It can feel uncomfortable and even downright counterintuitive to broach the subject of suicide with your child or teenager.
But it is also extremely necessary, according to Dr. Alysha Thompson, clinical director for the Seattle Children’s Hospital Psychiatry and Behavioral Medicine Unit.
“We talk about safe sex. We talk about avoiding drug and alcohol use. We also need to talk about suicide,” says Thompson.
Jarring nation and local statistics
The 2023 Health of Women and Children Report highlights findings of the U.S. Centers for Disease Control and Prevention: “Mental health among school-aged children continues to worsen overall, with disparities by race/ethnicity, gender, and sexual orientation. The CDC report highlighted that more than 40% of high school students felt sad or hopeless for at least two weeks during the previous year, consistent with the effects of depression. These feelings were more common among female (60%) and LGBQ+ (70%) students.”
Other CDC data found that between 2011 and 2021, 13% of high school girls had attempted suicide, and 30% had seriously considered it. And more than 20% of LGBTQ+ teens nationally attempted to kill themselves over those 10 years, while 45% had seriously considered it.
And then there’s this jarring, more recent, data from the research and advocacy group Mental Health America: Washington state ranked 48th in terms of prevalence of youth mental illness and lack of access to care in 2024. Only three other states—Oregon, Arizona, and Nevadah—have higher levels of mental illness and lower levels of access to mental health care. Here’s what that looks like, according to data distributed by the Washington State Department of Health and Harborview Medical Center:
- In 10th and 12th grades, 15%t of kids in Washington consider suicide.
- Between 6% of Washington 12th graders and 7% of 10th graders) attempt it.
- More than 50 percent of adolescent suicides were carried out with guns from the victim’s home.
- Between 2017 and 2021, 2.6 out of every 100,000 youth ages 10 and 24 committed suicide in King County.
- An average of 17 adolescents are admitted to the hospital with non-fatal suicidal behavior each week.
At the same time, there are insufficient mental health professionals to meet the region’s needs, explains Thompson.
Suicide Prevention Month is an opportunity
The situation can feel daunting. But September is Suicide Prevention Awareness Month, and Thompson says it’s a good time to remember that there are plenty of resources for families and steps parents and guardians can take to help their children long before a mental health crisis hits.
Graphic courtesy National Institute of Mental Health.
Open discussions are best
First, start talking about depression, mental health, and suicide early.
No, Thompson isn’t suggesting talking about suicide with your toddler. However, openly discussing feelings with very young children and labeling emotions can build an important foundation. She gives the example of a child starting to cry after spilling milk. To help that child express their emotions, a parent might say, ‘You’re feeling so upset right now because your milk spilled.’
In the toddler years, it’s important for parents to start talking to kids about coping with their feelings, Thomson says.
Kristie Neklason, director of school-based behavioral health at Youth Eastside Services, add that the conversation is broader than one scary word.
“Not all of suicide prevention is talking about suicide,” Neklason says. “Suicide prevention is also very much about supporting children and youth in knowing how to manage and express their emotions. Eating well, getting exercise, having fun, being able to relax, being involved in activities that are meaningful, and feeling connected to friends and family are also things that are key in being able to manage emotions. The ways in which kids experience these things are varied and there is no one right way. Parents can be great teachers, supporters, and role models and it can be hard work, so seeking out partners in your community, your child’s school, or accessing professional help can provide support.
Older kids need consistent conversation
By the time kids hit their teens, the job of preventing tragedy becomes more about checking in with them regularly about their feelings.
“It might be in the drive to and from soccer practice; It might be sitting down at dinner; It might be at night before people go to bed,” says Thompson. “There’s all sorts of different ways to weave these conversations in. But making sure that you’re giving space for [checking in] throughout the week allows for when kids are having a harder time. You’ve already got a venue for this.”
YES’ Neklason adds: “Building a positive relationship with your child early where it is ok to share difficult thoughts and emotions is key. This happens through listening more than talking, validating their feelings while shaping appropriate behavior, and helping them develop the tools to manage and express their feelings.
Parents can teach their children words to express their feelings and encourage their children to use those words to say their feelings, walk and talk it out, keep a journal, draw pictures, and know that life is not always happy or easy and that’s ok, that’s normal,” says Neklason. “It also requires adults to model what they are teaching and to do the hard work of taking care of themselves and their emotions so they can maintain a calm openness when their child is sharing about some things that can be very scary. Children often want to protect their parents from distress and if they think it will upset you, they may attempt to keep it to themselves and thoughts about suicide and related feelings are something we want them to share.”
A topic it is important not to avoid
Thompson recommends not avoiding the topic of suicide. Doing so can add to the stigma. Instead, she advises parents to make direct statements to teenagers. For example, she offers this approach:
‘Hey, I’ve heard that being a teenager is hard and that these are sometimes things that people think about, that they might think about hurting or killing themselves. Does that ever come up for you or any of your friends?’
Bringing up suicide to a child who hasn’t been thinking about it isn’t going to suddenly result in suicidal ideation, Thompson says.
“But kids who are thinking about suicide, if they don’t get asked direct questions about it, might never tell somebody that they’re having those thoughts,” Thompson says. “So then they kind of suffer alone without getting the support that they need.”
Washington: Signs of improvement
According to the 2023 Washington State Healthy Youth Survey, suicide is still the second leading cause of death for Washington teens 15-19 years old, although suicide rates dropped between 2021 and 2023. In releasing the 2023 survey data, the department wrote:
“Mental health outcomes among 10th graders are improving but remain highly concerning, especially for youth who already face more barriers to mental health support. According to the new data, depressive feelings and contemplation or planning suicide significantly decreased from 2021 to 2023. Even so, 30% of 10th graders reported persistent depressive feelings. While this is an unacceptable level of youth struggling with suicidal thoughts, it is also the lowest rate we have seen in Washington in 20 years.” Suicide trends among sexually or gender-diverse (LGBTQ+) youth and those reporting a disability in Washington have also gone down in recent years.
“However,” the DOH warned, “many of these students still experience far higher levels of mental health issues. Depressive feelings were nearly two times higher for students who identify as female compared to male, more than two times higher for LGBTQ+ youth, and three times higher among students identifying as having a disability.”
Watch for warning signs
Thompson explains there are several warning signs to look for. These include such things as sudden changes in mood or level of activity, isolating themselves, talking about death and dying, and making plans for suicide.
Although it is rarer for younger children to consider suicide, Thompson says it does happen. So, it’s important to look for warning signs in younger children as well.
988 Suicide & Crisis Lifeline is there to help
Over the summer, the 988 Suicide & Crisis Lifeline was launched across the U.S., giving the public a simple number to reach mental health support. There are also more local resources, such as Teen Link, which offers support from trained youth volunteers, and Seattle Children’s Hospital, which has an online mental health resource hub.
Thompson also highlights the importance of keeping guns away from children and medication, even over-the-counter pills, locked away. According to the CDC, more than half of suicides are by firearm.
If you think a child is planning suicide
If your child says they are thinking about suicide, have a plan and might do it, it’s vital to take immediate steps.
“That’s the time to get in the car and get to the emergency department, and get evaluated to see if they need a more intensive level of care, like inpatient psychiatric treatment,” she says.
Connection makes all the difference
But, she stresses, it’s not just about responding to these acute moments. It’s also about the days and even months leading up to them. If a child who is becoming depressed has a connection with a warm, loving, supportive adult it can help them navigate their pain.
All, children, but especially those who are struggling with depression or other mental stress, need at least one adule who is “ a sounding board for the things that they’re going through and is engaged in things that bring them joy.
“All of those are protective, to help prevent future suicidal ideation,” she says.
Know the signs of suicidal thinking
Knowing the signs that a person is considering or thinking about suicide is critical to getting them help. Some of these are most likely to be seen in adults, but most apply to children as well. Here are some warning signs from the 988 Suicide & Crisis Lifeline:
- Talking about wanting to die
- Looking for a way to kill oneself
- Talking about feeling hopeless or having no purpose
- Talking about feeling trapped or in unbearable pain
- Talking about being a burden to others
- Increasing the use of alcohol or drugs
- Acting anxious, agitated or recklessly
- Sleeping too little or too much
- Withdrawing or feeling isolated
- Showing rage or talking about seeking revenge
- Displaying extreme mood swings
- Seize those moments while listening to a song, watching a show, or when hearing your child share something that happened at school to have a conversation about suicide and emotional distress.
- Relate the movie, show, song, or story to the subject of mental health and suicide.
- Ask open-ended questions about if they or their friends have dealt with thoughts of suicide.
- Affirm assistance with getting help not only regarding the suicidal thoughts but also the emotional struggles underlying those thoughts. “It’s great to do some prior research on what resources there are at your child’s school and in the community where you can get both immediate help from a crisis line or emergency room and ongoing help from a counseling center or therapist,” says Neklason.
** Seattle’s Child staff contributed to the 2024 update of this article, initially published in 2022.
Read more:
“Unmasking anxiety: Resources for parents”
“Kids and mental health: A psychologist’s tips for supporting young people”
“Depression in kids: How to spot it and where to look for help”
