Suicide Prevention Month
Talk to your kids about their mental health. End the stigma. Don’t be afraid to ask the hardest questions.
Trigger warning: this article discusses suicide. If you or someone you love is having thoughts of suicide, please reach out to your medical or mental health team or call or text 988, the Suicide and Crisis Lifeline, or seek Emergency Care.
Photo by Dr. Julie Schlegel
September is Suicide Prevention Month, and while I am not an expert on mental health, as a pediatrician, I am in on the conversation. Death by suicide is one of the leading causes of death in children aged 10 to 19, according to the Centers for Disease Control and Prevention. If you are a parent, I want you to know how to ask the hard questions.
Talking about awkward or intensely personal subjects is easier for me because I work in the medical field and talk to children and teens almost every day. Now I’ve been practicing pediatrics for more than 20 years, but asking the hard questions the first time, years ago, felt pretty awkward. What has helped me is knowing what words to use to ask the hard questions, and that’s what I want to share with you.
I didn’t have the suicide hotline on the back of my school ID card in the late 80s, but I’m happy to report that when I ask teens today if they know about the suicide hotline, many will turn their school ID over and show me that it’s written on the other side of the ID card.
For struggling teens who have phones, I encourage them to put the suicide hotline in their contacts so that, in a moment of despair, help will be one step closer. The easiest number to remember is the 988 Suicide and Crisis Lifeline, which your child can call or text anytime.
Our teens are not afraid of hard questions. In fact, many of them are relieved when they find that their parents are not afraid of their big feelings. Some of us might worry that we will “put the idea in our kids’ head” if we ask them about suicidal ideation, but research shows that this is not true. If your child is having thoughts of suicide and you don’t ask, it just means you don’t know those thoughts are there. It doesn’t make them not there.
There are warning signs that a child or adolescent might be struggling. If your child’s behavior changes, you need to talk to them. If they are withdrawing from activities that they used to enjoy, you need to talk to them. If they are giving their belongings away, or drastically changing their appearance, talk to them. “Hey, I’ve noticed that you don’t enjoy tennis anymore. What’s going on?” “Hey, I’ve noticed that you aren’t hanging out with so-and-so much. Did something happen?”
Try to use open-ended questions. Try to listen more than you talk. “Can you tell me more about that?” “Is everything OK with your friendships?” “I remember having difficulty in high school with this friend or bully – is there anyone in your school like that and how do you handle him/her?”
Remember that the thing – or person – that is causing your child’s distress feels big and important to them. Generally, a response of “That sounds really hard for you” is much more affirming than “Don’t worry about that,” or “I never liked her anyway.” If you say “That sounds really hard” one hundred times and your child keeps talking, it’s better than saying “That’s silly – you have to let that go,” and having them shut down.
Make sure they know that there is nothing they will say that will change your love for them. Not trying drugs. Not having sex. Not getting in a bind by sending online nude photos to someone and then feeling despair because they’ve been forwarded. Not failing a class or forgetting a major assignment. Manage your own emotions about these things before you talk to your teen, so that you don’t bury your child in an avalanche of your emotions as they’re trying to manage the snowstorm of their own.
At my office, we use the PHQ-9 screening tool for depression that was developed by Drs. Spitzer, Williams and Kroenke in 1999. It goes through a list of questions that screen for depression. The final question asks how often the patient has “thoughts that you would be better off dead, or of hurting yourself.”
You can use these words to ask the hardest question of all. You can ease into it with questions like “Have your thoughts gone to a dark place?” And then more directly, “Have you had any thoughts that you’d be better off dead?” “Have you had thoughts of hurting yourself?”
If the answer is “yes,” your child will likely be relieved that it’s out in the open. Your follow-up questions will be, “Have you thought about how you would hurt yourself?” If your child has a plan in place for self-harm, the risk is higher. At this point, please stay with your child until you talk to a professional. If your child is actively suicidal, please seek emergency care – call 911 or take them to the nearest Emergency Center – as soon as possible.
Just like a cancer that lurks in our bodies that is not yet diagnosed, not knowing about suicidal thinking doesn’t mean it’s not there. It just means we don’t know about it yet. Thankfully, this generation of kids seems to talk more openly about mental health than we did when I was growing up. There’s a pretty good chance you will feel more uncomfortable than your child does.
When it comes to parenting, let no topic be taboo. End the stigma. Ask the hard questions. Be present and calm for the answers. Reach out to your medical or mental health team for advice. And if you stumble on your words, that’s OK, too.
Photo by Dr. Julie Schlegel
The advice and opinions herein are by no means meant to be a substitute for professional medical advice. Please contact your personal physician, mental health provider or health care professional for medical advice. Opinions are my own.