03 May When it doesn’t look like suicide – National Suicide Prevention Conference (2026) Keynote
When it doesn’t look like suicide
Challenging a few assumptions
Dr. Tim Sharp (2026)
Explainer: This Keynote was delivered by Dr. Tim Sharp at the National Suicide Prevention Conference, on April 30, 2026. A few minor changes have been made so it reads better in this context. In addition, several explanatory notes have been added to aid comprehension. You’re more than welcome to share this, but if you do, please do not change or edit anything AND please include my contact details. If you’d like to get in touch, or to discuss further, feel free to email info@thehappinessinstitute.com (or you can find me on LinkedIn at drtimsharp)
Opening
[After walking on stage, I paused for approximately 30 seconds.]
If that felt uncomfortable, imagine what it’s like for those of us who stay silent.
Silent because of shame.
Silent because of stigma.
Silent because of the fear of negative evaluation and potential consequences, in our working and personal lives.
Silent because we’re afraid others won’t understand and sometimes … because we, ourselves, don’t even understand.
Silent because we think we’re not supposed to be distressed …
Because we had a good upbringing.
Because we’re privileged.
Because we’ve achieved a lot.
Because … we’re sometimes known as “Dr Happy”!
Because … well, the list of “because-es” is a very long one.
Whatever the specific “because”, too many of us are silent and struggling.
Right now, in this room, there are people who are struggling, or have at some point in their lives struggled with thoughts of suicide.
I know this because I have several degrees in psychology and I can read your minds!
But seriously, we know this is true in any room because the stats have shown us it’s true. Lifetime prevalence studies have found that a significant proportion of people will experience suicidal ideation at some point.
And here’s the rub, most will never, ever tell anyone about it.
And if I asked you to point them out, even a group of people like you who’re highly qualified and experienced in this field, I don’t, with all due respect, think you’d be able to.
Because they don’t all look the way we expect them to look.
They’re not always withdrawn.
They’re not always crying.
They’re not always isolated.
Sometimes… they’re the most successful person in the room.
Sometimes… they’re the one making everyone laugh.
Sometimes… they’re the one helping others.
Sometimes… [pause] they’re the one on stage.
Today, I want to talk about that silence. Not just as a concept backed by research, but as something I’ve lived.
Because when I was younger, I tried to end my own life … more than once.
And since then, I’ve continued to experience suicidal thoughts, on and off, for much of my adult life.
For a long time, hardly anyone knew this. Partly because I didn’t talk about it. In fact, mostly because I didn’t talk about, because NO ONE talked about it back in those days. And partly because, for all intents and purposes, I looked happy and successful.
Now, the reality was that I might have been, by some definitions, “successful”. But the reality also was that I was hiding behind fake smiles much of the time, and “coping” with alcohol and other substances.
And so, what the outside world could see was that I was …
Completing university degrees.
Building a successful career.
I was in a loving and stable relationship with healthy and wonderful children.
I was doing all the things that, on paper, suggest someone is doing well.
Which just goes to show, paper is not a great diagnostic tool!
And this is something I really want to emphasise today. What we see, is very often not the whole the story.
Challenging the Stereotype
So, what do we see?
And before I go on, I want to pause to acknowledge that I know I’m talking to a room of people who’re experts, whose expertise I highly regard, and who’re more than likely very aware of the traps and pitfalls of which I speak.
And yet … we’re all human. And we still make mistakes and have blind spots.
As such, despite our best efforts, many of us tend to carry an unhelpfully narrow mental image of what suicidal distress looks like.
We imagine someone who is visibly broken.
Obviously hopeless and not coping.
Disconnected and lost.
And while that is indubitably sometimes true, it’s just as often not true.
Research increasingly shows that suicidal ideation exists across a broad spectrum of people, including those who are functioning highly. Large epidemiological studies show that many individuals who report suicidal thoughts are employed, in relationships, and even socially engaged.
Which challenges a very simple, but very persistent, narrative:
That if someone is “DOING well” … they must “BE well”.
This is where I believe the research of Corey Keyes and others becomes incredibly important. I discovered Corey’s work many years ago now, and it’s not overstating things to say, it fundamentally changed the way I viewed my clients, and my own experience.
At the risk of oversimplifying, Keyes demonstrated that mental HEALTH and mental ILLNESS are related but distinct dimensions.
So rather than a single line from “well” to “unwell”, there are two distinct lines, or dimensions.
For those of you who’re still involved in, or who still remember their research, it’s a 2 x 2 factor design (with the two axes being mental health and mental illness).
Which means you can be:
- high in mental health and low in mental illness … which we’d call flourishing
- have high mental health and high mental illness … struggling
- you could have low mental health and low mental illness … a combination we refer to as languishing
- or have low mental health and high mental illness … and be floundering
In fact, Keyes found that many people who would be considered “mentally healthy” based on functioning, still experience significant symptoms of depression and other forms of mental ill-health.
So, the idea that success or achievement or accomplishment equals wellbeing, is not entirely supported by the data.
And yet, our stereotypes persist.
And this isn’t the only common stereotype. Let’s look at a few more of them.
The “visibility bias” is where we assume distress must be observable.
We’re wired (and to some extent taught) to look for certain signs … tears, withdrawal, obvious struggle. But much of the time, distress is quiet, internal, and carefully concealed. People can be functioning, smiling, even succeeding, while privately struggling to stay afloat. When we rely only on what we can see, we can miss what matters most.
The “just-world fallacy” refers to when we believe that if someone has had advantages, they shouldn’t suffer in this way.
There’s a comforting belief that life is fair; that good circumstances protect people from deep pain. So, when someone who is successful, loved, or privileged struggles with suicidal thoughts, it doesn’t fit our narrative. But suffering isn’t distributed according to fairness or logic. Pain doesn’t check your résumé before it arrives.
There’s also the “resilience myth” in which we believe that seemingly strong, capable people are somehow protected from suicidal thinking.
We often equate competence with immunity. If someone is high-functioning, reliable, the one others lean on, we assume they’re coping. But strength can also mean being very good at carrying a heavy load, often without letting others see the strain. In some cases, those who appear most resilient are the least likely to ask for help.
And my personal favourite, the “binary thinking trap” — that someone is either okay, or not.
Most of us like clear categories: well or unwell, safe or at risk. But human experience doesn’t work like that. People can feel grateful and despairing, connected and alone, hopeful and exhausted; all at once. Suicidal thinking can coexist with outward signs of a “good life,” which means the question isn’t “Are they okay?” but “How okay are they, really?”
I can tell you from decades of professional and personal experience, reality is far messier than many of our assumptions would have us believe.
Now, I’m fully aware that none of these are formal diagnoses. But they are useful ways to describe individuals who present as positive, engaged, even high performing, while internally struggling.
And from a psychological perspective, this shouldn’t really be that much of a surprise. Many of us humans are exceptionally good at compartmentalising. We do it all the time.
You can be in the middle of a great day, and still have a thought in the background like:
“I don’t know if I can keep doing this.”
Those things can coexist.
And I’ve lived that; many times, in many ways.
I remember periods in my life where I would deliver a keynote, which was by all accounts well received, or have a great session with a client, or achieve something about which I was proud, and I’d feel a sense of purpose … and then later that evening, sitting alone, feel a heaviness that didn’t match the day at all.
No obvious trigger.
No clear explanation.
Nothing even remotely rational.
Just there.
And that disconnect; between external reality and internal experience … is one of the reasons this issue is so easy to miss.
The Experience of Duality
And this brings me to one of the most confusing and potentially least discussed aspects of suicidal ideation which is …
You can want to live…
And want to die…
At the same time.
This might seem incongruous, like a contradiction, but for many it’s a reality.
There are multiple theories that try to explain this by referring to perceived burdensomeness and thwarted belongingness; to defeat and entrapment; to “psychache” and unbearable psychological pain.
All of which are interesting and useful frameworks. But speaking from a lived experience perspective, I’d like to try to add another layer:
You can have all of that…
And still love your life in many ways.
Which is deeply confusing. I’ve felt this confusion; I’ve been confused by this confusion!
Caring deeply about my family.
Feeling committed to, and proud of my work.
Recognising all the good in my life; and there’s been so much good.
And still, at times, having thoughts about not wanting to be here.
Earlier in my life, those thoughts escalated into action. Later, they became something that ebbed and flowed. But importantly, and it’s worth noting that this is where research strongly supports lived experience …
External success doesn’t necessarily resolve internal struggle.
Why? Well, let me count the ways …
This list could be a very long one, so this is just the short version, with some of the more obvious and common are processes being:
Hedonic adaptation: This is our mind’s tendency to get used to improvements surprisingly quickly. A promotion, a new home, a major achievement; these genuinely lift mood, but often only temporarily. Before long, what once felt exciting becomes normal, and our expectations recalibrate upward. It’s not that the good things stop mattering; it’s that they stop feeling as good because they’re no longer novel. Without intentional practices like savouring or gratitude, we end up constantly chasing the next “lift” rather than fully experiencing the one we’ve already earned.
There are also a range of cognitive distortions, but today I want to focus on discounting the positive: Here, the issue isn’t the absence of good experiences; it’s how those experiences are interpreted. Discounting the positives mean we explain away successes or moments of joy …
“That didn’t really count,”
“Anyone could have done that,”
“It was just luck.”
[quick show of hands if these sound relatable?]
Over time, this creates a skewed internal narrative where negative events feel significant and meaningful, while positive ones are minimised or dismissed. The result is a kind of emotional asymmetry; life may contain plenty of good, but it doesn’t “land” psychologically.
And then there’s social comparison: particularly upward comparison: It’s natural to evaluate ourselves relative to others, but when that comparison is mostly upward (toward those who seem more successful, happier, or more accomplished), it erodes satisfaction. Even meaningful achievements can feel inadequate if there’s always someone doing “better.” In today’s environment, especially with curated social media, these comparisons are constant and often unrealistic. Upward comparison isn’t inherently bad (it can inspire growth), but when it becomes the default lens, it shifts attention away from personal progress and toward perceived shortfall.
Taken together, these processes can leave someone with a life that is objectively rich in meaning and achievement yet subjectively lacking in satisfaction; not because anything is “wrong,” but because of how the mind adapts, filters, and compares.
At the risk of sounding immodest, these are areas I’ve seriously excelled at in my life.
[PAUSE] … in case you were wondering, that’s NOT a good thing.
There’s strong evidence that people who are high achievers are often:
- less likely to savour success
- more likely to constantly and unhelpfully shift goalposts
- more likely to compare themselves unfavourably
It’s a bit like climbing a mountain, only to realise you’ve immediately started comparing yourself to someone on a higher mountain.
Which might, for some people, at some times, be motivating. But which can also be utterly soul-destroying!
I’ve done all of these so many times I’ve lost count; and sadly, I’ve struggled to learn from my mistakes.
Time and time again I’ve achieved something meaningful, and within minutes, shifted to:
“What’s next?”
Or worse, told myself …
“Others have done more.”
And in those moments … the achievement just doesn’t land.
There’s no real sense of arrival.
No lasting relief.
Which means the gap between how life looks, and how it feels, can actually widen. And that gap is important. Because the bigger the gap, the harder it can be to talk about.
Why We Miss It
Now I know for a fact that I’m not the only person who’s experienced this, who thinks like this, so why is this so hard to see?
Well, stigma undoubtedly plays a role. But it’s more complex than that.
First, there are gaps in training.
I know my clinical training, which in most ways was fantastic, was woefully lacking in suicide risk assessment. Admittedly, my training was several centuries ago, but even when this training is better, suicide risk assessment still often relies heavily on:
- disclosure
- observable distress
- known risk factors
And while these matter, they’re not always present. Or not always made known. Particularly in and by high-functioning individuals.
In addition, people hide it. And they get very good at it.
Research shows that many individuals engage in what’s called “impression management”, actively shaping how others perceive them. Especially in environments where competence and composure are highly valued.
Certain groups are particularly relevant here. Men, for example, are less likely to disclose emotional distress and more likely to externalise it. Professionals and leaders often feel they can’t afford to be seen as vulnerable. People in caring roles (psychologists, doctors, carers) may feel they should be the ones helping, not needing help.
So, they don’t speak up.
If you were paying attention, you might have noticed that I ticked ALL of those boxes; which is why I didn’t speak up. And I know you’ve already had one of these speak at this event, thank you Ian Thorpe, but I became the equivalent of an Olympic Gold Medallist at hiding how I was really feeling. I couldn’t blame my friends for not supporting me more in my early days because I knew it wasn’t their fault; because they didn’t know; because I didn’t let them know!
Over time, however, silence becomes the norm. Something that’s further reinforced by our systems which reward functioning.
If you show up.
Deliver.
Perform.
If you’re seen as okay. You must be OK.
I sometimes joke, only half joking, that if you respond to email in a timely fashion, people assume your mental health must be fine. And as some of you who know me are well aware, I respond to emails in a VERY timely fashion!
Which is not how any of this works. At least it’s not how it should work.
And coming back to something I mentioned earlier, that big ugly elephant that refuses to leave the room, stigma is still deeply embedded.
Despite progress, many people still associate suicidality with weakness, instability, or failure. And that perception has consequences.
Research consistently shows that perceived stigma reduces help-seeking. So, if we want people to speak up more, we have to do more than encourage them.
We have to create environments where it’s genuinely safe to do so. Where vulnerability doesn’t come at a cost. Where people aren’t quietly thinking:
“If I say this out loud … what will happen next?”
Until we address that, we will continue to miss people.
A Different Way Forward
Where to from here?
If we accept that suicidal distress is often invisible, or disguised, then we need to change how we respond.
Research on protective factors consistently highlights at least 3 big factors:
- connection
- psychological safety
- and the ability to disclose distress
Practically, this means asking better questions.
Not just “How are you?”
But: “Really… how are you going?”
And possibly asking more than once.
And then, notably, tolerating more complex and messy answers.
This can be really hard to do, for many of us for many reasons, but we need to resist the urge to fix immediately. Sometimes the most helpful response is simply staying present. And normalising complexity.
Normalising that it’s okay to be:
- grateful and struggling
- successful and struggling
- connected and struggling
All at the same time.
As I’ve hinted at, for a long time, almost no one knew my story. Because I didn’t tell them. And because there was nothing externally that made it obvious.
If anything, I probably reinforced the opposite impression.
And I know I’m not alone in that. There are many people living this dual reality. Which is why I think conversations like this matter and why I’m so grateful to have been given this opportunity to speak on this stage today.
A Practical Message
Where does this leave us?
I’d like to offer something simple. Not easy, but simple.
I hope this isn’t too obvious but this week, choose one person. Someone you think is “fine.” Someone who looks like they’ve got it together. And ask them, genuinely, how they’re going.
And when they answer … Don’t just accept the first response.
Research shows people often test the waters before opening up.
So, stay with them. Sit in the pause. Maybe even tolerate a bit of that same discomfort we started with this afternoon.
Because sometimes the most important conversations happen just after “I’m fine.”
And I’d also like to say something to anyone here who recognises themselves in any of this. For me, over many years, two very simple ideas have helped.
Not solved everything. But helped.
The first is this: This too shall pass.
I’ve learned, slowly and imperfectly, that how I feel is not fixed; that no feeling is final. Even when it feels stuck, it’s not, it moves.
Maybe not as quickly as I’d like. But it moves.
And sometimes, that movement is enough to create just a little bit of space. And sometimes, a little bit of space is where things start to shift.
And the second is this: I’m not alone.
Even when it feels like it. Even when it looks like everyone else has it together.
And not just in some abstract sense. But that there are people, many people, who understand this experience in ways we don’t often talk about.
I’m not the only one who has felt this way. And neither are you.
Plus, there are people who care. People who love me, and us, if only we let them!
When we start to realise or remember all this, even just a little, something changes. Because connection doesn’t have to be perfect to be powerful.
Research supports this too. Connection, even the belief in connection, is one of the strongest protective factors we have.
So, if you’re someone who is struggling, even quietly, you don’t have to wait until things are unbearable. In fact, please DON’T wait until things are unbearable.
You don’t have to prove how bad it is. You’re allowed to speak earlier.
Because things can shift. Because people do care. And because change, even small change, is possible.
And if you’re on the other side of that conversation, you don’t have to fix everything. You don’t need the perfect words. Just being there, really being there, can make more of a difference than you might ever know.
A story
I’d like to finish with a story I was told by a client I was working with many years ago now. This client’s family were immigrants, and his grandfather used to like to tell them all stories of his old life, so they’d know where they came from and appreciate even just a little of their cultural background.
My client’s family had come from a small rural town, where most people, and this was very common then, had small gardens where they grew herbs and vegetables and tended a few livestock.
Each weekend they’d have markets where they’d sell or swap excess or unwanted goods, for other products that they couldn’t or didn’t want to grow and farm. It was partly a commercial exercise, but it was also very much a community building exercise.
Everyone knew each other and everyone trusted each other; well, mostly, anyway. Nothing’s perfect.
Anyway, on this one particular weekend, my client’s grandfather had asked one of his neighbours to deliver some new chickens, to replenish his stock. And because, as just mentioned, there were high levels of trust, the neighbour did this while everyone was down at the markets, safe in the knowledge that he could just leave them out the front of the house.
But when my client’s grandfather came home, the top had come off the crate, and there were no chickens to be seen anywhere, just a few feathers fluttering around.
Now my client’s grandfather and his family were tired, they’d been at the markets all day, but they knew they had to do what they had to do, and so they started to look around and tried to find as many chickens as they could.
But again, they were tired, and it soon grew dark, and so after a while, they called it a day, and then he went around to his neighbour to explain what had happened. And he said … “thanks, but you didn’t secure the top of the crate properly, and the chickens all escaped, and we tried to find as many as we could, but we could only find 11.”
At which point the neighbour looked surprised and noted, with a smile … “that’s pretty good because I only delivered 6!”
Final Line
Like those chickens, I think I’ve been lost most of my life. But like my client’s grandfather in that story, I’ve somehow been able to find much more in life than I ought to have, despite being lost.
Every day, there are people making their way through life, feeling lost … and still showing up.
So perhaps my message is a really simple one.
To look a little closer.
To listen a little longer.
And to remind each other, whenever we can, that this will pass. We will find our way.
And that none of us has to go through it alone.