Teen Suicide Prevention- A Holistic Approach

For our beloved Ava.

Generation Z to Generation C for Covid

This is an extremely difficult subject to talk about and in fact, I have waited two years to write this article. A lot of us didn’t realize the impact that Covid had on our teens. They had been in isolation for so long without friends, without sunlight, locked into online remote classes, often times without proper nutrition or any exercise. Because we all couldn’t go out, many teens became clinically depressed with suicidal ideation, attempts and unfortunate deaths. In fact, many states and nations had declared a state of emergency for the intense uptick in teen suicide.

I am raising a teenage daughter, and so many of her friends became clinically depressed and that makes sense. It’s already hard enough to go through the normal teen developmental/hormonal process, and then we had years of isolation where the children were homeschooled. Our children had academic pressure and had to learn from remote learning, but many had absolutely no joy- no dating, dances, proms, after school sports. These children were sadly deprived of what we before them, took for granted.

Then, on the news, we were just hearing about millions dying from the disease, we were living in fear for our very survival and listening to our vitriol laden then-president Donald Trump. With so much constant toxicity and I can see why due to the culmination of these events, young people felt that life wasn’t worth living anymore. I am so grateful that we have moved past the pandemic, and I hope that we never shut down schools again because that caused significant, possibly irreparable damage to teens and children by missing out on essential socialization, education and health benefits of having access to community, fresh air, exercise, and play.

The Second Leading Cause of Death

Even though the pandemic has subsided, the problem with depressed teenagers and suicidal ideation or suicidal attempts is still a grave emergency. According to the National Alliance on Mental Illness (Nami), suicide is the second leading cause of death for youth and young adults ages 15-24. Only accidents take more lives in this age group. It can be difficult to imagine that life could be so painful for a child that they would believe that suicide is their best option, but the rate of suicide among children ages 10-14 has risen to the 2nd leading cause of death among this age group.

Media Addiction

Our children spend oftentimes all day on electronics, even now. In fact, the DSM is considering the fact that many of us are on our cell phones and computers all day to be a diagnosable form a very severe addiction called Media Addiction. They already have Internet Gaming Addiction, (IGA) and there are actual 30 day residential treatment centers for kids to go to learn life skills without being on the computer. And, we can’t really reprimand our children and tell them to go outside and play, and find other non-electronic means of community and entertainment if the parents are also, admittedly, modeling electronic addiction to: television, desktops, cell phones, Kindle readers and iPads.

Just this week, the country of Australia has banned all social media for all teenagers under 16, because it is deemed to be socially, emotionally and developmentally harmful. And it is not just social media, it is also parents not being aware of what the children are watching and are exposed to. In fact, in 2017, Netflix published a controversial miniseries called The 13 Reasons Why. It gives an intense and violent graphic account of a girl that decided to die by suicide and actually filmed a method of how to do this. According to a study published in Journal of the American Academy of Child and Adolescent Psychiatry, this miniseries was associated with a 28.9% increase in suicide rates among U.S. youth ages 10-17. Many parents, including myself, and my husband expressed concern to legislators, and to Netflix to remove this miniseries but it was such a moneymaker that our concerns were ignored and “copycat” teens continued to take their lives. Two years later, after many teens attempted or succeeded in suicide, they did remove the most egregious scene.

Recognizing the Need for Help

However, this all can be turned around. With awareness and intervention, we can offer our children support to get through this difficult time. There are proven steps of treatment that can help teens to recover and heal and have tremendous hope for the future. First and foremost, it requires parents, friends and caregivers to be aware of the signs of clinical depression, and to be able to have forthright conversations about depression, safety and well-being and even to talk about suicide. It would be helpful, just like many of us are trained in First Aid and CPR, if more of us get trained in Teen Mental Health First Aid. This program is oftentimes offered low cost or for free if you are involved with an academic institution or care community. The training can sensitize us to look for possible signals of children being in trouble and help to provide resources for where they could go to get help.

Warning Signs

Some of the signs of clinical depression or danger in children can go unrecognized by parents and the school system. Teens might be more quiet, listless, socially anxious, withdrawn or more argumentative and belligerent, and possibly even exhibit violence. They may be participating in drug and alcohol use, cutting or other self-harming behavior, and hiding it from their parents. They may stop caring for their personal hygiene, cleaning, or eating well and they may not have any more care about accomplishing their assignments and they stay home from school more often, or even drop out.

They occasionally mention something about hopelessness and drop hints about existential views about what happens after they die or what would happen to a pet if they were not around anymore. They may begin to give away things, and talk about or act as though they don’t care anymore. If they mention thoughts of suicide, believe them, take them seriously, and get them urgent help. If you are a friend, don’t worry about offending them, or hurting their feelings, you must report them to be professionally assessed for safety. Check to see if your state has a Safe To Tell, call the National Suicide Prevention Lifeline by dialing 800-273-TALK (8255), or 988.

One of the most challenging things for parents who experience their teen struggling is to find out how to help. Oftentimes, parents who have a child that is struggling will start to argue with their child and punish them and threaten them. We have the best of intentions and it’s so hard to know what to do when we see our children failing to thrive. We may not recognize the signs of danger and clinical depression and our punishment and argumentativeness can make everything much worse. We can lose open communication and trust between the teen and the parent, and once that is broken, it’s very hard for the parents to provide any support.

One of the first things that is suggested if your teen is struggling significantly, is to set up an appointment with the school counselor. Sometimes, teens may disclose more intimate details with someone neutral rather than a parent, and friends can attest to any concerns. After the teen and the school counselor meet alone, then you can set up a follow up meeting and include the parents and create a treatment plan.

A Temporary Problem

I had one of the most heartbreaking experiences in my life. I participated in a funeral of a 16-year-old girl who I knew since she was five years old. There were about 300 people at the funeral, and there was not one dry eye. The mom and the dad said that this was inconsolable, and they cried every day they sought help from other parents, whose children had taken their lives. They wanted to give back to prevent other children from making that decision. These were the three slogans that I took away from the funeral that were so poignant. I wanted to offer them to any other parents that might have a struggling teen and actually forthrightly tell them these things now, even if they are not in crisis. I remember talking to my daughter about suicide just casually to pre-prepare her if there was ever a time that she felt hopeless.

“You can think whatever you want, but don’t act, ASK FOR HELP.”

 

“Suicide is a permanent solution to a temporary problem.”

 

“If you think the pain will go away by you taking your life it won’t, it just get transferred to your family friends and everyone that knows you, and they have to live with it for their rest of their lives.”

Skills Before Pills… Unless

If it is determined that your child is in danger and has been having suicidal ideation, clinical depression, cutting, intrusive thoughts, and needs help, you may then consider making appointment with a provider like a children’s psychiatric nurse practitioner. I would find one that is not a proponent of major polypharmacy, but one that would help to support them with behavioral life skills and cognitive reframing, rather than just only medication.

Of course, many people are rightly opposed to giving teens and children psychiatric medication. I’ve always felt that diagnosing our children with permanent diagnosis like: ADHD, Generalized Anxiety Disorders, Eating Disorders, Dysmorphia, gives them a lifetime stigma when oftentimes their problems are situational or temporary and by the time they go through the hormone changes in the adolescence, many of them recover with proper support and grow out of whatever challenges they experiencing now.

I do believe, however that if children are in crisis, sometimes medication can be of benefit. I love the adage “Skills Before Pills” but sometimes people need the pills temporarily, to offer support and a respite from their issues and time to build the skills needed for recovery. The decision to medicate should not be taken lightly, and please find a provider that you trust. I would also find a provider that has some experience and expertise in de-prescribing. That is- once the teen is out of danger and has begun to recover and rebuild their lives, they can slowly taper off of medications under the close care of a provider that has experience in doing so.

Accessing the Need for Care

So let’s go through the steps of what is available if your child is struggling with clinical depression, suicidal ideation, or suicide attempts. The very first step is to recognize that your child might not just be having normal “difficult teenage” depression, but that they may very well be in danger. Seek professional help through a school counselor or a trusted therapist who is proficient with teen safety issues.

Hospitalization

If the teen is in imminent or acute danger, e.g. cutting, verbally saying that they want to end their life, or if there was a suicide attempt, they should be taken to a hospital for a comprehensive psychiatric evaluation and may be admitted for a 72 hour hold or longer.

Cutting

Some children who are in acute emotional distress or anxiety, will take a sharp object like scissors or knives and cut themselves, usually on the arm or leg until blood is drawn. One provider suggested that cutting is actually a bizarre form of self-care, even though it is exceedingly frightening to friends and family. People who cut claim that the cutting actually prevents them from taking steps to to kill themselves and it displaces the amount of emotional and psychological pain that they’re in. There is always the concern that the act of cutting might go too deep, and a major artery might be struck, and a child’s life could be in danger, even though that was not the original intention. So all children should be educated about the dangers of cutting and given alternative methods that are safe. One method is get some ice and place the ice on the inner arm or on the forehead. This can offer that same type of emotional displacement, without without harming the body. Other things that might work are really spicy candies like hot tamales, or fireballs. Here is a powerful list of alternatives to self harm.

Safety Contracts

If the child is discharged from the hospital or deemed not to be in any imminent danger, your provider may suggest what is called a safety contract. That is a written agreement that the child will be at home, but will promise to not harm themselves in anyway or have any active attempt to take their life. They instead, would reach out to their parents or their providers. It is essential to remove any pharmaceuticals from the home and lock up any knives and scissors as part of creating safety in the home.

Parents will be requested to monitor the child, or have a supportive friend or relative come to make sure that they are monitored at all times and even even sleep in the same room until they are out of danger. This is called wraparound care, and is essential but can be hard for families. Part of the safety contract is that you ask the child how they feel on a scale of one to 10 in terms of danger or hopelessness, and regular check-ins are part of the process.

It is important for the parents, even though this is exceedingly stressful and painful, to provide a sense of hope and strength to your child. You can be a loving and soothing presence and reassure them that what they are going through will be temporary, and they are not alone. During this time, try to find things to distract and find joy: cook nutritious meals together, bake a dessert, go on walks together, go shopping, clean and redecorate their bedroom, use “energy medicine” like massage, meditation and acupuncture. You’d be surprised how much a child can recover with the parent’s simple love and presence.

Residential Care

If your providers suggest a higher level of care as a step down from being in danger, or from being in the hospital, they may suggest a 30, 60 or 90 day residential program. Here the children can be away from family stress, or social stress, if they have been involved with drugs or alcohol, and need an immersive recovery program. I would be very careful and vet the facility that you choose because the quality of care and treatment of the teenagers varies substantially. Your insurance may cover residential care but often times you have to pay privately or use out of network benefits for some of the better facilities. You may want to type in to Google the term “holistic teen residential treatment” there are quite a few in California that have great reviews. Some focus on substance use disorder, and some specifically for behavioral health issues, and most of them treat co-occurring disorders.

If the child is afraid to go, refuses to go or noncompliant, I personally would not do the interventionist method where you trick your child and don’t tell them that they’re going and entrap them on a plane. This could cause irreparable trust issues, and terrify an already struggling child further. They may feel abandoned and groundless, and that may exacerbate suicidality. If residential care is needed, I believe that it is best to work with your providers to convince them to go voluntarily if possible. You want them to be willing to be able to be treated and if they are admitted in involuntarily they may not be successful.

*A word of caution. A lot of times our teens are dealing with gender identity issues, LGBTQ issues and body/gender dysmorphia. Some of these residential treatment centers, especially some in Utah, are religious fronts for conversion therapy and do not support teens struggling with these issues. Please always very carefully vet the organization, and read all reviews from all sources, and maybe even speak to someone who attended the facility prior to committing. The facility themselves, by law will never disclose that they are practicing conversion therapy so it is up to the parents to do their research.

P.H.P. and I.O.P.s

A PHP is called a partial hospitalization program and an IOP is called an intensive outpatient program. These are either done in person or remotely and are considered step down care from either hospitalization or residential care. They consist primarily of group therapy under the care of a licensed professional counselor and may include access to a provider. You are in a supportive environment with other people struggling and are taught resiliency skills and psycho-education skills to help to recover.

Immersive Ambulatory Therapy

Once it is deemed that your child is out of danger, and they can be safe in the home, your provider may suggest immersive therapy maybe once, or twice a week. The therapy can tailor to the personal issues that your child is going through and can also include the family in the treatment process. Here your child learns how to care for themselves during times of stress, overcome anxiety and learn healthy resiliency skills.

Holistic Life Skills

In order for our children to recover, it will require a monumental life overhaul if they’ve gotten into a point where they’re in danger. There is not simply one remedy like putting them on Prozac that will fix teen clinical depression. They must begin to make better self care choices with their diet and eat healthier, nutrient dense foods, minerals and proteins. They must limit time on electronics and go outside and have fresh air, sunshine and exercise. They must have supportive friendships and relationships, and develop a supportive working relationship with their parents if possible. Any type of trauma that they’ve experienced must be processed over time with patience and expert support. Children must begin to believe that they are good and believe that their life is worthwhile and their future has hope. As parents and caregivers, it is our love and strength that is imparted to them. This can’t be done through heavy-handed punishments, but from support and belief who they can become. For parents who are struggling with teens in crisis, there is a invaluable free class through Nami that you can sign up for here:

 

Conclusion

Preventing teen suicide requires a holistic, comprehensive, compassionate approach that addresses the many factors contributing to this crisis. By recognizing the signs of distress, fostering open communication, and providing access to professional help, we can create a safety net for our children. Holistic strategies—combining emotional support, life skills, proper nutrition, physical activity, and reduced reliance on electronics—are essential for fostering resilience and recovery. Kids can and do recover, this is not forever!

This work begins at home, with parents and caregivers leading by example and creating a nurturing environment with warmth and open communication. Wellness extends to communities, schools, and professional networks, where collaborative efforts can provide the resources and support teens need to thrive. Above all, we must remind our children that they are valued, loved, and not alone in their struggle. Together, we can help them see that life is worth living and that hope is always within reach. Be safe everyone, and well wishes.

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Sources:

Photo by Helena Lopes: https://www.pexels.com/photo/four-person-standing-at-top-of-grassy-mountain-697244/

https://www.cdc.gov/nchs/products/databriefs/db37.htm

Nami Class: https://basics.nami.org/courses/nami-basics/lessons/lesson-1-introduction-2/

Australia Bans Social Media for Teens: https://www.nytimes.com/2024/11/28/world/asia/australia-social-media-ban-law.html

Disclaimer: This is an opinion piece from peer lived experience, and not to be substituted for professional and/or medical care. We receive no commissions or referral fees from this article and do not endorse any method or organization and waive all liability for errors or omissions. This article and all contents here-within are for educational purposes only.