What is passive suicidal ideation and how can I spot the signs?

What is it, why does it happen, and what signs should I be looking out for? We share everything you need to know about passive suicidal ideation

Passive suicidal ideation is something that many of us experience, but few seriously talk about. Perhaps the thought has crossed your mind, “I wish I could just fall asleep and not wake up,” or “I wish I could die, so I don’t have to deal with this.” These are examples of passive suicidal ideation and, while they are not active plans, and often focus on ways in which someone may die rather than actively cause their own death (such as thoughts of death through an accident or natural causes, rather than suicide), these thoughts can be not only worrying, but can lead to engaging in riskier behaviour without being conscious of it.

Suicidal ideation isn’t an isolated event – it can be a symptom of other mental health issues, such as severe depression, or manic depression for those with a bipolar disorder diagnosis. Here, we’ll explain more about the different types of suicidal ideation, warning signs to look out for, and, crucially, how to then find help.

What’s the difference between passive and active suicidal ideation?

Having suicidal thoughts is a spectrum. For some people, these thoughts may be active: they think about suicide, and may have developed a plan for what they will do. They want to die. For others, it may be passive: they wish they were dead or could die, but do not have any concrete plans.

Neither kind of suicidal ideation should be dismissed. You are still at risk of harm if you have passive suicidal thoughts.

Intent and motivation can change quickly, meaning you may not feel at risk now, but that could change before you realise it or have time to seek help. Studies have suggested that if you experience high levels of depression and suicidality, thoughts of passive and active ideation have the potential to become more severe and dangerous. Experiencing physical illness, a significant decline in your mental health, or an unpredictable event (losing your job, a particularly bad day, fighting with a loved one) could trigger your thoughts to become active.

How many people experience passive suicidal ideation?

Passive suicidal thoughts are more common than many of us realise. Worldwide, around 9% of us will experience suicidal ideation at some point in our lives. Within the past 12 months, that sat at around 2%. One US study found that 4% of adults aged 18 and over have thought about suicide, with those aged 18–25 the most likely to have had such thoughts within the past 12 months.

As of 2020, around 10 in every 100,000 deaths were contributed to suicide in England. For men, that rate was much higher (15.3 per 100,000) compared to women (4.9 per 100,000). Men aged 45–49 have the highest suicide rate (23.8 per 100,000). Worldwide, the World Health Organisation estimates that one in every 100 deaths is a result of suicide.

All this to say, suicide is something that has touched many lives, and it’s something that we need to take seriously.

Are some people at more risk than others?

While men are three times more likely to complete suicide, research suggests that women show higher rates of suicidal thinking, non-fatal suicidal behaviour, and suicide attempts.

You may be at higher risk for suicidal ideations if:

• You have a personal history of mental illness (particularly depression, bipolar disorder, or other mood-based disorders).
• There is a family history of mental illness (suicidal thoughts or attempts, depression).
• You have experienced substance addiction.
• You have a history of abuse, or have experienced significant trauma.
• You exhibit impulsive behaviours or increased aggression.
• You have a physical illness.
• You have experienced a major loss (death of a close friend or family member).
• You have limited access to healthcare or a support network.

Could I be suicidal and not realise it?

Sometimes people can struggle to recognise warning signs of suicidal thoughts or behaviours. Signs that people often overlook can include:

• Feelings of being empty, hopeless, or like you have no way out of your problems.
• Strong feelings of guilt or shame.
• Believing that others would be better off without you.
• Becoming withdrawn or isolated socially.
• Unexplained changes in how you sleep (e.g. struggling to get out of bed, sleeping more, sleeping less, staying up all night then struggling to cope the next day).
• Becoming emotionally distant from others (e.g. seeming indifferent when faced with emotional situations like the loss of a pet, or when receiving particularly good or bad news).

Do passive suicidal thoughts need to be treated?

Seeking help and advice is recommended. Speaking with your GP can be the first step towards getting a full assessment and diagnosis. This can help you to access the right kind of help and support, better understand what may have led to you feeling this way, and find new ways of coping with these feelings, and addressing any triggers.

Experiencing any level of desire for death can lead you to unconsciously act in a way that may be riskier to your health and wellbeing. Even when passive suicidal thoughts remain passive, they suggest a level of unhappiness and discontent in your life, and risk negatively impacting your overall wellbeing and quality of life.

Reaching out for help is the first step to overcoming these thoughts and feelings. You don’t have to live with these thoughts, and you also don’t have to face them alone.

How do you overcome passive suicidal ideation?

There are a number of options that may be recommended, depending on your circumstances, symptoms, and what services are available in your local area.

Speak with your GP

Talking with your GP is often the first step towards getting a referral for specialist mental health services in your area, as well as talking through any medication options that may be worth considering. They may highlight local support groups you could access.

Medication

For some people, your GP may prescribe antidepressants or anti-anxiety medication to help decrease symptoms while you are working through the underlying causes that are triggering your thoughts in therapy.

Talking therapy

Counselling (therapy) is often highly recommended, as this can help you to identify the complex issues that may be causing the way you are feeling, help you to understand your thoughts and feelings better, as well as introduce you to new ways to manage your thoughts in a more productive or useful way.

Dialectical behaviour therapy (DBT) in particular can be helpful for those experiencing suicidal thoughts, as it uses acceptance and change techniques that can help you better understand why you’re feeling this way, and what you can do to help yourself. Other types of therapy may also be suggested, such as cognitive behavioural therapy (CBT).

Peer support

Talking with others who have had similar experiences can be a huge help. Reaching out to find online support networks can be the easiest way of doing this, or there may be support groups in your area.

Create a safety plan

Typically suggested for when you have active suicidal thoughts, it can be helpful to have one in place just in case. A safety plan may include listing any warning signs you or others can look out for, writing down coping strategies that could help, as well as listing the contact details for who you want to be contacted in the case of an emergency. Ensuring you know the steps you need to take to keep yourself safe can help you to feel more prepared if your thoughts do take a concerning turn.

Speak with your loved ones

Talking to your friends and family can help you to better understand how you are feeling, as well as to let them know that you are struggling. If you are worried that your thoughts or feelings may have been causing you to withdraw from others, this can be a helpful way to reach back out again to them.

What can I do if a loved one is experiencing passive suicidal ideations?

If you’re worried about someone, one of the most important things you can do is listen to them, without accidental judgement, or minimising how they are feeling – ask questions, and ensure they know that you are there to offer support.

Don’t promise to keep their suicidal ideation a secret. Doing so can not only harm their trust in others if you do need to speak out and seek help on their behalf, but it may also make you hesitate. Encourage them to seek help, but avoid pushing them before they are ready. Offer to drive them or go with them if they feel worried about going alone.

If you are concerned about their immediate safety, call 999 or take them directly to A&E.

If you are worried about your immediate safety, go to the nearest A&E department, call 999 if you can’t get to a hospital, or ask someone to call 999 or take you to the hospital.

If you just want to talk to someone or feel like A&E isn’t an option, you can call the Samaritans on 116 123 and someone will be there to listen without judgement, 24 hours a day, 365 days a year.

To find out more about the signs and symptoms of suicidal thoughts, how they can make you feel, and how you can access help, visit Counselling Directory or speak to a qualified counsellor.