The United States is in the middle of a youth mental health crisis with suicidal thoughts and self-harm behaviors rising among children, teens and young adults.
Suicide can be a difficult topic for families to talk about, but it’s still important to address since suicide is the second leading cause of death in youth ages 10 to 24.
In a recent survey of high schoolers, about 22% of students said they have seriously considered suicide in the past year.
Preventing suicide, especially among children, is a priority, but many may ask: where and how do you start?
Several experts from the C.S. Mott Children’s Hospital and the Department of Psychiatry at Michigan Medicine, the academic medical center for the University of Michigan, break down what parents and caregivers should know about childhood suicide, providing practical tips for families navigating a mental health crisis.
1.Suicide is preventable
While it’s upsetting to think about suicide risk rising among young people, fortunately there are still many ways parents and caregivers can support their children and help reduce the risk at home.
One of the best ways?
Talk openly about suicide with your child.
“There’s this fear that if we ask kids about suicide, will that increase their risk? Will that introduce an idea they didn’t already have?” said Christina Laitner, Ph.D., clinical assistant professor of psychiatry.
“Well, evidence has shown that’s not the case. For kids who experience suicidal ideation, when a clinician or a medical professional asks them about it, that can provide relief. For kids who aren’t experiencing suicidal ideation, it doesn’t increase their distress."
If you’re concerned about your child’s wellbeing or that they may be having thoughts of suicide, the best approach is to ask them about it to understand their feelings, and to show them that suicide isn’t a shameful discussion topic.
“Sometimes it can be hard to have these conversations but if you see someone struggling, just ask the question because no one may have asked,” said Syma Khan, M.S.W., lead social worker for the child psychiatry hospital.
Starting the conversation shows your child that you’re someone they can trust and a reliable resource they can come to for help handling difficult feelings.
If your child shares that they do have thoughts of suicide, you will be better prepared to take steps to keep them safe and to connect them with professional support.
Safety steps include reducing their access to items around the house that they could hurt themselves such as medication, knives and/or firearms.
It should also include listening to and acknowledging their feelings so they know they are supported.
“Sometimes it’s not about problem solving, it’s just being present and hearing the challenges they’re having,” said Khan.
If you are worried your child might attempt suicide, you can call or text 988 to reach the Suicide and Crisis Lifeline. Their lines are open 24/7.
You can also take your child to the nearest emergency department.
If your child says they are having thoughts of suicide, but they aren’t acting on them, connecting with their pediatrician or a mental health provider for advice is important.
2. Know the risks and warning signs of childhood suicide
Some children are at a higher risk of suicide than others.
Children from underserved populations tend to have a higher risk as they face systemic challenges their peers do not.
Children who are Black, Indigenous or live in rural communities with less access to care are at a higher risk, as are those with experience in the juvenile justice or child welfare systems.
Neurodivergent youth and those who identify as LGBTQ+ are additionally at higher risk as well.
“In particular, Black youth under the age of 12 is the fastest growing population of risk of suicide,” said Nasuh Malas, M.D., director and chief of child and adolescent psychiatry at C.S. Mott Children’s Hospital.
But among all children, there are other risks to consider.
“The number one risk factor for suicide is a previous suicide attempt,” said Malas.
“Some studies suggest ten-fold or higher risk for future suicide attempts once an attempt has been conducted.”
If your child has attempted suicide in the past, it’s important to seek help for them as soon as you notice any worrying changes in behavior.
Warning signs of suicide can include talking about wanting to die, looking for ways to kill themselves or sleeping too little or too much.
A child in crisis may express feelings of hopelessness, isolation, being trapped or being a burden to others.
Increases in substance use, reckless behavior and extreme mood swings can also be a signal that your child needs immediate help.
If your child is showing these symptoms, especially if the behavior is new, has increased or is related to a recent painful event, it’s important to seek help right away, whether through 988 or your local emergency department.
3. Suicidal thoughts can be passive or active
If your child is experiencing suicidal thoughts, you may hear clinicians use terms like passive or active to describe their thoughts.
That’s because suicidal thoughts exist on a spectrum and the treatment plan for a child varies depending on whether their thoughts are more passive or more active.
A child with passive suicidal thoughts may say that they wish they could sleep forever.
They may want to escape a situation or their feelings, but they don’t want to end their life or have any plan to do so.
It’s still important to seek care for a child with passive suicidal thoughts, but they are at a lower risk of suicide than those with active thoughts.
On the other side of the spectrum, a child with active suicidal thoughts may say that they want to end their life and even have a plan, including a place and time, for how they would go through with an attempt.
For these children, the need to seek mental health care is much more immediate.
Children with active suicidal thoughts may also engage in suicidal behavior, which could include preparatory actions.
“I think it’s important to note, in the time that we live, thinking about social media,” said Laitner.
“Are kids texting goodbye notes? Are they putting up Snapchat or Instagram stories with suicidal content? I think 20 years ago we would have talked about giving away possessions. Still the same thing, but I think we also have to bring it into modern times.”
Knowing the difference between passive and active suicidal thoughts can put parents and caregivers more at ease navigating the situation, but if you are worried about your child, seeking professional help is always the right answer.
4. Self-harm behavior is not the same as suicidal thoughts
When most people engage in self-injury, there’s no suicidal intent behind their actions.
These behaviors could include cutting or burning themselves.
While seeing signs of self-harm behavior in your child is alarming, it may be helpful to remember that self-harm and suicidal thoughts are not one in the same.
“[Self-harm] often serves a different function for kids,” said Laitner.
For example, children may seek the pain of self-injury to distract themselves from difficult emotions or to help them feel a sense of control that they may not feel in other areas of their life.
Children and adolescents are more likely to self-harm than those of other age groups since they face big emotional changes in and around puberty and are still learning how to cope with those feelings.
The good news is that children and adolescents can learn healthier ways to handle emotional challenges.
Seeking help from your child’s pediatrician or mental health provider, if they have one, is a great first step.
“So much of the function of this is, on an individual level, working with the child to understand, [what] at that time led them to use that behavior in an attempt to cope,” said Laitner.
Parents and caregivers should focus on finding a provider who can help their child understand what leads them to choose those self-harming behaviors and teach them healthier coping strategies they can use instead to feel better.
5. Childhood suicide screening saves lives
One of the most effective tools we have for preventing suicide is called universal screening.
Screening for suicide risk is quick and simple: a trained provider asks a child a brief set of questions and their answers will determine whether the child is at risk of suicide.
If the screening does show that a child is at a higher risk, the provider can suggest the right kinds of help and support right away to help keep that child safe.
Universal screenings are especially important because they don’t require a special visit to a mental health provider and can be done in the places where kids already spend their time.
This could include screening young people when they arrive for a routine medical visit or school-based health care providers screening children when they are at school.
Even one simple screening at a child’s yearly pediatrician appointment can help families find suicide risk early and prevent a more significant mental health crisis from ever occurring in the first place.
“Eighty-three percent of those who died by suicide saw a health care provider in the year before with 50% of them making a health care visit the month prior,” said Malas.
“Many of those health care visits are not to mental health care providers. So, we have a real significant opportunity…to identify this risk, and in a very supportive and empathic way, provide evidence-based suicide prevention strategies.”
If you aren’t sure if your child’s doctor already does suicide screenings, you can ask them to make mental health check-ins a part of your child’s care.
6. Suicidal thoughts are treatable
If your child is experiencing suicidal thoughts or behaviors, there are evidence-based treatment options that can help your child feel safe and secure again.
Dialectical behavior therapy, or DBT, is a common form of therapy that helps people deal with very intense emotions.
It’s especially effective in helping kids manage overwhelming feelings in a healthier way by giving them useful tools and strategies to cope.
“People engage in self-harm or suicidal behaviors when there’s no other option or they don’t have another skill set to use,” said Laitner.
“This kind of therapy [DBT] helps us teach kids better survival skills and better long term skills.”
Comprehensive DBT programs are a great option for children, but they can be hard to find and fill up fast.
If there aren’t any DBT programs in your area, you can look for an individual or group therapist who specializes in DBT.
That said, therapists of all specialties have the training and knowledge to teach your child healthier skills to manage big feelings, so don’t get too caught up in finding the perfect DBT fit.
“Kids are complex, and the problems before us are complex,” explained Laitner.
“What you’re really looking for is a clinician to help your child establish safety and stability.”
7. Safety plans, for kids thinking about suicide, keep them safe
Safety plans are one of the best tools to support children who are experiencing suicidal thoughts.
A safety plan is a personalized list of activities, coping skills and support people your child can call upon when they have suicidal thoughts.
“Safety planning relies on the role of distraction,” said Khan.
“Suicidal crises tend to be transient. We know that they can last minutes—10 minutes, 15 minutes, sometimes up to an hour—but the thought is if we can provide individuals with strategies to utilize during that time period, we can hopefully prevent them from attempting suicide.”
The elements of a safety plan are created in collaboration with you, your child, and a healthcare provider, and the strategies are tailored to your child’s interests and needs.
Family and friends all have a role to play in supporting the plan. Just as families practice what to do if there is severe weather or a fire, safety plans help them practice what to do in the event of a mental health crisis.
“We plan ahead for disasters,” said Laitner.
“It’s the same thing. Do we know where the closest emergency room is? Do we understand the process of taking a kid to the emergency room for a psychiatric reason?”
As part of the safety planning process, it’s also important to make your family’s home environment suicide safe.
This includes removing or locking away firearms, safely storing medication and reducing access to ligatures like ropes or belts.
If your child spends time visiting with family or friends, you can ask them to follow these steps to make their homes safer too.
“When we restrict access to means that are highly lethal, that reduces overall suicide rates,” said Khan.
“The goal is to intervene early and limit access to things that can be really dangerous to an individual.”
The Stanley-Brown Safety Plan is commonly used by providers, and the form can be accessed for free online or via app.
8. Families are a powerful space to build hope and resilience
Watching a child in your life go through a mental health crisis is challenging, and many parents, friends, and family members can feel overwhelmed or powerless.
It’s very common for parents to struggle with their own emotions while they are trying to support their child’s emotions too. Showing emotional kindness to your child—and yourself—is key.
“It is really hard to have a child that’s struggling with suicidal thoughts. So, it can be important to take time to think about yourself as well,” said Khan.
“When you’re parenting, so many emotions can come up in yourself.”
When parents and caregivers create space for their own self-care, they build a stronger foundation for their family.
Ways to build a strong, resilient family can include creating safe and supportive spaces for your child, being an active listener, helping your child foster trusting relationships and role modeling healthy communication about emotions.
Other important strategies might include educating yourself about mental health topics you aren’t already familiar with.
“There are lots of things I learned,” said Ronald Kumon, a parent advocate, speaking of his experience supporting his child through a mental health crisis.
“I didn’t have a lot of experience with issues related to mental illness previously. It wasn’t something my family talked about growing up. So, the first step I took was to try to educate myself.”
Kumon recommends the National Alliance on Mental Illness Basics course, a free, on-demand program that’s available 24/7 to parents and caregivers of youth experiencing a mental health crisis.
It gives parents and caregivers the tools and knowledge they need to support their child.
“If you have a situation where a child is experiencing mental illness that leads to self-harm or a suicide attempt, mental illness is not a choice for them. But mental wellness is a choice. That’s something that your child has to choose to do to be well,” said Kumon.
“What you can do to help your child is to help them make choices that can help them to be well. That can be challenging, but it’s particularly important when they can’t see the way to those choices themselves."
Even when the situation feels overwhelming, these strategies can help parents and caregivers find their footing, build trust in themselves and model hope and wellness for their children.
