And who can blame them? They only see the words we type.

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The Two Sentences Problem

More and more people are turning to large language models (LLMs) as a kind of therapy companion. As a clinician, I’m of two minds. On one hand, there simply aren’t enough therapists — estimates suggest roughly one therapist for every 600 potential clients. That’s a long waitlist. On the other, AI systems aren’t trained clinicians. They don’t follow clinical theory or evidence‑based treatment, and when it comes to suicidal ideation, they skim the surface of what actually signals risk.

Modern classifiers trained on Reddit, crisis text lines, and suicide note datasets can detect these with 80–95% accuracy in controlled research environments. But these are the easy cases with clear, lexical clues.

Imagine two statements a user types into an online conversation with their AI.

“I want to die.”

“I don’t see the point of anything anymore.”

Most systems will treat the first sentence as high risk and the second as “just depressed,” taking it literally as discouragement but not acute risk. Programmed responses follow a formula: empathy statement, validation, suggest calling or texting 988, and encourage reaching out to a friend.

“I’m really sorry that you’re going through something so painful. You’re not alone. If you’re thinking about harming yourself, you might consider contacting the Suicide & Crisis Lifeline by calling or texting 988.”

Clinically, the second sentence is often more troubling. That gap between what AI looks for and what the suicidal mind is actually doing is the core problem in AI suicide detection.

The Assumption Behind AI Detection

AI models usually treat suicide risk as a static language classification problem: given a single message, assign a risk label. Clinically, suicide behaves more like a state transition problem. Risk lies in the trajectory, not in any one sentence, and language may actually become less distressed as risk increases.

Most systems assume that when suicide risk rises, language becomes more explicit and negative. They rely heavily on “method lexicons” — curated keyword lists for self‑harm, methods, and crisis terms — to assign a risk score and trigger a standard response. Underneath that is a faulty assumption: that users will be honest and direct about suicidal thoughts. Clinicians know they often are not.

What Clinicians Actually Hear

From therapy offices to emergency departments, people at high suicide risk often say things that sound surprisingly ordinary.

They say things like:

“I’m just tired.”

“I can’t keep doing this.”

“Nothing really matters anymore.”

Clinicians detect the subtlety and sub-context. They look for tone, body language, and salience of the individual’s distress. We more readily pick up on story‑ending cues — the ways people quietly foreclose chapters, relationships, or futures. Higher risk statements rarely contain the dramatic language that AI systems are watching out for. They don’t resemble the crisis dialogue we imagine when we think about suicide.

The crux of suicide language is that it’s not about wanting to die; it’s about escape from the current distress. In addition to language, clinicians notice out‑of‑character behaviors: sudden spending sprees, substance binges, or a rigid hyper‑focus on concrete tasks. We also see black‑and‑white thinking and all‑or‑nothing interpretations — desperate attempts to resist, distract from, or control the escalating crisis.

Stuck in the Language Paradox

LLMs could benefit tremendously from real clinical input. As psychological distress becomes more severe, language often begins to shift, becoming shorter, flatter and less emotional. The user gives up on explaining their feelings.

They say things like:

“Nothing is going to change.”

“There’s no way out of this.”

“I don’t see how this continues.”

It reveals something vital: the user is no longer imagining a future in which their life improves. To a model, this looks like cooling, de‑escalating risk — the exact opposite of what’s actually happening. What looks like dangerous resignation to a clinician often reads as ‘stabilizing mood’ to a machine that mostly tracks sentiment averages. Suicidal language often gets quieter as the risk increases. We can get better at detecting and responding to these clues.

The Collapse of the Future

For many people approaching a suicidal crisis, the central psychological shift is not an increased desire for death; it is the collapse of a believable future. This is what Rory O’Connor describes as entrapment - the stuck place distress pushes a person into when all potential solutions seem exhausted.

We are remarkably capable of holding hope while enduring suffering as long as we can see some glimmer of a light at the end of the tunnel. The state of entrapment has no light and nowhere to turn. The future is closed and continuing to live seems pointless. Cognitive restriction narrows perceived options until death feels like the only viable choice left.

Outside of a suicide crisis, observers see a wider picture and can inject hope and light in the individual - as long as the user is still open. There’s a rich field of opportunity for AI systems to intervene at different stages to offer more meaningful strategies.

Why Prediction Has Always Been Hard

Researchers and clinicians have struggled for decades to predict suicide. Most models look from the outside in, using large historical datasets to identify risk factors: depression, trauma, chronic stress, substance use, social isolation. These are population‑level correlations, not individual predictors. Many people with multiple risk factors never attempt suicide, while some who die by suicide have few obvious signs. Prediction models end up generating enormous numbers of false alarms while still missing many real crises.

Despite that, many AI systems continue to lean on these same risk‑factor data, as if they can tell us who will cross into a suicidal decision state. They can’t.

What AI Systems Should Look Out For

Instead of flagging lexical signals, AI systems should shift their focus to recognizing dynamic state changes in users. The following are key concepts that get LLMs closer to detecting meaning changes in a suicidal user:

1. Narrative closure and loss of future - Life is framed in terms of endings (“last time,” “after tonight”), and the imagined future evaporates.

2. Cognitive Rigidity - Thinking becomes binary or all‑or‑nothing; possibilities shrink to “nothing will help” or “this is the only way.”

3. Emotional flattening / relief after decision – Intense distress gives way to a quiet, resigned calm; the user may feel they’ve ‘figured things out.’

4. Behavioral simplification / withdrawal - Pulling back of roles, routines, and relationships; life activity narrows to a few concrete tasks.

5. Decision language and logistics - Language shifts from struggle (“I don’t know what to do”) to resolution and planning (“I know what I need to do,” concrete steps).

6. Attention narrowing / ruminative tunnel vision - Focus locks onto one problem or solution; alternatives, innovation, and nuance fade from view.

Together, these signals indicate a state transition into a higher level of suicide risk. These shifts are psychological and experiential. They are not always visible in the words themselves. AI systems that focus on the structure of thinking will need to track language trajectories, narrative shifts, emotional tone changes, and decision language over time.

The Face-Value Problem

Artificial intelligence systems are very good at analyzing words and patterns but can only work with a user’s inputs. Suicide communication is rarely straightforward. People in suicidal distress may say reassuring phrases such as, “Don’t worry about me,” or “Everything’s under control” prompting the AI to relax its concern. Language becomes less reliable exactly when risk becomes highest.

Clinicians feel the disengagement and sometimes, the resolve to end one’s life. As more people seek support from chatbots, AI companions and even general AI assistants, AI systems must improve suicide risk detection as usage grows and conversations become more complex.

Why We Should Care About AI Safety

As people increasingly turn to artificial intelligence systems as companions and for support, we’re seeing the need for effective and safe management of people in psychological crisis. Technology companies are trying to build safeguards to detect suicide risk in real time. Many rely on keyword detection while others use sentiment analysis or behavioral signals. This is a start but often misses the key psychological shift that matters most: the decision state change.

Human-to-human interaction carries meaning that extends well beyond language — tone, pauses, emotional shifts, and context all inform how distress is recognized. AI systems, however, only see what users explicitly type. This creates a fundamental gap. If AI is going to respond safely to suicide risk, that gap between human communication and machine interpretation must be addressed.

AI systems need more than pattern recognition to recognize high‑risk decision states. They need clinically informed ways of tracking meaning collapse, cognitive narrowing, and decision language over time within text‑based inputs. That gap — between machine detection and real psychological risk — is where the most important safety work now needs to happen.

If you’re building or deploying AI systems that interact with vulnerable users and want to understand where suicide risk detection most often fails, you can learn more about my consulting work here: Walsh Psychology AI Risk Consulting.

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If you’re interested in the presentation slides, get them here. I mention a bunch of apps for suicide assessment and detection. Here’s the list and a summary of each.

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What is it?​

Alcoholics Anonymous (AA) is a self help 12-step group for people who have a problem with alcohol.

Who is it for?​

Anyone who self identifies as having a problem with drinking. Sometimes people who struggle with other substances or behaviors will attend meetings. There are ‘open’ meetings that anyone can attend, including guests, and ‘closed’ meetings that only people who have an issue with alcohol should attend.

How does it help?​

AA is a spiritual based (but not religious) program with specific steps to guide those towards a life that is free from substances. Using time tested steps and principles, the program has steps for self guidance with support to remain abstinent.

How do I use it?​

To start, just show up at a meeting. You have the option of sharing or not. If you do not want to share, a customary way to decline is to say your name and something like, “I’m glad to be here. Thanks.” Each meeting is separately run and has its own size, usual crowd, and type of things on which it focuses. The general rule is if you don’t like one particular meeting, try another.

What are some key facts?​

Some core components that improve your success are regular attendance at meetings (anywhere from once a day to once a week) and to get a sponsor. A sponsor is someone who has worked through all 12 steps and has generally been clean from substances for about two or more years. That person acts as a guide and support as you do your own work.

How can I learn more?​

Go to AA.org to find more information and links to online and in person meetings in your local area.

Recovery is often thought of as complicated. In many ways, it is: there are many feelings wrapped up in a proverbial ball and a lot of physical and emotional needs may have been unattended for some time. But at the same, it can also follow a typical pattern. While not everyone’s experience is exactly the same, we tend to think of recovery as following five stages:

Stage 1: Withdrawal (0–15 days)

You may sleep more, act impulsively, or feel depressed, anxious, shameful, fearful, confused, or self-doubt. Cravings to use are strong, and you may have trouble concentrating or coping with stress. You may become irritated easily with other people.

Stage 2: Honeymoon (16–45 days)

You begin to feel better physically, your energy increases, and you feel more optimistic and confident about your life. You may even begin to feel your addiction problem is under control or over and, as a result, you may want to drop out of treatment early or stop your recovery activities, such as attending NA, CA, or AA meetings or stop following the disciplines of recovery.

This may contribute to your using substances again.

Stage 3: The Wall (46–120 days)

This is seen as the major hurdle in recovery. You become more vulnerable to relapse as you feel reduced physical or sexual energy, depressed, anxious, irritable, or bored; have trouble concentrating; and feel strong cravings or thoughts about using.

Stage 4: Adjustment (121–180 days)

Once you get through the previous stages, you may feel a great sense of accomplishment. Life begins to feel like it’s leveling out as you adjust to changes in your lifestyle.

Although your mood improves, you still continue to feel bored and may even feel lonelier than you did before if you have not developed social supports.

Cravings for your drug or behavior of choice occur less frequently and intensely, and you may begin to question whether you have an addiction. You may even put yourself in high-risk situations that increase your relapse risk.

Stage 5: Maintenance (180 days +)

In this stage, one of the primary goals should be to maintain the meetings and sober supports put in place during initial stage. You may start to feel some stability in your recovery. If so, it may be time to get to the root of why you started using. This can be done by talking to a therapist or other professional. By this time, you may also be healing relationships with friends, family, your support groups, and the society. The best indicator as to how much progress you are making can be known by the feeling of balance within your mind.

What’s your path?

Each person’s path to recovery is unique to them. The most important factor in determining a person finding a path to recovery that satisfies their needs is planning. And the most important part of planning is anticipating what’s ahead, these stages should help shed light on what to expect.

If you or a family member is in recovery, what is your experience relating to these five stages?

Further Reading:

You may also find the following articles interesting:

• What is Process Addiction?

• Choosing the Right Treatment Center

Treatment Centers in the United States

There are many treatment facilities available all over the country of varying quality and efficacy. According to the United States Bureau of Labor Statistics, depending on the license and level of experience, there are currently upwards of half a million different individual providers offering substance abuse outpatient treatment. It’s overwhelming. How do you make the right investment without wasting time, money, and heartache?

The treatment industry has been under fire recently for funneling vulnerable families to expensive treatment that may or may not be the right fit. The competition for treatment dollars has resulted in massive advertising campaigns with promises of false hope. Families in crisis, who only want to help their loved one, are willing to try anything — especially if it seems different. However, treatment interventions that aren’t backed by research or outcomes only lead to more treatment. It’s the classic carrot on the stick.

Important Considerations in Choosing a Treatment Center

Choosing the right care for you and your family is daunting but we can help. Maintaining active addiction is expensive. The right investment in care converts wasteful spending into a long term healthy investment that pays dividends for life. Yes, there is an initial, short-term cost to treatment and recovery but there is also a real financial savings long-term that can be diverted into more meaningful pursuits. Consider the money that is thrown away maintaining the addictive lifestyle in a year. Channel those funds into the right treatment efforts for three months. The bleed stops here. These are conservative estimates as people are often in addictive lifestyles for years. This lends credence to the philosophy that your treatment should have the greatest impact for your efforts.

I believe in in the empowerment of informed choice to make effective decisions. Treatment facility quality varies over time with the policies, leadership and staff they employ.

Further reading

You may also be interested in this post:

• What is Process Addiction?

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There’s more than one type of addiction

A process addiction (also known as a behavioral addiction) is different from substance abuse in that the addiction centers around a behavior or process. The most common process addictions are sex and love addiction, food addiction, shopping, gambling, and/or video game or internet addiction. I define an addiction or an addictive behavior broadly and without judgement — it’s anytime something is out of balance in your life.

The “high” from the process or behavior comes from the reward the brain receives. Anything that gives us that extra boost has the potential for overuse. However, an addiction is a symptom and a coping mechanism for something more. It is an escape from pain — sometimes a painful event, or a number of events, from the past — but often the pain of missing key coping skills. The high obtained from using is a coping skill that can be replaced with a new set of skills with more benefit and less cost. Treatment and support are vital to this process.

I’m lonely and miss the connection of my partner/friends/kids/family/colleagues.

I want something different but I’m not sure I can do it and I don’t even know where to start.

Only you can make the determination if you are struggling with an addiction or a process addiction more specifically, but it’s important also to listen to people you trust in your life. These trusted others help us see our blind spots and often recognize patterns before we do. However, there are some essential questions to ask yourself to determine if you’re living your best life:

• Am I happy and satisfied with how things are going?

• Is it possible there’s a better way but I don’t know what is it?

• Am I getting the biggest bang for my efforts in life?

• Is this the way I want things to go?

• If I could change something, would it be something big?

• Is there something I’m doing that’s just not worth it anymore?

Types of process addiction

Below is a more complete list of process or behavioral addictions:

• Intermittent explosive disorder (compulsive aggressive and assaultive acts)

• Kleptomania (compulsive stealing)

• Pyromania (compulsive setting of fires)

• Gambling

• Food (Restricting, Bingeing, Purging, Cycles of Each)

• Sex and Partners of Sex Addicts

• Love addiction and/or Codependency

• Pornography (attaining, viewing, creating)

• Using computers / the internet

• Playing video games / games on the phone

• Working

• Exercising

• Cutting/Self Harm

• Shopping

Did anything surprise you? Let’s talk about it.

You may have done it yourself. Personally, I’m a fan: mental health days. The point is to relieve stress and restore wellness. My anecdotal experience, from working with clients for nearly a decade, is that most of these days are not spent recharging and instead may actually increase anxiety. But there are ways to change that and make the most of your time off. First, let’s start with some of the hidden reasons people take days off work.

1. Stress, Anxiety and Depression

Stress, anxiety and depression go by many code names: busy, worry, sad, irritated, down, unhappy, antisocial. Symptoms have a variety of sources and intensities. Regardless of whether it rises to the level of an actual diagnosis, the lived experience of people is very real and affects each person in different ways. It is context specific — meaning, there’s a bunch of stuff going on in your life, you have your own unique history and your own lens or worldview. One person may experience an event and, while stressed out, rolls with the punches while another person, on paper, experiences the same event and anxiety and depression symptoms leave them bedridden. The mental health day is a form of coping.

2. Bullying by Coworkers and Bosses

People can be cruel. Even though as a psychologist, I can understand the reasons why coworkers, bosses or other people in authority positions emotionally or verbally abuse others, it doesn’t excuse this behavior. One of my clients made an excellent point recently by discerning the differences between feelings and behavior — all feelings are valid but we must express them responsibly. Being bullied at work feels so personal because the bully targets you and specific things about you. It creates a toxic workplace environment for everyone. Oftentimes, it is hard to prove the harassment and the behavior flies under the radar, leaving you feeling powerless. It can show up as favoritism, inconsistent enforcement of the rules, overly harsh punishment for minor infractions, or pitting employees against one another. The worst case scenarios are with bosses who abuse their power. The employee is stuck because he or she needs something from the bully and fears retribution, large and small. The mental health day is a form of avoidance and escape.

3. Poor Work/Life Balance

As a GenX’er, it was drilled into me to value work/life balance. Even though I love my work, I love it even more when I’ve been away from it. I’ve also done a fair amount of processing with clients in regard to why they are unhappy at work. One reason is often too much work or responsibility for the role or position. Some people, departments, or titles become the ‘catch-all’ task collectors. Another person comes up with a new project and because there’s no specific person to assign it to, it gets passed to you. Anxiety, stress and guilt can push you to ‘overfunction’ and your task list grows. Without even realizing it, your 40-hour a week job has now grown to 70-hours but you’re still hustling to make it work. The mental health day is a form of balance and regulation.

4. Disengagement and Burnout

Do you feel the same about your job as when you started? Do you like your work? Are you excited about new projects? If not, you may have learned everything you can and the job has run its course. Some companies do better with continually training and challenging their employees — recognizing growth and promoting talents. However, most companies are content to let you go about your job and management is hands-off. Being at the stage where work is no longer engaging leads to apathy and burnout. Who wants to spend significant chunks of their day being bored? It’s a better use of your time to be at home, doing what matters more. The mental health day is a form of regrouping and future planning.

5. Child or Elder Care Issues

Parents with rigid schedules pay a penalty if their child needs them. The same goes with caretakers of elderly parents or chronically ill family members. When faced with going to work or taking off for a sick child and a loved one’s doctor’s appointment, it’s not a Sophie’s Choice — family needs come first. Companies with rigid leave policies create stress and additional costs for their employees. The lack of flexibility and focus on hours over task completion creates low morale. It’s true that some service companies depend on timeliness and that some employees would abuse a flexible policy. But there’s a tradeoff and the determining the most flexibility for a business can build a culture of mutual trust, retain valuable employees, and reduce absenteeism costs. The mental health day is a form of scheduling priorities.

Better Coping Skills

• Consider therapy from a psychologist or counselor for help with stress, anxiety or depression. Just sorting thoughts can provide relief. If you need more significant time off, you may qualify for leave under the Family Medical Leave Act (FMLA) which can protect your job.

• If you’re being harassed or bullied on the job, it is essential to document incidents. Keep a running list with dates, times, and descriptions of events as they occur. Stick to the objective facts whenever possible. When you feel ready, consult with the company’s HR or a person in authority if possible. You may be able to ask questions anonymously before making a formal report.

• Life is one long, endless to-do list. You’ll always have tasks on your plate. Consider chunking them by category, priority, or life compartment. Think about the real consequence of NOT doing it (or doing it now). Can it be put on the backburner?

• If work has become a bore, consider new opportunities. This might mean moving to a different position or seeking out a new career. Perhaps there’s a training you have been eyeing that will increase your skill set?

• Many companies are recognizing the need for flexible leave policies as well as work from home opportunities. If your company requires you stick to a rigid schedule and this doesn’t work for your family, it might be time for a change.

In all of these examples, the essential missing quality is the focus on mental health. Often my clients will report taking time off to cope and end up feeling desperate and more anxious. They are home but unable to relax — ruminating and feeling guilty. A mental health day ideally is meant to be restorative. When taking time off is the last resort, it’s a sign that you’re not dealing with the bigger issue. The result is a conflict of cross purposes — the intention to care for yourself is there but it’s just a bandaid for what’s underneath. If you’re stuck in a loop and don’t know your next steps, you may need more help.

What do you think? Can you relate? Why is there still a stigma on taking mental health days? Do you take days to restore your sanity?