Understanding Suicidality: Signs, Safety Planning & Therapy
Last week was Recognized Suicide Awareness Day, so I wanted to share a few thoughts about suicidality.
When things feel unbearable, we might have thoughts that focus on death or dying, or we might question the meaning or purpose of life. Suicidal thoughts, self-harm behaviours, and emotional dysregulation are some of the challenges that can unfold when physical or emotional pain becomes intolerable.
What do these terms mean?
Suicidal ideation
Suicidal ideation refers to persistent thoughts about wanting to die or end one’s life. These thoughts can range from fleeting “I wish I wasn’t here” feelings to a detailed plan. Recognizing these thoughts early matters — reaching out for support can help validate and reduce the intensity of these feelings.
Self-harm
Self-harm refers to non-suicidal self-injury, such as cutting, burning, or hitting. People often use these actions to reduce intense emotional pain or to regain a sense of control. Self-harm is a sign of emotional distress and doesn’t always mean someone wants to die, but it increases risk and always deserves care.
Emotional dysregulation
Emotional dysregulation is difficulty managing or calming strong emotions. We might feel overwhelmed and experience sudden anger, panic, shame, or intense sadness. Emotional dysregulation can lead to impulsive behaviours, including self-harm, or to intrusive thoughts such as suicidal ideation.
Warning signs to notice
A single sign does not always lead to suicidality or self-harm, but a cluster of the following—especially if new or worsening—should increase concern:
Talking about wanting to die, feeling hopeless, or believing you’re a burden to others
Withdrawing from friends, family, work, or activities you usually enjoy
Changes in sleep, appetite, or personal hygiene
Engaging in self-harm behaviours, acting impulsively, or taking risks you would normally avoid
Escalating emotional outbursts or an inability to soothe intense feelings
Saying goodbyes, giving away possessions, or making unexpected arrangements
If you notice more than one of these signals, it’s time to take action for yourself or someone else.
How therapy can help
Reaching out can be difficult. Understanding how therapy can help may make it easier to decide where to get support. Working with a counsellor can help by improving safety, building coping skills, stabilizing emotions, and slowly changing the patterns that keep us feeling stuck.
Safety planning is a step-by-step, personalized plan for what to do when suicidal thoughts become overwhelming or return. With practical guidance and concrete steps, a safety plan can be life-changing — and lifesaving.
Therapy can also help restore hope, strengthen relationships, find meaning, and teach ways to handle crises without harmful behaviours.
Approaches that can help
Internal Family Systems (IFS) Therapy
IFS understands suicidal thoughts or urges to self-harm as activities of particular parts of ourselves — often protective parts trying to stop unbearable pain, guilt, shame, hopelessness, or trauma. The aim isn’t to banish those parts but to listen and understand them so the system can find safer ways to survive.
Dialectical Behavior Therapy (DBT)
DBT is especially effective for people whose main struggle is intense emotional dysregulation and self-harm. DBT teaches skills in emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness. There is strong evidence that DBT reduces self-injury and suicidal behaviour.
Practical steps you can take right now
If there is immediate danger — call emergency services (911) or go to the nearest emergency department.
Crisis resources (Vancouver Island / Canada):
Vancouver Island Crisis Line: 1-888-494-3888
Island Health Crisis Text: 250-800-3806
KUU-US Crisis Line: 1-800-588-8717
Canada-wide Crisis: call or text 988 to reach a crisis responder 24/7
(If you are outside Canada, contact your local emergency services or local crisis line.)
A simple safety plan might include: connecting with your counsellor or another mental health provider, identifying internal warning signs, using coping strategies, connecting with trusted people/places, and taking steps to make your environment safer.
Reach out to someone you trust — a friend, family member, teacher, coach, colleague, or spiritual community member. Saying “I’m struggling and I need help” is hard, but it is brave and powerful.
If you are reading this because you’re struggling, you do not have to carry this alone. Reach out — to a crisis line, a trusted person, or a mental health professional. Consider therapy: together we’ll create a place of steadiness to help you through the hard moments.
