Recently, I intervened to prevent a friend from committing suicide. My friend is alive and I have the satisfaction that I knew what to do and had the opportunity to do it. That means a great deal to me because I value my friend. Her decision to live redresses some of the loss I feel because I was unable to prevent my son's death by suicide.

Suicidal Behavior runs on a continuum -- a long process during which suicidal people try various ways to reduce their profound emotional pain. Ambivalent, they have contradictory desires to live and to die and the balance between the two shifts back and forth.

SIGNS TO WATCH FOR:

• Deepening Depression -- Stressful life events cause temporary depression in most people. But some people suffer from major depression and manic-depression, inheritable illness which may lead to suicide. Caused by chemical imbalances within the brain, episodes of depression may arise with or without apparent cause. Fortunately, mood illness can be treated with medications and therapy; unfortunately, they often go unrecognized, undiagnosed and untreated. A depressed, uncommunicative, withdrawn person is at risk for committing suicide. The risk increases when depression goes untreated or if it is combined with alcohol or drug abuse. Although stressful life events do not cause depressive discuses, people who have these illnesses are more vulnerable.

Final Arrangements - A person puts their affairs in order, change a will, gives away possessions, talks vaguely of going away.

Sudden Elevated Mood -- Paradoxically a depressed suicidal person may suddenly appear better after they made a decision to end life, as if a burden has been lifted.

Risk Taking Or Self-Destructive Behavior -- may represent a death wish. The person isn't ready to take their own life but tempts fate by reckless diving for instance.

Presuicidal Statements -- Direct or indirect statements about suicide, hopelessness or death. Suicidal people pick rescuers. Despite what they say, they want these people to help them. A rescuer who picks up on these signs will ask direct questions.

Ask "Are you thinking of suicide?" -- Contrary to popular belief, you aren't putting ideas into this person's head. You need to assess how likely a suicide attempt may be. Ask more questions.

"Do you have a plan? A method? A means?" -- Is it deadly? Is it available, such as a gun or enough pills for an overdose?

"When?" Today, next week, a vague future time? Do not think you can talk a person out of committing suicide. Be supportive by letting the person know you care. Listen to them with respect for their profound despair. Do not make moral judgments.

• Take Charge - Do not worry about invading someone's privacy even though they try to get you to promise secrecy... this is not a test of friendship but a cry for help. Don't leave it up to them to get help on their own. See that arrangements are made for professional evaluation and treatment.

Don't challenge or dare a person to commit suicide thinking you will shock them out of the idea. Don't think suicide is a rational decision that you should leave the person free to make. Suicide is usually due to depression, an illness. Suicide is much more likely if the depression is not treated with medication and psychotherapy.

After you have assessed how acute the danger is, take appropriate steps. Arrange for professional evaluation and treatment. Get support from family members and friends.

If the crisis is acute -- Call 911, a hot line, or take the person to a crisis center, hospital emergency room, mental health center, their psychiatrist or family doctor.

DO NOT LEAVE THE PERSON ALONE.

Do take the signs seriously. If you don't feel equipped to manage a crisis yourself, find another person to help you or turn it over to someone you trust. Let the person's therapist know you are worried and why. It is not a breach of confidentially for you to tell the therapist that you're worried about the behavior of your friend. Though the therapist cannot talk about the person, he or she can listen to you.

Remember, you would intervene if someone had a heart attack. The suicidal impulse is just as deadly.

There is no certain way to prevent suicide. Do your best, then hope. The taboo against suicide causes some people, including professionals, to be reluctant to do the normal things a person should do to help someone who is sick and in danger of dying. Nevertheless, be persistent. That persistence by friends and family will eventually put pressure on doctors and mental health professionals to do better intervention, diagnosis and treatment.