Suicide is a topic very few want to talk about, yet discussion is critical to the greater subject of suicide prevention and the overall goal of ending mental health stigma in our nation.

September is Suicide Prevention Awareness Month and a time to shift perceptions surrounding suicide and suicidal ideations. Although this is a topic that’s important to address year-round, youth, parents, educators and care providers may see additional resources offered during September. This blog post will outline the prevalence of suicide among young adults, warning signs to watch for and statewide resources for those seeking help.

The National Alliance on Mental Illness offers recent statistics on suicide, keeping in mind mental health conditions, including suicide and suicidal ideations, do not discriminate based on age, gender or background.

  • Suicide is the second leading cause of death among people aged 10–34 and the 12th leading cause of death overall in the U.S.
  • The overall suicide rate in the U.S. has increased by 35% since 1999.
  • 46% of people who die by suicide had a diagnosed mental health condition.
  • Annual prevalence of serious thoughts of suicide, by U.S. demographic group:
    • 4.9% of all adults.
    • 11.3% of young adults aged 18 to 25.
    • 18.8% of high school students.
    • 45% of lesbian, gay and bisexual high school students.
  • Lesbian, gay and bisexual youth are four times more likely to attempt suicide than straight youth.
Warning signs

Ellipsis Chief Clinical Officer Nikki Thomson, LISW, SOTP-II, said there are warning signs friends and families may be able to pick up on if a loved one is considering suicide or having suicidal ideations.

“We talk about warning signs and watching for these shifts in behaviors or patterns, but sometimes, it’s not big, monumental things.”

Nikki Thomson, Chief Clinical Officer

“That’s why, as a community, we need to be familiar with a variety of things that can indicate a person’s mental health may be suffering and they are in need of help. Even things that people might think they are doing for attention can be just that — wanting someone to reach out and check on them,” Thomson said. 

Changes in appearance and/or behavior

Thomson said one key indicator that a person may be thinking of suicide is if they suddenly stop taking care of themselves or change their involvement in activities, social events, etc. Other behavioral-type changes might look like a shift in eating or sleeping patterns without just cause or reason. Thomson went on to say that even if it isn’t a change related to a suicidal ideation, it generally signals something is not right in their lives and is worth checking in to.

Finality talk

Another signal may come in the form of language and conversation. When a person, especially a teen, stops making plans for the future or stops sharing what they’re looking forward to, this can indicate they do not plan on being around for them. Other means of fatalistic or finality talk can come in the form of sounding hopeless, or a “what’s the point” outlook. Thomson another thing to watch for is a person’s dismissal or intolerance of praise and kindness, indicative of their feelings of low self-worth. It’s also common to see a person who is seriously contemplating suicide start to give away personal items that hold value to them.


While self-harm (also called self-injury) and suicide aren’t mutually exclusive, Thomson said it can indicate a person is in so much pain, they seek any way to simply feel something and release what they are holding in. Repeated self-harm can escalate to suicide over time. Self-injury may also look like new or excessive drug or alcohol use.

While these warning signs can be noticed by anyone in a person’s life — such as a family member, coach, teacher, friend, or care giver — Thomson said it’s critical to address the issue, rather than romanticize it or ignore it.

“Some people feel like if we talk about suicide, it’s going to put the idea in a person’s head,” Thomson said. “I will tell you — if you are noticing these warning signs, the idea is already there. Talking about, addressing it is actually what they are seeking."

"The conversations can be tough and at times, painful. It’s also scary to think someone you love is questioning the value of their life. But, letting them know you notice their changes, you care about them and you will help them get the help they need is so very critical to not only their well-being, but normalizing mental health as part of an everyday conversation.”

Nikki Thomson, Chief Clinical Officer
Where to go for help

If you or someone you know is in need of critical mental health assistance, Thomson said there are a variety of tools for Iowans to help with immediate and longer-term crises.

Iowa Mental Health and Disability Services (MHDS)

MHDS providers have the resources to help those struggling with mental health. All 14 MHDS regions in Iowa partnered to improve Iowans’ brain health and connect them to professionals who can help. MHDS offers the following types of crisis services, which can be accessed by calling 988 or visiting their website:

  • Mobile Response.
  • 23-hour Crisis Observation.
  • Crisis Stabilization.
  • Access Centers.
Your Life Iowa

Your Life Iowa is a program from the Iowa Department of Public Health and provides free, confidential support to connect Iowans to resources meant to help them get their lives back on track. They offer a 24/7 phone, text or live chat option to help people with issues related to alcohol, drugs, gambling, suicide and/or mental health.

  • Call: 855.581.8111.
  • Text: 855.895.8398.
  • Live chat.
988 Suicide and Crisis Lifeline

In July 2022, the phone number 988 was officially designated as the National Suicide Prevention Lifeline. It connects individuals with trained crisis counselors for support related to suicide, self-harm, emotional distress or those looking to support another person going through a crisis. It’s free, confidential and available 24/7 via phone, text or live chat.

  • Call: 988.
  • Text: 988.
  • Live chat.
  • Iowa callers are routed to resources within the state.
  • There is an option for a Veterans Crisis Line.
  • A Spanish-speaking option is available over the phone; currently the text option is offered only in English.

Thomson noted that if a medical emergency related to a suicide has occurred, call 911. 

Ending the stigma

“The pandemic, social media and the state of the world has made tough times even harder for some kids,” Thomson said. “Let’s make suicide prevention and awareness an OK part of a conversation. Or try different ways of expression, like art or music, if talking is too difficult. As adults, our response to a child in need can really influence their decision and further actions.”

 Thomson also pointed out that when there is a specific instance of trauma, such as a school shooting or devastating event, this can trigger those in vulnerable mental states to carry out ideations. That’s why, she reinforced, its critical to have an open line of communication with loved ones about their mental health.

“Even for those we see as being strong or always happy, check on them. You never know what a person might be needing. End the stigma, have the conversation, be there as best you can to support them or help them get the support they need.”

Nikki Thomson, Chief Clinical Officer