Does talking about mental health with those who are struggling make things worse? Tips on what not to say

World Mental Health Day is celebrated on 10 October; this year’s theme is ‘Lived experiences heard: real voices, real change’, which means giving more space and a listening ear to those who are personally experiencing a mental health condition. Those who have a family member or friend in difficulty often fear ‘saying the wrong thing’ or even making the situation worse by talking about it openly, perhaps by asking if they are thinking about suicide. It is an understandable fear: let’s see if research on this topic can help us.

Suicide remains a significant public health issue: it is estimated that more than 720,000 people die by suicide worldwide each year. For every adult who dies by suicide, it is estimated that more than 20 have made at least one attempt. Precisely because of the seriousness of the issue, many people avoid addressing it for fear of ‘putting the idea into someone’s head’ that wasn’t there before. The available scientific evidence, however, does not support this fear. A systematic review with a meta-analysis of eight randomised controlled trials found no statistically significant effect of being asked about suicide, either on suicidal thoughts or behaviours or on psychological distress, either immediately after the question was asked or in the days that followed. A 2014 review of the scientific literature, which analysed thirteen studies involving adult and adolescent populations, reached a similar conclusion: none of the studies considered had found an increase in suicidal thoughts among those who were asked directly about the subject, and in some cases, discussing it even appeared to reduce them.

Not exactly: what seems to make the difference is the way it is discussed. An empathetic, one-to-one conversation with someone you want to help is quite different from the way suicide is portrayed, for example, by the mass media. This phenomenon of imitation is known in scientific literature as the ‘Werther effect’, named after the protagonist of Johann Wolfgang von Goethe’s novel *The Sorrows of Young Werther* (1774), who takes his own life: at the time of the book’s publication, a number of cases of imitative suicide were attributed to it, hence the name chosen decades later by scientific research to describe this type of phenomenon. A systematic review with meta-analysis found that journalistic coverage of suicides by famous figures is associated with an increase of between 8 per cent and 18 per cent in suicides among the general population in the two months following publication, with an even more marked increase, between 18 per cent and 44 per cent, when the report describes in detail the method by which the suicide was carried out. Conversely, a systematic review with an analysis of individual data from eight randomised controlled trials found that, in people with an already established vulnerability to suicide, exposure to media reports focusing on hope and recovery from a suicidal crisis is associated with a small reduction in suicidal ideation over the following four weeks; however, the same research found no significant differences in people’s willingness to seek help. In short, the difference seems to lie more in ‘how’ the subject is discussed than in ‘whether’ it is discussed at all.

You don’t need to be an expert to be helpful. Here are some practical tips, taken from the Mayo Clinic’s guidance: talk to the person about what you’ve noticed, calmly explaining why you’re concerned, without making accusations or judgements; remind them that a condition such as depression is not a sign of weakness, but a condition that can improve with the right treatment; if you fear there is a real risk, ask directly and tactfully whether the person is thinking about suicide and whether they have already thought of a way to go about it: having a concrete plan is considered a sign that increases the likelihood of the act being carried out; in the event of a serious and immediate risk, do not try to handle the situation on your own: contact a doctor, a mental health service or A&E immediately.

This is precisely one of the key points at the heart of the theme chosen for World Mental Health Day 2026: people with first-hand experience of a mental health condition should not merely be recipients of care, but should play an active role in shaping it. A Cochrane review updated in 2022, covering 15 randomised controlled trials and over 3,100 participants, found that people involved in shared decision-making with a healthcare professional reported, immediately after the consultation, feeling more involved in the choices affecting them; however, the authors themselves rate the certainty of this evidence as low, as they do for most clinical outcomes and treatment adherence. The available evidence on peer support – that is, support provided by people who have personally experienced a mental health condition – remains limited: a review that synthesised the findings of 35 previous reviews reports that 97 per cent of these were of low or very low quality, and that the overall picture suggests a possible benefit regarding depressive symptoms and the personal recovery process, but without robust findings on general symptoms and hospital admissions. Another systematic review, covering nine studies that assessed the involvement of people with lived experience in the design of mental health services, noted that more extensive forms of involvement, such as co-design, are associated with services perceived as more accessible and with greater satisfaction, although robust data on long-term effects are lacking. On this basis, in 2023 the World Health Organisation published a policy document recommending the systematic involvement of people with lived experience in the design, evaluation and governance of health services.