If this were a question with me, or someone around me, I would get it professionally, um, listened to. Really. You are right, that the thought crosses everyone's mind, down to how one would do it, but if the distinction between idle thought and something more is unclear, get help somehow.

My basic understanding is that you need to be concerned if the person has a specific plan in mind -- place, time, method, that sort of thing.

Oh, and $CELEBRITY is pretty hot.

if the distinction between idle thought and something more is unclear, get help somehow

Post-preview, this is probably good advice in general, and specifically in this type of situation.

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I had an elderly female teacher in high school who played Harold & Maude in class as our 'Christmas movie'. Dementia had set in and they had to retire her before the school year was out.

Everybody I've know well who killed themselves had planned for it, apparently. Not a spur of the moment decision, but their planning was not obvious until afterward.

Whether or not a teenager decides to kill themselves is the biggest decision of their life.

I have been researching this very topic.

I think ideation is the process of forming a stimulus-response relationship wherein the response is a thought. In this case, some stimulus causes suicide to pop into one's head, however it is no more than internal mental noise. The stimulus can be virtually anything and may not necessarily have anything to do with suicide, like a particular bird call or the refrigerator compressor kicking on.

You can even take the suicide toy down off the shelf and play with it, forming all sorts of fantasies, and when playtime is over, you can place it back on the shelf and go about your business.

If you can't put the thought away however, that is when you need to seek help.

I am not a psychologist but I do have many stimulus-thought pairs that were at one time worrisome for me. Now that I understand their nature, I can brush them away without a worry.

When I was training for emotional support work for a phone hotline sponsored by the suicide prevention hotline, the general rule of thumb was that if the person had an actual plan in place, and the means at hand to carry it out, it should be considered high risk and the police should be involved. (That is, "I'm going to kill myself by shooting myself in the head, and I have a gun in the other room.") *That* was the danger point, at least with the group we were working with -- if those two conditions were not in place, then it was considered ok for trained volunteers to keep talking to the person, rather than involving any more highly trained therapists or psychiatrists.

CDC is calling pretty much any thoughts about killing one's self, with or without a plan, "suicidal ideation," though.

So I think the question may be more what you're considering "danger"?

The real question here is: what's the difference between idly asking a question about "suicidal ideation" and a genuine cry for help?

My (layman's) opinion is, yeah - planning makes the difference. Reading on the internet about how to run a garden hose from your tailpipe into your car window? Questionable, but lots of people come across information like that and do absolutely nothing with it. Buying a garden hose (particularly when you have no lawn nor garden to speak of) after having read up on it? There's where I'd call a pro.

Face value of this opinion: $.02

Okay, this is actually something I know about.

Suicidal ideation is when you continually think about suicide. For me, thinking about death and or suicide is simply a signal that my treatment needs tweaking. (It's a common symptom in bipolar depression.)

I think everyone at one time or another might have an idle thought or so on the subject but ideation is a little more involved.

I do see it as a spectrum. To me just thinking about it a lot is a caution light-starting to think more specifically about "how" and such is a psychiatric emergency and requires immediate evaluation/treatment.

Yeah, bunnyfire, me too.

But how do the experts winnow out the differences between that and danger?

They don't, and they can't. That is, they can't read minds. You want to know the answer? They ask the patient.

"Have you been thinking about killing yourself?"

It's pretty much in the answering. But if the answer is yes, they ask if you have a plan. Then they make you promise not to do it. If you have a gun, they ask you to give it to someone else for safekeeping.

I believe the use of the jargon ideation is to distinguish it from the random emotional spikes that you can get with e.g. psychotic conditions. Or some drugs. That is, is it in the forefront of your conscious mind? It's not just planning, planning is merely evidence of conscious thought.

Anyway, the first step to take here, if it's yourself or someone who can reasonably be engaged, is a Depression Self-Assessment.

It's pretty much in the answering. But if the answer is yes, they ask if you have a plan. Then they make you promise not to do it.

And if you don't seem on the verge of actually going through with something, they may very well just talk to you about it without thinking that you're in danger. The hotline I was training for was for HIV+ people, and with things like terminal illness, thoughts of suicide can be pretty normal and it can be more helpful to treat them as normal and talk about the (often expected) depression than to freak out about them and start calling in the cops. Normalizing the feeling of wanting to die can be a way of helping the person work through the dark patch -- you're sick, you're depressed, you want just to die, but you're freaked out because you're not supposed to have that feeling, so the effort of suppressing it is causing more problems (depression, fear, alienation) than the feeling itself.

Again, that's assuming there's not an immediate danger of the person acting out the idea.

I don't think it's as simple as stilicho suggests, but I believe it was being simplified for Mecha's sake. As in do you have a plan? What have you done towards completing this plan? What is your plan? Like anything in the psychological realm there's no litmus test giving you absolute answers in a world of differing gray areas. It all depends on the skill of the analyst in interviewing.

Thoughts of suicide are one of those boomerang issues for me. The sight of small dogs, hearing the yapping of small dogs, and running into the people who I know own small dogs trigger suicidal thoughts for me. Flashing blue cop lights are another trigger, as well as seeing clothes drying on a wash line.

I know the reason for the laundry being a stimulus, and last month I dredged up a repressed memory about a small dog that my father has verified. I don't know the origin of the flashing lights thing, but getting a grip on the other two as well as a bunch of other crap from my early childhood has depleted the stress value of all those stimuli.

As bunnyfire said, this all is a spectrum, and another axis includes the methodical planners on one extreme, and at the other extreme, those who are presented with an opportunity and who then act on impulse.

Note, by the way - this is NOT about me, although thanks for the concern about this person. This is a lot of useful stuff, thanks for that too!

When I take my schizophrenic brother in for his monthly psychiatric maintenance sessions, it's standard procedure for the doctor to specifically ask him about suicidal thoughts, thoughts about wanting to hurt himself or me, etc. 40% of schizophrenics make a serious suicide attempt, and between 10 and 15% eventually succeed. We sit there, and this good man patiently asks my brother those questions again, and my brother answers, as truthfully as he can. Every so often, I learn he's been thinking of killing himself, or me, and together we adjust his medications, or look for sources of stress, or sleep issues, and try small things that have worked in the past, to nudge what the makers of his medications theorize might be his fragile brain chemistry back into its groove.

So far, so good, in the last couple of years. But this summer, my brother was sick with an infection, and it took a while for his doctors to suss that out. I saw him eyeing kitchen knives in those weeks, and found a few in his room. One night I found him in my computer room, flailing about, confused and angry to be trying to find his bed, which is in the next room down the hall. We struggled a bit, as he was afraid of me, and didn't know I was trying to help him, and in the process, we knocked down a closet door. I fixed it later that afternoon while he lay sleeping and sick, and I could hear his restless turning.

Sometimes, for him and me, it comes down to being willing to do battle with unseen demons, and to keep them from being armed when that happens. For him, suicidal ideation means he can't turn his thoughts away from death and dying, of his own volition. He considers the option, and mentally rehearses the means. He stockpiles weapons, and struggles not to do so. And he struggles to maintain some control of all this by taking his meds and keeping his daily schedule and chores, and I have to let him, and yet keep us on the rails.

Usually though, our lives are not all that dramatic, and we eat dinner in the evenings, and listen to the radio together, or watch a ball game. Some nights, I bake a pie, and we have coffee in the kitchen. Some mornings, we go to the beach with our silly dog. And then, again, about once a month, we go to his psychiatrist's office, where it's safe to admit things that make no sense in daylight, and he does or doesn't, and we go on.

There are at least 1 million people in America (and their families) living similar stories, everyday. Another 1 to 2 million persons with schizophrenia live outside family situations, but struggle with the same mental processes, and problems, often compounded by self-medication with alcohol or street drugs. In a constant population of something like 2.5 to 3 million schizophrenics in America, and an annual rate of a few more than 30,000 suicides annually for all of the U.S., it's fair to say that schizophrenia is a leading cause of suicide in America, if you believe the various numbers. And while I don't know if anyone can know if anyone's numbers in these areas are right, I've come to think that it is good enough that the numbers can indicate some general trends.

We're not curing mental illness in America, we're medicating it. Until we can cure it, we're building a population of people that are inherently unstable, and likely to have continuing episodes of suicidal ideation throughout their lives, and a good number will eventually die by suicide. When this happens, it is in each case a personal tragedy, but not one for which anyone is generally accountable. So, there's no big push to find a cure for those mental illnesses that are literally, in the long term, the most deadly.

It should indeed be emphasized that it is a spectrum, just as depression is a spectrum.

I found it particularly enlightening to read that suicide is an inevitable part of depression: that is, not all people with depression kill themselves by far, but suicidal ideation occurs in some way, shape or form in the overwhelming majority of patients.

In my case, it takes the form of the sudden realization - "Hey, I just thought of dying! and I don't even want to die! Silly me." Rationalizing it this way really helps with the perspective for me.

So to answer your question, the difference in my opinion is either subtle or non-existent. IANAD.

Whoops, I think I didn't properly address your MI part, exactly.

I think there's a terminology issue here: the two terms in your main question mean more or less the same to me. I think what you're asking about is more like "suicidal ideation" vs. "suicidal planning and/or behaviour". Distinguishing between those is indeed of the greatest importance, and indeed very difficult. There are inventories (questionnaires), sure, but really the only way is consistent patient monitoring and interpreting signs early and then taking appropriate action. Obviously and sadly, some patients will occasionally slip through the net and actively seek out the permanent solution to their temporary problem.