Suicidal. It’s a word a lot of people dread. Suicide is a difficult topic, even for many people within the mental health space. It makes people uncomfortable, brings concern and worry, and can sometimes bring fear. What many people don’t know, however, is that not all suicidal thoughts are the same. Some people experience active suicidal ideation, which is what most people think of when they think of someone being suicidal. That someone has a plan and wants to act on it to end their life. However, passive suicidal ideation is even more common. And then chronic suicidal ideation is something that is more common than you would think. They’re all handled differently (for good reason!) and they all mean different things.
Actively suicidal
Someone who is actively suicidal is someone who we would say is at higher risk. When we’re talking about risk for suicide, what we really mean is the chance that they may attempt or complete suicide “soon”. Soon is defined differently by many people, however, the general idea is that “soon” usually means within 48 hours. If the concern is that someone has a plan, can act on it, and plans on acting on it in 48 hours or less, they’re usually considered high or imminent risk. These are the individuals that usually require immediate intervention through deescalation of some variety.
Sometimes that intervention is done in-office, sometimes that’s over the phone with a crisis line like 988, sometimes it’s with a Mobile Crisis Team, and sometimes it’s in the emergency department of a hospital. Either way, that person’s suicidal thoughts need to be addressed immediately and carefully.
Someone who is actively suicidal, however, may not always be an imminent risk to themselves. For these individuals, they do want to die, and they do have a plan they could act on (such as overdosing on pills or using a firearm), but they usually do not have a specific time frame. They don’t know when they plan on doing this, they just know they want to. Careful risk assessment, safety planning, and addressing of thoughts also need to be present here. It shouldn’t be assumed that just because they don’t have a specific time or plan that they’re safe to walk out of an office without it being addressed at all.
Passively suicidal
Passive suicidal ideation is pretty much what it sounds like. Someone wants to die, or not keep living, but it’s passive. They have no plans to do anything specific to harm themselves. They just wish they didn’t have to live anymore. Maybe they cross the street without looking to see if a car is coming. Maybe they pray every night that they won’t wake up in the morning. Maybe they hope they’ll get a serious illness and die.
Passive suicidality comes from the same place that active suicidality comes from. These individuals experience little to no hope for the future and they cannot envision a future for themselves in which they can be happy or mentally healthy.
These individuals often do not need intervention in the way people often think of suicide or crisis intervention. However, that does not mean they don’t need help. Ignoring passive suicidality is just as dangerous as ignoring active suicidality. Passive can become active quickly if not intervened. However, intervention more often looks like therapy centered specifically around the passive suicidality and the events or thoughts that triggered it. It can also look like medication management. Sometimes doses need to change or a medication may not be the right fit. Addressing these factors are important when helping someone who is passively suicidal.
Chronically suicidal
Suicide is often brought on by a specific event, emotion, or trigger. For the majority of people who experience suicidal thoughts (whether passive or active), it’s not something that they deal with all of the time. It happens once or twice, or many years apart. Some people, however, experience chronic suicidality. They’re suicidal often. Many times, it’s passive suicidality that becomes active or vice versa. It may not have a specific trigger or event. It just is that person’s normal state.
When someone is chronically suicidal, it’s important to remember that not every time they say “I wish I was dead” or “I want to die” means that they plan to kill themselves. However, it is just as important to remember that it could mean that or could turn into that. Risk assessment and safety planning is key here. With someone chronically suicidal, they may already have a safety plan. It’s important to review the plan often, make any updates that may be necessary, and adjust for potential factors that may come up (like a clinician’s vacation – these clients in particular may need to be provided with a back-up clinician for those times).
If you or someone you love is struggling with suicide and live in the US, reach out to 988, the national lifeline. Considering therapy can also be an important aspect of feeling better and feeling more hope.
