How to Talk About Suicide
How do we find the words to start these conversations at home?
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Last weekend, I heard about two teenagers who died by suicide in unrelated tragedies. There are no words of comfort here. It is an unimaginable loss.
In the midst of this grief, what I can offer is some information around conversations with our kids, and some important reminders on how we can work to prevent suicide globally. This is not to say that these tragedies could have been prevented, or that all suicide can be prevented - but to remind all of us of the role we can play in supporting each other on a daily basis.
I want to share some key points from a conversation with Dr. Kelly Posner, professor of psychiatry at Columbia University, and Director of the Columbia Lighthouse Project. Dr. Posner’s work around suicide prevention and awareness is saving lives all over the globe ,and she was awarded the United States Secretary of Defense Medal for Exceptional Public Service. I urge you to listen to this episode if you haven’t already, and to share the Columbia Suicide Severity Rating Scale with everyone in your lives. These questions save lives, and too often not enough of us know about them.
We need to break the silence around suicide. So many of us have been impacted by the death of a loved one, community member or friend. Death by suicide is the second leading cause of death among 10-24 year olds in our nation. That’s more firemen than from fires, more soldiers than from combat. The number of young people dying from suicide is up more than 150% in the last 8 years.
We need to ASK about suicidal thinking early. When people are suffering from depression and anxiety, they want help, and asking is a first way to make them feel that they are not alone and that there is treatment. Asking about suicidality has no link to inspiring or causing suicide. Asking helps to eliminate the punishing silence that consumes this topic, and makes it impossible for people to get him.
Suicide comes from a disease. Like cancer, suicide is not a choice. When we make it seem like a rational choice, we can encourage copy-cat behavior, but when we focus on underlying depression as a treatable condition, one where there are resources and support available, we reduce stigma and risk. Talk with your children about depression as a treatable medical condition, and one for which there is support.
We need to teach our children that seeking help is a sign of strength. When we work to destigmatize mental health treatment, to break stereotypes about masculinity or culture, and speak openly about mental health issues, we model for our children that asking for and receiving help is a GOOD thing. Helping our children to realize what they need and how to get it, can literally save their lives.
As friends, neighbors, parents, teachers, community members and concerned citizens, we can all save lives. Helping each other, keeping tabs on each other, asking each other about how we feel, and connecting regularly can keep all of us safer. This is not one person’s responsibility - this is all of ours. We can teach our children to check on their friends, to tell others when someone is in need of help, and to advocate on someone else’s behalf if they aren’t getting the support they need.
We need to pay attention to our children’s moods. So often, depression presents itself differently in young people. Many parents are not aware of how severe their child’s depression or anxiety has become, or how desperate or isolated their child may be feeling, especially if their outward behavior is inconsistent with what we imagine for adult depression. Paying attention to changes in their mood, behavior, appetite and sleep, are important ways to remain connected. Ask frequent questions, find opportunities for connection, and remain attuned to your child’s behavior whenever possible.
Here are some tips around having difficult conversations with our children after this type of horrifying loss. Though these have to be personalized for your child and your family, I’m hoping that they can help you find the words that you need to start these conversations in your own home.
Tell the truth. Discussing suicide and the details of the loss can be important for our children (depending on age), especially if there are rumors going around the community. If you can, answer whatever questions they have, and share the information that you know. Ask them what they have heard, too, and try to help make sure the information being shared is accurate. And while one death by suicide is too many, it is worth noting that it is still rare. National data reports 7-8% of adolescents attempt suicide each year, with approximately 17% reporting serious ideation.
Talk about depression and mental health diagnoses. Since we know that suicide is most commonly caused by depression or other mental health diagnoses, talking about this with our teens can help them to understand the “why.” Remind them about how treatable these conditions are, and how much we need to work to get people the help they need whenever possible.
Make room for a variety of reactions. As with all grief, there are a multitude of emotions that we experience. Make space for your child to have a range of emotions in the face of this loss, and honor and accept all of them. Try to avoid taking any of this personally, and allow them the space to work through their feelings with you.
Help honor the person they’ve lost. Attending memorial services, writing letters to the deceased, or getting involved in a suicide prevention organization, can all be ways to channel grief into action. Helping children to use their sadness to inspire change can help them from becoming overloaded with the burden of grief.
Stay connected. In the wake of a loss like this, remain available to your child for ongoing conversations. Sometimes the magnitude of the event won’t hit for a few days or weeks. Let your child know that you are there whenever they want to talk, and that it is OK to revisit the subject as many times as they need to.
Keep conversations factual and concise, and avoid media exposure. Concerns about suicide contagion, the link between exposure to suicide and the increased risk of suicide among those already at-risk, must always be top of mind. Avoiding repetitive or oversimplified media coverage, emphasizing that suicide is the result of many complex factors, and omitting unnecessary or descriptive details of methods can help manage the contagion risk. It is also important to make sure that risk is further minimized by seeking professional help (or contacting a suicide hotline) for those in the immediate community around the loss, or those exposed to loss at a vulnerable time.
This conversation will, and must, continue.
I still remember a nine year old detained boy at juvenile court-the day after a suicide, attempt with a sheet he carefully separated carrots and peas on his food tray. It was striking -12 hours before he wanted to end his life, and now -he was afraid of carrots! We were instructed by the court psychologist not to ask him anything about the event, so I let him lead the conversation.  He insisted he was allergic to carrots. He then chose a book and I read it to him. He seemed calm. Wish I knew his fate. With friends who lost kids to suicide. It took years for them to talk about it. But rarely. Suicide is shrouded in secrecy shame and lack of language to discuss it.