70 | Moment of Action: TIP Breaks Through

Action - We enter the fourth phase of the STEPS model — TIP — the moment when suicidal thought becomes action.

TIP is an acronym for:
 T – Tension Builds – the lead-up to the act: the events, emotions, and pressures that coiled the thread so tight it broke.
I – Impact Unfolds – the act itself: whether impulsive or rehearsed, interrupted or completed, and the mindset that accompanied it.
P – Postscript Remains – the immediate aftermath: what followed physically, emotionally, and relationally when survival was still possible.

We explore how the crossing into action can happen in two ways:

• Gradually, through the NEEDLE phase, as intention sharpens into planning.
• Or suddenly — as it does for one in four people — bypassing planning entirely and leaping straight from ideation into action.

Drawing on trauma-informed care, motivational interviewing, and solution-focused strategies, we discuss how to have these critical conversations — most often in the hours or first day after an attempt — to validate the pain, uncover the story of the rupture, and begin to stitch safety back into the weave of a life that has been torn.

Ari’s story returns, showing how the second time was different — fast, impulsive, fuelled by alcohol — and how a knock at the door became the thread that held.

Because the story does not end at the point of rupture.
 Not if the person is still breathing.
 Not if we are still listening.

Connect with Assoc Prof Manaan Kar Ray on Linkedin
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Transcript

1. Intro Song – The Piercing

2. Welcome and Recap

Welcome back to the PROTECT podcast.
 Here, we walk slowly through the tapestry of suicide risk and recovery —
 Thread by thread, moment by moment — to understand how pain weaves its way through a life, and how connection can begin to re-stitch meaning into the cloth.

If you've journeyed with us from the beginning, thank you for staying close.
 And if you're joining for the first time, I’m grateful you’ve found your way here.

In this episode, we arrive at a turning point — a sharp point —
 the moment where intention moves into action.
 This is the phase we call TIP.

The TIP phase marks the rupture.
 It is not a metaphor anymore.
 It is the act.
 The moment when pain tips into behaviour.
 When the internal battle breaks the surface.
 And what happens next — whether the person survives or not — changes everything.

This is not an easy place to visit.
 But it is necessary.
 Because if we’re to truly accompany people through the full spectrum of suicidal distress,
 we must be willing to sit at the sharp edge too — where the TIP of the NEEDLE ruptures through the FABRIC of life.
 We stay present, with reverence, with clarity, and with care.

3. Previous Episode Recap - NEEDLE 

In Episode 4, we stepped into the NEEDLE phase —
 a place of tightening threads, where suicidal ideation shifts into intention.
 It’s a quiet phase, but it is anything but passive.
 Here, the thread is no longer drifting.
 It’s pulling toward a point.

NEEDLE gave us six ways to trace that movement.

We began with Navigating Ambivalence —
that inner tug-of-war between wanting to live and wanting the pain to end.
Both sides pulling, the person caught in between,
sometimes still holding on to reasons to stay,
sometimes almost ready to let them go.

Then came Excluding Options —
when other ways of coping begin to fall away,
until suicide starts to feel like the only door left open.
Hope narrows, possibilities close,
and what was once a choice becomes a conviction.

Examining Means followed —
moving from vague thoughts to specifics.
The how, the where, the when.
It might be quiet online searches,
a visit to a certain place,
or a mental rehearsal of what could happen.

Next was Drafting an Exit —
early preparations that may seem small to others,
but are deeply significant.
Cancelling plans, putting affairs in order,
avoiding future commitments.
The subtle shaping of an end.

Then Leaving Subtle Signs —
the quiet goodbyes.
Giving things away, withdrawing from relationships,
messages or posts that carry more weight than they seem.

And finally, Exploring the Exit —
those moments when the person comes close to acting.
They may rehearse, they may even begin,
but for whatever reason — fear, interruption, a flicker of connection —
they step back.

For Ari, we saw each of these threads.
 She navigated the conflict between staying and leaving.
 She began to close off other options.
 She researched and pictured her means.
 She quietly prepared, left signs, and even stood at the edge once before turning away.

NEEDLE taught us that this is not a loud phase.
 It is deliberate.
 It is organised.
 And it is urgent.
 Because once intention is formed, the distance to action can shrink suddenly.

And that brings us to where we are now.
 Sometimes, the thread slips through.
 The tension is too much.
 The silence too long.
 And the point breaks through the cloth.
 That is TIP.

4. Episode Focus: Understanding TIP

In the STEPS model, TIP is the fourth phase — the moment when thought becomes action.
 The point where the threaded needle pierces through.
 It is rupture.
 And once it happens, everything changes — for the person, and for those around them.

Now, before we explore the three strands of TIP, there’s something important to understand about the pathway to this moment.
 We’ve been walking step-by-step — from THREAD into NEEDLE — assuming there’s a narrowing, a progression, from ideation to intention to action.
 And for many people, that’s how it unfolds.
 But not for everyone.

The National Comorbidity Study found that one in four people who attempt suicide never pass through the intention stage at all.
They jump straight from ideation — the thread we spoke about in Episode 3 — directly to action, the tip of the needle.
No warning plans, no careful preparations, no visible signs of intention.

For three in four, the absence of a plan is protective.
 For that one in four, it isn’t.
 And in that group, there are often factors like high impulsivity, heavy alcohol use, or acute stressors that collapse the gap between thought and act.
 A fight, a rejection, a wave of shame, an intoxicated night — and a piercing or a rupture occurs.

That’s why “no plans” is never enough.
 It’s not a substitute for safety planning.
 We cannot assume that the absence of intention means the absence of risk.
 The gap between ideation and action can be hours, minutes, sometimes seconds.

So in TIP, our job is to understand this crossing point.
 The acronym gives us three strands to follow:

T – Tension Builds

When we begin to talk with someone about the lead-up to their attempt, we need to set the tone early. I might start with something like:

"I want to understand what happened before you acted — not to judge you, but to see what the path looked like from your point of view. Sometimes those moments are a blur, sometimes they’re crystal clear, and both are okay."

We’re looking at the hours, days, or moments that pulled the thread so tight it finally broke. Was there a single, sharp trigger — an argument, a rejection, a sudden loss — or was it a cluster of smaller things building over time? I’ll often say:

"People describe that final day in different ways — some wake up already knowing it will be the day, others find the decision takes shape as the day unfolds. What was it like for you?"

Here’s where I normalise the role of alcohol or substances without judgment:

"For some, alcohol or drugs are part of that day — sometimes to numb things, sometimes without even thinking about how it might affect decisions. Was that part of your day?"

And we also want to understand whether they acted in isolation or with a part of them still hoping to be found:

"When you think back, did you choose a place or time so no one would find you? Or was there any part of you — even the smallest part — that thought someone might still step in?"

This part of the conversation is also where the behavioural incident technique comes in. It’s a way of walking through the sequence step-by-step:

"Would it be okay if we went through that day in as much detail as you can remember — from when you woke up to the moment you acted? If we skip over something, I might pause us and ask if we can go back, so we don’t miss any parts of the picture."

That step-by-step process is vital because it helps us identify exits — moments where, if a similar situation happens again, there might be a point to intervene or change the course.

I – Impact Unfolds

When we move into the moment of the act, we tread even more gently. This is where shame can be highest, and where details are sometimes hard to share. I might say:

"If you feel able, can we talk about the moment itself? Not to dwell on it, but because it helps me understand what it was like for you inside that moment."

We’re listening for whether it was impulsive, rehearsed, interrupted — and what the person’s mindset was. Instead of asking “What method did you use?” cold, I might soften it:

"What did you find yourself reaching for in that moment? Why that, do you think, rather than something else?"

If there was hesitation, that matters:

"Was there any point where you paused, even briefly, before going ahead?"

Sometimes I’ll explore whether the act was shaped to prevent discovery or allow for it:

"Did you want to make sure no one found you? Or was there a part of you that thought someone might?"

Again, behavioural incident sequencing works here:

"Can we walk through what happened once you decided to act? Step by step. If we jump over anything, I might ask us to go back, just so I can see the whole picture with you."

Those pauses in their story — the moments they skip over — often tell us where there was ambivalence, hesitation, or an opportunity for intervention.

P – Postscript Remains

Finally, we reach the immediate aftermath — what happened once the act was interrupted, reversed, or completed to the point of survival. I’ll start by framing it with care:

"You’ve been through a lot to be here now. Can we talk a little about what happened afterwards — in those first hours? There’s no right or wrong answer here, and you can share as much or as little as feels okay."

We want to know if they sought help or if help arrived unexpectedly:

"Did you reach out to anyone after? Or did someone else step in?"

We’re also gently exploring how they feel about being alive now:

"Some people feel relieved to have survived, others wish they hadn’t, and some feel both at once. How has it been for you since that moment?"

And we look for shifts — small or large:

"Has anything changed in how you see what happened, or how you see yourself, since that day?"

These reflections are not just about understanding the past — they are essential for building safety in the future. Knowing how the attempt ended and how they make sense of it now tells us where the threads might be strongest, and where they are most fragile.

By moving through Tension, Impact, and Postscript in this way — step-by-step, sensitive, shame-aware, and with careful sequencing — we’re not just gathering a history. We’re mapping the possible exits for the next time life’s weave strains this hard.

Now, in reality, it’s rare to be talking to someone in the exact moment of an attempt.
 Most TIP-phase conversations happen in the hours or first day afterwards — often in an emergency department bed, a resus bay, or an ICU cubicle.
 Sometimes with paramedics, sometimes with a crisis team, sometimes at 3 a.m. with a psychiatric registrar.

The Post-Action phase, which we’ll explore in MEND, comes later — days on, once there has been a sleep cycle or two and the first shock has settled.
 Here in TIP, we are in the immediacy.
 The body may still be recovering.
 The emotions may still be raw, tangled, or entirely numb.
 And that means our approach matters.

Trauma-informed care tells us to start with safety — both emotional and physical.
 We make it clear we are here to understand, not to judge.

Motivational Interviewing keeps us curious and collaborative:
 “Can you walk me through what happened?”
 “What was going through your mind as the day unfolded?”
 “If you had to describe what made it feel like you couldn’t wait any longer, what would you say?”

Solution-Focused strategies let us gently plant seeds for the future:
 “What, if anything, helped you pause or slow down that day?”
 “If something like this happened again, what would you want to be different in that moment?”
 “Who or what could make it even a little harder for you to reach that same point again?”

And always, we validate the pain without endorsing the act:
 “It makes sense that you wanted the pain to stop. It’s clear how much you were carrying.”
 We reframe the attempt as an act driven by unbearable distress — an escape from suffering, not from life itself.

But there’s something else we must address in these first conversations: safety reassurances.
It’s not uncommon for someone to tell us, “I’ll never do it again,” and for that to bring us relief.
We want to believe them — and sometimes that reassurance is genuine.
But we also know risk is dynamic. It can change very quickly.

So if someone says they won’t act again, we need to explore why they feel that way.
“What’s changed since then?” is a good place to start — and we need to go beyond “because I survived.”
If they express regret or remorse, we ask where that comes from.
Is it because they frightened someone they love? Because the method was painful? Because survival feels humiliating?
If nothing in their life circumstances has shifted, we need to understand what’s really driving the reassurance.

Equally, some people feel no regret.
 Some even say, “I wish it had worked.”
 Others feel ashamed they “couldn’t even kill themselves” — trapped in the same emotional pain, now with a belief they have failed at this too.
 These are not easy admissions, but they matter deeply for risk assessment and safety planning.

We might say:
 “Some people feel relieved to have survived. Others feel disappointed or even ashamed. Some feel both at once. How is it for you right now?”
 Or:
 “You’ve said you wouldn’t do it again. Can you help me understand what’s different now from before?”
 Or:
 “When you think about surviving, what does that bring up for you?”

For those living with chronic suicidality, especially in the context of borderline personality disorder, these questions can be confronting.
 They may have felt this way for years.
 They may act again.
 Here, the aim is not to win an argument about living or dying — power struggles will only entrench positions.

Instead, we stay alongside them:
 “It sounds like these thoughts have been with you a long time. That must be exhausting.”
 We look for moments — however small — when hope flickers.
 “What was the last thing, no matter how small, that made life feel even slightly more bearable?”
 We try to capture those fragments of connection, of meaning, of care, and hold them up without forcing a decision about the future.

In TIP, we are not just documenting risk.
 We are bearing witness to rupture.
 We are listening for the strain that built, the shape of the act, the echoes that remain — and the signals of what might still hold.
 We are holding a thread and a needle, the tip of which has already pierced the cloth,
 and asking — gently, clearly — whether there is any way it can be stitched back in.

5. Ari’s Story Segment – The Sharp Edge

Let’s come back to Ari.

The first time, she turned back.
 The second time… she didn’t.

And here’s what’s important — there was no slow build through the NEEDLE this time.
 No careful planning. No gathering of means over days. No subtle signs that might have given someone a chance to intervene.
 Ari was one of that one in four.
 She jumped straight from ideation — from thinking about dying — into action.

It wasn’t dramatic.
 There were no public posts. No note.
 Just a convergence of moments that tipped the balance:
 a message left unanswered,
 a day too heavy,
 a silence that landed hard.

That morning, she woke feeling flat, telling herself she was just tired.
 By the afternoon, the tiredness had shifted into a restless, dangerous clarity — thinking in shapes and steps.
 By evening, those steps had lined up into something she could follow.

There was alcohol in her system — enough to lower the barriers that had held her back before.
 She reached for the pills.
 No hesitation. No call for help.
 She didn’t avoid being found… but she didn’t make it likely, either.
 In her mind, this wasn’t about sending a message. It was about ending the noise.

That was the Tension.
Not just the bad day — but the months and years behind it.
Family fractures.
Shame that clung to her skin.
The grief that never quite lifted.
The wear of illness.
And the quiet, persistent belief that she was already fading from view.
All of it pulled tighter, until the thread passed through the eye of the needle.

The Impact was brief in time, but heavy in weight.
In that moment, everything inside her aligned with the act.
It felt like a point of no return.
There was no bargaining, no testing.
Only the sense that the pain and the action had finally matched.
And for a few hours, that seemed final.

But someone noticed.
 A friend who hadn’t heard back.
 A knock on the door.
 A call unanswered.
 Then an ambulance.
 And an ICU bed.

And now — Ari was breathing again.

The Postscript was complicated.
These were questions she had never rehearsed:
Was she relieved?
Ashamed?
Still certain she wanted to die?
Would anyone believe the depth of pain that had lived behind her silence?

She didn’t have the answers.
 She only knew the cloth hadn’t fully torn.
 Somehow, a thread had caught — maybe in the shape of that knock at the door,
 maybe in the quiet moments after the overdose when she’d realised she was still here.

And maybe — for now — that was enough to hold.

6. Closing Reflections

This is the reality of the TIP phase.
 It is raw.
 It is sudden.
 And it is sacred ground.

Not because the act was right or wrong,
 but because it reveals the truth about what it took for a person to reach that point.
 How long they may have been holding on in silence.
 How much strain they’ve been carrying in the weave of their life.
 And how easily we might miss the signs if we don’t look beneath the surface.

In TIP, we meet the moment of rupture.
 Sometimes it’s deliberate and rehearsed.
 Sometimes, as we’ve seen, it’s impulsive — a leap straight from ideation into action.
 One in four people take that path, bypassing the intention stage altogether.
 Which means the absence of a plan is never enough to reassure us.
 No plans can be protective for many,
 but for some, the gap between thought and act is measured in minutes, not months.

As professionals, as supporters, as fellow human beings,
 we must learn to be fluent in rupture.
 That means we prepare not only to prevent an attempt,
 but to respond when it has already happened —
 to walk into those first fragile hours with compassion, clarity, and courage.

TIP gives us three strands to follow:
 Tension — the build-up that brought the thread to breaking point.
 Impact — the act itself, in all its complexity.
 Postscript — what remains when the cloth has been pierced,
 and the person is still here, in whatever state survival has left them.

When we trace these strands with care,
 we begin to see not just what happened, but what still might be possible.
 Because the story does not end at the point of rupture.
 Not if the person is still breathing.
 Not if we are still listening.

And that’s where we go next.
 In the next episode, we enter MEND —
 a phase where survival becomes the starting point for something new.
 Where we begin the slow, deliberate work of meaning-making,
 of holding what happened, and finding ways to reweave the cloth where it has torn.

7. Closing Song – The Piercing