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5 Steps for Navigating Suicidal Thoughts, from a Psychiatrist Who’s Been There

These are their anchors to life. ByChase T.M. Anderson, MD, MS

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Content warning: This piece contains descriptions of suicidal ideation and suicidality. If you or someone you know is in crisis, please contact the National Suicide Prevention Lifeline at 988. 

“I’m suicidal again.” I looked at the unsent text with deep sorrow. Tears slid gently down my face. I didn’t think I’d have to send this message again. I hoped my sixth episode of depression with suicidality would be my last. 

Yet there I was struggling with embarrassment, self-loathing, and fear. Even though I was nearly 100% certain I’d live, there remained a thin thread of possibility I might not. Because I live with a history of two suicide attempts, I was predisposed to another.

As a Black, queer psychiatrist, I’ve worked with child and adolescent patients who live with suicidal thoughts. Together, we’ve crafted what’s known as a safety plan, a sequence of steps to keep them alive if their suicidality becomes active and they want to kill themselves. That morning, I needed to enact my own version of a safety plan. 

With a deep breath, I sent the text to my closest friends, my chosen family. Then I went about getting ready for the day. My movements were deliberate and slow. It was important to be kind to myself and take the time to be with–and understand–what was happening inside. 

In my mind, I uttered three words with searing precision: Run your plan.

That was six months ago. I’ve been in remission for the past few weeks, which means that my symptoms of depression and suicidal thoughts are gone. Still, I live with the reality that I may experience another depressive episode with suicidality. But, for now, I go through my day without those thoughts.

We can feel ill-equipped to talk about suicidality because the prospect of people wanting to kill themselves can be petrifying. Oftentimes, we aren’t sure what to do when someone is suicidal without needing to go to the hospital. We do not trust ourselves to have conversations about suicidal thoughts. 

But we actually need to talk about suicidality in order to decrease the shame and stigma associated with it. That’s why, in this most recent episode of suicidality, I was open about this experience online. It felt right to walk people through what it means for me to experience suicidality. And that’s what I’m doing here too.

Talking about suicidal ideation also lets others know that there is a path to healing and remission. I know because mine has saved my life multiple times. 

As a psychiatrist and as a human being with a history of suicidal ideation, these are the five steps I take to survive when I’m suicidal. They could help you (or someone you care about) too. 

Step 1: Notify your people and let them be supportive.

It takes willpower for someone to tell others they’re suicidal. And our response to these disclosures can either create space for bonding or silence future conversations.

Community can save lives. A survey by the Trevor Project found that LGBTQ+ kids who had one accepting adult in their life were 40% less likely to report a suicide attempt than those who didn’t. Some research also suggests that a sense of connectedness creates space for people living with suicidal thoughts to feel less alone, reducing their risk of suicide. 

The first time I told friends and family I was suicidal years ago, I was terrified they would leave me. I had to work through the internalized shame, external stigma, my pride, and thousands of other factors to remove the mask I’d worn. I was screaming inside. 

But, in my experience, self-disclosure gets easier each time. I’m incredibly fortunate to know friends and family love me even when I can’t fully love myself. That has healed my mind and soul time and time again.

In my most recent episode, every friend and family member responded to my text with love and support. But I also had to be open to their offers of comfort. When two friends texted to ask if they could come over to hold me, I had to slow my automatic rush to respond, “I’m OK, thank you though.” 

In previous episodes, I’ve isolated myself, especially at the beginning. But this time, a calmer part of my mind said, Do something different. Let your friends be there. Let them see all of you. Let them in. Later, my arms curled tightly around one friend while the other held me with such tenderness. RuPaul’s Drag Race played on the television. I fell asleep as we held each other close. 

Their kindness would help make this my shortest and least intense episode of suicidality. 

Step 2: Work with a licensed mental health professional.

There is an easier way for us to heal than struggling on our own. In its purest form, therapy is designed to help people be their authentic selves.

I first started seeing a therapist when I was in medical school. Weeks before my first session, an incident of discrimination triggered my suicidal ideation. Though I didn’t act on it (thanks in part to this plan you’re reading now), I didn’t think I could survive another day like that. I needed help.

Also, I was tired of hating myself. I wanted to see if there was a way to balance my unending care for my classmates as their class president and my righteous rage at certain behaviors infecting the medical system. 

I hoped I could learn to love myself again. And therapy was a large part of helping me do just that. 

In this latest episode, my therapist held space as I cried and shared that my suicidality had returned. Pain tore at my heart. However, something felt different. I knew what to do. 

I neatly laid out my plan to understand my suicidality. My therapist looked into my soul and said, “How you relate to your depression has changed.” We studied every reason why this episode occurred, how my depression works, and the why behind everything I do. What I once viewed as a sickness became a catalyst for personal growth. 

Step 3: Create goals that keep your future alive.

This part of my framework focuses on understanding what keeps you future-oriented. That used to feel overwhelming, but I’ve learned no goal is too big or too small if it keeps you alive. That’s why I call this step an anchor to life. 

Every time a suicidal thought arises, I remind myself of the promise my college friends and I made: to help society become a place where everyone is accepted. I haven’t met that goal, so I still have work to do. 

Setting my sights on that goal allowed me to focus on my unique skills to help that dream come to fruition. The visions of myself in the future were stronger than the desire to end my life. 

This is a strategy I use to help the kids I work with to chart a concrete course through suicidal ideation. Together with their parents, we use behavioral activation, SMART goals, and other techniques to set future goals.

Whether it’s going for a walk for the first time in days or applying to college when their suicidality tells them they’ll be dead before they get there, each step is celebrated. The question held between us: “Who do you want to become and how do you get there?” We reignite every dream held within and find ways to bring those hopes into reality. 

Step 4: Cultivate self-love.

When discrimination worsened in medical school, I examined every facet of myself I’d been told was wrong and didn’t fit society. My suicidality showed me which aspects of my identity to destroy. My queerness, my Blackness, and my vocality were always targets. 

Then I’d plot how to hide, distract from, or subvert those parts. I thought that if I contorted myself to the expectations of others, I wouldn’t want to kill myself anymore.

I’ve come a long way since then. Now when my suicidality critiques my identity, I remind myself that those facets are inherently loveable. It’s a chance to love the entirety of my being. 

On the mornings when I look in the mirror and feel ugly, I lean in closer. I gaze at my skin and remind myself that Black is beautiful. Derogatory words and actions from society, old classmates, and previous lovers are not mine to bear. I pause. I breathe. I transmute those moments into an appreciation for my queerness, my Blackness, all of who I am. This gives me the strength to confront discriminatory social norms.

I intentionally bring forth my ruthless self-compassion. I ask why I’m still permissive around certain behaviors from others and what detrimental behaviors I enact. I ask why I don’t guard my energy, time, heart, and mind as much as I do for those around me. 

If a pattern of behavior is hurting me and cannot be evolved, I say goodbye to it. 

The youth I work with go through this process too. There are few things I’ve experienced that are more soul-wrenching than a kid saying some version of, “What if I’m not worthy of living? What if I’m evil? What if I deserve to kill myself?” But once we’ve named their fears, the kids can more easily embrace their inherent worth. 

Step 5: Radically accept your suicidality. 

When I first experienced suicidality at age 13, thoughts of death threatened to consume me. I’d sit in class, frightened that classmates would out me in front of yet another teacher. As bullying continued into high school, my suicidality started to become all I could see. This led to my first suicide attempt.

I loathed my suicidality, what I thought it had turned me into, and that I wanted to die when I also wanted to live. But radically accepting this part of me changed that. This element of healing draws upon the therapeutic modality of radical acceptance, or accepting stuff we don’t like and changing our response based on that reality.

Now I tell my suicidality, I embrace that you are part of me for now, and you are not all of me. I shift from fighting my suicidality to flowing with it. I have thoughts of killing myself and those thoughts don’t mean I’m going to die. Part of me doesn’t want to live and I will find a way to remission.

With this last episode, I viewed my suicidality with more compassion. I met this part of myself and said, “Hello, old friend. What are you here to teach me about myself this time?” Even when I cried myself to sleep, my arms wrapped around my body, I was able to pivot: One day I’d use this story to connect with others as they experienced suicidal thoughts. 

Over the months, I healed. Then one morning, I woke up for the first time in months with a smile on my face. Internally I uttered, Keep going. That unconscious morning smile was a hallmark of my suicidality nearing its end. A few weeks later, the urge to dance in the shower comes. There I am, dancing to K-pop songs. Beneath the spray, I recall how far I’ve come.

I continue on, eternally grateful to be alive.

Chase T. M. Anderson MD (he/they) is an assistant professor in child and adolescent psychiatry at The University of California, San Francisco and Medical Director of The Muses Program for Minoritized Youth. You can follow them on X, Instagram, and BlueSky.