Talking to teens about suicide and self-harm can save lives

Becky is a 19-year-old college student who mentioned that she was struggling a bit when we spoke over the phone to schedule her first therapy session. 

Our session began with some “get to know you” conversation. About 15 minutes into our in-person session, I asked Becky why she reached out to me. She talked about having a hard time getting herself to class and not being motivated to get her work done. She was often tearful and expressed feeling “off,” overwhelmed and hopeless. 

I asked her if she was having thoughts of self-harm or suicide. I could see her body relax and she took a big exhale. 

She said, “How did you know? Thank you for asking me. I am exhausted from pretending I am fine. I feel trapped by how I am feeling. I have these thoughts when I am stressed and overwhelmed. They just come. It’s so scary for me. I feel like I can’t tell anyone. I don’t want to burden my parents. I am worried they will freak out and it might make things worse. I was hoping I would get the courage up to tell you today. Thank you for asking me.” 

I called Becky’s parents with her. I shared with them that Becky was having thoughts of suicide. She was not in imminent danger of taking her life (she did not have a plan and did not have an intent to take her life, only thoughts of dying). I helped them be able to talk about it together. 

The next time I saw Becky, she told me, “I have found some relief. I know these feelings might come and go and I need to reach out for help. I know my parents are there for me. It may not be perfect, but I know they are trying.”

During the pandemic, the Surgeon General issued an advisory that our youth are in a mental health crisis. Almost daily we hear more news about how our teens are struggling.  

But we also need to be encouraging parents to directly ask their kids about suicide. It’s one step that can help our teens. 

It is imperative that every parent talk with their kid(s) about their mental health and the topic of suicide. As a therapist in Boulder, CO, I have been working with teens and young adults for over 20 years. I am also a parent of three. I know how hard these conversations can be—but we must have them. 

Related: Teen girls are in crisis, CDC says. Here are 6 ways parents can help

Suicide risk among teens is rising

According to the National Alliance on Mental Illness (NAMI), suicide is the second-leading cause of death among people age 15 to 24 in the U.S. NAMI also reports nearly 20% of high school students report serious thoughts of suicide and 9% have made an attempt to take their lives. 

In some states, like Colorado, suicide is the leading cause of death for youth (ages 15 to 19). 

The CDC reports suicide rates among teens and young adults have gone up by 57% since 2007. Twenty percent of high schoolers report consistent feelings of sadness and hopelessness, an increase of 40% since 2000. Nearly 3 in 5 (57%) U.S. teen girls felt persistently sad or hopeless in 2021—double that of boys, representing a nearly 60% increase and the highest level reported over the past decade. 

Just as we talk with our kids about drinking and driving, we need to talk with our kids about suicide, which is increasingly taking the lives of our youth. The percentage of teens in high school who drink and drive has decreased by more than half since 1991.  According to the CDC, parent involvement, frequent conversations, and closeness were major factors in this reduction in teen drinking and driving. A conversation could save a life. 

As a parent, let your kids know that when we are overwhelmed, stressed and can’t see a way out of our feelings or situation, our thoughts can sometimes go to a dark place. 

Start the conversation with: “If you ever have thoughts of self-harm or suicide, I want you to tell me. I’m here for you.” But there are insidious myths that often prevent parents from having these conversations in the first place. 

Related: My daughter died of loneliness. I’m on a mission to prevent other families from experiencing this grief

6 myths that prevent parents from talking to their kids about suicide 

Myth 1: Teens would rather talk with their friends than their parents

When kids are struggling, it can feel natural to reach for a parent just as they did when they fell and scraped their knee as a toddler. Parents are their kids’ primary attachment figure and have an incredible ability to comfort their kids. But that attachment between parent and child needs to be a safe one for this to happen. 

When kids know they can go to their parents and get what they need, i.e., listening, understanding, validation and reassurance things will be OK, they have less fear in reaching for their parents in times of need.

Oftentimes there is a generational gap between parents and teens that prohibits this openness. The current generation is more self-aware, more in tune with emotional communication styles and do want to talk about their feelings. The subject of mental health and feelings is not something many of today’s parents of teens have been raised talking about. This causes a communication breakdown that creates disconnection. Teens are left to deal with their issues on their own, when they really just want their parents’ listening ears and empathetic hearts. 

Myth 2: Talking about suicide will put the thought in someone’s head

Talking about suicide or asking someone if they are having thoughts of suicide will not give them the idea to take their life. It actually has the opposite effect. It says, “I am willing to talk about anything that you are struggling with, even if it is thoughts of suicide.” 

When parents are afraid to talk about suicide, kids sense it and it actually makes them more afraid to share with their parents, and can make them feel more alone or trapped. 

Saying the word “suicide” acutally gives someone the permission to share—and they don’t have to find the courage to initiate the conversation. The subject no longer feels taboo. It also helps kids feel their parents are approachable and a safe landing place, where their parents have their back no matter what. 

Myth 3: Parents shouldn’t talk about their own mental health, struggles or feelings with their kids

Teens learn mostly from what their parents model. Parents consciously showing their kids how they care for their own mental health and discussing how they deal with day-to-day struggles is how kids will learn to care for their own mental health. Parents can do this without putting the onus on their kids to care for their parents, but in a way that normalizes the conversation.

Related: I don’t hide my depression from my kids

Myth 4: The only people who take their life are mentally ill

“The reason suicide rates have remained stubbornly high for decades is the outdated notion that mental illness is what causes suicide,” the American Psychological Association reports. The CDC found that 54%of people who died by suicide did not have a known diagnosed mental health condition when they died.

Parents should not assume that there is no need to talk about suicide if their child does not have a mental health diagnosis. General life stress, relationship problems, bullying, transitions, divorce, family conflict, a loss, abuse, financial troubles and trauma are other contributing factors that can cause someone to think about suicide. A mental illness is just one of the risk factors. Parents need to have open conversations about mental health and suicide with all of their kids. 

Myth 5: I only need to have a conversation about suicide if I see signs my kid is struggling

We shouldn’t assume that because a child doesn’t show typical signs of distress (i.e., isolation, changes in behaviors, sleeping too much or too little, not experiencing joy in things that normally bring them joy, talking about dying, feeling trapped, or being a burden; anxiety, depression, irritability, anger, substance use, sudden upswing in emotions after being down) they aren’t struggling. Not everyone shows outward signs when they are struggling or thinking of taking their life. 

Myth 6: Someone who is having thoughts of suicide has the intent to take their life 

Thoughts of suicide can be common and do not necessarily indicate a clear intention to take one’s life—though they do imply the need to talk about it and to get help. Ask both of these questions: “Are you having thoughts of suicide?” and “Do you have a plan to take your life?” If they do have a plan, please ask, “Do you have access to the means to take your life? Can you tell me more?” Then listen. Get them professional help. 

Related: AAP now recommends screening all kids 12 and up for depression and suicide risk

A note on talking about suicide with teens

Being a teenager now is tough. Historically, the teenage years have been met with the stress of physical changes, transitions and social/emotional challenges. Teens now have additional pressures that their parents didn’t experience. The bar is set so high in many areas of their lives. They can feel overwhelmed by the demands they face and feel like it is only them who doesn’t know how to figure it all out. They have more exposure to societal issues. And they are bombarded with continued comparison that leads them to feeling a lack of self-worth during a time when they are developing their sense of self. 

Asking, “How was your day?” isn’t enough. Be specific and ask them how they are feeling, what they are struggling with—and just listen. Listening doesn’t mean casting judgment or jumping to problem-solving. No matter how big or small the struggle, listening and validating provides comfort and reassurance parents are there to support. 

Being uncomfortable and even fearful about conversations around feelings, mental health and suicide is understandable if you were raised in a culture where those conversations were taboo. But even just expressing your openness to learn how to have these conversations can help. 

Try saying: “I sense something is wrong. I may not know how to talk about feelings, and what you are struggling with, but I am willing to seek help with you.” 

And aim to make it more than just a one-time conversation. Talking about feelings and how we are actually doing consistently brings a feeling of connectedness—a secure closeness that says we are cared for, understood, valued and are not alone. That feeling of connectedness allows transparency in expressing thoughts, feelings and needs without the barriers of fear and insecurity. 

Connectedness also prevails over the shame that is often accompanied with struggling. And when shame is present, it can cause a person to disconnect from those around them. What someone needs most when they are struggling? Connection.

I implore you to talk with your kids today about their mental health and the topic of suicide, and make it an ongoing conversation. Their mental health is too important not to.