Tough Talks: Suicidal Ideation and Self Harm

Learn how parents and caregivers can discuss suicide with their child effectively as a protective factor

to decrease risks for suicidal ideation, self-harm, and/or other mental health conditions. 

In the United States, suicide is the second leading cause of death for adolescents and young adults ages 10-24. Adolescence marks an increased risk for non-suicidal self-injury (NSSI), which is the purposeful act causing harm to ones body by cutting, burning, scratching, banging, hitting, and/or punching. Discussing emotional health and wellbeing with our children is one of the top protective factors to decrease risk for suicide and other mental health conditions. 

Mental and emotional health conversations are imperative to a child’s development and wellbeing. Lack of discussions about emotions with children can be considered a form of emotional neglect; failure to attend to a child’s emotional needs. We as parents are doing a disservice to our children’s overall being if we refuse to adopt techniques of open communication around feelings. Emotional neglect significantly increases the risk a child may experience suicidal ideation, self-harm, and/or other mental health conditions. Having these essential talks with your child helps evolve essential, developmental skills such as recognizing, understanding, and managing their feelings.

What leads to suicidal ideation and self-harm is complex, influenced by many biological and environmental factors. Continue reading to learn how parents can ensure children are emotionally supported at home. 

My Child Didn’t Tell Me They Were Struggling - Why?

Children experiencing suicidal thoughts and/or self-harm behaviors might not tell their parents. Oftentimes, they fear the parents’ reactions including loss of independence, worrying them, or dismissal of their feelings. They may not disclose to their therapist, especially if they believe the clinician will break confidentiality to inform parents. Children experiencing suicidal ideation and/or self-harm may disclose to peers or informal supports initially, people they feel like might understand them, validate them, or relate to them. Regardless of how the information comes to light, parents’ involvement with their child’s mental health is the key component to managing the safety, monitoring the risk at home, and facilitating treatment access for their child. 

What Can I Do As A Parent?

First and foremost, educate yourself on the evidence-based facts about suicide. The American Foundation for Suicide Prevention offers numerous resources to educate yourself about suicide: 

https://afsp.org/suicide-statistics/

https://afsp.org/risk-factors-protective-factors-and-warning-signs/

https://afsp.org/facts/rhode-island

A commonly believed myth is that talking about suicide with your child will increase their risk for suicidal ideation and self-harm. This misconception has been disproven through extensive research. Talking with your child about suicide can be difficult, but it is essential and potentially life saving. By having these conversations, you demonstrate that your child is not alone and access to support is available. Parents can establish an Effective Communication Routine to frequently check in on your child’s wellbeing and encourage an open line of communication.

Effective Communication Routine:

1. Have daily, informal check-ins AND weekly, formal discussions to discuss their stressors, overall happiness, schoolwork, and friendships.

2. Use open ended questions: “Tell me how you are feeling today” or “what made you happy this week?”

3. Give undivided attention: Technology-free, eye contact, attentive and open body language and facial expressions. 

4. Normalize and validate their feelings/experiences - do not assume they are lying, exaggerating, or seeking attention. Use affirming statements for their thoughts, feelings, behaviors in a calm tone without humor/sarcasm: “Talking about this is hard,” “it sounds like you are having a hard time and seem upset, I’m here to talk about anything if you need to,” or “it makes sense why you felt angry when your friend broke your toy.”

5. Use everyday, age-appropriate examples, like using characters from their favorite TV show/movie, to normalize conversations about emotions: “Rumi looked really sad there, why do you think she felt that way?”

6. Remain focused on the child and their feelings. It’s completely normal to feel sad/angry/upset as a parent to hear their disclosures and experiences. If they perceive they have hurt you, upset you, or are invalidated, they may not disclose to you willingly in the future. Resist the urge to share quick fixes or solutions as this tends to shut down further dialogue. 

7. Be mindful of their reluctance to share, and be open to push back. Ask permission to have the discussion to diffuse their defensiveness. If your child isn’t ready to talk, leave the invitation open for later by saying, “Whenever you want to talk, I’m here to listen and support you.” You could add “I won’t judge, and I’ll never stop supporting you, no matter what challenges you face.”

8. Believe your child’s reports. We cannot assume that our child’s actions are attention seeking behaviors or untruthful.  Dismissing these reports may lead to increased safety risks. Any discussion around emotional health, especially suicidal ideation and self harm, should always be taken seriously. 

9. If your child has been untruthful about a situation or refuses to share specific details, it’s important to remain calm and avoid an angry confrontation. Do not corner your child or call them a liar. Labeling them a liar can lead to distrust and a pattern of dishonesty. Lying, exaggeration, and attention seeking behaviors are extremely common and developmentally appropriate for adolescents. These behaviors are motivated by the desire to avoid trouble, seek independence, protect their privacy, and cover up/avoid discussing challenging emotions. Even if lying becomes “compulsive,” or frequent, it is a sign they need extra support. If your child later comes to you and says what they have said is a lie (or not the whole truth), continue to remain calm, thank them for sharing the new information with you, and listen intently to their report. 

10. Talk to your child about suicide. You can directly ask them about suicidal ideation and self-harm:  “It sounds like you’ve been dealing with a lot lately. Does it ever get so tough that you think about ending your life?” and/or “Can you say more about that? I’m so sorry you’ve been feeling this way. I want to understand more about your perspective. I’m here for you no matter what. There is no problem too big that we as a family can’t get through. I’m going to keep supporting you and will also make sure you get the help you need to feel yourself again.”

What Do I Do If My Child Discloses Suicidal Ideation or Self-Harm?

In an emergency, such as your child’s physical wellbeing at risk, immediately call 911 for medical help. 

If your child is expressing suicidal thoughts/wanting to end their life, has a suicide plan, or recently self-harmed without imminent injury, you can call or text 988 to connect with a clinician who can help guide you to the appropriate resources, such as a mobile crisis unit. 988 is available 24/7. You can also take them to your nearest emergency room or call 911 for hospital ambulance transportation. The hospital will perform a crisis evaluation and determine the best support for you and your child. 

988 can additionally support if your child is experiencing severe anxiety or depression, a substance use crisis, difficulties regulating their emotions, and/or if they are feeling overwhelmed and need someone to listen. It is recommended to reach out to 988 if you or your child need support with mental health in between therapy appointments.

Therapy Appointments: schedule regular sessions with your child’s therapist for non-emergent and ongoing support, but not for immediate crisis. Follow-up with the therapist once the crisis is stabilized. A therapist can assist in developing strategies and skills to manage future challenges in a scheduled session. 

Additional Resources for Parents

Consider informing support professionals at your child’s school about their mental health, as the school can offer ongoing support, accommodations, and observations about your child’s behavior. Share as much as you are comfortable with and keep an open dialogue with the other adults frequently involved in your child’s life. 

Access your own support: having any family member suffer from mental health challenges takes a significant toll on your own mental health. If you begin to notice an increase in stress, anxiety, depression, interpersonal relationship difficulties, or daily functioning impairment, these are common signs you may need to access support for yourself. You are also not alone in this and may decide to access individual counseling, family therapy, parent support groups, or educational training on your child’s mental health.

The Greatest 8 offers tips and activities you can use to nurture your child’s healthy emotions and behaviors (ages 0-8, but great tips for kids of all ages). Visit thegreatest8.org to learn more and sign up for daily text tips.