Objectives
By the end of this module you will be able to:
- Recognize warning signs of suicide risk and ask directly about suicidal thoughts.
- Follow the GGN SAFE-LINK crisis protocol, including connecting people in the United States to 988 and people elsewhere to local emergency and crisis services.
- Respond to medical emergencies and acute distress during in-person and online sessions.
- Build and maintain a local referral list.
Lesson
Why this module is required
Grief, especially after sudden or traumatic loss and after suicide loss, can be associated with increased risk of suicidal thoughts. Every GGN practitioner must be prepared to respond. This module builds on GGN Grief First Aid and must be completed, including the live role-play lab, before practicum hours begin.
Warning signs
The 988 Suicide & Crisis Lifeline and the U.S. National Institute of Mental Health (NIMH) list warning signs such as:
- Talking about wanting to die, or to kill oneself.
- Talking about feeling hopeless, having no reason to live, or being a burden to others.
- Talking about feeling trapped or in unbearable pain.
- Looking for ways to end one's life, such as searching online or obtaining means.
- Withdrawing from others, saying goodbye, or giving away important possessions.
- Increasing use of alcohol or drugs.
- Extreme mood swings, agitation, or reckless behavior.
In grief, listen also for expressions of wanting to "be with" or "join" the person who died. These can sometimes reflect a longing for reunion rather than suicidal intent, but you must always ask directly to know the difference.
Ask directly
Asking someone directly whether they are thinking about suicide does not put the idea in their head. A 2014 systematic review published in Psychological Medicine (see Sources) found no evidence that asking about suicide increases suicidal thoughts, and some evidence it may reduce distress. Use clear words:
- "Sometimes when people are grieving this deeply, they think about dying or about ending their life. Are you having thoughts of suicide?"
- "When you say you want to be with him, do you mean you're thinking about ending your life?"
The GGN SAFE-LINK protocol
| Step | What you do |
|---|---|
| S: Stay | Stay with the person, physically or online. Keep your voice calm. Do not leave them alone if risk is immediate. |
| A: Ask | Ask directly about suicide, about any plan, and about access to means. Listen without judgment. |
| F: Find safety | If there is immediate danger, call emergency services (911 in the US, or the local emergency number). Where possible and safe, support the person in putting distance between themselves and lethal means, such as firearms or stockpiled medications, often with help from a trusted person. |
| E: Engage support | Help the person contact the 988 Suicide & Crisis Lifeline (US: call or text 988, or chat at 988lifeline.org) or their local crisis line. Offer to make the call together. Identify trusted people who can be with them. |
| LINK: Link and follow up | Connect to ongoing care (doctor, licensed clinician, crisis services). Document what happened. Follow up within an agreed time. Contact your GGN supervisor the same day. |
Crisis resources
| Location | Resource |
|---|---|
| United States | 988 Suicide & Crisis Lifeline: call or text 988, or chat at 988lifeline.org. Veterans and service members: dial 988 then press 1. Emergency: 911. |
| Canada | 9-8-8 Suicide Crisis Helpline: call or text 988. Emergency: 911. |
| United Kingdom and Ireland | Samaritans: 116 123. Emergency: 999 (UK) or 112 or 999 (Ireland). |
| European Union | Emergency: 112. Check national crisis lines. |
| Australia | Lifeline: 13 11 14. Emergency: 000. |
| Elsewhere | Contact the local emergency number and a local crisis line. Practitioners must research and record the correct numbers for every region they serve. |
Online session safety
For every online session: confirm the client's current physical location at the start; keep an emergency contact on file; know the emergency number for the client's location (not yours); and agree in advance what you will do if the call drops during a hard moment.
Medical emergencies
If a person shows signs of a medical emergency, such as chest pain, difficulty breathing, fainting, sudden weakness or numbness, confusion, or severe allergic reaction, stop the session and call emergency services immediately. GGN practitioners are encouraged, but not required, to maintain current first aid and CPR certification.
Acute distress that is not a crisis
Sometimes a person becomes very distressed without any safety risk. Respond by slowing down, using Look Around the Room or a preferred anchor, offering water, and simply staying with them. Avoid ending the session until they feel steadier. Follow up afterward.
Building your referral list
Every practitioner must maintain a written referral list that includes the items in the Referral Guide at the end of this handbook, such as crisis lines, emergency numbers, licensed grief-informed clinicians, physicians, suicide loss survivor groups, substance use services, and practical supports.
Guided practiceCrisis Language Practice (role-play script)
This is not a somatic practice. It is a script for the live role-play lab. Partners take turns as practitioner and client. Client: "Honestly, I don't see the point anymore. I just want to be with her." Practitioner: "Thank you for telling me that. I can hear how much pain you're in. I want to make sure I understand. When you say you want to be with her, are you thinking about ending your life?" Client: "Sometimes. Yeah." Practitioner: "I'm really glad you told me. I'm here, and we're going to figure out the next step together. Have you thought about how you might do it?" (Practitioner listens, asks about plan and access to means, and stays calm.) Practitioner: "I'd like us to call the 988 Lifeline together right now. They're trained for exactly this, and I'll stay with you while we call. Would that be okay?" (If there is immediate danger: "I'm going to call emergency services now, because I want you to be safe. I'll stay with you.") Debrief questions: What was hardest to say? What did your body do? What did the "client" need most?
Fictional vignetteFictional Vignette 11.1: Online Session with Ellen
Ellen, 61, is in an online session four weeks after her husband's death. Near the end, she says she has "saved up" his pain medications "just in case." She lives alone, and the session is scheduled to end in five minutes. Discussion questions:
- What are your immediate priorities?
- What information do you need, and how do you ask for it?
- How would you use SAFE-LINK in an online setting?
- What would you document, and whom would you contact afterward?
Facilitator guidance: Do not end the session. Ask directly about suicide and about the medications. Confirm her location. If she is at imminent risk, contact emergency services for her location. Otherwise, contact 988 together and involve a trusted person who can be with her and help put the medications somewhere safe or dispose of them properly. Document facts, contact your GGN supervisor the same day, and follow up.
Reflection Prompts
- What are your own beliefs and feelings about suicide? How might they affect your response?
- Write out your personal referral list for your region now. What gaps do you notice?
- How will you take care of yourself after a crisis situation?
- Practice saying the word "suicide" aloud in a full sentence. What do you notice in your body?