Warning: This story talks about suicide. If you or someone you know needs help, please call, text or chat the Suicide and Crisis Lifeline at 988. You matter. You are important.

Crystal Cederna is an associate professor in the Charles Stewart Mott Department of Public Health in the Michigan State University College of Human Medicine. She has worked with more than 4,000 youth patients and families and sees a clear need for preventive mental health. Here, she shares insight about how parents and caring adults can help tweens and teens who may be at risk for suicide.

What are the trends in youth mental health?

Surveys of U.S. high school students by the Centers for Disease Control and Prevention, or CDC, spanning from 2013 to 2023 show that poorer mental health is evident in almost every way. Specifically, there were increases in persistent feelings of sadness and hopelessness — to the point that these feelings were reported to negatively impact everyday life. Also, the number of youths seriously considering a suicide attempt doubled in those 10 years. In 2013, almost 10% of teens surveyed had made a suicide plan. In 2023, the rate was 20%. That’s not a level we can ignore.

What are warning signs that might indicate a young person is considering suicide?

Many teens will share with someone — either a trusted adult or a friend — that they’re having thoughts of wanting to die or take their life. Those contemplating or preparing for suicide often feel hopeless about the future. This can show up as having no goals or events they’re looking forward to, struggling to create future-oriented plans, or making gloomy future-outlook statements, such as, “Things will never get better.” They may also think or say things that suggest they see themselves as a burden or that life is not worth living. All of these statements should be taken very seriously.

Clear changes in mood or behavior that last a couple weeks or more are also reason for concern. Does the youth appear more anxious, irritable or sad than usual? Do they show bigger mood swings or have more difficulty managing their mood?

Watch for withdrawal from social activities and activities that were once enjoyed. For example, if your child skips a dance or school event they’d usually love, this could indicate something more is going on. Also, do they spend significantly more time alone or in their room than usual?

Alternatively, a youth may start engaging in more risky or reckless behaviors, such as substance use and self-injurious behaviors.

They may give away prized possessions or write goodbye letters to loved ones.

Another warning sign is searching the internet for ways to harm themself or take their life. If you see a search history on a kid’s device that shows they’ve looked up ways to self-harm or take their life, that would be very concerning.

Things that are red flags include the thoughts, behaviors and feelings above, particularly when paired with recent losses, changes or stressors — like failing an exam, a breakup with a romantic partner or a conflict with a best friend. Research tells us that risk factors are different for each individual based on their relationships and family situation and their community or environment. Some general examples of things that might increase risk for suicidal ideation or an attempt include:

• untreated or inadequately treated mental health conditions like anxiety or depression;
  
  
• a history of hurting themselves or suicide attempt(s);
  
  
• unaddressed stressors, exposure to extreme stress, and/or multiple ongoing stressors for the child, family or their community;
  
  
• access to potential means for self-harm; and
  
  
• lack of access to help and professional mental health services.

Also, adults need to know that sometimes warning signs are too subtle to notice or seemingly nonexistent. Not every child is prepared, comfortable or has a trusted adult with whom to share their struggles or suffering.

How do I approach a youth whose mental health I’m worried about?

If you plan to initiate a conversation about mental health, prepare yourself. First and foremost, give yourself some grace. Having tough conversations is challenging. You’re human and you’re not going to say everything perfectly. That’s okay. Showing you care and are there to help are the most important things.

When you start a conversation with a tween or teen, create a safe space free of interruptions and distractions. Be as free of judgment as possible. Let them know you are there to share your concern. Then listen to learn, not to change their reality or talk them out of anything. Afterward, express gratitude that they shared their experience(s) with you. Assure the youth that you want to support them in getting the help that they need.

Here are some suggestions:

• Sit down and say, “Hey. I’ve noticed some things are different about you lately. Not bad. Just different. How are you? Like really?”
  
  
• If nothing is shared by your child, share what you’re seeing: “I’ve noticed some changes that I’d like to check in with you about.” Then say what you’ve observed. For example, “I'm seeing you not wanting to go to soccer practice. I’m seeing an F on a test in a class you love when you’ve gotten A’s your whole life. I’m seeing your phone pinging away and you’re not checking to see who’s texting you when usually you’d be glued to your phone. This is not normal for you. I’m here with you. I love you. Help me understand what I’m seeing.”
  
  
• As teens share, listen quietly and nonjudgmentally. Using statements like “Tell me more.” or “What does that mean to you?” can help them open up.
  
  
• Thank them for sharing. “It takes a lot to talk about what’s bothering us, at least it does for me. Thank you so much for telling me what’s going on.”
  
  
• Wrap up by expressing your concern and offering to help. “I see and hear you. I would love to support you in getting help.”

By resisting any temptation to deny their reality or treat their concerns as trivial, adults can show youth their reality is heard, legitimate and taken seriously. To them, whatever is troubling them, no matter how small it may appear to an adult, is a big deal.

What if I learn that a tween or teen is seriously considering self-harm or suicide?

A child’s safety is always the first priority. If you know a child is at risk of hurting or trying to kill themself, professional mental health evaluation and treatment are needed as soon as possible. 

If help is needed immediately, do the following:

• Convey a message of acknowledgment, assurance of help and love. Say something like, “I see you. I hear you. We’re going to get you the help that you need. You are loved. You are important. And you are not alone.”
  
  
• Call 911.
  
  
• Do not leave the child without adult supervision.
  
  
• Remove any type of weapon that could be lethal if used. Exactly what you need to remove will depend on what the child tells you they’ve been thinking of in terms of self-harm. It could be: guns and ammunition; cutting implements such as knives, razor blades or pencil sharpeners; or substances like over-the-counter medications, alcohol or illicit drugs.
  
  
• Get the person safely to the nearest emergency room or behavioral health urgent care where they can be evaluated by a professional and given the care that they need.

What should I do if my child needs help but isn’t in immediate danger?

If you’re concerned about possible self-harm but the child isn’t in immediate danger, follow up with a professional who can help develop a treatment plan. A few options include:

• scheduling an appointment with your child’s primary care provider, specifying that you want help with mental health concerns;
  
  
• calling your county community mental health agency and asking to schedule an appointment;
  
  
• taking your child to a behavioral health urgent care provider for evaluation and treatment recommendations; or
  
  
• calling the Suicide and Crisis Lifeline at 988 for support and local mental health referral options.

What if I’m worried about the mental health of a child that isn’t mine?

If you see something, say something. You can reach out to their parents or caregivers directly. Or you can talk to the child. If they confirm they’re having a hard time with their mental health, encourage or help them tell a trusted adult in their life. Say, “Let’s work together and share this with your [mom/dad/aunt/adult brother] so they can help you get the help you need.”

As a parent or primary caregiver, it can be hard to believe that your child has a mental health issue. How can adults get past this hurdle?  

First, understand that you have not failed as a parent if your child experiences mental health issues.

We are amidst a nationwide child mental health crisis. Having a child with suicidal thoughts doesn’t mean there’s something wrong with you or them. It means there’s a need for more support, resources and help to navigate what’s in front of them. This can happen to anyone. And it does.

It’s no one event. It’s no one person. It’s no one cause.

We are living in very challenging times. Kids are multi-stressed, meaning they have stress coming from all sides and angles — from academic and athletic demands to neighborhood and school safety, and from local to global events.

In today’s world, kids don’t always have the skills and resources to talk about mental health difficulties, cope with them or even recognize them. All of this creates a perfect storm. As parents, we like to think we’re all things to our kids. In reality, the older they get, the bigger the radius of influences on their health. Mental health difficulties and suicide don’t happen in a bubble.

What can adults do to keep kids as mentally healthy as possible?

What greatly supports kids’ resiliency is having at least one unconditional source of love and support, as well as a space where they can regularly talk and actually be heard. It does not have to be their parent — it can be any adult in their life.

The space to talk and be heard could anywhere . . . at the dinner table, in the car while driving to practice, along a walking trail or looking out at water. It could be seated on a bench watching cars or people passing. What creates safety is a place where kids feel comfortable to share and be heard —uninterrupted and without judgment.

Kids also benefit when we, as adults, talk about and demonstrate skills related to managing stress and our emotions. These are life skills that need to be taught, modeled and encouraged. They shouldn’t just be something a child learns after there’s a problem and they see a counselor. We need to teach youth how to handle stress and emotions as much as we’re teaching them how to tie their shoes because that’s the world we live in now.

Adults and youth alike can also learn to comfortably speak up when they see something concerning in another person. Let’s say your child comes home from school and they have a disgruntled look on their face. That can be a cue to parents to ask what’s going on. Share what you’re seeing. The more we make it normal to talk about life’s ups and downs and to receive support from those around you, the more normal giving and receiving support will be.

Do phones and online influences have a role in kids’ mental health?

Yes. Almost all teens (ages 13-17) interface with social media. And up to four in every 10 preteens (ages 8-12) say that they use social media too. Social media, the internet and digital apps can be both harmful and protective to kids depending on how they’re used, how often and the amount of supervision in place. However, in general, the more they are used, the more risk there is for poor mental health outcomes. Signs that a child is experiencing negative effects from phone and digital use include:

• missing out on real-life experiences and activities due to screen interference;
  
  
• acting more critical of themselves and others;
  
  
• complaining of being bullied online or their posts “not being liked enough” or “as much” as others’ posts;
  
  
• reporting that they feel isolated or alone, or are having difficulties concentrating; and
  
  
• not getting enough sleep or quality sleep because of device use.
  
  

The mental health outcomes that can come with either too much screen time or unhealthy use of screen time for kids could be symptoms of depression, anxiety, lower self-esteem, poor body image and disordered eating behaviors.

By Maureen Perideaux