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Adolescents and Suicide Prevention: A Guide for Clinicians

The teenage years are often marked by profound emotional and developmental shifts. Teens today are grappling with not only the timeless struggles of identity, acceptance, and performance pressures, but they are also learning to navigate an increasingly complex digital world, socio-political shifts, and the aftermath of a global pandemic.

According to the National Alliance on Mental Illness, suicide remains a pressing concern for adolescents. Nearly 20% of high schoolers report having serious thoughts about suicide, and 9% admit to a suicide attempt. Additionally, the CDC lists suicide as a leading cause of death for young people ages 15 to 19.

As the rates of depression, anxiety, and, unfortunately, suicidal ideation rise for this demographic, there’s a growing need for mental health professionals to be adept in teen suicide prevention and have a strategy in place to support the mental well-being of struggling adolescents.

Understanding the Warning Signs of Suicide in Teens

quick facts on teenage and youth suicide infographic

Treating teenagers exhibiting suicidal behavior presents unique challenges for a mental health professional. Many teens are reluctant to fully express their internal struggles, and what might appear as defiant or moody behavior can sometimes be a manifestation of intense emotional turmoil.

Additionally, teens may be faced with external pressures that have a profound impact on their mental health and increase the risk for youth suicides, including academic performance, peer relationships, major life decisions, and newfound independence.

What might be easily dismissed as “typical” teenage angst could, in fact, be a cry for help. For clinicians who play a role in youth suicide prevention, it’s essential to understand the nuances of adolescent behavior and recognize common suicide warning signs.

1. Drastic Changes in Behavior, Mood, or Appearance

Every teen undergoes change; it’s part of the journey to adulthood. However, abrupt or extreme changes, especially those that seem out of character, should raise concern. For instance, a consistently top-performing student suddenly seeing a dip in grades, or an outgoing teen becoming withdrawn and quiet, warrants attention. Similarly, neglect in personal hygiene or an unexpected shift in dressing style might be an outward reflection of inner turmoil. Self-harming, substance abuse, changes in physical health, and previous suicide attempts are other major signs that professional help is necessary.

2. Pulling Away From Loved Ones or Once-Loved Activities

Teenagers often seek independence and might distance themselves from family to establish their identity. However, there’s a marked difference between a teen craving space and one who is consistently seeking isolation from friends and family. If a teen who once spent every weekend with friends starts making excuses to stay home or begins frequently withdrawing into their room, it could be a sign of deeper issues.

3. Expressing Feelings of Hopelessness or Despair

While it’s not unusual for teenagers to occasionally feel overwhelmed by the world around them, frequent or intense expressions of hopelessness can be a serious red flag. Statements like “I can’t see a way out,” “Nothing matters anymore,” or even more direct comments about not wanting to live should be taken very seriously. They could indicate underlying mental health issues such as depression or anxiety, which are significant risk factors for suicide.

Building Trust With Adolescents

Teens can have a difficult time processing and coping with difficult emotions. If they’re experiencing suicidal thoughts or behaviors, they might not know who to turn to or fear the repercussions. While teenagers may feel more comfortable opening up to their peers, they are often more anxious about how their parents or other adults will react to their scary and overwhelming thoughts.

For this reason, it’s essential that clinicians strive to build trust with adolescent patients and create a safe space where they can explain how they’re feeling without judgment, overblown reactions, or invalidation. While there are many factors that can impact the therapeutic alliance between clinicians and adolescents seeking treatment, there are several ways mental health providers can play a role in suicide prevention for teens and pave the way for productive therapy sessions:

  1. Active Listening: More often than not, teenagers feel that their feelings are downplayed or misunderstood. By actively listening, without interrupting or prematurely offering solutions, we communicate that their feelings are valid. This kind of undivided attention sends a strong message: “I’m here for you, and what you say matters.”
  2. Removing Judgment: Being a teenager is a time of trial and error. They’re at a phase where they’re figuring things out, making mistakes, and learning from them. Many teens have experienced harsh judgment from others, whether it’s failing to meet the high standards of adults in their lives or not fitting in with their peers. By approaching them without prejudice and supporting them for who they are, blemishes and all, we create an environment where they feel safe to share without the fear of reproach.
  3. Keeping Consistent: Trust is not built overnight. It’s the result of consistent behavior and effort over time. By being a stable presence in what might be a tumultuous environment goes a long way in fostering trust with teens. Even small acts, like remembering details from previous conversations, can show them they are important and cared for.
  4. Empowering Teens: Allowing teens to have a say in the decisions that affect them, acknowledging their insights, and giving them a platform to voice their opinions can be incredibly empowering. It not only boosts their self-confidence but reinforces the idea that they are valuable contributors to their healing process.
  5. Maintaining Confidentiality: For clinicians, maintaining confidentiality is fundamental to the therapeutic process. Adolescents need to know their discussions are private and will not be disclosed without their consent, barring situations where their immediate safety or the safety of others is at risk.

Engaging Parents in the Therapeutic Process

In early childhood, the bond between a parent and child is foundational, laying the groundwork for an individual’s emotional, social, and psychological development. Yet, during the challenging teen years, this relationship can be strained, filled with misunderstandings and uncharted territories.

It’s a difficult and confusing time not just for the adolescent but also for the parents. As they watch their child grapple with suicidal thoughts or behaviors, it can evoke immense feelings of helplessness and frustration. Additionally, how a parent responds to their teen’s mental health issues can have a major impact on their child’s willingness to seek help and treatment outcomes.

Equipping Parents With Knowledge & Tools for Support

As clinicians, bridging this bridge can be one of our most impactful interventions. Often, the first step is educating parents on the many factors that contribute to mental health – including genetics, brain chemistry, early life experiences, environmental influences, and lifestyle choices.

Clinicians can help parents learn to identify the signs of suicide, teaching them how to differentiate between typical teenage mood swings and deeper emotional distress. They can also provide parents with workbooks, coping strategies, conflict resolution, effective communication techniques, and other resources to empower parents on their parenting journey.

Encouraging Parents to Find a Support Outlet

An emotionally healthy parent is in a better place to help their teen. If parents become overwhelmed, depressed, or angry about their child’s struggles, they will fail to be a pillar of support and understanding for their teen during this time.

Clinicians can urge parents to consider their own needs and find support. This can look like joining a support group for parents of teens, addressing their emotional needs and struggles with individual therapy, or considering family therapy sessions where they can learn and walk through issues alongside their teen.

Addressing Confidentiality and Boundaries in Treatment

Many parents will feel stressed, confused, and nothing short of distraught when bringing their child to therapy for suicidal thoughts or behaviors. While they know their teen is struggling, they might not understand the cause or assume that it’s their fault. Above all, they want answers.

As a clinician, it can be challenging to balance respecting the teen’s need for confidentiality and parental involvement. It’s important for parents to understand that while their involvement is paramount and no one’s goal is to keep them in the dark, teens need a safe and private space to dig into these issues. The adolescent must have the confidence that what they share with their clinicians remains confidential unless there’s a risk to their safety.

It’s a delicate balancing act. While parents should be actively involved in understanding and supporting their child’s mental health, they also need to give them the space to grow, make mistakes, and learn. Clinicians play a pivotal role in guiding parents on when to step in and when to step back.

The ideal situation is a triad of trust between the clinicians, teens, and parents. While this scenario is not always possible, a collaborative approach, where each party understands their roles and responsibilities, often produces the best results for struggling teens.

Confronting the Teen Suicide Stigma

Although teen suicide is a prevalent and growing issue, the topic is complicated by silence, misconceptions, and prejudice. Unfortunately, stigma prevents many teens from seeking help even when they’re at their most vulnerable, and others — including peers, teachers, and parents — may be judgmental or lack understanding.

As clinicians, we bear the responsibility to challenge these misconceptions and create an environment where discussing suicide and mental health becomes a norm, rather than an exception.

Promoting Open Conversations

By creating non-judgmental therapeutic environments where adolescents feel safe to express their feelings without fear of ridicule or misunderstanding, clinicians set the stage for genuine healing. Clinicians can also spearhead or support awareness campaigns in schools, communities, and online platforms. These campaigns can be instrumental in debunking myths, sharing facts, and highlighting the importance of early intervention.

Growing Suicide Awareness With Teens

One of the most powerful tools against stigma is knowledge. By educating young clients about mental health, we equip them to advocate for themselves and others. Additionally, peer support can be instrumental in helping teens manage mental health issues and suicidal thoughts. By fostering peers support groups and programs, clinicians help reduce stigmas while helping teens to find solidarity and understanding.

Practicing Self-Care for Clinicians

Clinician burnout is on the rise, and tirelessly working with teens struggling with severe mental health and suicidal ideation can be overwhelming, to say the least. It’s important to take care of yourself and take steps to safeguard your own mental and emotional health while serving the needs of adolescents in your community:

  • Set Boundaries: Understand and recognize your limits. It’s essential to have clear boundaries between professional duties and personal time. This ensures you can recharge and return to your patients with renewed energy and focus.
  • Seek Support: Regularly discuss your cases and feelings with a trusted colleague or supervisor while maintaining confidentiality. This not only ensures the quality of care for your patients but provides a platform for you to process and reflect.
  • Engage in Self-reflection: Recognize and acknowledge your feelings. By understanding your reactions and emotions, you can address potential burnout symptoms early.
  • Stay Connected: Engage with peer support groups or networks. Sharing experiences and feelings with colleagues can provide immense relief and perspective.
  • Take Time for Yourself: Whether it’s reading a book, practicing meditation, or taking short vacations, find what rejuvenates you and make it a regular part of your routine.

Leading the Way in Teen Suicide Prevention

Helping to prevent teen suicide — for individual adolescent clients and on a societal level — can be an overwhelming responsibility. Yet, clinicians have the potential to make a transformative difference in the lives of their clients. By staying informed, fostering trust with clients and their families, and providing a safe and non-judgmental place for teens to express what’s going on inside, we can help guide struggling teens toward a more stable and healthy future.

Ellie Mental Health provides compassionate and effective mental health care for individuals across the United States. Find your next mental health career with us.