Talking To Teens About Suicide and Self-Harm

How to talk to teens about self-harm and suicide

I often talk to parents who are worried about their teens’ self-harm and suicidal ideation. Usually, this is shocking news for the parents. They find out suddenly and don’t know what to do with it. Either their teen “all of a sudden” ends up in the emergency room saying they want to end their life, or the parents see bloody toilet paper in the garbage and notice scars and cuts on their teen’s arms. What do you do with this?

This is probably the most difficult subject, and parents are often not sure how to talk to their teens about it. Many are afraid that talking about suicide will give their teen ideas. Others know they need some help but just don’t know what words to use. Some parents fear hurting their teen’s feelings even more. And teenagers, let’s be honest, are not the easiest people to talk to. In this article, I will talk about some common questions I get from parents, the importance of a safety plan, and how to make a safety plan with a teenager.

Understanding the impulse

Essentially, suicidal ideation is often an impulse. An impulse that comes when a person cannot regulate themselves, when their nervous system is heightened or collapses, and they don’t know what else to do. This can happen after a long period of depression, rumination, or prolonged, severe anxiety. It could also be a result of a psychotic episode when the person is hallucinating and sees suicide as a way out of the episode.

For teenagers, it is often an impulse that, if not prevented and dealt with appropriately, may grow into ideation. Each impulse makes it worse. Each impulse creates a precedent in their mind and memory, and their mind may go to that place again, just because it is familiar. That is why it is important to prevent these situations and educate your teens that suicidal thoughts are an impulse that may not even last very long. These impulses tend to happen when the person is alone. It is important to explain that to the teen and encourage them to ask for help rather than closing themselves off from the world.

“What if this is just manipulation?”

What if they don’t mean to kill themselves, and it is just manipulation? Even if a teen doesn’t really intend to die, they may impulsively do something when they are in a state of despair and emotional dysregulation. They may not necessarily intend to die, but what they do can cause serious harm. For example, they may take a handful of tablets that can harm them without necessarily wanting to kill themselves. Therefore, every suicidal ideation is to be treated seriously.

First and foremost, you need a safety plan

A safety plan is like a fire safety plan. Every building has one in case of a fire. If you know or suspect that your child may be suicidal, talk to them about it and make a safety plan with them.

A safety plan should address these questions:

• What happens when these thoughts come?

• What will you do?

• What can you do about it, and how can you get out of that state?

The most effective thing to do is talk to someone about it. The way you can frame it to your teen is something like this: “Suicidal thoughts are a safety concern, and nobody should be alone with them, because it is dangerous. Therefore, you need to tell someone when the thoughts come to you. This information should never be kept confidential, not for yourself not for your friends”.

I know that this may sound unnatural to some parents. It may not make sense to them to talk to their teen about suicidal thoughts. But talking about a safety plan creates a record in their teen’s mind. Discussing what to do can have an effect. They will know, or at least think about and consider, talking to somebody and asking for help.

The main point here is that these states are not normal and need to be dealt with. They are a safety concern. This state is unsafe, and you need somebody’s help to get out of it.

The safety plan should include concrete steps and these need to be clearly discussed.

For example: when the thoughts come, call Mom, text Dad, or text a friend. Call or text somebody. Talk to a person you trust. If you are feeling unsafe with yourself, call 911. If it happens at school, go to the school counselor, a teacher, or somebody you trust. Your teen needs to understand that this is not an embarrassing thing. They are not doing anything wrong by having these thoughts. And they are not doing anything wrong by telling someone about the suicidal thoughts, their own or their friends’.

It is not an embarrassment or a betrayal to talk to an adult about it. It is a safety concern. The person having suicidal thoughts is not safe from themselves, and it needs to be dealt with immediately.

“What if my teen says, ‘I don’t want to talk about it’?”

You can say: “This is a safety concern. I am your parent, and I am responsible for your safety. Remember how I used to teach you about crossing the road safely and not talking to strangers? This is exactly the same thing. It is about your safety. Nobody deserves to die because of the suicidal thoughts. If these thoughts are present – it means the person is not okay and needs immediate help”

“What if I give them ideas by asking whether they want to kill themselves?”

No. Asking whether they want to kill themselves or hurt themselves does not give them ideas. The talk needs to happen. If you don’t talk about it, you may miss some signs. Teenagers, when they are alone in their rooms, can come up with a lot of terrible things, especially now with lack of sleep and social media.

“What about cutting? Is it a suicide attempt?”

Cutting is not necessarily a suicide attempt, but it usually goes hand in hand with depression and suicidal ideation.

Teenagers cut because they lack emotional regulation. Cutting is also correlated with higher suicide rates, so these concerns go hand in hand. You need to take safety precautions and talk about cutting, too.

Taking precautions around cutting

Cutting can cause scarring that they may later regret. It can also create an unhealthy habit of using self-harm to regulate themselves. Cutting is a serious symptom of emotional dysregulation and needs attention. Start by talking to your teen about it. Talk calmly, ask questions, offer help. Then take physical precautions, such as taking away sharp objects from their room and asking if you can check in on them once in a while.

You can say: “Some people cut to help them calm down, or when they are lonely, or sometimes they don’t know why they do it. We can get you help with this. For now, can we agree on some safety rules? I will need to come into your room and check in on you. I know you don’t like it, but this is about your safety. Can I please check in with you and make sure you’re okay?”

And again, if they have the impulse to cut, what can they do instead? Can they talk to you, can they talk to a friend? Often, they cut at night, when everybody is sleeping and they are sitting in their room. Another precaution is not allowing them to sleep with their phone in the room, because they may stay awake on it. Sleep deprivation is a factor in suicidal ideation and difficulty with self-regulation.

The main point is that you must talk about it. You must make a safety plan. Don’t take “No,” “I don’t want to talk about it,” or a slammed door as the final answer. If they slam the door and walk away, you can give them half an hour and then bring it up again. You can talk when you’re taking them to school.

A note about teenagers

One thing that puzzles parents is this:“This morning, she said she hates me, and the next thing I know, she’s asking for a hug at dinner.”Yes. Welcome to the world of a teenager.

They can be highly impulsive. They are hormonal, their brain is still growing, and their cortex is still catching up to their emotional responses. They can be very impulsive and abrupt.

If they yelled at you in the morning, that does not mean they hate you or will not talk to you tomorrow. They are still your child. You are still their caregiver.

Have patience. This does not mean condoning rudeness. You can talk to them about the rudeness later on as well. And if this is a pattern that concerns you, talk to a specialist.

What is imminent risk of suicide?

An example of imminent risk is when a person says, “I will do it right now,” and has the means to do it.

Questions to ask include:

• “Do you want to kill yourself?”

• “How are you planning to do it?”

• “Do you have access to what you would use?”

• “Are you planning to do it right now, or as soon as you are alone?”

If they describe a plan and say they are going to act on it right now or as soon as they are alone, that is an imminent risk, and you need to seek emergency help.These are not the only signs of imminent risk, and these questions are not a complete risk assessment. You do not need to wait for a teen to state a plan or have the means in hand before seeking urgent help. If you think they may act on suicidal thoughts or cannot stay safe, stay with them and seek emergency help.

The most important points

Talk about it. Don’t take a slammed door as a definitive “No, we will never talk about this.”

Explain that this is a safety concern. Suicidal thoughts and self-harm urges indicate that something is wrong and needs attention. Explain why the safety concern needs to be addressed.

You can even say:

“If there were a fire, would you just walk away and not tell anybody? You wouldn’t. You would do something about the fire. You would call 911 to get help.” It is the same principle with suicide: it is a safety concern that needs to be addressed. When there is immediate danger, safety comes first.

Be attentive to your teen. Some of the signs of self-harm and suicidal ideation are:

- Insisting on wearing long sleeve shirts

- Regular dollar store/drug store purchases showing up on bank cards (they buy razors)

- Sudden change from angry to melancholic and even “calm”. This happens when the person thinks they found a “way out” and they feel relief. This is the most dangerous sign because it may indicate that they are premeditating suicide.

Often, there are no warning signs, or they are subtle. Therefore, the best rule is:

Don’t assume your teen is immune to suicidal thoughts

This is probably one of the most unwanted and feared topics for a parent. No parent ever wants to find out that their child wants to kill themselves. Children know that as well, and they may not say anything. For many parents, the news comes as a huge shock. They didn’t suspect it. They didn’t know.

I strongly encourage all parents to think about this and not exclude the possibility. I get concerned when a parent tells me, “Oh, no, no, no. My child never thinks about that. “You cannot guarantee that. That kind of thinking can lead to overlooking serious safety concerns.

Even if you don’t think your teen would want to kill themselves, understand that teenagers can experience suicidal thoughts. They may struggle with emotional regulation, act impulsively, face pressures on social media, and have problems they don’t know how to deal with. Without being too gloomy or dramatic, just don’t assume that your child is immune to suicidal ideation.

Don’t be afraid to ask questions and have that conversation, it will demystify suicidal ideation and hopefully let your teen know that they are not alone in this.

Suicidal thoughts are not a secret they need to keep. Not their own thoughts, and not their friends’ either. It is not something to be ashamed of. It is a safety concern that needs immediate attention.

Help is available: https://www.crisiscentre.bc.ca/get-support/crisis-lines/

I offer a 30-minute focused consultation for parents who need prompt, practical advice about their situation without having to wait for a full appointment or committing to therapy. This service is available to new and existing clients. Book here: https://care2connect.janeapp.com/#/staff_member/1/treatment/116