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THE ROAD AHEAD I SUICIDALITY
Feeling suicidal means feeling like you don’t want to live anymore. Self-harm behaviors are things that kids & teenagers do on purpose to hurt themselves. Explore the questions below to learn how to recognize the signs, understand what causes it, and discover effective treatment options.
What caregivers might notice in their child
Kids and teenagers often feel emotions very strongly, and it’s normal for kids to feel sad and discouraged sometimes. However, if your child starts to think about killing themselves, this is always cause for concern and it is important to get help right away.
Kids and teenagers often feel ashamed or nervous to tell people that they are thinking about suicide, and adults may worry that asking a child about suicide or self-harm might make them think about it more. But it’s actually the opposite – calmly asking your child “have you thought about killing yourself?” or “do you ever try to hurt yourself?” helps them understand that it’s okay to come to you with their feelings and talk about their problems – and this makes it less likely that they will actually try to hurt or kill themselves.
You know your child best, and sudden changes in their behaviors and emotions are usually signs that something is wrong. If your child suddenly becomes more withdrawn from activities, starts talking more about death, or seems more depressed and sad than usual, you may want to start asking questions about suicide and self-harm. Even changes that seem positive can be a sign for concern – sometimes kids who have been depressed and then think of a way to hurt or kill themselves might suddenly start to feel better and more energetic. That’s why it’s important to keep an eye on your child for any changes and talk to them regularly to understand how they are feeling.
Suicide and self-harm can go together, but not always. Kids who want to kill themselves don’t always self-harm, and kids who self-harm aren’t always thinking about suicide either. There are different ways that kids might try to hurt themselves, but some common ones can be cutting their skin with sharp objects, burning themselves with something hot, and bruising or punching themselves. If your child has been harming themselves, you might notice that they:
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Have cuts, bruises, or burns on odd places on their body (often wrists, arms, thighs, or chest)
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Wear long sleeves or pants, even when it’s hot outside, so that other people won’t see their cuts or bruises
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Refuse to change clothes in common areas (e.g. for gym class or sports)
We know that it’s really important to respond well if your child tells you that they are thinking about killing or hurting themselves – if you are calm and offer help without judgment, it makes it more likely that they will feel safe and keep asking others for help.
What are signs that my child’s suicidal feelings are getting worse?
There are different levels of suicidal thoughts and behaviors. It’s pretty normal for most people to think about dying every once in a while, and even having thoughts like “I wonder what would happen if I killed myself?” can happen every once in a while. When kids and teenagers start to think this way all the time, that’s when we start to worry. It’s also important to understand the difference between suicidal thoughts, suicidal behaviors, suicidal intent, and a suicide plan.
Suicidal thoughts: thinking about killing yourself. Suicidal thoughts can be passive or active.
Passive suicidal thoughts: thinking things like “what would happen if I died?” or “what would it be like for my family if I wasn’t around anymore?” These thoughts are usually less serious than active suicidal thoughts and the person thinking this way is probably depressed and feeling sad, but might not actually want to kill themselves.
Active suicidal thoughts: thinking things like “I could kill myself tomorrow” or “I could end my life if I did this”. These thoughts are usually more about how and when a person might commit suicide, and the person thinking this way is probably more serious about actually trying to end their life.
Doing things to prepare to end your life. This can involve getting access to something that would seriously hurt or kill you, writing a will or telling people what you want them to do after you die, or hurting yourself in a serious way that is life-threatening. When someone’s suicidal thoughts turn into suicidal behaviors, this means things are getting worse and we usually need to take action right away.
This is how serious a person is about killing themselves, and whether or not they really mean to take their own life. It is hard to know a person’s level of intent unless you ask them directly – are you trying to kill yourself? Do you plan to kill yourself?
The details of how a person would end their life. If someone has already thought about how and when they would kill themselves, and they are able to get the things they need to do it, it’s important to take this seriously and intervene right away. People are at the highest risk of suicide if they have come up with a plan and intend to do it, so if this is the case for your child, do not leave them alone and get help immediately. You should not wait until their regular doctor or therapist has an appointment available – this is the time to go to the emergency room, call a crisis line, or check your child into a treatment facility where they can stay for a few days.
What causes suicidality and self-harm?
Suicidality and self-harm are not caused by just one thing – there are a few factors that can make it more likely that a child will develop this kind of disorder. Feeling suicidal or self-harming is not a mental health diagnosis on its own, but are usually signs of something else that is going on. Kids may feel suicidal or hurt themselves because:
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They feel sad or very worried or have had something bad happen to them
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They feel overwhelmed and can’t find another solution
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They feel empty or numb and want to make themselves feel something, even if it hurts
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They are trying to communicate that they need help
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They know someone who has recently died by suicide and think this might be the only way they can deal with their feelings, too
Suicide and self-harm can go along with other mental health diagnoses. Not all kids with these diagnoses will feel suicidal or want to hurt themselves, but having these symptoms can make it more likely. If your child already has a diagnosis of depression, bipolar or mania, an eating disorder, trauma, anxiety, or psychosis, you can always ask your provider to do a risk assessment or suicide screener with your child. And you can always make a safety plan with your child, even if they are not suicidal or hurting themselves – knowing who they can talk to and what they can do when they feel overwhelmed is always a good thing!
Treatments that work for suicidality and self-harm
Suicidality and self-harm can affect kids and adults. Suicide was the third leading cause of death for high schoolers in the United States in 2021 (see this report from the CDC), and there are even more kids that have suicidal thoughts but don’t kill themselves. When there are a lot of stressful and difficult things happening around them, kids and teens can have a harder time managing their emotions than adults, because their brains aren’t fully developed yet – so if your child is experiencing a lot of stress or there are difficult things happening around you, it’s important to check in with them and offer support!
Some groups of kids and teenagers have a higher risk of suicide. For example, kids who identify as LGBTQ+ are at higher risk of suicide. Older teenagers are at more risk than kids under 14.
Having just one risk factor doesn’t necessarily mean that kids will attempt suicide, but it’s important to pay attention especially when kids have multiple risk factors present. Here are some things that might make it more likely for kids to have suicidal thoughts:
Having another mental health diagnosis like depression, PTSD, bipolar, or substance abuse
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Being impulsive and not thinking through their actions
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Being bullied
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Being abused or not cared for by others
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Not having good relationships with others to support them
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Living in a rural area
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Having someone else in their community or school commit suicide
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Being stressed about money
Who is affected by suicidality and self-harm?
There are a lot of things that you can do to help your child who is suicidal or harming themselves – and you’re already taking a big step by learning more! Many kids & parents see a lot of improvement with the right support. Here are some treatments that scientists have found to help with suicidal thoughts and self-harm:
Not all healthcare providers ask questions about suicide, and it’s important for parents and providers to know what questions to ask. A good starting point is to simply ask “Are you thinking about suicide?” or “Are you thinking of killing yourself?” If your child says yes, gently ask them to tell you more. You can also ask your child’s therapist, doctor, or other healthcare provider to screen your child for suicidal ideation or self-harm. Getting help and support early is one of the best things you can do for your child, and that starts with understanding what’s going on.
In the past, some providers used “safety contracts” for people with suicidal thoughts or self-harm, which usually meant having the person sign a commitment that they would not harm themselves. Now we know that this actually isn’t the best way to help people who are thinking about suicide or self-harm. Safety planning is different from a safety contract – safety planning is more thorough and helps kids and families plan ahead for what to do when they have strong feelings or think about suicide. It usually involves figuring out warning signs that tell you things are getting worse, thinking about other things you could do instead of hurting yourself, finding emergency support like crisis lines or emergency departments you could go to, making sure kids are safe in their home and don’t have access to harmful things, and writing down a list of supportive people you could call when you’re struggling. You can find a sample safety plan here.
DBT teaches kids and teenagers skills that they can use to manage painful emotions and how to get through hard times. Kids learn mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills that can help them with a lot of different problems. And some DBT groups for kids and teenagers have parent groups too, so you can learn skills with your child and practice them at home!
ADVOCATING FOR HELP I SUICIDALITY
Getting support for suicidal thoughts and self-harm starts with knowing what to ask for. Use the questions below to find out how to get help, talk with providers, and access the tools your child may need.
How to get help
There are lots of different resources and providers that can provide support for kids and teenagers who are thinking about suicide or self-harm. Here are a few ways you can get started:
You can ask your child’s doctor to do a basic screening for suicidal ideation and self-harm. Doctors sometimes notice signs of self-harm in examinations, so you can also ask your child’s doctor if you have concerns or if you notice unusual injuries on your child’s body.
Therapists, psychologists, and psychiatrists are well trained in suicide assessments and are usually able to assess your child for suicidal thoughts and self-harm and to give them some help and strategies to help them manage their feelings. Psychiatrists can prescribe medication if they think that might help your child, and you can ask a therapist or psychologist if they are trained in working with kids and teenagers who have suicidal thoughts or are hurting themselves.
If you think your child is at a high risk, get help immediately by calling or texting 988, a crisis line and/or going to the emergency department. It’s great to think about therapy and other resources once your child’s symptoms have stabilized a little, but if you’re worried your child might try to kill themselves, get help right away from a medical or mental health professional. You can also call local law enforcement if you need extra help or if you cannot get your child into the hospital by yourself.
If my child is suicidal or hurting themselves, what treatment components should I ask my provider about?
An important part of working with kids who are at risk for suicide or self-harm is making sure they stay safe. Ask your child’s provider how often they check in with your child around safety, and how you can participate in safety planning as a parent. It’s important for kids to have support outside of treatment as well, and that’s where you come in.
Kids usually think about suicide or hurt themselves because they have strong emotions that they don’t know how to manage on their own. Having emotions is part of being human, and no matter what you do as a parent, your child will sometimes go through stress and hard times. Part of treatment is helping your child learn how to manage big feelings and hard times when they happen. Ask your child’s provider what skills they’ll be learning in therapy to tolerate distress and deal with difficulties, and ask how you can help practice these skills with your child at home.
Like we mentioned before, being suicidal or hurting yourself is usually a symptom of something else, and not its own diagnosis. You’ll want to ask about treatment components to get your child through a crisis, and once they’re more stable, you’ll want to have a long-term plan too. Talk to your provider about how your child’s suicidal thoughts or self-harm behaviors started, and ask if there is a mental health diagnosis that fits their symptoms (if you’re not sure where to start, you can also take our screener to identify some problem areas!). Once you know what your child is dealing with, you can talk to your provider about treatments that are usually helpful for their symptoms and diagnosis.
PROGRESS OVER TIME I SUICIDALITY
This section offers a few extra tools to help you along the way. Whether things are going smoothly or getting more challenging, these resources can support you as your child grows and their needs change.
My child has a diagnosis, now what?
Once your child has been diagnosed and is getting treatment, there are still more ways you can support them – and yourself. Here are some next steps to consider:
It’s scary to have a child who is thinking about suicide or self-harm, but it’s also important to let your child know that you can handle their symptoms and are willing to talk with them about what’s going on, even when it’s hard. Responding to your child calmly and openly when they talk about these things tells them that you’re a safe space for them, and encourages them to come to you the next time they’re struggling.
Know that you don’t have to figure this out alone. Parenting a child who is suicidal or self-harming is a huge challenge, and can leave you feeling frustrated, scared, and burned out. Joining a parent support group (such as Parent to Parent at Children’s Village, or a Parenting Skills Class through Catholic Charities) can help you learn new strategies and get encouragement and support from other parents who are on a similar journey.
There are some excellent, practical reads written for parents like you.
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“The Parent’s Guide to Self-Harm” by Jane Smith
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“Keeping Our Kids Alive” by Lyn O’Grady
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“What To Do Right Now (and later today, tomorrow, and next week) When Your Child is Suicidal” by Tara Rolstad
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My child is getting worse, what can I do?
If you think your child is in immediate danger, always call a crisis line right away. Don’t wait for your regular provider to be available. It’s important to get help as soon as possible if you are worried about your child’s safety. There are a few ways to do this:
Crisis lines like 988 offer a lot of services. You can call, text, or chat with them online (and they have support for kids who are deaf or hard of hearing, and kids who speak Spanish too). This is free for everyone and a counselor will talk to you or your child, ask if you are safe, listen to what is going on, and share any resources they think might help your child.
If you don’t think your child is safe at home, you can take them to a crisis center or to the emergency room if a crisis center is not an option. Crisis centers are more specific for mental health problems than an emergency room, but both can help provide your child with a safe space to be for a bit, and to figure out what support they will need to stay safe.
It’s hard to see your child struggling, especially when it feels like things are getting more intense, not better. You’re not alone—and there are steps you can take to get support and stabilize things.
Let them know what’s changed. Sometimes therapy needs to be more frequent or focused differently, or something needs to be changed in your child’s routines or environment. Be specific about what you’re seeing: more self-harm, worsening mood, school issues, more frequent outbursts, etc. This will help your provider to identify areas of change that might help your child.
Every family should have a plan for what to do if things get worse or if you or your child feel unsafe. This might include knowing who to call during a crisis (like a mobile crisis team or behavioral health urgent care), when to head to the ER, or how to calm things down safely at home. Your provider can help you build a plan that fits your family.
Resources like Wrightslaw explain special education laws in parent-friendly language. Knowing your rights helps you feel more confident in meetings and ensures your child gets what they’re entitled to.
Some communities offer higher levels of care and these may be appropriate for kids in crisis due to suicidal thoughts or self-harm. Instead of seeing a therapist in their office once a week, your child might spend a few days to a few weeks staying overnight at a treatment center while they receive therapy, group support, and medical help to get better. There are also levels of care in between, where kids get more support from providers but still sleep at home. These services are especially helpful when things feel complex or overwhelming. Consider what might be right for your child, and for you – it’s important to trust your gut and talk to your child’s care team if you don’t think it is safe for them to be at home for a period of time.
When your child is in crisis and you worry for their safety, it can take a toll on your whole family. Connecting with other parents, talking to a therapist, or simply having a support system in place can help you stay grounded while you’re supporting your child.
CAREGIVER TOOLKIT I SUICIDALITY
This section offers simple, practical tools to help you support your child—from building routines and healthy habits to improving communication and recognizing their strengths. It’s also a reminder that taking care of yourself is part of the plan—you’re not alone on this journey.
Daily habits that help
This includes emotional safety (helping your child feel comfortable to talk to you about their feelings and their problems) and physical safety. A common part of safety planning for people who are suicidal or self-harming is taking things away that might be used in this way. It’s best when you can do this together with your child and their provider. For example, you might talk to your child and say “I notice you use ____ to hurt yourself when you feel sad or angry. I wonder if it would help for us to put ____ away in a safe spot until you’re feeling better, and we can talk about other things that you can do instead when you feel this way.” Once you’ve had this conversation with your child and their provider, you’ll hide or lock up things that they might use to harm themselves, at least for a bit until they learn some more skills and have more support.
Kids who are suicidal or self-harming need other ways to work through big feelings. Taking away the things they use to hurt themselves might help for a bit, but they will still need a way to get through tough times. You’ll want to work with your child and their provider to find other things that they can do when they feel this way. These things look different for each child, and what helps one child might not help another. It’s important for you to help your child figure out what will work for them, and most of these things can be done with a parent or another trusted adult, which also helps your child feel more connected to you. Some examples of other behaviors to try could be:
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Watching a movie
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Going on a walk
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Spending time outside
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Playing a video game
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Being with a friend
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Exercising
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Cleaning something or doing a practical task
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Listening to music
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Painting or drawing
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Playing an instrument
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Taking a shower or bath
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Counting things to focus your mind on something else
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Taking deep breaths
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Holding an ice cube or running cold water over your face to focus your mind and body on something else
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Doing something nice for someone else
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Kids who are suicidal or self-harming need other ways to cope with big feelings. Taking away the things they use to hurt themselves or providing distractions might help for a bit, but this won’t fix the way they feel. You’ll want to work with your child and their provider to find ways they can work through their feelings. This is different from the list above because these are coping strategies that help them think about their feelings, instead of distracting them so they feel less upset. This is best to discuss with your child’s therapist before implementing at home, but could involve things like changing thought patterns, engaging in mindfulness strategies, or learning other thinking or action skills to use when strong feelings happen.
Kids with psychosis will usually struggle to pay attention to things and concentrate on what is going on around them. It can be hard for them to listen to complicated instructions and it can be especially hard for them to focus on listening and learning new information when they are in loud situations with a lot going on. To avoid frustration for both you and your child, try giving short instructions and sharing information in short sentences. Be clear and brief in what you ask your child to do, and repeat yourself as often as they need you to.
Kids need sleep, good food, and exercise. Kids who have healthy habits are usually able to manage their feelings and emotions better than kids who don’t. In particular, not getting enough sleep, not being physically active, and using drugs can all be risk factors for depression and suicide. Teaching your child how to be physically healthy can help their mental health, too.
Having social support and good relationships is one of the best ways to protect your child from suicide and self-harm. Spend time together as a family. Invite friends over from your neighborhood and community. Teach your child how to build relationships with other people, and model how people can support each other. Having other people around helps support you as a parent and also shows your child that they can count on others to be there for them when times are tough.
Caregiver self-care
Parenting a child with suicidal thoughts and self-harm behaviors is a big job. It’s okay to ask for help, and it’s good for your child to learn that they can also ask others for help when they need it!
It makes a big difference when you can be consistent in the way you respond to your child, but you don’t have to do it alone. Bring in other people that you trust to help you create a safe environment for your child and to talk about ways to keep your child safe in a crisis. Rely on your community to help generate ideas and identify other places in the community that are safe and supportive for your child.
When your child feels upset and has strong emotions, sometimes they need to take a break from things – and sometimes you need that break, too! Find a space in their room, a corner of the house, or a safe spot outside that they can go to when they get upset. Stock that space with things that make them happy and calm them down (and make sure they don’t have access to things they could use to hurt themselves). If you want, you can make a calm zone for yourself too – every parent needs some time alone sometimes!
If you don’t feel you can safely monitor them at home, advocate for them to stay overnight and receive inpatient care. Talk to your providers about what options exist for your child (and for you) and don’t be afraid to ask for changes in their care plan if things aren’t getting better.
Kids with psychosis can definitely get a lot better, especially if you’re getting help early. It’s important to celebrate victories they have in treatment, whether those things are big (like getting a first job or graduating high school) or small (like remembering to brush their teeth, taking a shower, or doing a chore independently for the first time). It’s also important to be realistic and honest about what you and your child can expect as they deal with psychosis. You can talk to your provider about this too. Some people with psychosis are able to manage their symptoms well on medication and they might keep going to therapy as adults but also be able to work and have families. Other people with psychosis continue to need more support in treatment and might not be able to hold a regular job or do some things on their own. Figure out what progress is realistic for where your child is at and talk to your provider about ways to work towards those goals. Then when you reach those important milestones – celebrate them together!
Psychosis is a challenging and complicated illness, and even scientists aren’t totally sure what causes it in some people and not others. Don’t blame yourself as a caregiver – you did not cause this to happen to your child. There are lots of complicated things happening in their brains that they (and you!) can’t fully control or understand. Also, don’t be ashamed to reach out to others to share what’s going on. The illness is the problem, not you or your child. Connect with other people who already understand or are willing to learn about what psychosis is, and who can encourage you on this journey. Your child will also benefit from having more relationships with others who are willing to be a part of this journey with them.
Sometimes it’s hard for parents to feel like they can set limits and discipline their child if they are worried their child will hurt themselves. However, your child needs you to continue to show up for them in this way, and it’s important for all kids to have rules and limits in the home. Talk to your child’s provider if you are having trouble figuring out how to parent your child because of their suicidal thoughts or self-harm, and ask for support from your community, your own provider, or parent support groups.
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