Let’s get this out of the way up front: suicide is a difficult topic to talk about. As a child and adolescent psychiatrist, I’ve had the privilege of sitting with countless kids and parents as we’ve navigated these conversations together. It’s not easy for parents to see their children hurting, and it’s hard for kids to share something that feels scary or even shameful. But what I have learned is that children and teens often know and can do more than we give them credit for as adults. They know when something isn’t right at home or with their friends. They can bring lightheartedness into moments that we, as parents, didn’t recognize needed them. But there are also situations and feelings that can overwhelm any child or teenager. 

When things seem the darkest, kids can struggle with upsetting thoughts—not knowing how to move forward, not knowing if they can find a way through, not wanting to stay alive to keep trying. It’s difficult to think about a child or teen contemplating suicide, but we can’t let our uncertainties and fears keep us from safeguarding their health - just as we do in every other facet of their lives. Because suicide is a very real issue for our children right now: it is the second leading cause of death among individuals between the ages of 10-14 and 25-34, and the third leading cause of death between the ages of 15-24. Thankfully, one thing kids and families have taught me over the years is that we can navigate even the most unthinkable situations, by learning about what’s happening, communicating openly, and making plans to connect with and care for each other. 

Addressing major emotional challenges with children and teens can be challenging: They  get mixed messages about expressing their emotions and how families, friends, and society will respond. As parents, we do not always know how to address such a serious topic directly and questions abound. What do we say and when? How do we navigate social media access during difficult emotional periods? When do we need to bring this to the attention of school or a pediatrician? Will bringing this up now have other long-term consequences? 

Most importantly, you don’t need to navigate these challenges alone. Hopscotch, your Hopscotch clinician, and your child’s healthcare team are here to support you and your child. First and foremost, though, if your child is having suicidal thoughts, bring this to the attention of their healthcare team now. If you’re working with a mental health provider, call them to discuss what’s happening and make a plan. Connect with your child’s pediatrician or primary care provider. And remember, every region has a crisis mental health support system. As the national 988 mental health crisis line system goes online, this may be the most useful “go to” resource to keep in mind if things are feeling overwhelming.

How to Recognize Suicidal Symptoms in Your Child

When young people are struggling with suicidal thoughts, they are often struggling with intense feelings of sadness. Depression generally presents as a mood change from baseline, but it can look different in children and teens. Children often do not have the emotional vocabulary or skills to talk about what they’re experiencing. Some may look sad and withdrawn, but others can appear irritable or agitated. There will often be a retreat from activities they used to enjoy. Depression can also impact the way we think—struggling with guilt, hopelessness, and/or helplessness. It can also change our daily patterns drastically with eating, sleeping, and energy levels. And most concerningly, depression can be sometimes accompanied by dark and challenging thoughts that can span from wishing “I wasn’t around anymore” to “I want to kill myself” to having explicit plans to end one’s life.

Sometimes we have to differentiate these depressive symptoms from emotional transitions that young people often make in their teen years, especially increasing movement away from family towards same-age friends, typical “generational” clashes about safety versus freedom, and some general frustration and disappointment with newly understood social realities. Teens wanting to spend more time with their friends and less time with the family is typical. A young person impulsively blurting out “I just want to kill myself!” in the middle of a heated argument about curfews or other boundaries may mean something different than a tearful late night conversation describing feelings of hopelessness or despair. And while as parents, we may be tempted to compare (what we recall about) our adolescent experiences with our children’s experiences, it is important to give them the space to struggle with their own realization of some of life’s “hard truths”—unfairness, awareness of others’ pain and suffering, or real concerns about how things are in the world around them. Young people finding intense ways to express these emotional upheavals - while challenging - may need to be approached differently than gradually worsening mood, worsening functioning, and persistent suicidal thoughts. 

How to communicate with your child about suicide 

As stressful as it may sound, if your child expresses they are having difficult thoughts - from “I wish I weren’t here anymore” to “I just want to go to sleep and never wake up.” to “I just want to die” or even “I’ve been thinking of killing myself” - there are ways to help your child navigate them. We need to acknowledge that this is a shocking and challenging experience as a parent. Then create the space you need to take a moment,, and then engage your child. One of the key communication principles here is to resist the “righting reflex.” Initially, spend time trying to understand what they’re experiencing, how they’re feeling, and what they’ve been doing about those feelings. There is no evidence that talking about one’s suicidal feelings makes it more likely that one will attempt or complete suicide. On the contrary, there is evidence that helping young people express what they’ve been struggling with can improve their emotional state. Even though it’s hard, talking about this helps. 

Of course, we would not talk to an 8-year old about this topic the same way as a 17-year old. If you’ve noticed your child struggling with depression and are concerned they may be struggling with suicidal thoughts, here’s what to say: 

• For an elementary school-aged child, you often have to give them a menu of thoughts or feelings before you can explore with them. “Sometimes when we’re feeling really down for a while, we can have some tough thoughts… maybe wanting to go to sleep and never wake up or wanting to not be alive any more… is anything like that happening to you? What’s that been like?”
• For a middle school-aged child, you might check for their understanding about depression first. “What do you know about what it’s like to be depressed?” If they are unsure, you may have to teach some basic concepts. After they’ve demonstrated their understanding, you can ask, “Has that been something that’s been going on for you? What’s that been like?” At this stage, you can begin to ask more explicitly about suicidal thoughts: “Have you been having any thoughts about not wanting to be alive any more? About wanting to end your life or kill yourself?”
• For a high schooler, many will have some knowledge about depression, but you can check for understanding as above. You can ask if any of their friends or peers have struggled with depression and then check to see if anything similar is happening for them. At this stage, if it is clear they are having suicidal thoughts, it is important to ask directly about any specific plans or intentions to harm themselves soon.

For any age group, if you discover that your child is struggling with suicidal thoughts, you need to dig deeper. Again, not problem-solving (yet), but seeking understanding of what they’re experiencing, what they’re feeling, and what they’re doing about those feelings. This is not the time for anger or shaming or guilt trips, but rather understanding and, of course, expressions of your love and concern and support for them. And again, this is the time to reach out to your child’s healthcare provider team to get the support and guidance you need.

What to Do When You Think Your Child is at Risk for Suicide

If your child is struggling with suicidal thoughts, you are not alone! This is a time to get your child’s whole healthcare team on board. If your child is working with a therapist or counselor, you need to connect with them first to brainstorm a safety plan and discuss next steps. If you do not currently have a mental health provider for your child, you can search for a Hopscotch clinician in your area here (currently available in Delaware, Florida, New Jersey, New York, North Carolina, Ohio, Pennsylvania, and Texas). Your child’s pediatrician can be a strong ally to assess your child and help determine next steps, especially if you are not currently connected to a therapist. 

While you are getting support in place, what should you do if you don’t feel comfortable leaving them alone? First, we want to make sure we scan the physical environment for safety concerns. If there are firearms in the home, they should be removed. All medications (prescription and over-the-counter) should be locked away in a safe or other space that is inaccessible to your child. If your child has been having specific safety concerns related to other potentially dangerous household objects (e.g. alcohol, knives or other sharp objects, cleaning chemicals, rope), these should also be removed. Next, you need to develop a plan for adult supervision. This can be challenging given the difficulties of balancing work and family life, but we need to treat this just as any other health crisis. Your child may need to be supervised by another parent, an extended family member, or a trusted family friend, who needs to understand that there is a safety concern and that direct supervision is required.

But sometimes, we will not be able to develop a safety plan that we feel comfortable with or we cannot find a way to ensure our child’s safety in a meaningful way. In these situations, it is important to know your regional crisis mental health resources. Every region in the country has access to a crisis mental health hotline. Nationally, the launch of the 988 mental health crisis number will also connect families to either regional or national systems to get support in a mental health crisis. If your child is struggling emotionally, it can be helpful to put these numbers into your phone preemptively. And of course, your local emergency response resources are available to support your family in extreme safety concerns by taking your child to your regional psychiatric emergency department or children’s emergency department or even calling an ambulance if necessary to transport you there. If there is any concern that your child has already done something to harm him/herself, it is always safest to call EMS immediately.

While this can all feel overwhelming, your efforts to prepare in advance of suicidal thoughts can help your child make sense of what is happening to them during a difficult time, ensure they have an avenue of support that is open to them, and help you understand your options if things get more challenging. Most importantly, know that you are not alone in this. Reaching out to the team you’ve assembled for your child - be it their therapist or pediatrician or psychiatrist - can help support you as you support your child.