As May is mental health awareness month, I want to talk about the toughest of all mental health outcomes - a child’s death by suicide. Just last month, a local teen died by suicide, and our community was shaken. I know I speak for all parents when I say this would be our worst nightmare. It’s a difficult subject to contemplate; everything in us seeks to push away the thoughts and feelings that come up when we hear or read the word, but we have to talk about it. And we have to talk with our kids about it. The sooner the better, so let’s explore together. 

First, I think it’s helpful for all parents to know about risk factors for teen suicide. These include:

• prior self harm or suicide attempts

• access to lethal means (especially firearms, pills)

• recent loss or relational stressors

• being a victim of bullying

• active substance use

• family history of suicide, domestic violence, or abuse

• a mental health disorder like depression, bipolar, psychosis, or a trauma-related disorder

• social isolation/lack of support

• lack of access to care (language barriers, economic barriers, transportation barriers)

• cultural or religious beliefs that suicide is a noble way to handle an interpersonal problem 

It can sometimes be hard to discern what is a “cry for attention” vs. a true cry of distress when it comes to teens, who are often relatively more dramatic in their emotional responses than adults. But it’s important to take your child seriously if they mention to you, or to a friend, or online, that they’ve been thinking about suicide. The first step in such a situation should be to seek emergency psychiatric support, and the guidance of a mental health professional about the best next steps. Although bringing your child to the emergency room for feelings of suicide will likely feel surreal, doing so assures your child that you take them seriously. It also let’s them know that suicide is not something to be joked about, or a word to be used offhandedly or reactively. If your child were using the word suicide, or a similar statement (e.g.  “I wish I was dead”), for dramatic effect, spending hours in the emergency room will deter future use of such language. Presenting for emergency psychiatric evaluation will also help to get your child a sooner follow up mental health care appointment than if you just called a local provider, as suicidal ideation or attempts indicate potentially serious mental health issues that will be triaged accordingly. 

Second, I want to relay the sobering statistics about suicide and encourage all parents to take steps to make their homes and the homes of their children’s friends and family members safer. 

Suicide is on the rise. Since 2007, the rates of suicide have increased in teens. Suicide is now the second leading cause of death for young people in the US ages 15-24. A recent study of over 7,000 high school students in 2021 found that nearly 20% of respondents had seriously considered suicide in the preceding 12 months and 9% had attempted to end their life in some way. 

Protective factors include:

• strong connections (family, friends, teachers, community members, trusted adults)

• strong problem solving skills - kids who don’t give up easily and seek to find a solution to problems are less likely to get overwhelmed and think of suicide as a feasible option to a temporary problem, even a big problem

• restricted access to lethal means (eg - firearms, pills)

• access to medical and mental health care and engagement with mental health care

• cultural or religious beliefs that discourage suicide

I encourage all parents to ensure any firearms are locked, out of reach, and ammunition is stored separately. In addition, all prescription medication, but especially sleeping pills, benzodiazepines, pain medications (opiates), and psychiatric medications, should be locked and out of reach of children. Similarly, tylenol, cold medications, and aspirin should not be accessible in large quantities. Buying a simple plastic tool box and a padlock can be an easy way to keep medication out of reach. 

Not all people who attempt or complete suicide are depressed. In fact, only about half meet clinical criteria for depression. High achievers with vulnerable self esteem, particularly personality types that pride themselves on being independent, may feel unbearable shame in seeking help. Individuals who value themselves only when they are performing, may also be at higher risk.

One thing we do know is that talking about it is not going to make it worse. Asking our kids if they know anyone who has ever felt so overwhelmed that they considered ending their lives may be a good way to open the conversation. If you child tells you they personally have experienced suicidal thoughts, just take a deep breath, listen, and be curious. Seek to understand whether this is something that happened in the past, or if it’s ongoing. Know that it’s not uncommon, and you don’t necessarily have to be in a panic if they reveal such a history to you. In fact, if your child feels comfortable enough to talk to you about it, it’s a really good sign, because they feel safe opening up to you. If your child is still struggling, please seek support without delay. 

Psychologytoday.com is a good resource to explore local therapists and doctors. 

Anyone can now call or text 988 for 24 hour suicide and mental health support. Make sure your kids and their friends know this option. 

The National Suicide Prevention Lifeline is 800-273-8255.