May 20, 2022
Content trigger warning. Please be advised that today’s episode discusses suicide and suicidal ideation. If you are having thoughts of suicide, feeling suicidal or have concerns that someone you know may be at risk of suicide, please contact the National Suicide Prevention Lifeline at 1800-273-TALK that is 1800-273-8255 or text Crisis Text Line at 741741. You are not alone.
Cindy Lopez:
Welcome to Voices of Compassion, CHC’s podcast series providing courage, connection and compassion, highlighting topics that matter to our community, our parents, families, educators and other professionals. My name is Cindy Lopez, today we’re talking about a really important topic: teen suicide. As a parent, how do you know when to seek help for your child who seems depressed? You know admitting your child is experiencing mental health issues or suicidal thoughts is difficult. It’s really so much easier to talk yourself into thinking that it’s just a phase your child’s going through and really, how do you know it’s not just growing pains? Well, according to the CDC, the reality is that in 2019 1 in 5 youths had seriously considered attempting suicide. So it’s important for you as a parent to know more. Listen in to today’s episode as we talk with two CHC experts, Katie Reeves, psychiatric mental health nurse practitioner and Jason Tinero, doctoral psychology intern about what all parents should know about teen suicide.
Welcome Katie and Jason. I’m wondering if there’s anything that you’d like to share with our listeners as we get started today?
Katie Reeves, MS:
I’m Katie Reeves as you mentioned, I’m a nurse practitioner at Children’s Health Council and I see mostly teenagers, specializing in self-harm and suicidality. So this area is kind of my niche clinically. I’m also a suicide researcher up at UCSF, so I spend at least half my time sitting and thinking about this phenomenon about suicidal thoughts and the mechanisms behind this so that we can really get in and prevent any suicides possible. I’m also a local, so I’m from Palo Alto. I went to Gunn high school. Unfortunately, that also means that I’ve been close to the issue personally. So, really happy to be here.
Jason Tinero, MS:
I’m Jason Tinero, I’m a doctoral intern here at CHC in clinical psychology. I also specialize in working with teenagers, and all different kinds of teenagers, but specifically a lot of gender and sexual minority youth. So we know that there’s large overlap between people who experience suicidal thoughts and depression and queerness and gender and sexual minorities, so that’s an area I’m really passionate about.
Cindy Lopez:
We’re so excited to have both of you here today with us, especially with your background and your work with teens around issues like this that are so important. As we get started today, Katie, I’m wondering if you could talk about data around teen suicide that would help set the stage for us. Like what’s the impact of suicide on teens?
Katie Reeves, MS:
So suicidal thoughts are very common in the teenage community. Suicide itself is the 2nd leading cause of death among young people and that’s actually now I think somewhere between 12 and 25. So it’s a huge impact, that being said, it happens less than 1% of the time in the population. And so the phenomenon itself is not that common, especially when we compare it to suicidal ideation. And what I mean by suicidal ideation is anyone that’s thinking about considering or planning suicide, what we know about suicidal thoughts in adolescent communities is that 1 in 5 adolescent boys and 1 in 4 adolescent girls have reported seriously considering suicide, between 20 and 25 percent of high school students. That’s huge, that’s a huge number. I mean as a researcher too, it’s now a phenomenon that is so common, you know, we have to really consider what’s happening in this huge population of people that are thinking about whether or not life is worth it. And for context, compared to adults before COVID-19, 4% of adults were reporting suicidal thoughts. Since COVID 19, that’s gone up to 11%. We don’t yet have data on suicidal thoughts among adolescents during the pandemic. So we don’t know if that’s gone up, which would just be very tragic. So hugely, hugely important topic, with a lot to learn.
Cindy Lopez:
Thank you for sharing that data. It’s sobering and we don’t want parents to be discouraged by it, but we do want parents to know what they should be paying attention to. So that’s what our conversation is about today. Jason, what can you say about this continuum or spectrum of teens that we could be talking about here today?
Jason Tinero, MS:
Yeah, sort of like what Katie was mentioning, there are really different aspects of what we call suicidal ideation, and I think really it can go anywhere from, an adolescent thinking, I don’t want to be here anymore and which of course is still concerning to something which is a lot more active and just sort of like the actual thought that I want to die, I want to kill myself in this sort of way. And so we have a really wide spectrum of this kind of thinking and teens who really fall anywhere on that spectrum. And it is really important to take all of these things seriously and also as a parent, I can imagine that hearing any of these thoughts is going to be really scary and really frightening and a parent might not know what to do with that. And I think it’s also really important to consider the spectrum and consider where your teen sort of falls on the spectrum in order to figure out what to do and where to go from there.
Cindy Lopez:
Jason, you commented before we even got started in our conversation about your work with LGBTQ. Are there parts of the teen population that are more susceptible?
Jason Tinero, MS:
Yeah, you know, anyone is susceptible to having these thoughts. There are tons of teens who have mood disorders and have depression who don’t have these kinds of thoughts and there are tons of teens who do. We know that there are risk factors into having suicidal ideation, being a sexual or gender minority youth can be a risk factor to having suicidal ideation and suicidal thoughts, but not everyone who is gay or who is trans is going to have these kinds of thoughts. And, you know, that doesn’t also mean that someone who doesn’t have any of these minority identities is not going to have these thoughts either. And so I think it is really important to not just assume based off of somebody’s identity that they might be thinking this way or not.
Katie Reeves, MS:
As clinicians and as parents and anyone really interacting with teenagers that could potentially have these [suicidal] thoughts, we need to really open up a space, a nonjudgmental space where we can allow kids to explain their ideation, so that we can really understand it because that understanding is where we’re going to be able to do the most good and provide the most support.
Cindy Lopez:
So what do you do as a parent when your teen is expressing suicidal thought?
Jason Tinero, MS:
Yeah, I think one of the major things that you can do is really just offer an empathetic, just open and engaged ear. So really just being there for them and not coming at it from a place of, and I know it sounds way easier than it actually is in reality, but not coming at it from a place of fear, but instead from a place of compassion and really recognizing that if your teen opens up about this to you that’s a really good sign because first of all that means that they trust you enough to want to talk to you about this. And also that means that they are in some way concerned enough about their health and about their own life, that they want to talk about this with somebody and that they’re asking for help. So I think recognizing that if they’re talking to you, they really want you to be there for them in some way. And so, really providing a lot of validation and providing a lot of empathy and really being there with them. I know it can be hard as a parent to want to problem solve and to jump to that solution and to jump to, okay, we’re going to need to take care of this immediately and sometimes, you know, if it is a really acute crisis that is what needs to happen and other times if a teen is just coming to you saying things are really, really hard, that’s a time when you can open a conversation with them and really see how you can be there for them.
Katie Reeves, MS:
I will also add as a parent you’re going to be terrified, you’re just going to be really, really scared. If a kid is coming to you and you’ve been reporting most mild amount of suicidal thought, that is, that is a very scary thing to hear from your kid and so one of the things that I often talk to parents about is a couple of reminders: first, you can do hard things. And one of these hard things is to kind of lock that fear in a little bit in that moment and not make it about you, it’s got to be about the kid. So if you start talking about your own fears and thinking about how you would deal with this or what this would mean for you if you lost a child we’re already on the wrong path for this conversation and of course you’re having those feelings and, you know, definitely go talk about that with somebody else, but that teen needs you to be there for them.
Cindy Lopez:
Just a note before we continue on with today’s episode, we hope you’re following us on social media, so you don’t need to wait a whole week between episodes to get engaging, inspiring and educational content from CHC. Our social handles are linked on our podcast webpage at podcasts.chconline.org.
Katie Reeves, MS:
The second thing that I tell parents often is if your kid is in the room with you, they are safe. There is no need to fix that problem in that moment. So one of the ways that we can really self-regulate as parents when we’re terrified is to just take a deep breath, tell them to sit down and that you want to listen. Just remember, as long as they’re sitting there with you they are safe; you make that conversation as long as you want, right. And it’s okay to say, I know you have work right now, or I know you have school right now or whatever, but you just told me something that’s really big, and I really want to make sure that I understand it fully. So whatever you’re up to whatever I have to do can wait, this is really important.
Cindy Lopez:
I can’t imagine as a parent having that kind of conversation. I mean, as Jason said, you want your child to come to you, right, when they’re thinking about those kinds of things, but again, as you said, Katie, it’s just really hard for parents to have that conversation without jumping to their fearful place, so communication is key. So as a parent, if my child isn’t bringing it up, and I’m concerned how can parents bring this up with their teens and what advice do you have for parents on that?
Jason Tinero, MS:
Yeah, I think there are different ways to do this, the first way sounds like the simplest and also might be the hardest, but just asking. So if you have any concerns, you know, you can always ask your teen and there’s a myth that asking about suicide might be implanting the idea in their heads that’s really been fully disproven. If you ever ask about it and a teen isn’t thinking it, they’re just going to say no and you know, if they are, they might feel comfortable enough to open up to you. And also the thing that we know about adolescents is that this is a time when they’re trying to really become independent from their parents and so they might not want to have a conversation. And if you do ask the question and they kind of are closed off it might not be the right time and so really just having open conversations about suicide as they come up in other parts of life. If something comes up in the news, having a conversation around the dinner table or during a time when everyone is sort of together and talking about, you know, this is really hard and also it’s so tragic that those teenagers weren’t able to seek out support, and really trying to create a space where the suicides aren’t viewed as they did something wrong, so that the teen can feel comfortable hopefully and maybe saying, you know, I also am experiencing some of these thoughts or I also am experiencing some of these feelings.
Katie Reeves, MS:
Unfortunately this is not one thing to do one time, this is just something that you have to kind of embed into the culture of your home. So one of the ways that we do this is asking lots of questions. If you spend most of your time as a parent telling the kids what your opinions are, you’re still taking up a lot of emotional space. So like you said Jason teenagers are really trying to create their own identity and so a lot of the time and knee jerk response is to push back. If something comes up in the media or comes up in the news, saying, oh, wow, I’m having an emotional response to this, are you or what do you think of this or how does this make you feel? Any kind of open-ended questions that you can pose will hopefully begin these types of conversations and even if the teen kind of shuts them down, they at least open up space for those conversations to happen in the future, right. You ask five different open-ended questions and every time your teen’s like, I don’t care, I want to talk about it, I don’t know, I haven’t thought about this before that sixth time maybe they’ll say, well, they keep asking so maybe they actually care about my opinion. Just creating an environment that’s open to these types of conversations is something, again very difficult, but very important.
Cindy Lopez:
If parents are in the situation what are some resources for them and where could they go to find help?
Katie Reeves, MS:
I will jump in and just say that if a kid is coming to you with suicidal thoughts you do not need to know exactly what to say. Jason and I and many other providers, we have a lot of training on this because a lot of training is needed. This is a hard kind of conversation to have. So please reach out to any providers that can be you know primary care provider, this can be a specific psychiatric provider or therapists, even calling CHC. We have providers that are ready and willing and well-trained to talk to the family, to talk to the individual and to just do an assessment, right. As a parent, your job is to love and care for your child, it’s not to know whether or not they need medical intervention, it’s always okay to reach out to providers.
Jason Tinero, MS:
Therapy works great in helping adolescents who are having any of these kinds of thoughts and really specifically a kind of therapy that has the most evidence for helping adolescents through some of these thoughts is called dialectical behavioral therapy, whether that’s on a weekly basis or on a daily, intensive outpatient basis, like we have at the RISE program here at CHC, in our IOP, there are tons of different levels that can be really helpful depending on the severity of your child’s suicidal thinking. I also just do want to mention that if there is a really acute circumstance, like your child is mentioning, I have thoughts of killing myself and this is how I’m going to do it, or I want to and I have a plan in place that’s a time when a hospitalization might be more necessary so going to the ER if you ever feel like there is a really acute concern that is definitely something that you can do, and something that you should do.
Katie Reeves, MS:
I often talk to parents about it’s okay to like, quote unquote, “get it wrong,” as long as we’re getting it wrong on the safety side. So if you’re really concerned about your kid and you’re not sure if their suicidal thoughts are severe enough to warrant a trip to the hospital, and you can’t get ahold of a provider or somebody that can help you make that kind of decision, then go ahead and go to the emergency room. If it’s not a situation that warrants a hospitalization, they’re going to tell you that there, and they’re going to be able to give you resources for what to do when you leave there. Also there’s interpersonal difficulties with your teen in those circumstances too of course. So saying to the teen that you want to go to the hospital when they don’t is going to generate a lot of difficulty. I will continue to say none of these moments are going to make or break a parent-child relationship.
Jason Tinero, MS:
As we’ve sort of been talking about with adolescents, they might not be super open talking to their parents about this. And so letting your child know that if they don’t want to talk to you, there are other people they can talk to and really, opening up that door can be really helpful. So, even if you’re saying something like, I get that you probably don’t want to talk to me about this would you want to see a therapist or this is kind of a moment when it sounds like things are really hard I get if you don’t want to talk to me, do you want to utilize a crisis hotline or a crisis text line? Really great national resources like the Suicide Prevention Hotline or Crisis Textline, which teens really love using because they can just text about it and they don’t have to worry that their parents are listening in on the conversation. There are these really great resources that can still involve trained professionals and providers that aren’t necessarily jumping to a hospitalization or if you can’t see a therapist in that moment, different avenues that you can take where you can still sort of know that your child is safe while if they don’t really want to talk to you, they can still be getting that help.
Cindy Lopez:
As Jason referenced Crisis Text Line, suicide prevention all those resources are on our website at chconline.org, and he also referenced dialectical behavioral therapy or a DBT, that’s an evidence-based strategy or practice specifically for students in the space experiencing suicidal ideation, cutting and more. So we have an Intensive Outpatient Program or an IOP and Jason referenced that too, it’s called RISE. And we do that in partnership with Stanford at CHC and Stanford, and you can find that information on our website too chconline.org. So Jason and Katie as we wrap this up I’m wondering if you can comment on how parents can create a validating environment for their teens.
Jason Tinero, MS:
It definitely can be a preventative measure and I think it’s really important to always try to create validating environments and spaces for adolescents as they really grow into the people that they want to become. We know that adolescence is really a time of identity exploration and your kids might challenge you in the kinds of things that they want to do, or the kinds of people that they’re exploring being. And also it is really important that they hear from their parents that they’re okay and the people that they want to be. There may be some decisions that they want to make, like, you know, getting a crazy piercing or something and I totally hear that that might not be what you want them to do and at the same time figuring out a way where your child can still experience validation. It’s not necessarily about giving into the teen, but really trying to create a space where they’re still able to express the type of person that they want to be. And I work a lot with teens who are queer or who are gender minorities, and I think it can be really tough as a parent to, view your child in a way that might be different from the expectations that you had of them and all these biases that your child is going to be a certain way. And in adolescence that’s really the time when we start exploring that we might not be that way and so share with your child it’s okay, I’m still going to love you no matter what, and really putting action to those words as well. If you know, someone famous comes out as a sexual minority or as a gender minority, really just showing support in that way because kids are going to remember those little things. And they’re sort of feeling out whether it’s okay for them to just share something with you. So if you sort of express that it is okay to be whoever they want to be, then they’re going to feel a lot more comfortable coming to you about it. It really is a preventative measure if we do foster these spaces where kids can be the person that they want to be and know that no matter what, they’re not going to be judged or they’re not going to be disowned or they’re not going to have worry for their own personal safety in their home, whoever they want to b.
Katie Reeves, MS:
Well said, Jason, I think it’s also important to realize that even if your kids aren’t talking to you, they hear you. They really internalize and they hear the things that you say, and they understand the tone in which you’re saying them too. So one of the things around suicidal thoughts is, whether or not, you know, your kids are having suicidal thoughts, they will know what your opinions are on them. If you believe that there’s nothing wrong with kids that have suicidal thoughts, it is scary and it needs to be addressed, there’s nothing wrong with those kids, right. There’s nothing that makes them somehow, extraordinarily different or worse or broken. If you say you know this is one more thing that we need to address in our child’s health then we decrease the stigma and your kid is going to be able to feel that. Like we said, one in four, one in five teens that is a huge number of teenagers and so it is something that’s happening quite often. My final words would just be start thinking about it. It’s really scary to think about, but if we think about it more and we understand it better, we’re going to be less scared and that will translate to our kids. There’ll be far more open to coming and communicating with you.
Cindy Lopez:
Thank you, Katie. Jason any final thoughts or anything you want to leave our listeners with?
Jason Tinero, MS:
You can be open with your kids about when you find things hard, the world is a really tough place right now. We can see in the news that things are just really hard for so many people and we can’t create the expectation that everyone is going to be fine all the time. We sort of talk about this like this duck metaphor where like everyone seems very serene on the outside and everyone seems like they’re doing great. Sort of just gliding along the water, but underneath the water the ducks are paddling their feet as fast as they can to stay afloat, and if you create a space where you sort of talk about some of the things that are hard in the world, it kind of can teach your kids as well that not everyone is as serene and calm and successful as they might seem, and it is okay.
Cindy Lopez:
Parents think about it, think about what you want to say and how you’re going to say it and how you make it part of your conversation. And thank you, Katie and Jason so much for joining us today and for sharing your expertise and insights on this really important topic. Find us online at podcasts.chconline.org. Also, please follow us on our socials. Find us on Facebook at chc.paloalto and Twitter and Instagram at CHC_paloalto. You can also visit our YouTube channel at chconlinepaloalto. And we are on LinkedIn. Subscribe to Voices of Compassion on Apple podcasts, Spotify and other podcast apps, and sign up for a virtual village email list so you never miss an update or an episode. I always love to hear from you so send me an email or a voice memo at podcasts@chconline.org or leave us a rating and review. We look forward to you tuning in each week.
