For many adults, talking about suicide with a teen can feel daunting. They might fear planting the idea in the teen’s mind, even though research shows that simply asking about suicidal thoughts or feelings doesn’t increase a person’s risk of taking their own life. Then there’s the language. Should the conversation be casual or serious? Should it include the latest TikTok lingo? Perhaps most worrisome is what to do if the teen indicates they do feel suicidal. Suddenly, the adult is thrust into a high-stakes situation, possibly unsure of how to help the teen they love.
While these fears are understandable, parents, caregivers, and other caring adults should know that certain resources can take the guesswork out of asking a teen about suicide. Doctors use a questionnaire known as a universal screener to accurately assess suicide risk, which adults can adapt for conversations with teens. In addition to consulting a trusted health care provider for help, adults can reach out to local and national mental health organizations that offer referrals or search tools to help locate professional and informal support (more about these resources below). Crisis lines also connect callers or texters to services, and that includes aiding adults concerned about a teen.
Alex Karydi, a therapist with expertise in suicide prevention, says adults can learn the symptoms of youth suicide risk, rely on a mental health screener to guide a conversation with a teen, and plan next steps in advance should the teen indicate they’re suicidal.
Symptoms of a suicidal teenager
Karydi recommends that adults frame youth suicide risk as part of childrens’ overall health and well-being. Parents, for example, are taught to call a pediatrician if their child has a high fever or other worrisome symptoms. Similarly, adults should seek help if they notice signs of emotional or psychological distress in a child they love.
“The first step is not to create a divide between the body and the mind,” says Karydi, who leads technical assistance for the Suicide Prevention Resource Center’s States and Communities Initiative, and urges adults to take a holistic approach to a teen’s health that views mental health as equally important as their physical well-being.
Yet even with a holistic approach, some adults might struggle to distinguish between normal teen behavior, like being irritable or moody, and behavior that suggests heightened suicide risk. Seeking out sad music or movies can be cathartic or fulfilling for teens, and doesn’t necessarily indicate suicidal thinking, says Karydi. However, if a teen begins to over-identify with a fictional character who attempted or died by suicide, that may increase suicidal thinking through a process known as contagion. Karydi cites the Netflix young adult series 13 Reasons Why, in which the female teen protagonist dies by suicide, as a prominent example. Not everyone exposed to media and entertainment with graphic messages about suicide are susceptible to contagion, but youth are particularly vulnerable.
“If a kid is watching [13 Reasons Why] and is looking at that girl’s experience, and is saying ‘That is me. I am her. I can’t get out of it, like she couldn’t get out of it…they start to over-identify with certain personas or identities out there that really end in death or increased suffering,” says Karydi.
Other signs of suicide risk include increased substance use, trouble at school, social isolation, withdrawal from friends and enjoyable activities, conflicts with parents and caregivers, and angry outbursts. Teens might spend time online researching websites with depressed themes or forums where users talk about suicide. Some may even say things like, “I don’t want to be here anymore.” (To learn more about risk and protective factors for suicide, visit the Centers for Disease Control and Prevention.)
Teens who self-harm aren’t necessarily suicidal, says Karydi. Instead, they’re using a maladaptive coping skill to deal with overwhelming emotions, since the self-inflicted physical pain can counterintuitively provide relief from intense feelings. Yet, self-harm can be ritualistic behavior that makes a teen more comfortable with blood or pain, and thus, increase their suicide risk. Karydi says it’s not a “big leap” for a teen who’s been self-harming to consider taking their own life.
Questions to ask a suicidal teenager
Adults who notice these symptoms should absolutely ask a teen about suicide. The American Academy of Pediatrics also recommends that physicians conduct suicide risk screening for all adolescents ages 12 and older, regardless of whether adults have noticed warning signs. While AAP urges physicians to screen their patients, some doctors may not follow this guidance. Additionally, more than 4 million children lack health insurance and may not have access to regular checkups. Teens might also feel more comfortable sharing suicidal feelings with a trusted adult.
Caring adults who want to assess a teen’s suicide risk can adopt screeners with straightforward questions. Adults can take an empathetic approach, explaining to the teen that they want to have open conversations about mental health, or that they’re concerned for the teen’s well-being based on recent observations. They should also be sensitive to factors that can increase suicide risk, like bullying, discrimination, and historical trauma. What may seem insignificant to someone with a different background, identity, or life experience can drive suicidal thinking and behavior for others.
To help guide a conversation about suicide, Karydi recommends a caregiver handout created by the Columbia Lighthouse Project, a suicide-prevention initiative led by researchers at Columbia University.
This screening contains six questions with specific instructions on whether to ask all of them. These are the first two:
1) Have you wished you were dead or wished you could go to sleep and not wake up?
2) Have you actually had any thoughts about killing yourself?
Adults can ask the subsequent questions in the handout based on responses to the first and second.
Karydi also recommends the Ask Suicide-Screening Questions (ASQ) Toolkit. Funded by the National Institute of Mental Health and validated as accurate by researchers, the ASQ screening tool is a set of four short questions to ask:
1. In the past few weeks, have you felt that you or your family would be better off if you were dead?
2. In the past few weeks, have you wished you were dead?
3. In the past week, have you been having thoughts about killing yourself?
4. Have you ever tried to kill yourself?
A “yes” answer to one or more of these questions indicates heightened suicide risk.
What to do if a teen says they’re suicidal
Karydi says it’s important for adults to stay calm and avoid panicking if the teen answers these questions affirmatively. When a suicide attempt is underway or imminent, Karydi says adults should go to the emergency room with the teen — or call 911 — immediately to seek care. If the teen shares that they’ve thought about suicide, Karydi recommends asking if they’ve developed a plan. When the teen names a method or location, it’s vital that the adult disable the means, or limit access to it. That can include restricting medication, firearms, and other fatal means. The adult should consult a mental health professional, such as a therapist, psychologist, or psychiatrist, about obtaining urgent support and treatment for the teen.
Karydi says adults and teens should take advantage of services like 988 Suicide & Crisis Lifeline, The Trevor Project, and the Trans Lifeline, which connect callers and texters to trained listeners who can de-escalate the situation and provide information about local mental health support.
Adults may underestimate the resources available to them, Karydi says. If the adult or teen lacks access to a trusted health care professional who can make referrals, Karydi recommends talking to a school counselor, youth counselor, or supportive faith leader, who will have their own suggestions. (Ideally, these professionals will be empathetic and avoid judging or stigmatizing what the teen and their adult are experiencing.) County- and state-based mental health organizations can also provide information about accessing care. Mental Health America, a national nonprofit organization, has a comprehensive list of resources for how to find therapy. Adults interested in the best practices for treating youth suicidal thinking and behavior can review this guide created by the Substance Abuse and Mental Health Services Administration.
While therapy can be vital for youth, it may be out of reach because of the cost or the shortage of mental health professionals. Karydi says adults should think creatively about ways to boost a teen’s connectedness, which helps reduce suicide risk. This may include findings ways to fulfill a teen’s desire to belong to a peer group at school, gain acceptance from friends and family, be part of an athletic team, or participate in religious activities.
Adults can help teens identify healthy choices that help keep them safe and alive — and then ensure the teen follows through. While this won’t necessarily treat underlying mental health conditions that influence suicidal thinking, or fundamentally change life circumstances that make someone more vulnerable to suicide, it can improve their sense of belonging. In turn, that can lead to improved happiness and well-being, as well as reduced anxiety, depression, loneliness, and suicidal thoughts.
“We always want to help [a suicidal] person reengage, connect, to feel a sense of belonging,” says Karydi.
If you’re feeling suicidal or experiencing a mental health crisis, please talk to somebody. You can reach the 988 Suicide and Crisis Lifeline at 988; the Trans Lifeline at 877-565-8860; or the Trevor Project at 866-488-7386. Text “START” to Crisis Text Line at 741-741. Contact the NAMI HelpLine at 1-800-950-NAMI, Monday through Friday from 10:00 a.m. – 10:00 p.m. ET, or email [email protected]. If you don’t like the phone, consider using the 988 Suicide and Crisis Lifeline Chat at crisischat.org. Here is a list of international resources.