“I’m Sorry, I Have to Ask These Questions": Normalizing Questions about Suicide in Health Care and Beyond

We all have that one special day we look forward to every year. You know which one I’m talking about: your annual physical.

I had mine recently. You know the drill. The nurse called my name and led me to a scale to check my weight. They took my vitals, blood pressure, oxygen levels, etc. Then came the routine questions. “Still taking your medications?” “Any family history of cancer or diabetes?” “Are your parents still alive?”

But then, just before the next question, the nurse paused and prefaced it with a look of hesitation:

“I’m sorry, I have to ask these questions.”

She looked uncomfortable, like she was about to say something inappropriate: something she didn’t want to say out loud.

And it was only after that awkward, apologetic preface that she began the suicide risk assessment, which included (good) questions like, “Have you thought about killing yourself?” and, “Have you wished you were not alive?”

Now, here’s the thing: I want these questions to be asked. I believe in them. I’ve spent over a decade of my life advocating for them. Suicide prevention research shows that up to 45% of people who die by suicide visit their primary care physician in the month prior, and that simply asking questions directly about a patient’s mental health can often lead them to lifesaving help. (Learn more about suicide prevention in health care systems in this video featuring AFSP researcher Dr. Brian Ahmedani.)

What struck me was how uncomfortable the nurse seemed; how she felt the need to apologize for checking on my mental health. It unintentionally sent the message that I should feel awkward and hesitant about responding.

A week later, I returned to review my bloodwork. Same screening. But a different nurse. This nurse didn’t apologize. Instead, she giggled her way through it.

Yes. Giggled. As if asking someone if they’re thinking about suicide was something to laugh about.

To some, this might seem like a small thing. But for me, as someone who lost his daughter to suicide, the discomfort displayed by a health professional in talking about such an important aspect of one’s overall health was a glaring reminder of how much work we still have to do in making conversations about mental health and suicide safe, normal, and meaningful.

It also brought me back to one of the hardest times in my life.

After my daughter Raven died, I went to counseling. I was raw, grieving, and emotionally drained. One of the very first questions the counselor asked me was, “Do you own a gun?”

And I said no.

But I lied.

Not because I was trying to be difficult, but because I was afraid. I was afraid she’d label me unstable, report me, or worse: that someone would show up and take away my guns. At the time, I owned gas stations and ATM machines. I was carrying large sums of money, and I had a firearm for protection. But I didn’t feel safe enough within the conversation to explain that.

And that’s the heart of the issue: how we ask these questions matters. The tone, the timing, the trust. It all matters.

The intersection of firearms and suicide prevention is enormously important, and something that should be discussed clearly and openly.

In retrospect, I wish the counselor had approached the subject by giving me some context first. For instance, she could have said, “Alan, I want to talk through a few things with you. Part of my job is making sure that, if there’s ever a time when things feel really heavy or overwhelming, we already have some supports and steps in place to keep you safe. These next questions are only to help me understand how to best support you: not to judge, label, or take anything away from you. One of those questions is about firearms. Some people own them for protection, work, or sport. Do you have any firearms right now? If so, would it be okay if we talked about ways to keep them secure during tough moments?"

If they had approached the topic in this way, I would have felt more open to responding with full honesty. I wonder how many other people have done the same: answered questions about suicide “safely” rather than truthfully, because the way the question was asked made them feel vulnerable, ashamed, or misunderstood.

When we treat these conversations like something shameful or awkward — something to breeze through or apologize for — we miss the moment. We miss the person. And sometimes, we miss the chance to save a life.

Suicide risk assessments shouldn’t be treated as awkward requirements to quickly power through. They are opportunities to connect, listen, and maybe, just maybe, reach someone who is silently struggling. The tone we use, the language we choose, and the attitude we bring to these questions matter more than we realize.

But I want to leave you with hope, because I do see a shift happening.

More doctors’ offices are starting to integrate behavioral health. More professionals are being trained. More everyday people are learning how they can play a role in saving lives by looking out for each other and having real, authentic conversations about mental health. I’ve seen what’s possible when we approach these conversations with compassion, without judgment, and without apology.

Because asking someone if they’re thinking about suicide shouldn't be something we dread or rush through. It should be something we do because we care. And more stories, like mine, like Raven’s, are being shared, so that others don’t feel so alone.

When we ask the right way, we might just save a life.

We can change the way we ask.
We can make space for honesty.
We can build trust; not just check boxes.

So, the next time you find yourself on either side of that conversation, whether you’re the one asking or the one answering, remember this:

You don’t need to apologize for caring.

Just ask, and listen, like it matters.

Because it does.

Learn more about AFSP’s stance on health professional training in suicide assessment, treatment, and management.

Read “More Than Referrals: The Role of Primary Care in Suicide Prevention,” from AFSP’s Real Stories blog.