus on hygiene, nutrition or exercise
• Final preparations: Organizing affairs, giving away possessions or drafting a will

Emotional and mood indicators

Emotional shifts can signal deeper mental health concerns. Pay attention to changes in mood, tone and self-expression.

• Sudden mood shifts: A transition from despair to calmness or apparent relief
• Heightened agitation: Noticeable anxiety or anger
• Expressions of burden: Verbalizing feelings of being trapped or weighing others down
• Feelings of shame or embarrassment: Intense feelings of worthlessness, even in minor situations

“One of the most misunderstood signs is a sudden calmness after a period of deep sadness,” Dr. Gregory explains. “It can feel like relief, but it may mean the person has decided to end their life. That’s why it’s so important to stay engaged and ask questions.”

Urgent warning signs

Some behaviors and emotional states require immediate attention, even if suicide is not directly mentioned. These signs may indicate a crisis:

• Escalating substance use as a coping mechanism
• Social withdrawal or isolation from family, friends and activities
• Seeking means of self-harm, such as researching methods or acquiring weapons or pills
• Significant disruptions in sleep or eating patterns

How to respond: supporting someone in crisis

You don’t need to be a counselor to make a difference. Your role is to respond with compassion, ensure the individual’s safety and connect them with professional help.

“The most powerful thing you can do is show up,” says Dr. Gregory. “Ask the hard questions, listen without judgment and stay with them. You don’t need all the answers. Just be present and help them take the next step toward safety.”

Read: Seeking Care in a Behavioral Health Crisis

Recommended actions

1. Ask directly: Calmly inquire with questions such as, “Are you thinking about suicide?” or “Do you feel like you might harm yourself?”
2. Listen without judgment: Offer empathy without debating or suggesting quick fixes. Simple statements such as, “I’m sorry you’re going through this,” can validate their experience.
3. Ensure safety: Remove access to potential means of self-harm. Stay with the person until help arrives if they are in immediate danger.
4. Connect to professional help: Encourage engagement with mental health professionals and assist with finding resources or making calls. Call or text 988 to reach the Suicide and Crisis Lifeline.
5. Follow up: Continued contact and support significantly reduce suicide risk.

Key considerations for supporters

Supporting someone in crisis can be emotionally challenging. These reminders help ensure you’re offering safe, effective and compassionate support:

• Do not promise secrecy: Let the person know that their safety outweighs confidentiality
• Trust your instincts: Take warning signs seriously, even if they seem uncertain
• Care for yourself: Supporting someone in crisis can be emotionally demanding. Seek guidance from peers, supervisors or a mental health professional if needed

Read: Our Commitment to Mental Health Care with the Zero Suicide Initiative

Your willingness to listen and act can save lives. By recognizing subtle changes and responding appropriately, you may provide critical support that helps someone in crisis move toward safety and healing.

Learn more about our mental health, behavioral health and substance use services. If you are experiencing a mental health crisis, call 988