Suicidal thoughts: what they mean and how to get help

Key points

• Suicidal thoughts range from a passing sense that life is not worth living to persistent thoughts of dying.
• They are far more common than people think, and having them does not mean a person will act on them [5].
• They signal pain that has become hard to bear, not weakness or a fixed decision.
• They can change and pass, and how long they last differs from person to person [5].
• Free UK help is available at any hour, by phone or text [1][3][4].
• Asking someone directly about suicidal thoughts does not put the idea in their head [6].

What suicidal thoughts are

Suicidal thoughts are thoughts about ending your own life. They range from a vague wish not to be here any more to frequent, insistent thinking about dying. They are a sign of distress rather than a diagnosis in their own right, and they are much more common than most people assume [5].

If you need help now. Samaritans: call 116 123, free, 24/7. Shout: text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.

Having these thoughts does not mean a person will act on them. How long they last differs from person to person: they may be there for a short time or a long time, and they often come and go rather than staying at one level [5]. That does not make the feelings less serious. Getting through the period when they are strongest, with other people involved, is what matters.

The Adult Psychiatric Morbidity Survey for England is the main UK source of figures [8]. No single current national percentage is given here, but suicidal thoughts are consistently found to be widespread [5].

Symptoms

Suicidal thoughts are described in two ways: the thoughts themselves, and the feelings underneath.

The thoughts themselves

• Thinking that life is not worth living, or wishing not to wake up.
• Thinking other people would be better off without you.
• Frequent or insistent thoughts about ending your life.

The feelings underneath

• Hopelessness, or a sense that nothing will ever change.
• Feeling trapped, with no way out.
• Pain that feels unbearable rather than merely difficult.
• Feeling like a burden to family, friends or colleagues.
• Shame, self-hatred, or feeling cut off from others.

Others may notice withdrawal, talk of being a burden, heavier drinking, or changes in sleep and self-care.

Commonly confused with. Suicidal thoughts are not the same as self-harm. NICE covers self-harm regardless of intent, because many who self-harm are not trying to end their life [2].

Types

Suicidal thoughts have no formal subtypes. They are described along two lines: passive or active, and fleeting or persistent. Neither is a scale of severity.

• Passive thoughts. Not wanting to be alive, without any intention to act.
• Active thoughts. Wanting to end your own life, rather than wanting to stop existing.
• Fleeting thoughts. Thoughts that arrive, last a short time and pass.
• Persistent thoughts. Thoughts that return regularly or sit in the background.

Passive thoughts are not trivial, and active thoughts are not automatically an emergency. NICE says professionals should not use risk assessment tools or scales to predict future suicide or repeat self-harm [2].

Causes and risk factors

There is no single cause, and suicidal thoughts are rarely a response to one event. They usually appear where several difficulties overlap and a person’s usual ways of coping are overwhelmed. These factors raise the chance, but do not make it inevitable.

• Mental health: depression, bipolar disorder, post-traumatic stress disorder, psychosis, borderline personality disorder, eating disorders, previous self-harm.
• Alcohol and drugs: both lower mood and make distressing thoughts harder to manage [1].
• Life circumstances: bereavement, relationship breakdown, debt, job loss, insecure housing, loneliness, abuse, discrimination [2].
• Physical health: long-term pain, disabling illness, or a terminal diagnosis.
• Care-related: recent discharge from inpatient care, or poor continuity of care [2].

How it is diagnosed

Suicidal thoughts are not diagnosed as a condition, and there is no blood test or scan. Instead there is an assessment of what the person is experiencing and what support they need, alongside diagnosis of any underlying condition.

In the UK this can start with a GP, with NHS 111, or in A&E [1][7]. Where a mental health professional is involved, NICE calls it a psychosocial assessment. It should happen at the earliest opportunity, in a private area, and looks at what is happening for the person and at their strengths and difficulties [2].

A diagnosis of an underlying condition opens routes to treatment. It is not a judgement about the person.

Treatment

NICE guideline NG225 is what UK services follow for self-harm and suicidal thoughts [2]. Fear of the response is a common reason people delay asking for help.

• A GP appointment. The GP asks directly about the thoughts, checks physical health and medicines, and can refer to mental health services [2].
• NHS 111, mental health option. Available 24 hours a day, it may connect you to a mental health professional by phone [1][7].
• Crisis teams. These support people intensively at home rather than in hospital [7].
• A&E. Staff treat immediate physical and mental health needs and refer to liaison psychiatry. A mental health professional should see the person at every attendance [2][7].
• Safety planning. A safety plan is made with a professional, not alone. It records triggers, warning signs, coping strategies, who to contact, and steps to make the person’s surroundings safer [2].
• Psychological therapy. NICE recommends a CBT-informed intervention tailored to the person, typically 4 to 10 sessions [2]. It should not be withheld because of diagnosis, age or substance use [2].
• Medication. NICE does not recommend drug treatment as a specific intervention for self-harm [2]. Medicines may be prescribed for an underlying condition, and starting or stopping one is a prescriber’s decision.
• Hospital admission. Admission is considered only in specific situations, such as ongoing safety concerns [2]. NICE’s recommendations centre on assessment, safety planning and aftercare. Being detained under the Mental Health Act is not the usual outcome of telling someone how you feel.

Living with suicidal thoughts

The aim is to get through this period with other people involved, not to manage it alone.

• Tell one person today: a friend, a relative, your GP, or Samaritans on 116 123 [1][3].
• If talking out loud is too much, text SHOUT to 85258 instead [4].
• Ask someone to stay with you, or go where other people are [1].
• Avoid alcohol and drugs, which make distressing thoughts harder to manage [1].
• Get somewhere you feel safer, and ask someone you trust to help make your home safer [1].
• Make a safety plan with a professional and keep it where you can find it quickly [2].

Do not wait to see whether the feelings pass on their own. Support shortens the period when things are hardest.

When to speak to a professional

• Samaritans: call 116 123, free, 24/7 [3].
• Shout: text SHOUT to 85258, free, 24/7 [4].
• NHS 111: call 111 or use 111 online, then choose the mental health option [7].
• CALM: call 0800 58 58 58, 5pm to midnight daily [1].
• Papyrus HOPELINE247: call 0800 068 41 41 or text 07860 039967 [1].
• Your local crisis team, if you are already under a mental health service.
• 999 or A&E if anyone’s life is at immediate risk, or someone has seriously harmed themselves [1][7].

Speak to your GP if thoughts that life is not worth living have lasted more than a few days or keep returning. You do not need to be in crisis to ask.

Get urgent help the same day if you cannot keep yourself or someone else safe [7], if the thoughts are becoming constant, or if you have harmed yourself.

If you are worried about someone else, ask them directly and stay with them while they get help [6].

Common questions

Does asking someone about suicidal thoughts put the idea in their head?

No. This is a common myth, and it is wrong. Mind advises asking directly if you are worried, even when you are not certain: speaking openly makes it easier for people to seek help [6]. Many feel relieved and less isolated when asked [6].

What should I do if I think someone is suicidal?

Ask them directly, then listen without judging and without rushing to fix things [6]. Stay with them, help them contact their GP, NHS 111 or Samaritans, and offer to go with them [1][6][7]. If their life is at immediate risk, call 999 [7].

Will I be sectioned if I tell someone I am having suicidal thoughts?

Usually not. Most people who talk to a GP, NHS 111 or a crisis team are supported at home or as an outpatient. NICE’s recommendations focus on assessment, safety planning, therapy and aftercare, with admission only in specific situations [2].

Do suicidal thoughts go away?

Often, yes. How long they last differs from person to person, and they commonly rise and fall rather than staying at one level [5]. Treating what sits underneath, such as depression, and having support in place, both help.

Clinical review pending

References

1. NHS. Help for suicidal thoughts. NHS. https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/help-for-suicidal-thoughts/
2. National Institute for Health and Care Excellence. Self-harm: assessment, management and preventing recurrence (NG225), Recommendations. NICE. https://www.nice.org.uk/guidance/ng225/chapter/Recommendations
3. Samaritans. Contact Us. Samaritans. https://www.samaritans.org/how-we-can-help/contact-samaritan/
4. Shout. Shout: The UK’s free, confidential, 24/7 mental health text service. Mental Health Innovations. https://giveusashout.org/
5. Mind. Suicidal thoughts and suicide prevention. Mind. https://www.mind.org.uk/information-support/types-of-mental-health-problems/suicidal-feelings/
6. Mind. How to support someone who’s feeling suicidal. Mind. https://www.mind.org.uk/information-support/helping-someone-else/supporting-someone-who-feels-suicidal/
7. NHS. Where to get urgent help for mental health. NHS. https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/
8. NHS England. Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4. NHS England, 2025. https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey