Fall Seminar: “Beyond 13 Reasons”

By Maneesha Sharma

Know your child. Talk to your child. Be alert to changes in your child.

These three simple strategies, easy to learn, can help parents promote their children’s emotional well-being, an important component of suicide prevention.  That was the encouraging message delivered to an audience of over 200 on October 2, 2018, at Trevor Day High School, where NYC-Parents in Action hosted a panel discussion on suicide prevention with experts from The Jed Foundation (JED), Child Mind Institute, American Foundation for Suicide Prevention and Horace Mann School.

Moderator John MacPhee, Executive Director of JED, introduced key areas to be covered, including data on the rate of suicide among teens and adolescents; how parents can know if a teen is struggling; and what parent-child conversations about mental health should look like.

Research indicates that teenage depression rates have increased by 37 percent since 2015. Contrary to popular understanding, however, children under 15 years of age have the lowest rate of suicide, followed by teens. Middle age to older populations have the highest. Among teens 14-19 years of age, 9.2 people die by suicide for every 100,000. So, although it is not frequent, it  is not rare either; it is estimated that more than 5,000 15-24 year-olds died by suicide in 2016.

According to Dr. Jill Harkavy Friedman, Vice President of Research at the American Foundation for Suicide Prevention, teenage suicide is complex. Many factors, health, genetic, environmental and event-related may contribute to, but do not alone cause, such a tragedy. She then explained the expanse of the suicide “spectrum.” For instance, not wanting to get up in the morning is common. Thinking of killing oneself isn’t, but it does not necessarily lead to acting on the thought. A key question parents should ask is, does this person have a step by step plan? Having a plan can indicate greater risk of death by suicide. In helping a person at that risk level, it is vital to decrease access to lethal means. One level of concern applies when a person develops a plan to take his or her own life; the next, when someone engages in behavior to kill themselves (regardless of how lethal it is); and the last is death by suicide.

RISK FACTORS

How does a parent notice if a teen is at risk? Dr. Joanna Stern, a clinical psychologist with the Child Mind Institute, advised that the most effective method is to observe your child and know what constitutes his or her baseline behavior. If he or she is usually chatty at the end of the school day, be alert if that behavior changes. Pay attention if your child suddenly exhibits a loss of appetite, becomes less communicative, or shows changes in self-care, sleep patterns, or behavior. Any departure from your child’s baseline may be a signal to start asking questions and encourage dialogue.

It’s tempting for family members to just assume “things are fine.” A better approach is to give your child space to express his or her feelings. For example, if your child seems worried about not having friends, do not say, “Don’t be silly, you do have friends.” Instead, listen. Find out what’s going on.

STARTING THE CONVERSATION WITH YOUR CHILD

How do you start that conversation with your child?  There is a delicate balance between asking questions and respecting your child’s privacy. For instance, a parent can say in a non- confrontational manner,  “I notice you used to hang out with Susan often, but lately you don’t mention her or make plans to see her.” Be mindful of how you feel if asked a probing question.

The important message to give kids is that you are here for them. Don’t just offer criticism. Parents should express unconditional love and support. Some students feel that their parents only care about grades and are reluctant to share other important details. Even when discussing difficult subjects, reiterate your love and support. For some, conversations may be easier to start, and less awkward, when not face to face. Extensive eye contact might make it more uncomfortable for your child to discuss a difficult situation or give bad news. For example, one parent reported texting with the child while in the doctor’s waiting room and found it worked well. Any creative strategy parents can find to keep the conversation going is acceptable, as long as you are communicating.

WHAT ARE THE WARNING SIGNS?

How can parents tell when a child’s behavior is significant and should trigger concern for mental well-being?  The key elements to look for are: intensity, duration and frequency. If the behavior that gives you concern is of an intensity, duration or frequency that impacts the child’s ability to function, then you need to act. Parents should not wait until a crisis moment. It is better to do “background work,” by lining up resources and support right away. Your background work may include speaking with a school counselor, or pediatrician, a teacher or school principal. Notice if your child is not eating, sleeping, or seems isolated or agitated, and discuss the changes you see with your support resources.

WHO IS THE RIGHT RESOURCE?

It depends on the situation.  Children, like many adults, may cover up issues at a doctor visit or try to diminish concerns. Use resources available in several arenas: contact the student academic advisor, a teacher, or the school counseling department. Do tell them exactly what you are hearing and seeing at home.

How does one get a professional to take notice? Be specific. Keep track of key details. If your child is not sleeping three nights out of five, say so, and be precise. While research does not necessarily show more suicide attempts by students than in the past, it does show increased anxiety and depression among children. Academic pressure generated by the college applications process and pressure on students to perform at extraordinarily high levels may contribute to both anxiety and depression.

HELPING A FRIEND

Dr. Daniel Rothstein, Director of Guidance at Horace Mann School, stressed that mental health counseling visits at school do not go on a student’s transcript, and will not affect their college chances. Most independent school teachers and administrators view getting psychological help as a strength. The panel’s advice for parents, when your child expresses concern for a friend’s mental health, is to act, even if the friend might be angry. One panelist noted the expression, “An angry friend is better than a dead friend.” You can ask your child, “Wouldn’t you want to know, if you were a parent?” The suggested best practice for the child is to share the information with a psychologist, guidance counselor or trusted teacher at school. For parents, it is to contact the parents of the child at risk, or the psychologist at the school, depending on the severity of the situation and their own comfort level. Parents were advised to point out to their children their shared goal of “keeping your friend safe.”

If your child, or one your child’s friends, says “I want to kill myself,” how seriously do you take it? Does he or she mean it? Experts recommend that parents do take such statements seriously. Find out what your child means by “I don’t want to be here.” Do ask what will help him or her feel better, and be aware that an answer like “I don’t know” may also reveal that he or she is in distress.  Untreated depression is a matter of real concern, so take the time to inquire further.

 

WHAT ARE PARENTS OVERLOOKING?

Dr. Stern urges parents to be inquisitive and ask your children questions. Learn about his or her life, both in and after school. It’s important to recognize that all behavior communicates something. If your child is behaving in a way that seems ‘dramatic’ to you, it may be his or her way of communicating a need for support or attention.

One example of ‘dramatic’ behavior may include their behavior on social media. While social media may exacerbate problems, it does not directly cause suicide. For children who are already vulnerable, constant monitoring of friends’ and peers’ social profiles and activity can have a negative impact.

Sometimes vulnerability may include factors like impulsiveness. Does impulsivity in a child mean that talking about suicide will automatically move thoughts to action? Not necessarily. Parents, if concerned, should talk directly to their children. Listening to a child can defuse the situation. Addressing impulsivity issues or anxiety with your support resources is good strategy.

Dr. Sara Gorman, Director of High School Programming at JED, explained why we should feel optimistic about the future despite media reporting on teenage suicide, or television shows like “Thirteen Reasons Why.” Children today are an accepting generation in many ways: more willing to talk about mental health issues and to help their peers and less bothered by stigma than earlier generations. This attitude makes it easier to find opportunities for early intervention, and decreases the shame associated with seeking help with depression and anxiety.

CONCLUSION

An audience member summed up the principal message from the panel members, saying: “Know your child, tend to your child, listen to your child and inquire even if it’s uncomfortable for you to hear what he or she is saying.” Experts remain optimistic that students can learn to balance their mental health needs with their demanding schedules, despite the pressure and stresses of early adulthood. Parents willing to make time for communication and time for listening will make a critical contribution to their child’s ability to learn that skill.