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What to do when your teen has suicidal thoughts.

There isn’t much scarier to a parent than learning that their teen is thinking about ending their own life. As a parent, you want your teen to be healthy, happy, and thriving. But when we see them struggling so much they want to end it all, our hearts pound, our minds race, or we freeze. How can you protect them from themself?

At Joon, we provide therapy to 13–24 year olds every day. So we understand how scary this is for you, how out of control your teen may be feeling, and we can help.

Amy Mezulis, PhD
Licensed Clinical Psychologist
,
Co-Founder & Chief Clinical Officer

Understanding teen suicidality.

Teen suicidality is a complex topic. Teens may be thinking about, talking about, or considering suicide in many ways. These types of suicidality vary in severity, but all should be taken seriously:

  • Passive thoughts about suicide. These can include thoughts such as “What would it be like not to wake up?” or “Sometimes I think I’d be better off dead.” These thoughts do not include any plan or intent to make a suicide attempt.
  • Active thoughts about suicide. These can include thoughts such as “I would like to die” or “I could end my life by ____________.” These thoughts include a plan and/or intent to make a suicide attempt.
  • Suicidal behaviors. These can include actions that suggest preparing for suicide, such as writing goodbye notes, collecting pills, or practicing the steps of a suicide attempt. 
  • Suicide attempt. This is any action that is undertaken with the intent to die. 

Discovering that your teen is considering suicide is terrifying. One thing is clear: your teen needs urgent help and mental health support.

Is it time to get support for your 13-24 year old? We’re here to help.

Why would my teen be suicidal?

There is no one reason why teens have suicidal thoughts or make suicide attempts. Suicidality, unfortunately, is common in adolescence. These are some of the most likely underlying reasons that teens may be thinking about suicide:

  1. <h3>Depression or other mental health problems.</h3>

Suicidal thoughts are common when teens are depressed. They may range from fascination with death to passive suicidal thoughts to active suicidal thoughts or plans. While suicidality can be present in any major mental health disorder, depression is the most common mental health problem among suicidal teens.

  1. <h3>Loneliness, emotional distress, or hopelessness.</h3>

Experiencing loneliness, social isolation, or feeling constantly emotionally overwhelmed can sometimes make a teen think they’d be better off dead. When these distressing feelings persist over time, teens can become hopeless that they will ever feel better.  Suicide becomes a way to escape their emotional pain.

  1. <h3>Loss of a loved one, especially if that loss was by suicide.</h3>

Teens who have experienced a recent loss are likely to experience severe distress and may consider suicide as a way to escape that distress. Teens who have lost a loved one or friend to death by suicide are especially vulnerable to considering suicide themselves because it makes suicide seem like a solution to their pain.

What are risk factors or signs to watch out for?

Many teens struggle with depression, loss, or emotional distress and are not suicidal. How can you tell if your teen is at elevated risk of suicide beyond their mental health symptoms? Here are additional risk factors to watch out for:

  1. <h3>Talking about suicide or wanting to die.</h3>

If your teen expresses suicidal thoughts or intent to you directly, take them seriously.

  1. <h3>Engaging in self-harm.</h3>

Self-harm is a risk factor for suicide because it can increase pain tolerance and decrease fear of death. (You can also read our Parent Guide on Self-Harm.

  1. <h3>Access to methods, especially guns.</h3>

Having easy access to suicide methods increases the risk of suicide. Teens who are distressed or suicidal should not have access to pills, knives, guns, or other potentially lethal materials.

  1. <h3>Substance use.</h3>

Substance use impairs decision-making and can lead to impulsive behavior, increasing the risk of suicide. 

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What to do if your teen is suicidal.

Finding out that your teen is suicidal can feel overwhelming. Here are some clear steps to follow that you begin right away:

  1. <h3>Talk to them.</h3>

Asking about suicide does not increase the risk of suicide. You cannot “put the idea in someone’s head” by asking if they are suicidal. In fact, just the opposite—asking matter-of-factly if your teen is having or has ever had thoughts of suicide is the first step in identifying risk and getting them support. Asking directly might sound like, “When people are as upset as you seem to be, they sometimes wish they were dead. I’m wondering if you’re feeling that way?” Or simply, “Are you thinking about killing yourself?” If you find these words hard to say, practice aloud first.

  1. <h3>Take them seriously.</h3>

Even if you believe it’s a “phase” or that your teen is “being dramatic”, it’s always important to take suicidality seriously. Remember that attention-seeking for mental health support is not negative - it is a way for your teen to communicate their distress to you.. Express to your teen that you will remain consistently attentive to resolving this until they are safe.

  1. <h3>Get mental health support.</h3>

Suicidal thoughts, plans, or behaviors are a clear indicator that your teen needs mental health support. If your teen is immediately at risk, seek emergency support (see below for a list of resources). If your teen is not immediately at risk, seek therapy that is specifically oriented to teens and young adults, and that relies on evidence-based treatments, like DBT, that have shown effectiveness in treating suicidality among teens.

Does my teen need to be hospitalized?

If your teen has active suicidal thoughts with a plan and intent to die, they likely need an intensive or inpatient treatment program.  

If your teen refuses to cooperate with a safety plan or demonstrate their intent to keep themselves alive and safe, they likely need an intensive or inpatient treatment program.

If your teen has passive suicidal thoughts and no active suicidal plan, they may be adequately supported by outpatient therapy. As discussed above, outpatient therapy for suicidality should include evidence-based treatments such as DBT which work directly to reduce suicidality. Teens with any level of suicidality should have a current safety plan and demonstrate a desire and intent to keep themselves alive and safe.

If you are unsure if your teen needs an intensive or inpatient program, consult their pediatrician or therapist to get their recommendation.

If your teen is immediately at risk, call 911 or take them to the emergency room. Most ERs have a crisis response team to evaluate your teen’s safety and make treatment recommendations. 

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Therapy Works for Teens with Suicidal Thoughts

There are evidence-based therapies for suicidal teens. Dialectical Behavior Therapy (DBT) and Cognitive Behavior Therapy for Suicide Prevention (CBT or CBT-SP) have both been shown to reduce suicidal thoughts and behaviors and to prevent suicide attempts. 

At Joon, about one-third of clients have suicidal thoughts and/or are engaging in self-harm when they start treatment. Their therapist will do a full safety assessment at the first appointment and create a safety plan if necessary. Then the therapist will work with your child to recognize the thoughts, feelings, and behaviors related to their suicidality and develop more effective coping skills for handling difficult thoughts and emotions. For example, they’ll get better at recognizing when they are feeling overwhelmed, lonely, or hopeless and when they start having thoughts of suicide. They’ll learn more effective coping skills, such as self-soothing, asking for help, and reframing negative or self-critical thoughts. Finally, therapy can help teens build strengths and identify reasons for living.

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