Warning signs: what to look for, and what to do

A reliable profile of a person at risk of suicide does not exist, and no single sign settles the question. Most people who die by suicide give no obvious signal that is recognised at the time.

What follows is therefore not a checklist for diagnosing anyone. It is a set of changes which, when several appear together or one appears sharply against a person's usual behaviour, justify acting. The purpose of noticing is to start a conversation, not to reach a conclusion.

Changes in what someone says

Speaking about themselves as a burden: that others would be better off, or that they are a problem for the people around them.
Talk of being trapped, of having no way out, or of a situation being permanent when it is not.
Saying goodbye in a way that sounds final, which may include giving away possessions, sudden visits to people not seen for years, or unusual tidying of affairs.
Direct statements, however lightly they are delivered. “I will not be around for that” is not always a joke.

Changes in what someone does

Withdrawal from people and activities that previously mattered, particularly a change that is sudden rather than gradual.
Sleep that has broken down, especially waking very early or going several nights without sleeping.
Increased use of alcohol or drugs, which both signals distress and raises risk directly.
Looking for ways to harm themselves, including searching for information about methods. This is one of the most significant single signs and it is frequently missed because it happens privately.
Putting affairs in order: writing a will, closing accounts, or making arrangements that suggest an expectation of not being present.

Changes in how someone seems

Agitation or restlessness rather than visible sadness. This is often missed, because it does not match the picture people expect to see.
A sudden calm after a long period of distress. Sometimes this is genuine relief. Sometimes it indicates that a decision has been made.
Loss of interest in appearance, eating or ordinary self-care, particularly where it has changed quickly.

What raises the level of concern

Certain circumstances make the same set of signs considerably more serious, and are worth weighing when deciding how quickly to act.

A previous attempt. This is the strongest single predictor there is.
Bereavement by suicide, particularly a recent one.
Recent discharge from psychiatric care or hospital, or the ending of treatment.
A relationship ending, job loss, financial difficulty or legal trouble, especially in combination.
Access to a means of harm.

What to do

Ask. Ask directly, without softening the question into something that can be deflected. The fear that asking plants the idea is mistaken, and the reasons are set out in Talking about suicide does not put the idea into someone's head.
If there is immediate danger, act now. Call the emergency services and stay with the person until help arrives. Do not leave them alone, and do not postpone it until the morning.
If the danger is not immediate, help them reach a service. A crisis line, their doctor, or a walk-in service. Offer to sit with them while they make the call, which makes more difference than it sounds as though it should.
Reduce access to means. This is the measure with the strongest evidence behind it and the one people are most reluctant to raise. It can begin as one sentence, without confrontation and without going through anyone's belongings.
Stay in contact afterwards. The follow-up carries most of the value and is the part most people leave out.

You do not need to be certain before acting, and you are not responsible for the outcome. Being wrong about a worry costs an awkward conversation.