If the person is currently suicidal:
- Get medical help: Contact the person’s clinician or community mental health team. If the person is in immediate danger of harming themselves, call the emergency services or take them to the closest emergency department.
- Don’t leave the person alone: If you cannot be with them, arrange for someone else to keep them company.
- Remove whatever means to attempt suicide you can (e.g. lock away medicines and remove guns).
- Contact a suicide or crisis helpline.
- If the person has a suicide prevention plan, assist them to use it.
Not all people with bipolar disorder attempt suicide, but the risk is much higher than in the general population. As a caregiver, there may be things you can do together with the person and their health professionals to reduce the risk of suicide. Suggestions include:
Recognize warning signs
A warning sign is something the person does or says that makes you think they may be intending to kill themselves in the near future. Things to look out for include:
- Does the person express their intention to kill themselves? The person may threaten to kill themselves or mention their intention casually.They may write or talk more generally about suicide or death. Take any mention the person makes about feeling suicidal or hopeless seriously.
- Does the person have a plan to kill themselves? Having a plan increases the risk of attempted suicide and the person needs urgent medical help.
- Are their changes in the person’s mood or behaviour that may indicate that the person is thinking of killing themselves? The person may express suicidal thoughts indirectly rather than verbally. Examples include:
- Hopelessness (e.g. the person can see no hope for their future or reasons to live).
- Doing things to put their affairs in order before they die (e.g. makes a will, takes out life insurance, gives their possessions away or sells their house).
- Apathy and lack of interest in things they used to enjoy.
- Withdrawal from friends and family (e.g. cancels arrangements and isolates themselves).
- Anxiety, agitation or insomnia.
- Increased recklessness as if they don’t seem to care what happens in the future.
- Increased use of alcohol or street drugs. Also, a person who is suicidal and intoxicated may be likely to impulsively attempt suicide.
- Extreme anger, irritability or desire for revenge.
- A sudden lift in mood. Sometimes, once a person has a plan to kill themselves, their mood temporarily improves. If the person has been talking about suicide and their mood suddenly improves, ask them if they still have any intention to attempt suicide.
Please note: It can help to look out for warning signs. However, sometimes the person may attempt suicide without warning. Also, the warning signs may be so individual that it is understandable if they were not noticed.
- Don’t avoid talking about suicide.
- If you think the person might be suicidal, ask them directly if they have any thoughts about suicide.
- If the person does discuss their suicidal thoughts, listen without judging them.
- Recommend medical help and if necessary assist them to access it. Don’t hesitate to get emergency help if you think the person is about to kill themselves (see dealing with a bipolar crisis).
- Even if the person only has very occasional, vague, passing suicidal thoughts, and none of the factors that increase their risk, still encourage them to discuss these thoughts with their clinician. Keep an eye on the person to see if these thoughts become more specific, frequent or intense.
- It is not always easy to assess the risk of suicide. If you are uncertain about the extent of the risk, assist the person to get a risk assessment from their clinician or mental health service.
- Don’t try and deal with the suicidal person alone. Besides getting emergency help if necessary, contact health professionals, family and friends you can trust, or a helpline (see also reducing stress in a crisis).
- If the person is currently suicidal, they may resent any action you take to prevent them from killing themselves. However, don’t let this stop you from taking action to help.
Make suicide risk prevention plans
- Discuss with the person ways that you can help them to get through times when they feel suicidal.
- Assist the person to develop a plan to prevent suicide that you can both rely on if they become suicidal.
- There are organizations dedicated to preventing suicide and some of them offer support, information and occasionally training courses for caregivers (for more information see the section on suicide prevention in the resources section).
Factors that increase suicide risk include if the person has:
- A plan to kill themselves (e.g. the means to do it or a time frame).
- Previously had suicidal thoughts or attempted suicide.
- A depressive or mixed episode or has recently had such an episode.
- Rapid cycling (i.e. they relapse four or more times a year).
- Bipolar symptoms between episodes.
- Someone else in their family who has died by suicide.
- A number of previous bipolar episodes or hospitalizations.
- Anxiety or drug or alcohol problems in addition to bipolar disorder.
- If the person lives alone.
Please note: Although these are common risk factors, it is possible for suicide to still occur without these risk factors.
Suicide sometimes occurs despite everyone’s best efforts to prevent it
If you have lost the person to suicide, keep in mind that when a person is determined to kill themselves, there is only a limited amount anyone can do to stop them. Don’t blame yourself. You don’t have to go through this alone (see resources section for links for those who are bereaved by suicide).