The simple idea — a few words, kept clear
- Self‑harm — intentionally hurting oneself, whether or not there's an intent to die.
- Suicidal thoughts (ideation) — thinking about suicide.
- Suicidal plan — thinking about how.
- Suicide attempt — an act of self‑harm with the intent to die.
Two of these are often confused: a person can self‑harm without wanting to die, and can have thoughts without acting. They're related, but not the same.
A gentle pathway (that can be interrupted)
This is not a fixed staircase — people move both ways, and protective factors (people who care, responsibilities, hope, help) can interrupt it at any step.
The myth that costs lives 🚨
The opposite is true: a caring, direct question — "Have you been having thoughts of ending your life?" — brings the pain into the open where it can be helped. Doctors then explore thoughts, any plan, access to means, past attempts, and — most importantly — how to keep the person safe right now (reducing access to means, building a support network, arranging follow‑up, treating the underlying illness).
| Gently ask about… | For example |
|---|---|
| Thoughts | "thoughts of ending your life?" |
| Intent | might you act on them? |
| Plan | have you thought about how? |
| Means | access to what you'd use? |
| Past | previous attempts or self‑harm? |
| Protective | people, hope, reasons to keep going? |
The mindset shift
A risk assessment isn't a crystal ball that predicts the future. It's a way of asking: what's happening now, what might happen next, and how do we keep this person safe?
Quick check ✅
- Does asking about suicide make it more likely? (Why or why not?)
- What's the difference between self‑harm and a suicide attempt?
Remember this 🌟
Where we're going next → One of the most common and serious substance problems — alcohol (Concept 41).