EXPLAINER: Suicide warning signs: What to watch for before it’s too late

***A depressed woman at a psychologist's office/FREEPIK***

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Suicide does not begin with the act. It starts with a thought, a quiet fantasy no one sees, psychologist Stephen Oluoch, a mental health practitioner who works closely with individuals in crisis, says.

In Kenya and around the world, suicide remains one of the most urgent and under-acknowledged public health issues, also deeply entangled with human rights concerns.

Despite increasing awareness, stigma, misinformation and lack of access to psychosocial support continue to claim lives that could otherwise be saved.

A hidden crisis

The World Health Organization (WHO) estimates that over 700,000 people die by suicide every year globally, more than are killed by war and homicide combined.

In Kenya, the situation is equally troubling, with the Kenya National Bureau of Statistics reporting a steady rise in suicide-related deaths, particularly among youth and working-age adults.

Oluoch warns that suicide is often preceded by subtle changes in behaviour, with some easily missed and others tragically normalised.

“Warning signs start before physical attempts,” Oluoch explains.

“If someone was outgoing, they may suddenly withdraw from friends and family. If they were active online, you might notice them deleting photos, closing their accounts, or using dark, fatalistic language.”

The language of despair

Verbal cues are among the most overlooked red flags. Oluoch says that conversations around death, hopelessness or being a burden should never be brushed off.

“Suicide starts in the mind, through thoughts that become words,” he emphasises.

“If someone says they feel hopeless, like life is meaningless, or like a burden, those are not just feelings. Those are serious risks. That is the first step toward actualising suicide.”

Indeed, studies show that people often give verbal or behavioural clues before attempting suicide.

Yet friends, families and communities often fail to pick up on them or do not know how to respond when they do.

Overlooked signs and everyday misunderstandings

One common misunderstanding, according to Oluoch, is the assumption that withdrawal, silence or isolation is "just part of life", especially in a tough economy or after personal hardship.

He, however, warns that these behaviours can often signal something far deeper.

“We normalise withdrawal as someone just needing space. But if someone was attending work or school regularly and suddenly stops, shows up late or starts avoiding others, that is a change worth noticing,” he says.

“The same goes for grooming. A teenager not bathing or doing homework is not always lazy. It might be depression.”

Oluoch adds that “the skin speaks”, warning that visible physical signs like cuts on the wrists, burn marks or needle pricks are also frequently missed or excused as accidents, especially by those who do not know the person well.

Substance use as a coping mechanism

Oluoch points out that substance abuse is another indicator that mental health is deteriorating, especially when there is an increase in usage or a new substance is introduced.

“You will see someone who maybe drank occasionally now drinking excessively, or starting to use drugs altogether. That is not just substance use; it is an escape,” Oluoch says.

“It can be a sign of deeper mental illness; depression, bipolar, other mood disorders or schizoaffective disorders, all of which raise suicide risk if left untreated.”

Different faces, same pain: Teens vs adults

While the signs of suicide can vary slightly by age, the root causes are often similar: emotional pain, isolation and untreated mental illness.

For teenagers, signs may include skipping school, poor grooming, changes in academic performance or social withdrawal.

For adults, red flags include failing to meet parenting or work responsibilities, substance abuse, chronic fatigue or disconnection from usual activities.

“The skin speaks. The behaviour speaks. The language changes,” says Oluoch.

“You just have to be close enough to notice.”

The human right to mental health

The Constitution of Kenya recognises the right to the highest attainable standard of health, which includes mental health care.

The Mental Health Act and Kenya’s National Suicide Prevention Strategy are steps forward, with a need for stronger implementation.

Many communities still lack access to affordable, stigma-free counselling. And in some cases, people expressing suicidal thoughts are criminalised under outdated laws, further silencing them.

This is, however, being corrected, with the decriminalisation of suicide.

On January 9, 2025, High Court Judge Lawrence Mugambi declared that Section 226 of the Penal Code, which makes suicide a criminal offence, is unconstitutional.

The criminalisation of suicide in many countries is a legacy of the colonial era. Section 226 punished individuals for “attempting suicide” with up to two years in prison.

It was found to violate constitutional guarantees of dignity, equality and the right to the highest attainable standard of health

How to respond: What you can do

If someone in your life is showing warning signs, Oluoch says your presence alone can make a difference.

“Sometimes, the most powerful thing is to just be there. Listen without judgment. Help with daily routines if they are struggling,” he says.

“If their room is unkempt, they are not eating, they are sleeping all day; these are signs.”

Oluoch also advocates for a listening ear, noting that sometimes, people need only to talk in a safe space and heal.

Offering to link them with a counsellor or mental health service is also key.

And while asking "Are you suicidal?" might feel direct, Oluoch advises against it unless you are trained in crisis intervention.

“I advise against it. That question can be a trigger. Instead, read the signs and respond with support. Ask how they are feeling. Be present. Guide them to professional help,” he says.

What institutions can do

Oluoch urges schools and workplaces to go beyond surface-level support.

He advocates for having dedicated, trained psychologists, not just teachers or HR personnel doubling as counsellors.

“Schools need full-time psychologists who can assess and counsel students. Having a teacher who doubles as a counsellor. Those roles can be conflicting,” he says.

Oluoch, who has worked with students, says sometimes, behaviours leading to suspension or expulsion come about from underlying issues, some psychosocial issues.

“Workplaces should link with mental health professionals who offer confidential services. Most of the pressure people face, burnout, personal issues, does not go away just because someone shows up at work.”

Hope through understanding

At its core, preventing suicide is about recognising human suffering, not ignoring it.

Oluoch advises against stigmatisation, advocating for acting with compassion and understanding before it is too late.

If you or someone you know is struggling with suicidal thoughts, please reach out for help: