It should help to know that reaching the state of being one smile away from suicide implies a profoundly severe illness; the problem wasn't smiles, it was the way we route the ill to the mental health resources they need.

One needs to consider that suicide is not just an affliction of the mind, it's also a product of the circumstances a normal person finds him or herself in. It's not just the thoughts that need fixing, it's the circumstances too. Usually this is a chicken and egg problem: the thoughts prevent the person from fixing the circumstances himself, and the circumstances reinforce negative thoughts. This way somebody can get sucked deeper and deeper into a black hole of increasingly irrational negative thoughts. Even if the thoughts are clearly irrational to an outsider, they are not to the person themselves. Therefore suggesting that they simply fix their mind does not help. In their view their mind is not just what needs to be fixed, it's also the circumstances. We all should do our best to not create such circumstances and to fix them when they exist. In the story of the OP for example, it's fair to say that the behaviour of the professor played a big role in almost causing his suicide. If suicide is caused by circumstances a normal person finds him or herself in, do we not bear a collective responsibility to prevent it, even if it's just a smile?

On the other hand, we need to be diligent to avoid assuming responsibility for the actions of others. If we look at suicide prevention as an assumed responsibility, it can be hard to avoid feeling guilt when someone close to us takes their own life.

We should always be good to each other, and we should reach out to others in kindness, whether they appear to be in need or not. But, we should be careful with how we relate to the actions of others, lest we fall into a trap that we cannot get out of.

If you or someone you know is experiencing suicidal impulses, you are experiencing a medical emergency. Please get professional help as soon as possible.

There are a variety of conditions that can make a person suicidal. Depression isn't the only one.

In some of these cases, the resolution of the problem may involve changes to environment or circumstances. In others, the resolution might be chemical. In still others, prolonged inpatient treatment may be required in order to ensure safety.

What's true in all cases is that the decisions about how to proceed in resolving the emergency should be made by people trained to do it. As you can see from many other comments n the thread, our intuition on how best to help suicidal friends and acquaintances are, at best, unreliable.

And, the attitude of simplifying all of this to "get professional help asap" is not very productive. For one, not everyone can afford or access that kind of help. Two, pronto professional help can sometimes yield to bad choices very quickly. Blowing it up risks violating a depressed individual's privacy, they might see that as an action of offense. When a friend of mine was suicidal some odd years ago, I didn't just dial the phone for some professionals to get him, I tried to make it clear to him how much I valued his friendship and what it would do to me if he were to go away -- the guy is rocking life these days. Of course that's definitely not to say don't call for help, rather that this sort of thing demands a more considered response.

The national suicide hotline in the US is:

1 (800) 273-8255

Given no other modes of helping someone that will result in them obtaining medical help, and assuming that suicidal thoughts have reached a point where they are intrusive and there is evidence of planning or intent, a 911 call is not unreasonable (you can also drive someone to the hospital).

I have been in a position where I called a friend because I was frighteningly close to actually doing it. This is after many years of very aggressively pursuing professional mental help in therapy / outpatient settings (which all my close friends are aware of).

If my friend had called 911 after I asked them not to, I would have considered it a betrayal. It would have set in motion a set of events that would cause extreme distress for me, and (I am fairly certain) not provided any greater relief than the years of medications and talk therapy I was already pursuing.

And it would have breached the trust I feel in one of my closest friends in a way that I'm not sure could have been recovered. I believe this would have put me on a path towards having distance from my friends, and being more imperiled overall.

If I couldn't trust my friend not to call 911, I never would have called them. Unless that national suicide hotline above promises absolute confidentiality and not involving authorities, I guarantee I will never call it.

Everyone is different and I'm not giving any advice here. I'm just glad my friend didn't take the hard-line stance on this that you do.

It is incredibly important to understand that many inpatient facilities are profoundly hostile environments for some patients, despite claims of a "therapeutic milieu" (which is somehow exactly the same for both depressive and manic disorders; sure, of course that's credible /s). Based on my experiences at the only two such facilities in my metro area, I would be very, very, very hesitant to ever admit to suicidal ideation in the future. The idea of going back to such a place is enough to make me consider the risk of "going it alone", even knowing that doing so could be a fatal mistake. Comparisons to imprisonment are not exaggerations: it absolutely did feel like punishment, like I had no rights, like the staff merely treated me as a "problem" rather than as a patient or client. Some of the "professionals" were not worthy of the term, particularly the "clinical social worker" types (some of whom expressed, with complete confidence, deeply weird and absolutist "theories" of mental illness that correspond to no credible theory that I've read about in reputable literature).

(punchline: my depression was almost certainly caused by a chronic physiological disorder, one which neither facility screened for; most of the "treatment" I received was probably exacerbating my condition instead of improving it)

I guess if I had to make this venting "practical" I would say this: if you ever have a close friend or family member in an inpatient facility, and they tell you that they really, really need to leave because it's a bad place, believe them. No one else will.

There are a variety of things you can do before calling 911; "call an ambulance NOW" is not the message I am trying to send.

If you're someone I know well enough to judge the credibility of a plan to kill yourself (which could mean "complete stranger" is the plan is particularly credible), and I become aware of such a plan, I would feel obligated to ensure you saw a doctor, with the word "ensure" chosen carefully.

At this point I feel like I'm replying to comments on these threads more out of habit and standard message board compulsions than anything else, and, given that the topic we're discussing is sensitive, I'm going to force myself out of the thread now.

The scenario I am describing to you is one in which I was seeing a doctor, regularly (once a week). I was already getting help. The only assistance I was not getting was inpatient, take-your-rights-away-for-a-while forceable assistance.

That's a pretty harsh and unrealistic generalization. Not everyone who commits or wants to commit suicide is "profoundly mentally ill". If you woke up tomorrow and your bank account were empty and your family were gone, would you consider suicide? Alot of people would, and it's not because they formed a mental defect overnight. Terrible things happen every day that can make otherwise rational people believe suicide is their most viable option.

Not overnight, but this event might trigger clinical depression which is a mental illness in which suicide might appear as a "viable" (sic!) option.

Suicide is simply not the response of a healthy individual in the scenario you described. One would either fight, flight or freeze without willingly harm oneself.

That's what makes it so dangerous. Because in reality it IS self harm, it's just that suicidal people can't truly understand that. And it's also true that it's an escape, and the pain stops when you're dead. The value system is distorted such that the loss of all positive feelings isn't weighed properly. Especially since depressed people tend to have far fewer positive feelings, and have a confirmation bias to be unable to remember those feelings existing.

That is the power of having a seriously screwed up brain. My symptoms improved not with antidepressants or psychotherapy or self-help, but with treatment for a previously undiagnosed chronic physiological condition. Despite having a "real illness", I've found validation for most of my experiences in first-hand accounts of people with "mental illness" (which is defined in such a way that the practical definition is "any psychological symptoms not explained by a lab test known to your GP"). Allie Brosh was mentioned by another commenter, and I definitely had a "holy crap, someone else gets it" moment when reading her "Adventures in Depression" comics.

After ~20 years of on-and-off psychiatric treatment (some fairly intensive, some not, none especially effective), I found a psychiatrist with enough sense to strongly recommend that I get the relevant lab test. He had to tell me to request it from my primary care doc, because according to the worldview of American health insurance a psychiatrist is not qualified to order said lab test. My primary care doc gave me a questionnaire. My score was just below the threshold where the lab test is considered warranted. He told me he'd figure out how to make it work. I guess he did, because I got the test, got it interpreted by ${DOMAIN_EXPERT}, and got a prescription for treatment that seems to be working pretty well (albeit not perfectly).

That said, I've never seen any harm in being generally nice and hospitable, and it can do more than a little good.