We Cannot Prevent What We Refuse to Understand - World Suicide Prevention Month | September

THE DOOR

There is a particular kind of door we leave open when someone is struggling."I'm here if you need me. You can call or text anytime."

The door is technically open. The invitation is genuine. Most people who say it mean it completely. But there is still someone standing on the other side, expected to decide when to enter, push the door further open, explain why they're there and ask to be let in.For someone carrying severe emotional distress, even that small sequence can feel impossible.This is not because people don't care. The problem is that care alone does not always tell us what to understand, what to notice, or what to do next. There is a distance between “I'm here” and “being there.”

That distance becomes especially important when we talk about suicide. Suicide prevention is often reduced to awareness, warning signs and asking someone if they are okay. Those things matter, but prevention also requires us to understand the experiences we are often uncomfortable talking about: suicidal thoughts, self-harm, emotional distress, stigma and the reasons someone may struggle to ask for help in the first place.

This article is an attempt to look more closely at that space. Not to reduce suicide to a single cause or a single conversation, but to ask what we might understand differently if we were willing to have the conversation more honestly.

CARING IS NOT THE SAME AS KNOWING HOW TO HELP

Most people who say "I'm here" mean it. That's worth stating plainly, because this isn't an argument about who cares and who doesn't. It's an argument about a gap that exists even where care is real: someone can know a friend is struggling. They can love them. They can say the right sentence at the right moment. And the person on the other end can still receive very little that actually helps, because caring about someone and knowing what to do with that care are two different skills, and only one of them gets taught.

We are told, constantly, to check on our friends. We are rarely told what checking on someone should involve once they say something is actually wrong. So the conversation stalls at the sentence. Compassion is there. It just has nowhere to go.

WHAT WE ARE ACTUALLY TALKING ABOUT

Part of why compassion stalls is that the words involved get used as if they all mean the same thing, and they don't. Mental health is something everyone has, and it can be steady, strained or in crisis. Mental illness refers to diagnosable health conditions that affect a person's thoughts, emotions or behaviour. Emotional distress can exist with or without a mental illness.

Self-harm is different from a suicide attempt. A person may hurt themselves without intending to die, sometimes as a way of coping with overwhelming emotions or getting through something they do not yet know how to put into words. That does not make self-harm harmless or insignificant. It deserves to be taken seriously without automatically assuming that the person wants to die. It rarely comes out of nowhere. Usually there is a build-up first: racing thoughts, exhaustion that sleep doesn't touch, a loneliness that feels total even in a room full of people, pain that has stopped feeling like it has an edge or an end. And when self-harm happens, it is not necessarily thoughtless or simple. A person may know it will not solve what is hurting them, argue with themselves about it, want to stop, and still reach for it because, in that moment, relief from unbearable emotional pain can feel more immediate than any other option they can see.

That conflict, knowing that it will not fix what is underneath while still reaching for it because the pain has become too much to sit with, is part of what can make self-harm so difficult to stop and so difficult to explain to someone who has never experienced that kind of distress. It is also why reducing it to attention-seeking, weakness or a desire to die misses what may actually be happening.

Suicidal thoughts are also not one uniform experience. They can range from wishing things could stop or feeling that it would be easier not to exist to thoughts about suicide that may be more persistent or specific. Having suicidal thoughts does not, by itself, tell us exactly what level of immediate danger someone is in. A suicide attempt involves behaviour carried out with some degree of intent to die, while suicide refers to a death resulting from such behaviour.

These distinctions matter because collapsing everything into one category can cause harm in both directions. Someone who is self-harming may be dismissed because people assume it is "just attention-seeking," while someone experiencing suicidal thoughts may be treated as though they are incapable of making sense of their own experience. Someone having a difficult month can also be made to feel as though they are being treated as a crisis when what they first need is to be heard. None of this is about treating suicide as an acceptable answer to pain. It is about being accurate enough that the right kind of help reaches the right situation, while paying attention to what may be contributing to the distress in the first place.

CIRCUMSTANCES

None of this happens in a vacuum. Academic pressure, financial insecurity, family conflict, loneliness, exhaustion, unstable living conditions, a relationship ending, uncertainty about the future or a sense of not belonging can all weigh heavily on someone. Rarely does just one thing do all the work, and none of these circumstances, by themselves, determines whether someone will become suicidal. But prevention cannot treat distress as though it exists separately from the life a person is actually living. Telling someone to "think positively" does very little when what they need may include stability, support, treatment, rest, connection or simply someone willing to take what they are saying seriously.

WHY IT IS HARD TO SAY

Suicidal thoughts can be extremely difficult to disclose, and it's worth asking why rather than treating silence as evidence that nothing is wrong. Shame is part of it. So is the fear of being treated differently afterward, watched, managed, or handled like a problem rather than a person. So is not wanting to become a burden to people who already have their own lives.

None of that makes suicidal thoughts rare. The World Health Organization estimates that more than 720,000 people die by suicide every year worldwide. Suicide was the third leading cause of death among people aged 15 to 29 globally in 2021. What the numbers cannot show is the shape of the experience itself. Suicidal crises can intensify during acute periods of distress, which is part of why prevention cannot rely only on recognising a perfectly visible, fully formed crisis in advance. Sometimes someone can be struggling without looking like they are struggling at all.

STIGMA AND INVALIDATION

Understanding these distinctions matters because misunderstanding them is exactly what stigma runs on. Mental illness still isn't treated the way physical illness is. Someone with chest pain is likely to be taken seriously. Someone who has been struggling for months is more likely to hear "be strong," "everyone has problems," "think about your family," or "you have everything, so what could possibly be wrong."

Most people saying these things are not trying to be cruel. They think they're being encouraging, or they simply don't know what else to say. But each one can quietly tell the listener that their pain is disproportionate, ungrateful or temporary, making the next disclosure harder. In a culture where pain has to be proven before it's believed, prevention becomes harder, not because anyone intends it to, but because disbelief is exhausting to keep pushing against.

This is where validation matters, and where it gets misunderstood. Validating someone's pain is not the same as agreeing with a suicidal conclusion. If someone says, "I don't think I can do this anymore," the reflex is often to argue: you have so much to live for, don't say that, you'll be fine. These responses are meant to help, but they can tell the person that their experience is something to be corrected rather than understood.

Validation looks different. It means acknowledging that what someone is feeling is real and serious, listening without immediately trying to argue them out of it, and then moving toward what happens next. Validation is not agreement that things are hopeless. It is closer to the difference between "you're wrong to feel that" and "I hear that this is real, and I'm taking you seriously." On its own, it isn't a treatment or a guarantee of safety. It can, however, make an honest conversation and the next practical step more possible.

SUPPORT BEYOND THE CONVERSATION

That next step is often where good intentions run out, because support gets imagined as a single emotional conversation rather than something ongoing and practical. Severe distress can make ordinary life difficult in ways that are easy to underestimate: getting out of bed, eating regularly, attending class, making a phone call or arranging an appointment.

Meaningful support can mean helping someone find a counsellor rather than simply telling them to see one. Going with them the first time, if that's what makes it possible. Helping them put into words what they're experiencing when they can't quite do it themselves. Reducing pressure where that's realistic, an extension, a lighter week, a conversation with a professor. Staying in contact after the immediate crisis has passed, since distress doesn't end the moment someone gets an appointment, and recovery rarely moves in a straight line.

A harder week later on doesn't erase whatever progress came before it. None of this requires a friend to become a counsellor, or to solve someone's academic, financial or family problems for them. It requires treating support as something that continues past the first conversation, not something that ends there.

WHERE FRIENDSHIP ENDS AND PROFESSIONAL CARE BEGINS

Friends can support. They cannot diagnose, treat or manage a mental health crisis on their own, and it helps everyone involved to say that plainly rather than let it go unspoken until someone is exhausted or in over their head.

A friend can notice a change, ask directly and calmly, listen without flinching and stay present. A friend can also help someone reach Tele-MANAS, a campus counsellor, a doctor or another appropriate professional service. Getting professional help is not a failure of friendship. Helping someone reach it can itself be one of the most important things a friend does, because it means the burden is not being carried by one person who was never expected to carry it alone.

PREVENTION BEFORE THE CRISIS

We cannot prevent what we refuse to understand.

Most of what's described here isn't crisis response. It is the ordinary work that happens before a crisis: knowing the difference between the words we use, recognising that stigma is often unintentional rather than cruel, making disclosure feel possible rather than shameful, and building environments where asking for help isn't read as weakness.

Prevention is also about making life more supportable in the broader sense: relationships, stability, treatment, a sense of belonging and practical security. The point isn't to suggest that someone has to become happy or productive to deserve support, or that finding a purpose resolves distress on its own. It is to recognise that the conditions someone is living inside can affect whether they can imagine more than one way forward. It's also worth remembering that a person can be attending every class, submitting every assignment and laughing with friends, and still be carrying something serious underneath all of it.

Functioning is not proof that someone is okay. Prevention that only looks for visible signs of struggle will keep missing the people who have gotten very good at not showing it.

BEING THERE, REDEFINED

"I'm here if you need me" asks the other person to do the work of reaching.

A different sentence does something else: I noticed you haven't been yourself. You don't have to explain everything right now. Can I sit with you? It doesn't wait to be summoned. It doesn't demand an explanation before it shows up. And it doesn't pretend that sitting there is the whole answer, only the beginning of one.

Care matters. But care without somewhere to go stays passive. If someone tells us they are not okay, the harder question isn't whether we care. It's whether we actually know what being there for them requires.

SEPTEMBER | WORLD SUICIDE PREVENTION MONTH

September is observed as World Suicide Prevention Month, a time to move the conversation beyond awareness and towards understanding, prevention and meaningful support.

Prevention does not begin only when someone reaches a crisis. It begins much earlier: in the conversations we are willing to have, the pain we are willing to take seriously, the stigma we are willing to challenge, and the support we are willing to offer before someone has to ask for it.

Sometimes being there begins with simply noticing.And sometimes, it means doing more than saying, "I'm here."

Because prevention is not only about keeping someone alive through a crisis. It is about helping build a world in which they do not have to carry their pain alone.

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If You or Someone You Know Needs Support

Tele-MANAS
Government of India's national tele-mental health service
14416 or 1800-89-14416
Available 24/7.

If someone is in immediate danger, seek emergency medical care or contact local emergency services.

Credits:

Patron: Dr. T.Purshothaman M.E.,Ph.D, Principal of GCT

Staff In-charge: Dr. M. Kalpana

Editor in Chief: Mathimalar V (IT 23-27)

Article prepared by: Mathimalar V (IT 23-27)