Youth Suicide Risk Management and Prevention

It is any parent or caregiver’s worst nightmare: a child’s attempted suicide or death by suicide. It can lead to feelings of guilt and self-blame as they ask themselves why and how they missed the signs. The aftermath of a child’s suicide attempt or death can be devastating for a family. Often, the salt in the wound is that suicide is a preventable cause of death. And, unfortunately, the need for youth suicide prevention is increasing.

As clinicians, navigating suicide risk management for children and adolescents can feel daunting. After all, best practices when working with youth is to not only understand the individual patient, but also their family, friends, and school life. Additionally, clinicians may feel pressured by parents to achieve certain treatment goals or manage specific behaviors, which may not align with the needs of the patient.

The way to successfully navigate suicide risk management with children and adolescents is by managing expectations of parents, addressing needs and concerns of patients, and improving communication between the parent and child about the presence of suicidal ideation and ways to stay safe.

The rising need for youth suicide prevention

The statistics are harrowing. Suicide continues to be the second leading cause of death among 10–24-year-olds in the U.S., accounting for 19.7% of all deaths in that age group in 2019.

Longitudinal research into suicide rates in the U.S. show that while the trend in suicide rates among females over the age of 25 declined between 2000 and 2020, suicide rates for females between the ages of 10 and 24 increased in that period. For females between 15-24 years-old, suicide rates increased by 87%. Meanwhile, suicide rates increased by 300% for females in the 10-14 age group.

Among males, the rate of suicide also tripled for 10–14-year-olds between 2007 and 2020, however, for 15–24-year-olds suicide rates increased between 2000-2017 and then held steady between 2017-2020.

Assessing and safety planning

The strongest tool that clinicians have in intervening on and managing suicide risk is proper assessment. Best practices for suicide risk assessment are well-established in the literature.

Be patient and take your time. When working with youth, it is crucial that clinicians allow enough time for the development of trust with the patient. Oftentimes, reactions from the patient, such as withholding information or being reluctant to talk, can be perceived as disinterest or combativeness, when in reality, the young person may just need to have more trust established before disclosing their feelings.

Rather than using interrogation style questions and answers, rushing past questions that the patient does not answer quickly, or deciding that the situation is a waste of time, focus on building trust with the patient. Do this by normalizing the experience of having suicidal ideations, explaining that nothing is wrong with them, and reiterating that your focus is to help them stay safe.

How to support parents and families

While most of the focus will be on the patient, parents and families are an important part of the intervention strategy for suicide risk management. It is critical that clinicians do not hide any suicidal ideation or previous suicide attempts from parents.

Instead, discuss with the patient about how they can disclose this information to their family in a way that feels comfortable for them and keeps the family informed. While some amount of privacy can be respected in the intervention process, the best way to keep a child safe when suicide risk is present is to make sure that the family knows and that they can provide the necessary support.

One thing to consider is allowing patients some autonomy with the process of sharing about suicidal ideation. This can involve allowing the patient to tell their parents directly, allowing the patient to write it in a note, or even relaying the information on behalf of the patient.

It is imperative that the parent knows about any suicidal ideation disclosure before the visit ends. This is especially true when a safety issue arises between follow-up visits.

Teaching parents to practice youth suicide prevention

When a child discloses suicidal ideation, the parent should express empathy, thank them for disclosing, and gently ask follow-up questions.

Avoid being dismissive about suicidal ideation. Passing comments such as “you don’t mean that” or “you’re being dramatic” are hurtful to a child trying to sincerely disclose suicidal ideation to their parents.

Worse still, they may cause the child to stop talking about their suicidal ideation for fear of dismissal or ridicule. Disclosure of suicidal ideation should be taken seriously.

Another situation to avoid is making the child’s suicidal ideation about the parents. Teach parents to avoid phrases like:

• “What would I do without you?”
• “I would be so sad if you die.”
• “You can’t do that to me.”

Though these are genuine concerns and feel authentic to the parent, they rarely prove helpful when practicing youth suicide prevention.

Such parent-centered statements may increase feelings of shame and guilt in the child. Additionally, it may make the child feel burdened by the responsibility of their parents’ feelings or may make them feel unworthy of their parents’ love and concern. Rather than using such phrases, the parent should reiterate that the child is worthy and loved.

Clinicians should also recommend that parents talk about how the child adds value to the world and to their own lives. Additionally, parents should find ways to spend time with their child doing activities they both enjoy.