Psychiatric Care for Self-Harm and Suicidal Thoughts

If you are in crisis or thinking about harming yourself, call or text 988 (the Suicide & Crisis Lifeline) or call 911. You do not have to carry this alone. These thoughts are a sign of deep pain, not weakness, and with the right care they can ease. Self-harm means hurting yourself on purpose, often to cope with overwhelming emotions; it is not always a suicide attempt, but it signals real distress. Suicidal thoughts can be passive, like wishing you could disappear, or active, with intent or a plan; both deserve attention.

How our physicians help

Our physicians take time to understand what drives these thoughts or behaviors, such as depression or trauma, and build a safety plan with you, and with parents for young people. Care can combine medication and psychotherapy from the same physician. Some situations need a higher level of care, such as a hospital stay or intensive program; outpatient care does not replace it, and we coordinate with that team.

Warning signs

Signs can be easy to miss, because people often hide how much pain they are in. Young people may show it through irritability, trouble at school, or pulling back from friends. Adults may keep working and seem fine. At any age, watch for:

• Talking about wanting to die, feeling trapped, or being a burden
• Withdrawing from people and activities
• Big changes in sleep, or more drinking or drug use
• Saying goodbye or giving away things that matter
• Injuries that are hard to explain

Getting help now or soon

There is no need to wait until things feel unbearable. Reach out to us if thoughts of death or self-harm keep coming back, if you are hurting yourself to get through hard feelings, or if someone else has you worried.

If you might act on these thoughts, cannot stay safe right now, or are not sure, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service. If you can, stay with someone you trust until help arrives.

What a first evaluation covers

We ask about these thoughts directly and calmly: how often they come, what sets them off, and what has kept you going.

Self-harm and suicidal thoughts are not diagnoses on their own, and no single cause explains them. They can come with depression, bipolar disorder, PTSD, borderline personality disorder, substance use, or eating disorders. We also look at sleep, recent stress, and medical causes.

Together we write a safety plan. It lists your warning signs, what calms you, who you can call, and how to make your surroundings safer.

Treatments that can help

Medication does not treat self-harm directly. It can treat what may sit underneath, such as depression or bipolar disorder, often with antidepressants or mood stabilizers. It can take weeks to help, and your physician follows you closely when a medication starts or changes. In children, teens and young adults, suicidal thoughts can increase for some at first on an antidepressant, so please tell us right away about any change.

Therapy is usually at the center of care. Feeling better is rarely a straight line. Established options, which often come from separate therapists or programs we coordinate with, include:

• Dialectical behavior therapy (DBT): skills for intense emotions and moments of crisis
• Cognitive behavioral therapy (CBT) for suicide prevention: practices other responses to the thoughts that lead to a crisis
• Family-focused therapy: brings parents in to rebuild trust with a young person

Supporting someone who is hurting

Your calm presence matters more than perfect words. You might say, 'I am glad you told me. How can I help?'

• Do not promise to keep it secret. Safety comes first
• Avoid asking the person to promise to stop, which can add shame
• Stay with them if they seem in danger, and call for help
• Keep checking in after the worst has passed

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