How to Talk to Kids about Suicide Risk and Prevention

This podcast provides tips and scripts for talking to kids about suicide. What are the risk factors? What are the protective factors? And what should we say if a child seems that they are hopeless, helpless or have said that they are thinking about ending their life. This is an uncomfortable topic- but one that we should and need to discuss.

Special Guest: Jonathan B. Singer, Phd, LCSW

Preliminary estimates suggest that suicide deaths declined during the Covid epidemic- the US had 2,677 fewer suicide deaths in 2020 than in 2019, translating to a 5.6% decline, according to an analysis of provisional government data recently published in the medical journal JAMA. Although these numbers may be obscuring the full story- either way, accurate or not, experts are saying “let’s not be complacent!” This past year has been unusual- with more people being at home and keeping a watchful eye on those who were suffering from mental health issues and distress- where there may have been a “we’re all in this together” feeling—where young people faced less bullying, fewer sexual assaults and avoided school shootings and the threat of them. But with the aftermath of this pandemic comes more uncertainty- job loss, homelessness and PTSD. Our next guest also worries that Kids returning to in-person schooling, particularly those who have excelled at online learning, may also face “re-entry shock,” no longer surrounded by family but by staff and peers- many whom they haven’t seen in over a year. With all these changes and risk, it’s important that we discuss suicide, suicide risk and suicide prevention in our young people today. (Article: https://www.marketwatch.com/story/we-shouldnt-be-complacent-suicide-deaths-fell-during-the-2020-pandemic-but-why-11617887838)

If you or someone you know is having thoughts of suicide, call the free, confidential National Suicide Prevention Lifeline (1-800-273-8255). Additional resources include the Crisis Text Line (text HOME to 741741), the Veterans Crisis Line (press 1 after dialing the national Lifeline), the Trevor Project for LGBTQ youth (1-866-488-7386), the Trans Lifeline (877-565-8860) and the Substance Abuse and Mental Health Services Administration’s Disaster Distress Helpline (call 1-800-985-5990 or text TalkWithUs to 66746).

Bio

Jonathan B. Singer, Ph.D., LCSW is Associate Professor of Social Work at Loyola University Chicago, President of the American Association of Suicidology and coauthor of the 2015 Routledge text, Suicide in Schools: A Practitioner’s Guide. He is the author of over 70 publications and his research has been featured in national and international media outlets like NPR, BBC, Fox, Time Magazine, and The Guardian. Dr. Singer is the founder and host of the award-winning Social Work Podcast (www.socialworkpodcast.com), the first podcast by and for social workers. He lives in Evanston, IL with his wife and three children

Important Messages:

  • We need to acknowledge the pain, fear and suffering that kids and their families are going through. But it’s also about hope. Finding the reasons for living. Build worlds that they want to live in. Finding that little piece of hope and helping it to blossom in a kid.
  • Risk factors vs warning signs (these are different for suicide just as they are different for a heart attack).
  • Risk factors: Age, gender assigned at birth, access to fire arms (older they are, more likely to die by suicide). Females 3X more likely to attempt suicide, Males 3X more likely to die by suicide. Firearms in house: 32X more likely to die by suicide. Having a parent die by suicide- risk factor.
  • Warning signs: Indication that something is about to happen (just like heart attack). Someone who is talking about suicide or death. “Nobody would care if I lived or died.” “You guys have fun because I won’t be around next weekend.” “I’m thinking about killing myself.” Expressing hopelessness about future. Overwhelming emotional pain. 
  • Developmentally normative for teens to be emotional. But when you have a kid who is talking about wanting to die, and they’re in pain and they are expressing hopelessness about the future and then they withdraw from social situations (deactivate social media), irritable, agitated, not just with one person but with many people (yelling at grandma) or not sleeping. These are indicators that the child is likely thinking about killing themselves- and thinking about how they will do it. This is the time to jump in and act.
  • What do we do? (1) Acknowledge & label. “I don’t think anyone would care if I lived or died.” “That sounds like a really sad and scary place. I’m so glad you told me that you were thinking that.” “Nobody should have to go through this much pain.” This doesn’t happen out of context. If you’re the parent, you know what’s happening inside the house. If you are the coach, you see the kids in practice. If you’re the teacher, you see the kids at school. You want to get to (2) Appreciation: “I really appreciate that you trusted me with this.” (2) Let’s get you some help. Let’s get you someone you can talk to about this.”
  • What’s the context? 38,000 kids lost their parent to Covid this past year. “You’ve been through so much this year. Nobody should have to go through so much- go through what you’ve been through, losing a parent. Please know that there are people out there who can help. I know it doesn’t see like it’s possible, but it is.” Personalize it. Knowing that the kid feels heard and validated, is, in an of itself, protective against suicide.”
  • *Personalize—don’t sound like a generic greeting card.
  • Avoid saying: “I understand what you are going through.” Adolescents don’t feel that we understand. Even if you suffered heartache and pain, you didn’t go through their situation (i.e., no phone in room). Suggests we understand how deep their pain is or how brood their suffering is across multiple different systems, multiple relationships. And we don’t! We can’t understand what they are going through in a way that’s going to be helpful in a couple of sentences.
  • How do you show you get them? To sit with them. To listen to them. To nod. “Tell me more.” Open up space for them to be heard. And only then could you begin to understand what’s going on.
  • “I want to understand what you are going through. I would love to know more. You deserve to have people who will listen to you and help you. I would love to hear more so we can find the right folks for you.”
  • *App- “My Three”- “Not Ok”- a way to have an app on your phone that alert people right away when you are not okay- have them at the ready. By the way, designed by teens! Press an icon and it sends a message to your key people that you are not ok- and you decide in advance- gps coordinates, message- what do you want to send out? Set up in advance- to know who those folks are- for kids who are struggling.
  • Avoid saying things like “think of other people.” If you think about a team that just lost the championships, you wouldn’t tell them to think of the other people who won and how this impacts them. Just step outside of yourselves.
  • You are relaying: “I want to hang, I want to be with you because you just went through something crappy.”
  • Protective factors: Only qualifies as a protective factor if there is a risk that it’s protecting a child from. Family, religion—these can be. A functional family- supports the kid to be themselves but also have a loving community when they feel scared or hurt or unprotected. A family of a trans youth who misgenders is not a protective factor! You want to feel safe and free to be yourself.
  • If you want a world where people feel that their life is worth living, we can’t have a society that says that some lives are worth more than others. We can’t have a school that says some students are worth more than others. We can’t have a neighborhood that says “you’re not as good as these other kids.” This is a broader issue when we talk about building worlds where people wasn’t to live- where life is worth living.
  • The idea that you can recognize the kid who is suicidal just by looking at them is a myth.
  • Can’t be that the kid is listening to heavy metal or playing D&D, therefore they are suicidal.
  • Ask directly: Have you had thoughts of killing yourself? Have you had thoughts of ending your life? Ask about suicide- not self harm. Stat- 1 in 7 kids before college have engaged in non-suicidal self injury. Don’t say, do you want to hurt yourself? Because they may be thinking- no, I don’t want to hurt myself, I want to end the hurt.
  • Schools- you need to do screening. Could be anyone.
  • Folks a re terrified- if I ask the question, won’t I put the thought in someone’s head? No. Research study. Maddie Gould. Level of distress. The kids that reported thoughts of suicide had decreased levels of stress when someone asked them about suicide. The kids who did not have thoughts of suicide, the levels of distress did not change. Two days later: showed no risk in answering the question- no increased in distress. Might actually been benefit- reduce distress.
    • Another myth- If a child or teen really wants to die by suicide, there’s nothing I can do to stop them.
    • Another myth- If a child or teen is thinking about suicide all the time, they might not really be suicidal and I don’t really need to take these statements seriously. Dangerous myth- be clear about what they are saying- you must talk to the kid!
  • There is a difference between being sad or scared or angry- and wanting to die. Pandemic- increase depression, anxiety, eating disorder. No stats right now that say there is an increase in suicidal ideation. Kids can be distraught and not suicidal.
  • Difference: If you are sad, mad, scared, lonely and you want to have connection, please tell me that- because I can help you to find that. I can connect you to those resources. But if you tell me that you are suicidal when you are not, you’ll need to talk to a psychiatrist and you may be hospitalized. And at no point will they care how happy you are- they will only care about that you haven’t attempted to end your life. If you are suicidal, tell me that, of course. Want to address. There’s a difference. Did the child learn that no body will pay attention to me? Don’t have to go to 11- you can just tell me that you are sad. Powerful.
  • If we think there’s nothing we can do about it- then we are not doing anything to help. We want to do everything up to the very last second to ensure that these kids stick around.
  • We don’t want to send kids to school knowing that some school staff might be thinking- there are going to be kids who do bad things to themselves and there is nothing I can do. That is not the attitude we want people to have! We want them to think; “I can do something about this and I should do something about this.” I have a responsibility to do something about this.
  • If a suicide has happened: How do we help those who have been left behind? Acknowledge that everyone can share the same loss but have a totally different experience of it. When grieving- very different ways. Intense, delayed, complicated grief.
  • Post-vention. Intervening address grief and loss and to prevent suicide dealths result from the death. Intervention as prevention. Contagion. Only in youth. When one dies by suicide, those who are at high risk will also die by suicide in quick succession.
  • Should think about how to address a suicide death before it happens. The way we grieve more culturally bound than anything else in our lives.
  • Acknowledge that there was a death. If they are open to calling it a suicide death. Don’t mention method or where or notes. “This is a really sad time for us because we’ve lost a friend. And we are going to spend some time talking about it.”
  • In a school be flexible enough to address the grief for those who are grieving.
  • Also talk to family and community- how they can support their kids. After a suicide death, make sure kid is sleeping, that they are available to talk to that child, that the parent models seeing a therapist if they are having trouble. Hard to say “see someone and talk to someone” if you aren’t seeing someone for help and you are having a hard time.
  • Not that you want your kid to “be the best” but that you want the best for your kid.
  • Top tip- come away with a sense of hope. This is something I can address. Know that the most important thing is to be there for the kid. And listen. Genuinely be there.
  • Suicide hot line, Trevor project for LGBTQ. Trans life line. Resources.
  • Basic thing- it’s a good thing for me to be involved in this- and to know others are involved in this- for me to talk about it. This is a team sport here. Got to be part of the team.
  • Resource of the week: American Association for Suicidology.
  • Google his name! Also on Twitter.

Notable Quotables:

  • Having a kid feel heard and validated, is, in and of itself, protective against suicide.”
  • “The way that you can really help a kid to feel you ‘get them,’ is to sit with them. To listen to them. To open up space for them to be heard. Only then can you begin to understand what’s going on.”
  • “If you want a world where people feel that their life is worth living, we can’t have a society that says that some lives are worth more than others.”
  • “This idea that we have to make things accessible and culturally relevant and meaningful to folks is one of the things that, quite likely, could make the difference for kids who are thinking about ending their lives or kids who are thinking about living.”
  • “The idea that you can recognize the kid who is suicidal just by looking at them is a myth.”
  • “Kids can be distraught and not suicidal.”
  • “One death by suicide is one death too many.”
  • “Everyone can share the same loss but have a totally different experience of it.”

Resources:

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