The Leader Nobody Thinks to Ask How They Are Doing

If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day. If someone is in immediate danger, call 911 or go to the nearest emergency room.

At the top of an organization, the questions mostly travel in one direction. People ask the chief executive about the forecast, the hire, the quarter. They ask the managing partner about the client and the senior physician about the schedule. Very few people ask the person in charge how they are actually doing, and fewer still wait around for an honest answer.

That silence is rarely unkind. Teams assume the leader has things handled, because handling things is the job. Spouses assume work stress is just work stress. Friends assume success is its own cushion. Meanwhile, a leader living with depression can go months without one candid conversation about it.

For some, the depression includes thoughts of not wanting to be alive, or a quiet conviction that everyone would be better off without them. Those thoughts can sit right alongside a full calendar and a steady voice in meetings. They are a health concern, not a character flaw, and they deserve the same prompt attention a leader would give any serious risk to the business.

Why the top can be the loneliest seat

Leaders often hold information they cannot share. They know about the restructuring before it is announced, the dispute before it is filed, the partner who is about to leave. Over the years, that habit of keeping things close can spread to their own health.

Consider a composite: a founder in his fifties who has spent two decades being the calm one in every room. He may discover he has no practice at all at saying, out loud, that he is struggling. The words simply are not in his vocabulary yet.

Role matters too. Many executives believe that admitting distress would unsettle the people who depend on them, so they keep performing steadiness. The performance becomes one more thing to manage, and it can be exhausting in its own right.

Signs worth noticing, in yourself or a colleague

• Talk of being a burden, feeling trapped, or seeing no way forward
• Pulling back from people, including longtime friends and family
• Sleeping far more or far less than usual, or working through the night with no clear reason
• A sudden calm after a long low stretch, which can be a warning sign, or putting affairs in order without explanation
• More drinking, more reckless choices, or losing interest in things that used to matter
• Remarks about not being around, even when said lightly or as a joke

Any one of these is reason to check in. Several together, or any mention of wanting to die, is reason to check in today.

Asking the question nobody asks

If you work closely with a leader and something seems off, a private, plain question carries more weight than a hint. You might say: "You have seemed weighed down lately. Are you having thoughts of suicide?" Asking directly does not put the idea in anyone's head. It tells them the subject is allowed.

If the answer is yes, stay with them, listen without arguing, and help them reach the 988 Lifeline or a clinician. If there is immediate danger, call 911. During a hard stretch, it can also help to have medications and any firearms in the home stored securely.

One treatment a clinician may bring up

Leaders who like to understand every option before a first appointment may hear about Spravato. Spravato (esketamine) is a nasal spray the FDA has approved, taken along with an oral antidepressant, to treat depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. It is also approved for treatment-resistant depression. It is not a crisis treatment: it does not replace emergency care or a hospital stay when one is needed, and it has not been shown to prevent suicide or to reduce suicidal thoughts or behavior. It is given only in a certified clinic under a safety program called the Spravato REMS. The patient takes it there under supervision, stays at least two hours to be monitored, and does not drive until the next day after a full night of sleep. It is never dispensed for home use. Whether it fits is a clinician's decision after an evaluation.

Help is real

Depression with suicidal thoughts is treatable, and recovery is possible. Reaching out is not a lapse in leadership. It reflects the same judgment a good leader shows when something important needs expert attention.

If you have been the one nobody asks, you can be the one who asks first. A free 30-minute consultation, offered by some clinics that provide this treatment, is a private place to describe the last few months and find out whether a full evaluation makes sense. Bringing your spouse is fine.

If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day. If someone is in immediate danger, call 911 or go to the nearest emergency room.