Assisting Students Who Report Suicidality

These warning signs include overt expressions of suicidal thinking and elicit the most distress or worry.

Warning signs at this tier include:

• Threatening to hurt or kill themselves
• Looking for ways to kill themselves, such as seeking access to pills, weapons, or other means
• Talking or writing about death, dying, or suicide (includes social media, handwritten letters, text messages, emails, phone messages)

These warning signs include more subtle expressions of suicidal thinking and a broader range of factors that should be taken in combination and the larger context of the person’s natural tendencies and environment.

Warning signs at this tier include:

• Feelings of hopelessness
• Feelings of anger, rage, and wanting to seek revenge
• Feeling trapped
• Feeling anxious, irritated, agitated, and having difficulty sleeping
• Acting recklessly or engaging in risky activities
• Using increasing amounts of alcohol and/or drugs
• Withdrawing from friends and family
• Displaying dramatic changes in mood, typically over a period of a few days to a few weeks
• Expressing difficulty finding a reason or purpose for living, such as “I wish this were all over,” or “I can’t go on like this for much longer.” 

Mental and Physical Health

• Mental disorders, such as Depressive disorders, Anxiety disorders, Substance Misuse, Schizophrenia
• Previous suicide attempts
• Self-injury

Individual

• Isolation, hopelessness, anger, impulsivity, risky behavior and other factors mentioned in Tier Two Warning Signs
• Feeling burdensome to others
• Low distress tolerance
• Few or poor coping or problem-solving skills 

Environmental

• Relationship difficulties (e.g., friends, partner, family)
• Academic problems
• Employment problems
• Financial difficulties
• Current or past physical, psychological, or sexual abuse
• Chronic illness or disability
• Major loss or negative life transition
• Limited access to effective care
• Exposure to or experience with discrimination and stigma
• Exposure to media reports that glamorize or normalize suicide

Familial

• Family history of suicide or suicidal behavior
• Family history of mental health difficulties
• Current or past family violence or abuse
• Family loss or instability
• Lack of familial support 

Responses to Tier One Warning Signs

If any of the following apply to a distressed student, call 911

• Has a weapon and is threatening to use it
• Threatening immediate harm to self or others
• Has engaged in a behavior that requires immediate medical attention

In Response to Tier Two Warning Signs

• Express care and concern for that individual who is distressed.
• Refer that individual to a trained mental health professional. This may include on-campus, local and national resources.

Ask The Student Directly

When talking with a student, consider the impact of your language about suicide. Ways to ask someone if they are contemplating suicide:

• Are you thinking of killing yourself?
• Are you currently having thoughts of suicide?
• Sometimes when people are experiencing difficult situations, they have thoughts of suicide. Are you?

Avoid saying “completed suicide” or “committed suicide” to not convey a sense of judgment, success, punishment, or other negative tone. Instead, say “die/died by suicide” or “death by suicide.” 

In situations like this, it may be important to ask briefly about any protective factors that may help the student cope with current distress.

Protective factors are those that may reduce the likelihood of suicide and protect students from other risks, such as violence, substance misuse, and academic difficulties.

There are a variety of protective risk factors among college students, they can be sorted into intrapersonal and interpersonal characteristics.

Intrapersonal Characteristics

• Psychological/emotional well-being, positive mood, optimism
• Positive beliefs/hope/anticipation about future plans and events
• Desire to finish school
• Internal focus of control (one has an impact on others and the world, and is responsible for one’s accomplishments)
• Adaptive coping skills, including problem-solving and conflict resolution
• Ability to regulate emotions and tolerate distress
• Self-esteem
• Cultural and religious/spiritual beliefs that affirm life, provide fellowship and a sense of purpose and meaning in life
• Physical activity and exercise

Interpersonal Characteristics

• Family support, parental/caregiver involvement
• Support from friends and partners, involvement in social activities
• Involvement in social activities
• Positive role models, mentors, professors, coaches, peers, and others who provide understanding, care, and support
• Sense of connectedness to school and campus/peer community
• Access to care to support one’s physical and psychological well-being 

* The CARE Team at Ohio University provides advisory and consultative services to the Dean of Students. It provides a rapid response to concerns about students and critical situations as well as coordinating with other helpful university and community resources to assist. A CARE Team referral can be made in person, online, or by contacting the Office of the Dean of Students.

Make A CARE Referral