What Do We Know For Sure About Suicidal Ideation in Young People?

Suicide is one of the leading causes of death among young people in the United States. Data compiled by the CDC (Centers for Disease Control and Prevention) from 2020 tells us that, among individuals ages 10-14 and 25-34, suicide was the second leading cause of death. It was also the third leading cause of death among individuals ages 15-24.Managing a child with suicidal ideation can be an overwhelming task for parents. In the midst of a crisis, families are forced to navigate a dizzying treatment landscape with waiting lists, high treatment costs, and a confusing mix of different treatment methodologies and recommendations.  

So what do we know for sure when it comes to managing suicidal ideation in young people?

Expert and timely psychiatric assessment is essential at the first sign that a young person is having thoughts of hurting themselves or committing suicide. The emergency room and sometimes hospitalization can be wholly necessary when a person is communicating high urges to commit suicide. An initial assessment may have to be conducted in the ER, which is helpful and appropriate since the urgency of the situation does not allow for waiting days or weeks for an evaluation appointment.  Once the individual is stabilized or deemed safe to leave the hospital setting, it’s best to secure follow-up care in the least restrictive setting possible. For many, this will be outpatient treatment, which is essentially therapy services that are delivered outside of a facility setting and while the individual is re-engaging back into their lives. Outpatient treatment should be structured to regularly monitor suicidal thoughts and urges. It’s essential for a mental health professional to know when an individual’s risk for suicide is heightened so they can respond accordingly. The monitoring structure needs to be transparent and direct, balancing open communication about suicidal urges while also being sure not to inadvertently reinforce these communications. It’s easy for family members, friends, and even providers to actually encourage suicidal communications by “rewarding” the communications through an uptick in care and attention when the individual references “feeling more suicidal.” It’s a delicate balance to responsibly attend to these communications while simultaneously not reinforcing them.There are proven treatments designed specifically to target suicidality. These “evidence-based treatments” include Dialectical Behavior Therapy (DBT), Collaborative Assessment and Management of Suicidality (CAMS), and Cognitive Therapy for Suicide Prevention (CT-SP). Research to date points to DBT as the most effective intervention for adolescents experiencing suicidal ideation.Adolescent treatment outcomes significantly improve when parents and caregivers are involved and engaged in the process. Any treatment for suicidality should incorporate a parent and/or caregiver component. 

The revolving door of hospitalization for suicidality

Hospitalizations are typically short-term, and patients are discharged promptly when their suicidal ideation begins to go down. The reality, however, is that a patient’s risk of suicide is very high in the period after hospital discharge. A meta-analysis of 100 studies indicated that, in the first three months after discharge from the hospital, the suicide rate was about 100 times the global rate. The risk is even higher for patients whose admission was prompted by an actual suicide attempt.  Managing a suicidal teen is a challenging task for parents or caregivers, so support, education, and guidance to parents are essential. If parents lack the skills and confidence to support their suicidal teen, an over-reliance on hospitalization can occur. We can see that revolving door with patients admitted to the hospital, stabilized, discharged, and then headed right back to the ER with the next communication of suicidality.

So how are parents to keep their teen out of the hospital and safe at the same time?

First, it’s essential to leave the hospital with a plan. If there is no treatment or plan in place, then the next time the child expresses suicidal ideation or urges to self-harm, caregivers panic and are forced to bring the child right back to the ER. As a result, treatment only happens during crises, and the child becomes a frequent flyer in the hospital system. So, in addition to having an actual treatment plan and providers tee-ed up post-hospitalization, families should have clarity about how they can most effectively respond if the child begins to experience a re-emergence or uptick in suicidal thoughts.Second, parents need to know how to maintain a safe environment at home—an environment that will reduce the possibility that their child can hurt themselves should the urges come back up again. And chances are that urges will resurface until the child learns how to cope with the emotional and situational triggers of their self-harm or suicidal thoughts. Coping skills will come from treatment, but until those skills are developed, parents can create a safe physical space for the child by securing medications, tools, and other potential hazards out of the teen’s reach. It’s essential for parents to learn how to properly secure the environment for safety. If instructions have not been provided explicitly, families should inquire about the steps necessary to secure the environment.  Watching a child suffer from self-harm and suicidal urges can be painful. However, parents can feel both reassured and empowered, knowing that with some skills and strategies, they can play a central role in keeping their teens safe and supporting them in their return to health and independence. When combined with therapy, these thoughtful and practical shifts in the home environment can promote short-term safety and a long-term reduction in vulnerability to suicidal urges. If someone is experiencing a psychiatric emergency, please take them to the nearest emergency room, call 911, and/or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).For additional resources, please visit SAVE: Suicide Awareness Voices of Education.If you or a loved one is struggling with an eating disorder and/or suicidal thoughts or behaviors, please reach out to our team at info@columbuspark.com to discuss treatment options.