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What Are The Warning Signs Of Suicidal Behavior?

And other important facts to know about suicide and depression.
PHOTO: istockphoto

Have you ever felt like you are a burden on your friends, on your family? Have you ever thought that nobody understands or really sees you? That maybe you don’t even understand yourself? These are feelings pretty much everyone has had at one time or another. These are also two of the predominant feelings that affect people who turn to self-harm, to suicide.

The World Health Organization (WHO) estimates that close to 800,000 people die by suicide every year, which is one person every 40 seconds. 

Suicide is becoming increasingly common on a global scale. The World Health Organization (WHO) estimates that close to 800,000 people die by suicide every year, which is one person every 40 seconds. This means that, if you read at the speed of the average adult, by the time you get to the end of this article, it’s possible that seven (200-250wpm) people may have taken their lives.

It is the second leading cause of death in people aged 15 to 29 worldwide, and the WHO further estimates that for every time one person takes their own life, there are over 20 suicide attempts. About 79 percent of suicides globally occurs in low- and middle-income countries. 

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But one thing everyone should know about the issue is that, as the WHO points out, “Suicides are preventable with timely, evidence-based and often low-cost interventions.”

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And worldwide initiatives are quick to stress that while mental health service providers are spotlighted in the effort to prevent suicide, anyone can help save a life. The key is understanding the issues around suicide and mental health, being willing and unafraid to start the conversation, providing support and directing help to those who need it.

So keep reading—you may just learn how you can save a life. And if you are having thoughts of suicide yourself, the life you save might well be your own.

What is suicide? How does depression relate to suicide?

The American Psychological Association (APA) defines suicide as “the act of killing yourself, most often as a result of depression or other mental illness.” Meanwhile, depression, or major depressive disorder, “is a common and serious medical illness that negatively affects how you feel, the way you think and how you act… [It] causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.”

While most people who suffer from major depression do not die by suicide, it does increase suicide risk. Still, just because a person has not been diagnosed with a mental illness does not mean they are not at risk for suicide or that they do not have one. According to the WHO, one in four people worldwide will be affected by mental or neurological disorders at some point in their lives, and even when treatments are available, “nearly two-thirds of people with a known mental disorder never seek help from a health professional.”

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Robby Echavez, a registered psychometrician and psychologist working with the Vicente Sotto Memorial Medical Center’s Women’s & Children’s Protection Unit and a resident psychologist for the University of the Philippines-Cebu, identifies two elements of suicidal behavior. The first of these is “burdensomeness, so you feel that you are a burden to yourself, or to other people. You feel like you can’t stand yourself living because you feel that you’re weighing heavily on other people’s lives, on their priorities. You feel like you’re dead weight for somebody else, your family, parents.” The second, he says, is disconnection, a feeling of being alone or cut off from others.

“You feel that you’re disconnected because nobody understands, or nobody dares to understand what you’re feeling or thinking.”

“So imagine yourself weighed down by these burdensome thoughts and emotions, and then also feeling that you can’t express all of this to another person,” says the psychologist, who runs the RBE Psychological Services clinic in Mandaue City, Cebu, which offers services like psychotherapy, guidance and counseling, and more. “You feel that you’re disconnected because nobody understands, or nobody dares to understand what you’re feeling or thinking. So the suicidal, the person who thinks about the suicide, might in many cases really withdraw from the usual social supports. And it makes suicide and suicide-related behaviors very likely.”

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What are warning signs of suicidal behavior to watch out for?

The APA and the US National Institute of Mental Health (NIMH) identify the several danger signals. Be concerned if someone you know exhibits these warning signs, and take action to get help as soon as possible:

  1. Talk about wanting to die or kill themselves, or a preoccupation with death and dying
  2. Talk about feelings of:
    -Lacking a reason to live
    -Great guilt or shame
    -Feeling trapped or without solutions to their problems
    -Unbearable pain (emotional or physical)
    -Being a burden to others
  3. Making plans or looking for ways to kill themselves, including acquiring the methods to do so and searching for lethal methods online
  4. Changes in behavior, including:
    -Trouble sleeping or eating
    -Extreme mood swings
    -Acting anxious or agitated
    -Unnecessary risk-taking
    -Losing interest in their personal appearance or grooming
    -Withdrawing from family and friends
    -Giving away prized possessions
    -Showing rage or talking about taking revenge
  5. Increased alcohol or drug consumption
  6. Losing interest in school, work, or hobbies
  7. Making preparations for death like writing a will, making final arrangements
  8. Previous attempts at suicide or self-harm
  9. Having recently experienced a serious loss
  10. Being exposed to other people’s suicidal behavior, including peers, family members, or celebrities
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Echavez reminds people to factor in our cultural values and perceptions, emphasizing the importance of making assessments by seeing ourselves from the viewpoint of others. “Much like [how] Caucasians or Americans would view themselves as highly independent, Filipinos have a sense of kapwa, of otherness, being together. I feel that can be a very helpful informal intuitive but powerful metric for determining whether someone might be at risk of depression, and thus stand at great risk for suicide.”

One way to identify these cues, he says, “is tuning to how people see you and what people are saying to you. So when people are saying, ‘Hindi na kita nakikita sa mga gig,’ ‘I’m not seeing [you] anymore in class,’ or ‘Where have you been?’ To some people this might seem intrusive... But I feel, from the vantage point of detecting depression and helping people who might be at more risk for suicide, that can be a very powerful early sign, in providing help and getting this person more access to support.

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Aside from this, Echavez says, “It’s not just what people say to you, it’s also their descriptions of you. ‘Mukha kang matamlay,’ ‘You don’t seem to be yourself lately,’ or ‘I haven’t seen you smile in a while.’ Rather than just [taking] that as social criticism or judgment, that can also be an index for, maybe this person needs access to mental health support, maybe this person requires company, a bit more listening.”

What should I do if I am worried a loved one is suffering from depression or suicidal thoughts?

When dealing with a person in a mental health crisis (such as planning or considering harming themselves or others, panic attacks, suicidal ideation, and more), the National Alliance on Mental Illness (NAMI) advises two things: (1) Practice clear communication and let the other person know they are heard and understood and have your undivided attention and (2) Reach out for help from a mental health provider, hotline, or other resource.

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“Know that when you listen, you’re not doing nothing. You’re doing everything you can for that person.

Echavez, who was one of the volunteers to help found Mental Health Hour Cebu and its #TheListeningMovement, which has since expanded to partner groups in Manila and Cagayan de Oro, also stresses that you should never undervalue the importance of listening to another person. “I think the first thing I would want to see is that we trust that when we listen to somebody else, we’re doing everything that can be done for that person in that moment...

“These are the two things I’d want to share with others who want to become better listeners for themselves and for others: Know that when you listen (forgive me for the double negative), you’re not doing nothing. You’re doing everything you can for that person. Second, try to remind yourself what’s the more important thing here. What do I need to listen to? Do I listen to a hug, a touch, a voice?”

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What should I do if I am suffering from depression or suicidal thoughts?

Ask for help. This cannot be stressed enough. Whether it’s from a loved one, a mentor or adviser like a teacher or priest, or from a mental health professional, the first step is to ask for help.

“When you fail in your reaching out, in your help-seeking, in your getting access to mental health support, try again because you didn’t lose anything because you’re already at the point of nothing to lose.”

“You will lose nothing, coming in for help. If you fail during the first try, because it is a possibility, any reaching out risks failure,” Echavez says. “This is a given for all reaching out, including help-seeking. So when you fail in your reaching out, in your help-seeking, in your getting access to mental health support, try again because you didn’t lose anything because you’re already at the point of nothing to lose… And if you fail there, you lost nothing. If you try the third time and you felt you lost something, remind yourself, you didn’t lose anything. I’m already anxious, I’m already depressed, I’m already suicidal. I’d rather try again.

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“So go ahead and try again. Because I feel at the next try, the next try will work for you. The next try might connect you back to a listening person, connect you back to someone who can help you move forward.”

What hotlines can I call for help for myself or a loved one?

Here are some of the hotlines you can call. Please share the numbers with your loved ones as well.

Where can I go for psychological/mental health services or support groups?

Some places you can go for psychiatric or psychological services include:

  • In Touch Community Services (Crisis Line)
    Offers counseling services for adults, children and families, plus training for their Crisis Line volunteers
    Address: 2/F Holy Trinity Church Offices, 48 McKinley Road, Makati City, Metro Manila
    Phone: (02) 8893-1893 / (0917) 863-1136
    Counseling Hours: 8:00 a.m. to 8:00 p.m. on Mondays to Fridays / 8:00 a.m. to 5:00 p.m. on Saturdays
  • UST Graduate School Psychotrauma Clinic
    Free psychological services, including assessment, evaluation, counseling, and psychotherapy
    Address: Room 104, G/F Thomas Aquinas Research Complex, University of Santo Tomas, España Boulevard, Sampaloc, Manila
  • Ateneo Center for Family Ministries Foundation (CEFAM)
    Offers free consultation, family and individual psycho-spiritual counseling
    Address: Spiritual-Pastoral Center, Ateneo de Manila University Campus, Katipunan Avenue, Quezon City
    Phone: (02) 426-4289 to 92
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  • Amang Rodriguez Memorial Medical Center
    Offers basic consulting and teaches some psychotherapeutic techniques
    Address: Sumolong Highway, Sto. Niño, Marikina City
    Phone: (02) 941-6289
    Consulting hours: 8:00 a.m. to 5:00 p.m. Mondays to Fridays (registration hours: 8:00 to 10:00 a.m., 1:00 to 2:00 p.m.)
  • Center for Behavioral Sciences—Vicente Sotto Memorial Center
    Provides consultation and treatment for different psychiatric and mood problems, sleep problems, anxiety, and substance-abuse related problems
    Address: Vicente Sotto Memorial Center, B. Rodriguez Extension, Cebu City

    Clinic Hours: 8:00 a.m. to 5:00 p.m.
  • PsychConsult, Inc.
    Offers psychotherapy services and psychological evaluation, plus workshops and training
    Address: Unit 227 Regalia Park Towers, 150 P Tuazon Blvd, Cubao, Quezon City
    Phone: (02) 8421-2469 / (02) 7357-6427 / (0917) 808-0193
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    Online platform for mental health consultation and treatment run by a team of licensed mental health professionals
  • Mood and Anxiety Resource and Referral Center (MARRC)—Makati Medical Center
    Evaluates clients with mood and anxiety concerns and recommends treatment options for them
    Address: 3rd Floor Tower 1, Makati Medical Center, No. 2 Amorsolo Street, Legaspi Village, Makati City
    Phone: (02) 8888-8999 local 7316
    Service Hours (by appointment): 8:00 a.m. to 5:00 p.m. Mondays to Fridays
    *Mood Harmony by Makati Medical Center Support Group for Mood Disorders
    Landline:(02) 8888-8999 local 7316
  • UGAT Foundation (Ugnayan at Tulong Para sa Maralitang Pamilya, Inc.)
    Offers individual, marriage, and family counseling by appointment, formation training, and counseling training
    Address: 2/F ISO Annex, Social Development Complex, Ateneo de Manila University, Loyola Heights, Quezon City
    Phone: (02) 8426-6001 loc. 4872-73
    Service Hours: 8:00 a.m. to 3:00 p.m. Mondays to Fridays
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A few Philippine-based mental health support groups include:

For a more complete list of mental health service providers, check out the list crowd-sourced by #MentalHealthPH. The directory is also available as an Android app.

What if I or a loved one can’t afford professional help?

The Mental Health Act, Republic Act No. 11036, was signed into law in June 2018, but a surprising number of people still are unaware of its provisions, which include affordable and accessible mental health services for Filipinos. 

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Hotlines offer one avenue of getting help, for the cost of a phone call. Many hospitals, including government hospitals, have psychological clinics that offer services at affordable rates. If you are in school or university, you may also be able to avail of counseling services there. If you are looking for spiritual counseling, you can approach your family or parish priest. If you prefer something less formal, support groups are free and often allow you to stay anonymous.

How can I help?

Volunteer for crisis hotlines and other initiatives, or show up to support groups to lend your ears and your support. Educate yourself and others on mental health issues. Most importantly, reach out to friends and family who might be struggling—let them know you are here for them, give them the gift of active listening and your undivided attention, and help them get the help they need from mental health professionals via the avenues listed above.

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Robby Echavez, MAEd, RPm, RPsy, runs the RBE Psychological Services clinic at Sotero B. Cabahug, Barangay Ibabao-Estancia, Mandaue City, Cebu. To contact them, call (032) 512 8092 or (032) 318 4246 or email He also works as a psychologist at the Women’s and Children’s Protection Unit at the Vicente Sotto Memorial Medical Center and as a resident psychologist at the University of the Philippines-Cebu.