From Recognition to Response

Practical Steps for Massage Therapists in Crisis

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Jun 03, 2025

If you or someone you know is experiencing suicidal thoughts or a crisis, call or text 988 to reach the suicide hotline in the United States. For international helplines go to findahelpline.com

You can read the first post of this series here.

The CDC report revealed that massage therapy ranked fourth highest for female suicide rates in the United States—25.8 per 100,000, nearly double the national average and four times the average rate for females.

The problem exists whether we talk about it or not. Now that we understand what's happening, the question becomes: what can we do about it?

This post is more about you than your clients.

Most of our education as massage therapists focuses on helping others. Our self-care classes are often about ergonomics or meditation, partially for our own health, but mostly so we can avoid physical or mental injury and keep working. Keep helping. But understanding suicide risk means understanding that people who attempt or die by suicide are people exactly like you and exactly like me.

Protect Yourself - Immediate Actions

Recognize the Signs in Yourself

Dr. Rory O'Connor's Integrated Motivational Volitional (IMV) model describes suicide as a series of happenings that we can identify, understand, and potentially interrupt. The model has three phases: vulnerability, motivation, and action.

The second phase, motivation, is primarily driven by feelings of inescapable defeat. These feelings of defeat lead to a feeling of entrapment—the sensation that there is no way out of your situation. Entrapment can then lead to thoughts of suicide.

Suicide isn't about wanting to die; it is about escaping unbearable pain.

There is a simple questionnaire called the Entrapment Scale that helps assess feelings of entrapment. The short version contains four statements:

I often have the feeling that I would just like to run away.
I feel powerless to change things.
I feel trapped inside myself.
I feel I'm in a deep hole I can't get out of.

The first two statements refer to external entrapment: feeling trapped by circumstances. The last two are internal entrapment: feeling trapped inside yourself. These last two are more dangerous because they are more likely to lead to suicidal ideation.

Crisis Intervention Steps

Call the helpline. It only exists for one reason, and it is to help you. Call or text 988 or use findahelpline.com to find an international line.

If you feel like you or someone else is in immediate danger, call emergency services, or contact a general practitioner or mental health professional.

Remove anything that you would consider using in an attempt. Ask someone you trust to hold on to it for you. This is critical because the act of suicide happens in a window of time—when the feelings become their most intense, and people take action. The window lasts between 1 and 10 minutes. It may happen again in a minute or an hour or a day, but the overwhelming urge is short-lived, although it feels like an eternity.

If you have a plan and have the tools to complete that plan, it is much easier to take action during this window. This is why the existence of firearms is an incredibly important factor in suicide. Attempts involving anything other than a firearm are 5-10% likely to be completed. Attempts with firearms are 90-95% likely to be completed. If you are experiencing ideation and have a firearm in your home, please follow gun safety procedures, or ask someone you trust to keep it for a while.

If you're experiencing that window where thoughts feel like they could become actions, don't be alone. If you don't have a person you can go to, go to the library or other place with people. You don't need to interact, just don't be by yourself.

When to Seek Professional Help

Even if you're not in that emergency place, seek out help. General practitioners or local mental health clinics are good places to ask because both will know what resources are available in your area. You can tell both places that you are having thoughts of suicide. You don't need to sugar coat anything. They are professionals and they can help you much easier if they understand the gravity of your situation.

We don't have good tools to predict suicide attempts. Existing screening tools are about 50% reliable. So just as your general practitioner shouldn't rely on those tools to find the truth, neither should you rely on those tools to tell your doctor your truth.

Long-term Care of Self Strategies

Professional Treatment Options

For longer term treatment, talk therapy can be a very powerful tool. Some kinds of talk therapy are more general, like DBT (dialectical behavioral therapy), which focuses on balancing the need for change with acceptance; or CBT (cognitive behavioral therapy), which focuses on challenging dysfunctional thoughts and behaviors and learning new skills to navigate problems.

Other types of therapy are specific to suicide prevention, such as the Collaborative Assessment and Management of Suicidality, or CAMS. The goal of CAMS is to stabilize people and engage them in the management of their own safety.

Talk therapy might be very helpful for you, but sometimes finding a therapist to work with can be a challenge, either because of limited access or because of personality mismatches. As a massage therapist, you’re probably familiar with how important the therapeutic relationship between therapist and client is, and how much can be accomplished if that relationship is a good one.

Safety Planning

Your prevention plan might include something called a Safety Plan. A Safety plan is a document that you fill out with a mental health professional. It spells out steps you might take in order to stop you from acting on suicidal feelings. It asks you to write down warning signs, coping and distraction strategies, people you can ask for help including professionals, and how to make your environment safe.

It is important you fill it out with someone because there might be unexpected challenges to your solutions. For example, if going for a run makes you feel better, but it isn't safe to run at night, the person assisting you with the plan will help you think of other plans for when it's dark.

Sleep as Prevention

Get some sleep. Really, it sounds simple, but sleep is a key factor in suicide and self-harm prevention. Not sleeping can increase impulsivity and mental disorder, and decrease emotional regulation and decision-making power.

I start feeling bad in the late evening. I get anxious, I worry about things I said or did that day, I start panicking about the state of the world. I now interpret this as the "start your bedtime routine" signal. My brain tends to be loud, so I help it out with a pair of headphones and podcasts like "Boring Books for Bedtime."

Combat Professional Isolation

Our work is inherently isolating. We spend our days in small rooms with people who are paying us to focus entirely on them, then we move to the next room and do it again. Meaningful connections with colleagues are difficult to build.

But isolation isn't just about being alone—it's about feeling disconnected. You can be surrounded by people and still feel isolated if those connections lack depth or authenticity.

Find and be with your people. Seek out massage therapists who are willing to talk honestly about the challenges of the work. This might mean joining online communities or reaching out to colleagues you respect.
Trading massages is still a work activity. Contact with another massage therapist doesn’t have to mean a trade. You can sit and have tea, and it will still fall under the category of taking care of each other. It might be more beneficial, because the dynamic is one of mutual care, instead of client and practitioner.
You don’t have to pretend everything is fine. The fun house mirror of social media creates pressure to present a polished version of your practice. In the Healwell Online Community, we encourage members to discuss their dreams and their realties.
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Supporting Others

Recognition Skills

You are not, and are not expected to be a mind reader. Some people are very good at hiding their distress. Sometimes there are no indications that someone was even considering suicide or self-harm. You can only know what people choose to share with you.

That said, there are red flags to watch for:

Have you noticed a change in their behavior, like sleeping, eating, drug-taking or risk-taking?
Are they acting out of character or unpredictably?
Do they talk about being trapped or having no future?
Do they talk about being a burden on other people?
Are they sorting out their life affairs or giving away important possessions?
Are they having a hard time dealing with stressful life events, like loss or rejection?
Counterintuitively, has their mood suddenly improved?

If you know someone who is struggling with thoughts of suicide and their mood improves, check in on them. Unfortunately an improvement in mood doesn't always indicate someone is out of the woods—they may actually be more at risk. Their mood lift might be because they may have made a decision to take action and are feeling relieved, or they may now have enough energy to take action.

Ask the Question

You can directly ask someone "Are you thinking about killing yourself?" It seems like it could cause a problem, but there is no evidence at all that asking that question will put the idea into someone's head. In fact, asking the question can protect the person because being able to tell someone is a relief.

But keep in mind, once you have asked it is now your job to listen. And you will need to listen very, very carefully. As massage therapists, we have an instinct to help, but trying to solve someone's problem before you understand what they're experiencing isn't going to be helpful.

Don't bright-side, don't try to talk them out of feeling bad, or dismiss what they say. Phrases like "Everything happens for a reason" or "It could have been worse" are harmful. Also, if they don't want to talk to you, don't be insulted. Tell them you're concerned about them and ask them if there is someone they'd feel more comfortable talking to.

If you or someone you are speaking with has a specific plan and access to the means to do it, and isn't sure they can keep themselves safe, it is time to call a professional. That might be a general practitioner, a mental health expert, or emergency services. The most important thing is to not leave someone in crisis alone, and to call the helpline.

Simple Interventions

Talking Honestly

Recently I had a friend text me "I feel powerless" while I was at the grocery store. Because I've been writing about this topic for several months, I realized this statement indicated both defeat and entrapment. I immediately moved my cart out of the flow of shoppers and called my friend three times in a row, until they picked up (it turned out they had put their phone down). Then I simply said, "talk to me."
For the next thirty-five minutes I stood in the middle of the baked goods and talked to my friend. We spoke about being overwhelmed by the news, feeling helpless and frantic at the same time, and worrying about friends and family. I told her what I was doing to cope: limiting my news intake, calling my representatives, and searching for an organization local to me where I can be helpful. Also watching a lot of Star Wars and planning a toast party—which is a potluck centered around fancy toast.
We talked until my friend felt better. If they hadn't seemed better by the end of the conversation, I probably would have asked them to have their kind and loving spouse join the call so the three of us could talk about what might need to happen next. My friend is not having suicidal ideation, but there is no reason to wait until someone has reached that point to start interventions.

Small Things

If a person says they don't want to talk, and you continue to worry about them, send them a postcard. Seriously. In a randomized controlled trial, the University of California sent a two-sentence letter four times a year to people who had been seen for severe depression or suicidal thoughts. Compared to the control group, deaths by suicide dropped significantly, especially in the first two years. The letters said

"It has been some time since you were here at the hospital, and we hope things are going well for you. If you wish to drop us a note we would be glad to hear from you."

Tell the person you're worried about that you're glad they came into your office, or glad that they're your friend, and you're looking forward to seeing them again soon. Sometimes a small gesture is the thing that stops someone from taking action. Being kind to the people around you, even and maybe especially in simple ways is a form of suicide prevention.

Conclusion

Being a massage therapist is a fulfilling, important, hard job. We work our bodies, minds, and souls in the service of others. We hold people in a caring way, for a long time, every time we go to work. We care about other people all day and then we go home and care about our plants, pets, parents, kids, and partners. We care.

But it can feel lonely out there. And if you're lonely, and if you're feeling trapped, and if you're feeling like you would rather not be here anymore, you're not doing it wrong and you're not alone.

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