Suffering does not always come with tears or cries for help. Often it hides behind an automatic reply, a brief smile or a silence that nobody questioned again. This Yellow September, perhaps it is worth asking again: “Are you really okay?”
“How are you?” - “I'm fine.”
This brief exchange is repeated every day. At home, at work, at school, on the chapa or in a quick exchange of messages. On some days “I'm fine” is true. On others, it is just a way of avoiding a conversation for which there are still no words.
It can hide tiredness, anxiety, loneliness, fear or a pain that is hard to explain. Yellow September, the month dedicated to suicide prevention, invites us to stay a little longer with that question, to notice what has changed and to listen to what is not always said.
A reality that demands attention
More than 720,000 people die by suicide every year. According to the World Health Organization, in 2021 it was the third leading cause of death among people aged 15 to 29. About 73 per cent of cases occurred in low- and middle-income countries.
Suicide does not result from a single cause. It can be related to a combination of emotional, social, psychological and economic factors. Depression, problematic use of alcohol or other substances, violence, abuse, loneliness, prolonged illness, family conflict and financial difficulties can increase vulnerability.
Behind these numbers there are also stories of recovery: people who received support at the right moment and managed to find other possibilities.
Suffering is not always visible
There is no single appearance for psychological suffering. Someone can keep working, studying, looking after their family, meeting friends and posting happy photographs while fighting an inner battle.
Some changes in behaviour deserve attention, especially when they appear suddenly or together. Isolation, marked mood swings, loss of interest in usual activities, feelings of worthlessness or hopelessness and phrases such as “I can't take it any more” or “nobody would miss me” may reveal that something is wrong.
Unexpected goodbyes, giving away objects of sentimental value and any direct reference to death or suicide should also be taken seriously. They should not be treated as a joke, as weakness or as a mere attempt to attract attention.
Asking can open the conversation
Many people fear that talking about suicide might encourage someone to do it. The World Health Organization makes clear that asking directly does not put that idea in the person's head. On the contrary, an open conversation can reduce anxiety and create space to seek help.
We can start by saying “I've noticed you've been more withdrawn. Do you want to talk about what is happening?” or ask “How do you really feel?”. When there is greater concern, it is important to be clear: “Are you thinking of hurting yourself?” or “Have you been thinking about suicide?”.
If the answer is yes, the first step is to stay calm. Expressions of shock, criticism or threats can make the person pull back and hide what they feel again.
You do not need to have all the answers. You need to be present, listen and seek support.
Listening without judging
Listening is not quickly offering a solution or trying to convince someone that they have no reason to suffer. Phrases such as “You have everything to be happy about”, “This will pass” or “Some people have worse problems” can increase guilt and isolation.
Simple words are usually more helpful. A “Thank you for trusting me” shows that what was shared has been received. Saying “I'm here to listen to you” or “You don't have to go through this alone” offers presence without pressure.
Then the more practical question may come: “Shall we look for help together?” or “May I go with you?”. Faith and spiritual support can bring comfort, but they should not be used to blame those who are suffering or to replace the care of a health professional.
When action is needed
If someone says they are thinking about suicide, that they have a plan or that they may hurt themselves at that moment, the situation should be treated as an emergency. The priority is to make sure the person is not left alone.
Stay close, talk calmly and seek the help of a health professional. Whenever possible, accompany them to the nearest health facility or hospital emergency department and involve a family member or another trusted person.
When life is in danger, you should not promise to keep it secret. Asking for help is not betraying someone's trust; it is a form of protection.
After the crisis, follow-up is also important. A message, a visit or help in booking an appointment can make a real difference.
A conversation for the whole year
Yellow September helps give visibility to suicide prevention, but care cannot end when the month does. We need to create spaces where talking about mental health is not a reason for shame and asking for support is understood as an act of courage.
There are times when everything seems harder and finding the right words is not easy. On those days, talking to a relative, friend, colleague or health professional can be an important first step.
Nobody needs to carry everything alone.
The next time someone answers “I'm fine”, perhaps we can stay a few more seconds and ask: “Are you really okay?”
Sometimes it is after that second question that the conversation truly begins.
