Warning signs — what a crisis centre taught people to notice

Before anything else

The starting position

The centre's warning-signs material opened with a deliberately ordinary observation: everyone has hard times, that is part of life, and when someone is having a particularly hard time it usually shows — if you really look. Feelings, thoughts and changes in behaviour in response to difficulty are normal. The point of learning the signs was not to pathologise distress but to notice when the pattern has tipped.

That framing does a lot of quiet work. It lowers the threshold for a lay reader to engage at all, and it heads off the two failure modes the centre would have seen constantly on its own phone line: people who dismissed obvious signals as normal moodiness, and people so alarmed by ordinary sadness that they could not tell what mattered.

The three steps

Everything else in the centre's prevention material hangs off three steps, stated the same way across a decade of pages.

Ask the question — directly. Are you thinking about suicide?
Show concern — talk, and listen.
Connect the person to someone trained in suicide prevention. Today, that is 988.

The centre added a fourth instruction specifically for young people: if you are a teenager, do not try to handle this on your own — get an adult in your life to help you get help for your friend. That instruction is preserved here because it is the one piece of the original guidance most obviously still correct, and because the failure it addresses — a frightened teenager holding another teenager's secret alone — is the exact scenario the do-not-be-sworn-to-secrecy rule exists for.

What the centre taught people to notice

Its most direct list covered signs pointing to risk: no interest in the future; a strong interest in death expressed through reading, conversation, writing or art; giving away important possessions; hinting about suicide; talking about it directly; and talking about a plan, especially where there is access to a firearm.

It identified history that raises risk — a previous attempt, a suicide death in the family, or the suicide of a friend or of a public figure the person identifies with — and traits associated with higher risk, including severe depression, bipolar disorder or anxiety alongside substance use; an active thought disorder; high impulsivity; and extreme perfectionism.

Beneath those it published four broader groupings, and the breadth is the point: the centre was teaching an untrained reader to notice change rather than to diagnose.

Behaviour: Trouble concentrating; loss of interest in school or hobbies; no energy; changes in grades or work performance; changes in appearance; a change in who someone spends time with; physical complaints; frequent accidents; changes in appetite or sleep; increased alcohol or other drug use; withdrawing; fighting; taking more risks; extreme mood swings; and intentional self-harm.
Situations: A bad review or poor grades; relationship violence or a breakup; not making a team; rejection by peers; feeling different; unplanned pregnancy; a death or serious illness in the family or among friends; serious illness of one's own; financial problems at home; substance use in the family or one's own; and physical, sexual or emotional abuse.
Feelings: Depressed, hopeless, lonely, worthless, misunderstood, angry, ashamed, embarrassed, alienated, powerless, trapped, guilty, sad, alone, confused, helpless, disappointed, discouraged, overwhelmed, frustrated, pressured.
Thoughts: I don't fit in. It's my fault. I do everything wrong. I'm no good. No one cares. No one understands. Why me? This will never end. I am a burden.

The last list is the one worth pausing on. Several of those sentences map directly onto constructs that suicide research has since formalised — perceived burdensomeness and thwarted belonging in particular. A community crisis centre in Kansas was teaching people to listen for them, in plain language, in a bulleted list on a web page, because those are the sentences its volunteers actually heard on the telephone.

How to respond — what the centre said, and did not say

Its guidance to a worried person was concrete. Ask directly. Find out whether the person has already done something, and if so do not leave them alone and get medical help. Find out whether there is a plan; the more specific and available the means, the more likely an attempt, so where a firearm is involved and accessible, removing access matters. Listen, believe the person, express concern. Help them make a plan to stay safe through the crisis period, and make sure other people around them know how they are feeling so they can help.

The do-not list was just as specific: do not refuse to talk about the thoughts; do not offer simple answers or reassurances; do not challenge the person or use scare tactics; do not be sworn to secrecy; do not start doing therapy — help the person find someone trained; and do not take on responsibility for another person's life.

The centre closed on a sentence it repeated in several places and which is worth reproducing exactly, because it is aimed at the person left afterwards: a suicide is never someone else's fault, and the only person who has control over it is the person themselves.

Warning signs: what the field teaches