Upon hearing about the suicides of Kate Spade and Anthony Bourdain, many are in a state of shock. How could this happen to people who were so wealthy and seemingly happy? Didn’t anyone realize something was wrong? Why didn’t they seek help? However, as a mental health professional, I was not at all surprised. Depression is a powerful force, and one of the largest mental health challenges our country faces.
But suicide is more than just a mental health issue: It is a crisis. According to the Centers for Disease Control, since 1999, suicide rates have increased by 30% in more than half of our states. In the most recent report from the CDC, nearly 45,000 Americans lost their lives to suicide in 2016. Those numbers are, unfortunately, likely to increase in 2017 and 2018.
We’ve recently seen that suicide does not discriminate based on net worth or popularity, but suicide also does not discriminate by age. While some parents might try to avoid discussions of suicide with young children, that’s not always a good idea. Near my community in South Florida, a child around ten years-old recently lost their life to suicide. To deny the facts and reject the impact depression has merely gives depression more power. The idea that we can somehow protect our kids from mental health ailments by stifling the conversation does not stack up to reality. We must make sure our kids, as well as ourselves, are equipped with the tools to understand suicide and mental health so that we are not left confused and unable to respond should they develop a mental illness or think about suicide.
What is Suicide?
Before speaking to our children, we need to understand what we are talking about. Suicide, including suicidal thoughts, plans and actions, is a symptom of a mental health crisis. Threats of suicide are not always “a call for attention” nor “an act of giving up,” but rather the manifestation of severe symptoms of depression.
According to the CDC, more than half of the 45,000 Americans we lost to suicide in 2016, some 54%, did not have a known mental health condition. Many of these deaths were not caused by mental health conditions. Indeed, not only depression but post-traumatic stress, acute stress, substance use, anxiety, insomnia and psychosis are all major risk factors for suicide. Thus, awareness of the warning signs can help more people than we think — and it is the responsibility of all of us to spot these symptoms before they become lethal.
Like many crises, your children will likely hear about news related to suicide through social media, their school teachers or friends. Therefore, it is important to proactively have a discussion with your child to dispel any myths or false facts they may have heard or created with their beautiful and imaginative minds. Know that speaking about the details of suicide will not increase suicidal ideation or contribute to the likelihood of suicide, but could encourage someone who has been contemplating suicide to open up about it.
How Do We Talk About Suicide?
Speaking with children begins with listening. Listen to your child as they speak and listen to their behaviors as well. However, before even beginning the conversation, it is important that you deal with your own reactions and emotions first. You must be strong enough and capable enough to provide help. If you are anxious or overwhelmed, it will be hard for you to carefully listen to the child. Further, your own anxiety and fear may increase theirs. Calm yourself down with mindfulness, deep-breathing techniques or your preferred coping method. Modelling is often times the most effective teaching technique and may increase your connection with your child. Speak to your own friends, family and support system. Consult with a professional if necessary.
Whether you are speaking with a child to understand their own experience with depression or their thoughts and feelings regarding the recent news or their peers, the approach to opening up this conversation is similar. Provide them space to talk and make sure you listen. Ensure that the setting is appropriate and safe. This isn’t a conversation about the school day; this is a conversation about depression and suicide. Invite them to speak with you one-on-one in the living room, or in a more confined space, such as their bedroom. For some, it may be helpful to wait until they are playing a game or playing with a toy.
Speaking With Young Children
In opening up the conversation with young children, start by gathering information to see what they know. A simple open ended question will often work, such as, “What have you heard about (at school or with so-and-so) today?” Following this, you may say a closed statement such as: “J died from depression and I am going to miss him.” During this conversation, it is important to be honest about your feelings. “So and so died yesterday, and I am sad about that.” Finally, treat each child differently and know when enough is enough. No one knows your child better than you do, so trust your instincts if you think the child understands the situation or if you believe you need to speak more. If your child tends to be sensitive to this type of news, then they may need more explanation.
For young children, it is generally best not to provide any further details because this may add to their fear and build the story up in their mind. Your child may absorb this information and create unintended imageries and stories. Thus, one conversation is not enough, and you should always follow-up a few weeks later. This conversation can be minor, such as: “Remember when we talked about so-and-so?” Then see whether they take this further. Sometimes they may respond with a “No, I don’t remember,” or “Yes, that was sad,” and it may be appropriate to move on. Reassure your child that there are resources that can help them feel safe or can help them further explore their thoughts and feelings.
Speaking With Teenagers
The conversation changes slightly when you’re discussing suicide with adolescents. Kids today have more awareness and access to more news than prior generations, and have likely heard the news when celebrities die from suicide just as soon as you have. Pretending that they don’t know about news such as the passing of Spade or Bourdain may lead the child to believe that there is a fear around the topic and increase the stigma and hesitancy they have to speak about the topic themselves. Approach the conversation with the assumption that they do know the details of what has happened — and may also have their own depressive thoughts and feelings. “What have you heard about Kate Spade?” “What do you know about depression?” Sometimes even stating, “Hey, I am here to talk if you need me,” is a good start (though may not be enough). Taking a more direct approach with care such as asking, “I’ve noticed you’ve been a little more sluggish lately; is everything okay?” may be necessary. Use the same techniques mentioned for young children for opening up the conversation, such as honesty, openness and genuinely caring. Allow yourself to show empathy for their experience and be honest with how you are feeling, but remind yourself that this is not about you. Let them lead the discussion and help them identify coping skills and support systems. Finally, as with young children, the conversation never ends and there should always be a follow-up.
When They Don’t Want to Talk
While some children and adolescents may want or need to have a long discussion about suicide and mental health, it’s also okay if they don’t want to speak with you about it. Sometimes they do not want to discuss suicide with you because of the timing or because of their relationship with you. In this situation, closing up the conversation may be as important and helpful as opening it. Know when to back off and allow your child the space they want. To take rejection personally may give the impression that you don’t genuinely care about the individual child. Just let them know that you are available to talk further or are willing to help them find the appropriate space (such as psychotherapy or a guidance counselor) to explore it. If they deny anything is wrong, believe them, and share resources with them as a “just in case,” because you never know if they or their friends might be able to use them. The best thing to do may be to arrange a conversation with someone else, such as a sibling, friend or trustworthy psychotherapist. As always, follow up with a gentle conversation some time after and as often as necessary.
When Your Child is Exhibiting Dangerous Thoughts
What happens when you speak to your child and you discover that they are having suicidal thoughts? First of all, remember that this is not about you. Your goal at this point is to calm them down, assure them that they will be okay and carefully arrange a consultation with a professional for further assistance. If your approach is to genuinely understand the other person, then that sincerity will be received. You are a critical link in their chain to getting the help they need and deserve. As you have opened up the conversation, be prepared to speak about it. Your child may be harbouring some deep thoughts, and, if you are lucky, they will share them with you. If you are having your own reaction, then you must cope with your own emotions, as mentioned above. If the situation becomes critical, consult a mental health professional.
Timing is everything — and so is how you handle the conversation. Responding along the lines of, “I get it” can be invalidating and further alienating. The child may think, “No, you don’t get me after hearing me speak for fifteen to twenty minutes about something I’ve been dealing with for months or years.” Sometimes saying, “I actually don’t fully understand what you’re going through, but I want to hear about it,” instead conveys the message that you want to understand them and their situation and you care about them.
In recent years, there has been an increase in mental health awareness and a decrease in the stigma of speaking about suicide and depression. As Director of Operations for Refuat Hanefesh, an organization whose mission is to decrease mental health stigma —- specifically as it pertains to the unique challenges facing the Jewish community — by increasing knowledge, awareness and, support, I have seen a tremendous increase in attention towards our website and programs in recent months. While certainly helpful, it is not enough to say, “Let’s increase mental health funding!” or proclaim a “National Suicide Prevention Month.” Because of the shame, guilt and feelings of weakness that accompany suicidal thoughts, many people keep their thoughts and feelings to themselves until it is too late. We need to increase genuine, one-on-one conversations about suicide and invite our children, and ourselves, to explore these feelings.