My teen is thinking about suicide. What should I do?
Suicidal ideation (SI) is a symptom of depression or other mood disorders. I like to describe suicidal ideation on a spectrum. On one end is passive SI. These can be thoughts such as, “If I didn’t wake up tomorrow, that would be okay,” or, “I don’t want to die, but I don’t want to live.” On the other end of the spectrum, the thoughts become active SI. Active SI includes willingness or intent. Examples of this can be “Hmm, I know where mom keeps the Tylenol, I could take the whole bottle tonight.”
Many parents are afraid to ask “the question” to their kids. They feel awkward or have the misconception that if they ask about SI, it will plant the idea in their kid’s head. It won’t. If a person is thinking of ending their life, they are experiencing a tremendous amount of psychological pain. You need to be direct and explicit without judgment. Show your child they can trust you with their painful thoughts, that you will hold them with care and respect in those difficult moments.
Using a gentle and firm manner, ask your child, “Do you ever think about dying or suicide? Or ending your life?” Ask and then listen. Assess for intent and means by which they could harm themselves. Do they have a plan or access to weapons? Do they express the willingness or intent to end their life? Are they open to receiving help? Listen to what they say, and then repeat back what you hear them say to make sure you are understanding. This is called “reflective listening.” Refrain from saying things like, “You don’t mean that,” as challenging their thoughts feels dismissive and may provoke self-harming behaviors. Your goal is to obtain information on your child’s perspectives and to communicate care. The way to get information is by facilitating a feeling of non-judgment and safety between you and your teen.
It is very important for a parent to take action to make the home a safe place for the team. The first step is to matter-of-factly describe the measures being put into place and ask for your teen’s feedback if other steps should be taken. Create a rule that no doors are allowed to be locked, including bathroom doors. Locking away medications and other means of self-injury is very important. Of course, ALL firearms and ammunition should be locked in secure safes that are unable to be accessed by your child(ren). In Texas, leaving a firearm where a child can access it is considering criminal negligence (Texas Penal Code Sec. 46.3). Also notify your child that you may enter take invasive steps to ensure their safety (e.g., surprise inspections of their bedroom, examining their bodies for self-injury marks, etc.). Your teen may protest, but these are safety measures to support their wellbeing.
Most importantly, if your teen expresses passive or active SI, reach out to a mental health professional as soon as possible. If you are not sure of what to do, call the Suicide Prevention Lifeline for the most up-to-date, evidence-based guidance. You can also take them to the nearest hospital emergency room or find a psychiatric hospital.
It is naturally terrifying to hear your child express suicidal ideation. Reach out to obtain professional help to address this complex issue!