Opening the Conversation About Suicidality

Susan Noonan, MD, MPH, discussed the importance of routinely assessing patients for suicidal ideation. Drawing from conversations with many patients with mood disorders across the country, Noonan reported that many patients stated their psychiatrists had never asked them about suicidal thoughts or self-harm. These patients were deprived of a vital aspect of care, she said, suggesting potential missed opportunities for intervention.

Noonan also explored several explanations for this omission, including clinician reliance on self-report questionnaires, assumptions of low suicide risk, or simple oversight. She emphasized that even patients considered low risk should be directly asked about suicidal thoughts, as risk prediction remains imperfect and passive ideation can quickly evolve into active suicidal intent under stress. The discussion of screening highlighted the continuum of suicidal ideation, from active (specific plans for death) to passive (a wish not to live without plans), both of which require prompt clinical attention. Noonan underscored that discussing suicide does not “plant the idea” but instead provides an opportunity for communication, relief, and potential prevention.¹

She urged clinicians to employ empathetic, nonjudgmental, and open-ended questioning (eg, “What kinds of thoughts have you been having?”) and to validate the patient’s distress. In closing, Noonan reminded psychiatrists that despite time pressures, prioritizing these conversations demonstrates care, reduces stigma, and may save lives.²

Dr Noonan is a physician, mental health and wellness coach; author of 5 books on managing mental health and mood disorders with a print and video blog; consultant; group facilitator; and certified peer specialist. Dr Noonan is the inaugural recipient of the National Depression and Bipolar Support Alliance Peer Support Specialist of the Year 2022. Her most recent book, published by Johns Hopkins University Press, is Reconnecting After Isolation: Coping With Anxiety, Depression, Grief, PTSD, and More

References

1. Suicide screening and assessment. Suicide Prevention Resource Center. Accessed October 30, 2025. https://sprc.org/wp-content/uploads/2022/12/RS_suicide-screening_91814-final.pdf

2. Researchers have a proven prescription for reducing suicide rates. Kaiser Permanente. April 8, 2025. Accessed October 30, 2025. https://kpwashingtonresearch.org/index.php/news-and-events/recent-news/news-2025/researchers-have-proven-prescription-reducing-suicide-rates