In 2023, an estimated 16 million adults and adolescents in the U.S. reported having serious suicidal thoughts in the past year. That means around 5 percent of the adult population and 12 percent of the adolescent population were in such pain that they were considering ending their lives. While these statistics are certainly distressing, we know that the majority of people who have suicidal thoughts will not go on to attempt suicide. Something stops them—perhaps they have glimmers of hope that their lives will improve if they just hold on. Indeed, hope is one of the most profound protective factors against suicide. As clinicians, we may feel stuck as we try to help our suffering patients find hope in a hard world. To support patients, I created a HOPE acronym that describes four strategies for fostering hope. I have found this approach helpful in my clinical practice, and I hope you find it helpful in yours.
H—Seek Help
When patients are having suicidal thoughts, they may feel like a burden on others. Understandably, this makes it hard to ask for help. Yet, support from others can be crucial to making hardships manageable. Who can your patients ask for help when they are feeling hopeless? Some suggestions include family, friends, spiritual and other types of communities, mental health professionals, and helplines. You and your patient can collaboratively plan specifics for how they will reach out to these resources (e.g., email, text, phone), when they will contact them (day/time), and the kind of help they will ask for (e.g., to listen, to problem solve, to spend time together). The more specific the plan, the more empowered they will feel to carry it out.
O—Find Optimism
When people are in pain, a type of cloudiness can take over that makes it hard to see any future bright spots. To find reasons for optimism, try guiding your patient to make a list of things they look forward to (no matter how big or small). Do they look forward to coffee or tea in the morning, an upcoming new movie release, a future trip, or a friend’s birthday celebration? Thinking about these types of events can strengthen the sense that there is something positive on the horizon. Another way to build optimism is to look at past struggles they made it through. How did they make it through them? Can they use some of those same strategies again? Are there similar resources that can help them through their current struggles that can bolster their sense of hope?
P—Change Perspective
The theory of hopelessness proposes that people lose hope when they believe negative events are completely their fault and that their future is doomed. A shift in perspective can generate hope. You can help patients push back against self-blame by looking at all the situational factors that were not in their control. Even if they played some role in the negative event, you can talk to them about approaching themselves with compassion instead of criticism. Are there reasons for them to believe that the situation could get better with time? If so, help the patient list those reasons to shift into a more realistic, hopeful mindset.
E—Attend to Emotions
It’s natural for people to respond to pain by trying to avoid or deny it. However, painful emotions can serve as alerts about specific needs that are not being met. Rather than fighting their emotions, patients may benefit from learning how to validate and understand their emotions with warmth. If they’re lonely, maybe they need to connect with a friend. If they’re drained, they might need some rest. If they’re feeling down, maybe they need an emotional uplift. Attending to their emotions does not require grand gestures. They can find small ways to soothe themselves, boost their mood, and meet their needs. For example, they can try connecting with a caring person, spending time in nature, cuddling a pet, or doing something creative. Even small actions can spark hope during painful times and light the path to a better future.