by Renée Matthes
From the outside, Sam seemed fine: showing up to work, texting friends, doing sports, and smiling on photos. Inside, Sam was planning to take their own life. Yet, nobody knew, because Sam never said a word.
Sam’s story is more common than most realise. Studies suggest that more than half of people who experience suicidal thoughts never disclose them to anyone. And many of those who survive a suicide attempt never share their distress with the outside world in the days, weeks, or months leading up to the attempt.
This so-called non-disclosure presents a major challenge in suicide prevention. Although discussions about suicide prevention in societal, political, and clinical settings have increased in recent years, it is hard to help if we don’t even know that someone is struggling.
So, why do so many stay silent?
Who speaks and who stays silent is influenced by many reasons. When looking at demographic information, studies indicate that men are less likely to disclose suicidal thoughts and behaviours than women. And younger people are more open about their struggles compared to older adults. Additionally, people with little social support or who have had negative experiences when disclosing suicidal thoughts or behaviours in the past, are more likely to keep their struggles hidden. While the reasons for non-disclosure are complex and highly individual, some of the most common reasons reported in the literature are fear of stigma, impact on others, and concerns about loss of autonomy:
Fear of stigma: In our society, the stigma surrounding mental illness, and particularly suicide, remains widespread. Still, suicide is sometimes considered as a personal weakness or as something shameful. Therefore, suicide remains a highly tabooed subject. Too often, individuals fear that they will be misunderstood, judged, or treated differently by others, if they disclose their suicidal thoughts or behaviours. Another widespread concern is that others may not take them seriously or might respond with clichés (‘It’s just a phase’). These kinds of negative experiences associated with help-seeking can further reinforce the fear of disclosure. Some also might experience self-stigma (i.e. internalised negative beliefs about their own suicidal thoughts or behaviours) which then additionally prevents them from seeking help.
Impact on others: Individuals experiencing intense distress in their daily lives, whether they have a mental health diagnosis or not, often see themselves as a burden to the people around them. This sense of burdensomeness can make disclosing suicidal thoughts or behaviours difficult or feel impossible, as they worry that sharing these will cause their loved-ones emotional pain or distress. Despite having suicidal thoughts, some perceive their actual risk of suicide as “low” or manageable and therefore not worth discussing with others. Therefore, to protect their family members, partners, or friends from feeling responsible or overwhelmed, they might choose to stay silent.
Concerns about loss of autonomy: Across many studies, the primary reason for non-disclosure is concerns about loss of autonomy. Individuals often fear that revealing suicidal thoughts or behaviours could lead to interventions that take away their autonomy, such as involuntary hospitalizations or unwanted medication. In addition to the direct negative attitudes towards these interventions, these were often thought to then lead to further negative consequences such as a negative impact on a person’s career or concerns about others finding out about their suicidal distress. As a result, even when someone wants help, staying silent can feel like the only way to maintain control.
If silence is common, what can we do to make disclosure easier?
We can provide a safe environment for individuals to break their silence and share their distress, but there is no single fix.
Many times, shame and fear of judgment prevent people from speaking about their struggles. Therefore, reducing stigma around suicide and mental health in general is crucial. Normalising honest conversations about suicide makes it easier for people to disclose their thoughts. At a community level, strengthening social networks can help to create safe spaces for individuals to open up and talk about how they are feeling. Asking someone directly about suicidal thoughts does not increase the risk, instead it can provide the opportunity to have an honest conversation. Training and public education around suicide can help families, friends, and partners to respond with compassion rather than fear or judgment. On the clinical side, making mental health services more accessible, also increases the likelihood that individuals will seek and find help. Finally, many reported that not knowing what would happen if they shared their suicidal thoughts with a mental health professional prevented them from speaking up. Therefore, transparency about involuntary hospitalization and other interventions can make disclosure feel safer.
Too often, suicidal thoughts stay hidden behind closed lips. This is not because people don’t need support, but because fear, shame, and uncertainty make it feel safer to stay silent. Tragically, the silence also cuts off lifelines of support to the person in pain. Yet, openness could be the very thing that saves a life.
Renée Matthes. Master’s student in Psychology and Psychotherapy at the University of Mainz, Germany.
Suicidal Behaviour Research Laboratory 