How to talk to your teenagers about suicide, and what to do if they're experiencing suicidal thoughts

Asking your teen if they are considering suicide will not increase their chance of suicidal ideation - but, it can give you very important insight.

• Suicide is the second leading cause of death for ages 10-14, and the third for ages 15-19.
• Asking a child directly about suicide can reduce their risk of dying by suicide.
• If you are in crisis, text "HOME" to 741741 to reach the Crisis Text Line for immediate support.

This article may be triggering for people at risk of suicide. Please take caution before reading.

Over the past 20 years, suicide rates in the United States have risen sharply. Currently, suicide is the second leading cause of death for teens ages 10-14, and the third leading cause of death for teens ages 15-19.

Not everyone is at equal risk: Teens involved in the juvenile justice and child welfare systems, LGBTQ+ teens, Native American and Alaskan Native teens, and teens currently or formerly involved with the military could all be at higher risk of attempting or dying by suicide. 

It's important for parents or caregivers of loved ones to identify signs of suicide or suicidal ideation as soon as possible so they can get their kids help, says John Seeley, a professor in the School of Education at the University of Oregon.

But it's easy to miss the warning signs. If you're concerned your teen might be thinking about suicide, here are tips on how to broach the subject with your child and signs to look out for.

1. Ask them directly if they're thinking about suicide

One of the most dangerous myths about suicide prevention is that by asking someone if they're thinking about hurting themselves, it might plant the idea of suicide in their minds. 

This is untrue and research suggests the exact opposite, that asking people about suicide actually reduces the risk of suicidal ideation. 

Mental health experts agree that the most effective means of suicide prevention is to ask someone directly if they are considering suicide.   

"If you see any of these warning signs… you can just check in with the person and say, hey, I noticed you've been having trouble sleeping, I noticed you haven't been hanging out with your friends like you normally would. Talk to me," says Megan Schabbing, a psychiatrist and Medical Director of Psychiatric Emergency Services for OhioHealth. 

"Certainly if you have reason to believe somebody might be suicidal, it is appropriate to ask: 'Are you having any bad thoughts, wishing you were dead?,'" Schabbing adds.

What to do if they say they're thinking about suicide

If your child tells you they're thinking about suicide, don't panic. Their transparency is a good thing.

• Affirm their decision to trust you: "You want to really encourage them and tell them you're really glad that they told you," Schabbing says. This can help keep the lines of communication open and make sure that your child feels safe confiding in you in the future.
• Reassure them that there's a solution: It's also important to let your child know that, though the situation might seem insurmountable right now, suicidal ideation is a problem that can be moved through. 
• Tell them this is temporary: You can tell your child "this is a thought that is not going to be there forever," Schabbing advises. "Just provide positive reassurance, we're gonna get you the help you need, we're gonna get you feeling better."
• Determine the severity of the situation. Ask questions to figure out how intense your child's suicidal thoughts are. The Columbia-Suicide Severity Rating Scale is widely used by professionals to assess severity. 
• Seek professional help. If your child is imminently planning on attempting suicide, you should call 911 or immediately take them to an emergency room or psychiatric crisis center, Seeley says. You should not leave them alone. If your teen's suicidal thoughts are less severe, it may be more appropriate to schedule an appointment with a mental health professional, like a therapist or psychiatrist.

What to do if they are not thinking about suicide

If your child says they're not thinking about suicide, that doesn't necessarily mean you're in the clear, says Theodore Beauchaine, the William K. Warren Foundation Professor of Psychology and Co-director of the Notre Dame Suicide Prevention Initiative at Notre Dame University.

Many kids who are contemplating suicide don't have strong communication with their parents or caregivers, and several risk factors for suicide – including being LGBTQ+ or heavy alcohol and drug use – are things that kids may keep secret from their family. 

When these kinds of disruptions prevent open discussion between a caregiver and child, "You can't take no at face value necessarily," Beauchaine says.

If you're worried about your teen, it may be appropriate to take them to see a mental health professional regardless of whether or not they express suicidal ideation.

You can also affirm to your kids that they can confide in you in the future, Schabbing says. "It's totally reasonable and in fact important to say to your teen, 'If you ever did feel like that, I want you to know I'm here for you, and I want you to tell me,'" she says.

2. Remind them they are not alone

Suicide and suicidal ideation are often tied to social isolation. Loneliness and a lack of emotional support both increase the risk of suicide.

On the other hand, having a strong social support system can help protect against suicide, Schabbing says. So how can parents ensure their kids aren't isolated? 

"Preventing it is really hard because isolation is a choice," Beauchaine says. "You can't force a child to hang out with peers." However, a mental health professional may be able to help tease out what's going on and how to build a stronger support system, he says.

Schabbing also notes that if someone is having a mental health crisis, part of their treatment may include making sure they are with other people for most of the day who can help them feel better.

And, Seeley says, even if you can't do anything to immediately improve your child's social network, you can remind them that they're not alone and that you care about them.

3. Recommend professional help

The best way to treat suicidal ideation is to see a therapist or psychiatrist, Beauchaine says. Even if you aren't able to see a mental health professional in person, teleconferences over Zoom are a great way to get help.

To find a therapist – which is a psychologist, social worker, or mental health counselor who provides psychotherapy – you can use online tools like the APA's Psychologist Locator or the National Register of Health Service Psychologists. It is important to note that most therapists cannot prescribe medications, although talk therapy can be equally crucial to healing. 

Likewise, to find a psychiatrist – which is a doctor who specializes in psychiatric medications – you can use similar tools. This might include the American Society of Clinical Psychopharmacology guide or the website PsychologyToday. 

If you're not sure what might be best for you, Schabbing recommends asking your primary care physician for a referral, since they'll be familiar with your specific needs.

When looking for a therapist or psychiatrist, it's important to ensure that they're a licensed medical professional who takes your insurance. You may also want to ask questions about their past experience and their therapy style to learn if they're a good fit for you. 

Unfortunately, wait lists for most clinicians that accept health insurance plans can persist for up to five months. If your teen is at high risk of attempting or dying by suicide, bringing them to a hospital may be the fastest way for them to receive clinical treatment.

If you can't afford a therapist, there are free hotlines you can use, including the 988 Suicide and Crisis Lifeline or the National Alliance on Mental Illness (NAMI) helpline at 800-950-NAMI (6264).

4. Provide other helpful resources

If you can't access a mental health professional, there are additional resources to use in the meantime (although not entirely supplemental to mental health treatment). Caregivers and children can visit the NAMI website to find resources and information about mental illness and suicidal ideation. The website Healthychildren.org also has information about mental illness in teens, Schabbing says. 

And "you can always go to the school counselor," she says. "There are lots of resources through the school that you can have access to." 

Many times, school counselors and social workers are mandated reporters, meaning they must tell the school when a student expresses suicidal thoughts. In many states, anyone in a school who is told that a child is experiencing suicidal ideation must legally report it to the family and school administration. 

Even those who aren't legally obligated to report may do so for moral reasons. However, concerns about mandated reporting shouldn't stop parents or children from seeking care.

"It is important to remember that the role of a counselor, therapist, or other mental health professional is to help the child regardless of the situation," Schabbing says. "Seeking help for a child who is struggling with mental health problems is always the right choice."

Warning signs of suicide

The number one sign you should watch out for is hopelessness, says Schabbing. 

"When someone is feeling hopeless and stuck and just sees no light at the end of the tunnel, that is a huge warning sign in terms of suicide," she says. 

Even people who have never had challenges with a mental health condition can die by suicide. That said, many teens who attempt suicide are actively in mental health treatment, so it's crucial to continue to talk to teens about suicide throughout every phase of their mental health treatment(s).  

For adolescents in particular, you can keep an eye out for:

• Signs of worsening depression, such as increased sadness, angry outbursts, or fatigue
• Signs of worsening anxiety, such as restlessness, trouble concentrating, or gastrointestinal problems
• Difficulty sleeping
• Social withdrawal
• Faltering grades
• Lack of participation in normal after-school activities
• Alcohol and drug use
• Not responding as usual to praise

Other red flags that are common in adults but less common in teenagers include giving away possessions, writing a suicide note, and coming up with a plan to die by suicide.

Still, it's important to note that not all of these signs necessarily indicate suicidal ideation. 

Many signs of mental illness overlap with signs of suicide, so it can be hard to tell the difference between the two. 

Insider's takeaway

If you think your child might be contemplating suicide, don't be afraid to ask them about it. 

If they confirm your suspicions, then you should take them to see a mental health professional as soon as possible. Or if you don't have immediate access to therapy, consider calling a hotline for help. 

"The main thing is if you suspect somebody is not acting themselves, is experiencing distress, ask how they're doing. Ask if they're okay. Ask if they're thinking about suicide," Seeley says. "Let's not shy away from it. Let's ask the questions and then respond accordingly."