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How to support someone in crisis: five principles of psychological first aid

Updated Well Day Media Editorial Team
A woman on a sofa comforting her friend with a hand on her shoulder, listening attentively
The short answerSupport from loved ones is one of the most important factors in recovery after traumatic events. Experts identify five principles: a sense of safety, calm, self-efficacy, connection and hope. Research shows that asking directly about suicidal thoughts does not plant the idea and may reduce distress.

Key points

Why support from loved ones matters

After a traumatic event, such as an accident, a disaster, violence or a sudden loss, practical and emotional support from people nearby helps recovery more than any single professional intervention.

Five principles

A panel of trauma experts identified five evidence-informed principles for supporting people after disasters and mass violence (Hobfoll et al., 2007):

  1. Safety: help the person feel physically and emotionally safe.
  2. Calming: reduce distress, for example with slow breathing or a quiet space.
  3. Self- and community efficacy: help them regain a sense of control.
  4. Connectedness: link them with family, friends and community.
  5. Hope: support realistic optimism that things can improve.

How to talk

It is okay to ask about suicide

A systematic review found that asking about suicide does not increase suicidal thoughts and may reduce them (Dazzi et al., 2014). Restricting access to lethal means, such as firearms and medications, is one of the most effective suicide prevention strategies (Zalsman et al., 2016).

Take care of yourself too

Supporting someone in crisis is demanding. Rest, talk to someone you trust and seek help if you need it.

Frequently asked questions

What should I say?

Simple words help: "I’m here," "That sounds really hard," "What do you need right now?" Avoid minimizing or giving unsolicited advice.

How do I ask about suicide?

Directly and calmly: "Are you thinking about killing yourself?" If yes, stay with them, remove access to lethal means if you can and contact 988.

Sources

  1. Hobfoll et al. (2007). Five Essential Elements of Immediate and Mid–Term Mass Trauma Intervention: Empirical Evidence. Psychiatry: Interpersonal and Biological Processes 70(4):283-315. doi:10.1521/psyc.2007.70.4.283
  2. Dazzi et al. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?. Psychological Medicine 44(16):3361-3363. doi:10.1017/S0033291714001299
  3. Zalsman et al. (2016). Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry 3(7):646-659. doi:10.1016/S2215-0366(16)30030-X
  4. World Health Organization. Psychological first aid: Guide for field workers. www.who.int
  5. Substance Abuse and Mental Health Services Administration. 988 Suicide & Crisis Lifeline. 988lifeline.org

Prepared according to our evidence methodology and the principles of lifestyle medicine. For education only; it does not replace advice from your doctor.

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