But in all honesty: it does not work that way. People do not fit into boxes. And certainly not when they are wavering on the border between staying and disappearing.
What does help is something both ancient and surprisingly modern: closeness. Real, human closeness, which comes before the risk score. It is a way of being more than a technique. An invitation to look together at what the despair is trying to say.
Not acting brave, but staying curious
In practice you see it again and again: as soon as you stop making risk pictures and start listening, something happens. People relax. Room arises. A story gets going, often messy, with side paths, silences, tears, irritation, everything mixed together. But that story is the signpost.
You do not have to act tough. You do not have to know how it should be done. The only thing you have to do is stay curious. Where does the pain come from? What exactly is unbearable? What is the suicidal longing trying to make clear? These are not ‘interventions’. This is simply good human work.
Hope as a stubborn form of care
Hope is not a sugar coating that you apply. Nor is it saying: “It will be all right.” Nobody knows that, and it often does not feel that way either. Hope is something quite different. It is the quiet message: “I am staying with you, also now that you can no longer carry it. Then I will carry it with you for a while.”
That simple gesture (staying seated, not looking away, asking one more question, searching along) has more impact than any statistic or risk score. People feel it. They feel that they matter. And sometimes that makes just enough difference not to step out of life.
Better to look again than to build on old assumptions
Every human being is dynamic. And yet diagnoses, treatment plans and assumptions sometimes stay standing for years like stone monuments, while the person has long been somewhere else.
That is why it helps to look at everything again regularly: the diagnosis, the story, earlier experiences, physical complaints, possible trauma, medication, side effects, the situation at home, everything. And then to puzzle again together: is this still the right story? People often already feel calmer and safer when someone is sincerely willing to think along again, without judgement and without haste.
An emergency plan made together as an anchor
An emergency plan, let us simply call it that, is a small, clear document that you make together. It is not a form you fill in to tick off a protocol; it is a conversation that you summarise.
What helps when things go wrong? Whom may you call? What can you try yourself? What do you have to avoid? Which words or situations pull you deeper into despair? And above all: what makes you still be here, despite everything?
Such a plan is a promise on paper: we think ahead together. You are not on your own. See also the signalling plan.
The professional is a human being too
Working with suicidal people is hard. For care providers too. It touches you, it unsettles you, it sometimes makes you unsure. That is allowed. You do not have to be the infallible expert. More than that: people sense very precisely when you have parked your humanity behind your desk.
Care professionals who feel supported dare to be more present. To listen more. To panic less. And that makes all the difference for the person who is wavering.
Finally: no magic, but humanity
A suicidal crisis cannot be solved with a trick, a test or a ‘care pathway’. It is an intense human emergency. And because it is human, it asks for human work: closeness, acknowledgement, puzzling together, continuing to search for meaning.
We do not have to do it perfectly. We only have to be willing to sit down beside someone who no longer knows how to go on existing. And that, strangely enough, is often the most powerful form of care there is.
Read also: Living with thoughts of suicide.
Do you need help now?
PsychosisNet offers information. We do not offer a chat, a helpline or crisis support. If you or someone else is in immediate danger, call the emergency number in your country. If you are thinking about suicide, or you need to talk to someone now, see Need help now? for helplines by country.
Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare.
Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.
Want to read more?
Blogs by Jim van Os can be read here
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