When Someone Says, “I Don’t Want to Be Here Anymore,” Your Team Needs a Plan

A Structured, Compassionate Response to Suicidal Ideation

Suicidal ideation can occur in nursing homes, sober living environments, residential programs, treatment facilities, and community settings at any hour.

When it happens, staff should not have to improvise.

Fight for Life provides trained behavioral health professionals who can respond, evaluate the immediate concern, engage the individual directly, develop a plan for safety, coordinate appropriate next steps, and document the encounter for continuity of care.

Our crisis approach can incorporate principles from two widely recognized suicide-response frameworks:

ALGEE

A Clear First Response to a Mental Health Crisis

The Mental Health First Aid ALGEE Action Plan provides a practical framework for responding when someone may be experiencing a mental health or substance-use challenge.

A — Approach and Assess

Approach the individual calmly and privately.

Assess for immediate risk of suicide or harm.

When suicide is a concern, the conversation should be direct. Avoiding the word suicide does not make the situation safer.

The goal is to understand what is happening and determine whether immediate intervention is required.

L — Listen Nonjudgmentally

A person in crisis needs to be heard.

Listen without arguing, lecturing, minimizing, correcting, or attempting to immediately solve everything.

Statements such as:

“Tell me what is happening.”

“I’m listening.”

“I want to understand what you are going through.”

can create space for an honest conversation.

G — Give Reassurance and Information

Help the individual understand that support is available and that the immediate goal is safety.

The crisis professional works to reduce isolation, increase connection, and identify realistic next steps.

E — Encourage Appropriate Professional Help

A behavioral health crisis may require additional clinical intervention.

Depending on the situation, this may include:

• Crisis intervention
• Psychiatric evaluation
• Medication follow-up
• Therapy
• Substance-use treatment
• Medical evaluation
• Emergency services
• A higher level of behavioral health care

E — Encourage Self-Help and Other Support Strategies

Safety often depends on connection.

The professional can help identify appropriate supports such as:

• Family
• Trusted friends
• Facility staff
• Therapists
• Physicians
• Peer support
• Recovery supports
• Community resources

The goal is not simply to end the conversation. The goal is to connect the individual to a safer next step.

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ASIST

Moving From Suicidal Ideation Toward Safety

Applied Suicide Intervention Skills Training — ASIST — is designed to help trained helpers intervene directly with someone experiencing thoughts of suicide.

The approach emphasizes asking about suicide openly, listening with empathy, understanding what is driving the suicidal crisis, developing a collaborative safety plan, and connecting the individual to ongoing support. (⁠LivingWorks)

1. CONNECT

The first task is human connection.

Our professional engages the individual directly and compassionately rather than avoiding the subject.

When indicated, this means asking clearly about suicide.

“Are you thinking about suicide?”

A direct question creates an opportunity for the individual to speak openly about what they are experiencing.

2. UNDERSTAND

Suicidal thoughts rarely occur in isolation.

The responder works to understand:

• What happened?
• Why does death feel like an option right now?
• Is there a suicide plan?
• Is there access to lethal means?
• Has the individual taken steps toward acting?
• What has kept the individual alive until now?
• Who or what still matters to them?
• What support is immediately available?

The objective is not simply to assign a label such as “high risk” or “low risk.”

It is to understand the person’s current relationship with suicide and what is required to increase safety.

3. ASSIST

Once the immediate concerns are understood, the responder works collaboratively with the individual to create a path toward safety.

That may include:

• Reducing access to lethal means
• Increasing supervision or observation
• Identifying reasons for living
• Activating trusted supports
• Developing a safety plan
• Coordinating behavioral health treatment
• Contacting medical or psychiatric providers
• Arranging a higher level of care when necessary
• Activating emergency services when imminent danger cannot be safely managed

ASIST specifically teaches development of a collaborative plan intended to help the person remain safe for now while connecting them to further support. (⁠LivingWorks)

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OUR CRISIS RESPONSE

Recognize. Engage. Assess. Stabilize. Connect. Document.

When Fight for Life responds to a suicidal crisis, the goal is to create a clear clinical pathway:

1. ENGAGE
Establish connection and reduce isolation.

2. ASK DIRECTLY
Determine whether suicidal thoughts are present.

3. ASSESS IMMEDIATE SAFETY
Explore intent, planning, access to means, recent behaviors, protective factors, and available supports.

4. INTERVENE
Provide crisis intervention and work toward stabilization.

5. CREATE A SAFETY PATHWAY
Develop appropriate immediate safety measures and determine the next level of care.

6. CONNECT
Coordinate with the facility, treatment team, family, emergency services, or other appropriate resources.

7. DOCUMENT
Provide appropriate documentation of the encounter back to the referring organization, consistent with privacy, consent, payer, and regulatory requirements.