Table 3 Additional items endorsed across the Delphi panels from the three lower-middle-income countries

If the first aider thinks someone might be having suicidal thoughts, they should ask that person directly.

The first aider should not avoid using the word ‘suicide’. It is important to discuss the issue directly, without dread or expressing negative judgement.

If the first aider clearly states that thoughts of suicide may be associated with a treatable disorder, this may instil a sense of hope for the suicidal person.

The first aider should establish whether the person has definite plans and intentions to take their life as opposed to vague suicidal notions such as “what’s the point?” or “I can’t be bothered going on”.

If the suicidal person is psychotic, the first aider should call a doctor, psychiatrist or other professional right away for the suicidal person.

The first aider should remind the suicidal person that suicidal thoughts need not be acted on.

The first aider should not argue or debate with the person about their thoughts of suicide.

The first aider should encourage the suicidal person to do most of the talking.

The first aider should discuss the ‘good things’ in a person’s life, their hopes for the future, and other reasons to live.

The first aider should encourage the suicidal person to think about their personal strengths and the positive things in their life.

By discussing specific problems, the first aider can help the person work out ways of dealing with the difficulties that seem insurmountable.

The first aider should make sure any potentially harmful items are not available to the suicidal person by removing access to these items.

The first aider should try to determine whether there is anything important in the person’s life which may reduce the immediate risk of suicide (e.g. attachments to children).

The first aider should ask for help from the person’s relatives, friends or housemates to ensure the person does not have access to weapons, poisons, or other means for suicide.

(When passing time during the crisis) It is preferable that the suicidal person chooses an activity which has been found in the past to help them to cope or that they enjoy.