Suicide Prevention

Cindy Lopez:
Welcome. My name is Cindy Lopez, the host of this CHC podcast, Voices of Compassion. We hope you find a little courage, feel connected and experience compassion every time you listen. For our youth ages 10 to 24 suicide is the second leading cause of death in the U S. It’s complicated and tragic and it’s often preventable. So just knowing the warning signs for suicide can possibly help save lives. Listen to today’s podcast episode where you will learn about risk factors, warning signs and protective factors as we talk with the expert Jennifer Leydecker, who works every day with teens in our RISE Intensive Outpatient Program. Welcome, Jen.

Jenn Leydecker, LMFT:
Good morning. I’m excited to be here again. I’m the RISE – IOP Program Manager and so the idea of talking about suicide is something that I do pretty consistently in my role both in terms of talking with families when they’re kind of post-crisis and then also supporting families in terms of treatment and finding the right level of treatment for their teens and then also a parent of a a couple kids and one that is starting to ask questions. And so as a parent having these kind of conversations around suicide or mental health is also something that I’m trying to balance.

Cindy Lopez:
Thanks so much Jen for being here. So, Jen just referenced the RISE – IOP it’s RISE, R -I-S-E. IOP is the intensive outpatient program and that’s here at CHC that we do in collaboration with Stanford. So that’s a program for teens with suicidal ideation, self-harm behaviors and it includes teaching kids and families parent skills like DBT, dialectical behavioral therapy, and if you’re interested in learning more about that, we have other podcasts on that topic as well. So as we think about this topic of suicide prevention for most of us, I think the topic of suicide feels kind of uncomfortable and difficult to talk about. So why do you think that is? And then what’s your advice about how we talk about it?

Jenn Leydecker, LMFT:
I think in talking with parents over the years when they learn that their teen is thinking of suicide or they’ve made a suicide attempt the piece that I think is a really disconnect is the idea that we can hurt ourselves. And so there’s a lot of fear in that because I think as parents we also have this kind of protective bubble of trying to prevent our children from being hurt. And so the idea that we can hurt ourselves and be in that kind of level of suffering is really difficult. And I think with the stigma around suicide there’s definitely the idea of like if we don’t talk about it it’s not really there when the opposite is actually the most effective strategy, which is offering to have the conversation and putting it out there and naming it sometimes in those big events, in a way that is safe and effective in terms of the conversation.

Cindy Lopez:
So you just mentioned naming it. What would that talk be like?

Jenn Leydecker, LMFT:
There are pros and cons to this or pluses and minuses around the idea of like media. So both social media and then like shows and things, suicide is definitely a topic that is openly discussed and kind of presented. And so when those moments come up sometimes it does help to just kind of broach the subject around like when you see that, how does that look for you? Or when you hear things about teens dying by suicide what is your response or do you know anybody that has suicidal thoughts? And I think the other piece that is hard is outside of those moments, we have to be careful of our response as parents because our teens are always listening, even though we think they’re not paying attention to us and that we are not on their radar, they’re paying attention. And so when something comes up on a show or like the news or there’s something that’s in the community, our response to that they’re gonna key into, and so even in those moments where we’re responding authentically to an event of like talking about suicide at school or something that comes up in a TV show, kind of sitting with it for a minute and then making a comment that is like neutral or just curious around how that impacts the teen.

Cindy Lopez:
So the language we use around suicide is important. What is the terminology that we should be using?

Jenn Leydecker, LMFT:
So when teens are having suicidal thoughts, that’s kind of just thinking of dying and then attempting suicide or making a suicide attempt or planning an attempt is kind of the next level for us. And then if there is a completed act, then we talk about the person dying by suicide. So, the issue before was around “committing suicide.” And so that language has kind of been removed from our vernacular in terms of mental health. And so it’s really that’s how they died and the same way we would use that to reference they died by some sort of medical condition cause we do kind of use that parallel, that mental health there is a medical component to that and so really not separating the two, but recognizing that together.

Cindy Lopez:
So why does a person consider suicide and are there usually existing mental health conditions or not?

Jenn Leydecker, LMFT:
I think sometimes there are and they might be kind of at a lower level. The latest statistic is like 60% of teens report actively having some sort of suicidal thoughts. And so it’s something that most teens especially are experiencing sometimes it’s passive where it’s like, “I just wanna die. I don’t wanna be here anymore. Like, this is really hard.” And then that goes all the way up to really actively planning and considering suicide, and I think it’s there we don’t always know why it’s there. Sometimes things are really hard. So you have kind of this low period where things are really difficult, where the anxiety is so high that it makes them really uncomfortable, and the only thing that they see as an out is just not waking up. And so I think just in terms of other things mental health is a shade of gray sometimes. So it doesn’t have to be this really big crisis. It does have to be addressed and so doing that in a way that holds both things at the same time, right? Recognizing there’s these suicidal thoughts happening and also the factors that are contributing to that around different like low level mental health stuff sometimes too.

Cindy Lopez:
Listening to this episode I might be thinking, what should I be looking for? What are the warning signs for suicide?

Jenn Leydecker, LMFT:
One of the key factors that we consider quite often with our teens is knowing somebody that’s died by suicide or like in proximity and then in conjunction with that, also things like, depression, anxiety, that’s interfering with day to day. Sometimes parents will hear teens say like, “oh, I just wanna die. Like, this is horrible, I just wanna die.” And the perspective is sometimes like they’re being hyperbolic when actually key into that because that means that there’s some level of suffering. And so really holding in that moment of like, okay, something’s going on and opening the door to conversations about that and so both the idea of like mental health stuff is definitely a risk factor that we look at. And then also other things where there aren’t protective factors. So do they have somebody that they’re talking to or they really isolated and not engaging? Sometimes our teens experience like a really big dip in their grades where they just can’t anymore. So academics becomes really, really difficult and right in the Bay Area, especially there’s this pressure to be these really incredible students really well rounded all of these expectations. And so in that moment, sometimes they just can’t anymore. It’s too much.

Cindy Lopez:
I’ve read that the rate of suicide and suicide attempts increased during adolescense and that’s the population you’re working with. So why is that?

Jenn Leydecker, LMFT:
I think the key factor for adolescents is developmentally there’s so much going on for them in terms of both like socially, intellectually, in terms of their family system, right? There’s this big push pull at that point in time to formulate their identity, to really seek social connections and really look towards the life outside of their family unit. And so we do see that where the teen is trying to make those connections. It’s not working the way they want or things are difficult and academics is hard and then you also have puberty hitting. And so there are all of these multiple factors. And so I think in adolescence, it almost feels like the perfect storm sometimes in terms of there’s so many directions they can go and then they also don’t have the skills sometimes to navigate those things, and so that piece I think really comes into play around when we see mental health get harder for them.

Cindy Lopez:
So then my mind jumps to risk factors. We talked a little bit about warning signs. So what are the risk factors for suicide in children and teens? And I’ve also read that there is a risk assessment that can be done, like when is it appropriate to use that? When would parents want to request that or be seeing it?

Jenn Leydecker, LMFT:
I think the piece for us is any time a teen mentions suicide or any time as a parent you kind of notice that something is a little off or different. Sometimes a teen is willing to talk with a parent other times it’s more about reaching out to the community to seek support, a school based counselor, a therapist, I think are all really great resources. And if there’s a really high concern, then you go get a risk assessment at the emergency department or at like Uplift where now the really great thing is using 988, the mental health crisis line in your community and being able to have someone come and assess that’s trained in risk assessment. In RISE where I spend time with the teens we risk assess every time we see them. And so for us asking those questions, I think about where they’re at, what they’re thinking about and having somebody that’s comfortable asking those questions is also really important. We are direct and to the point, which really removes kind of that stigma that we had talked about earlier in asking about what their thoughts are. Starting from like, I call ’em like the little bubble thoughts that sometimes just peak up like in the middle of the day where something’s hard and it’s like, “oh, I wish I could just go to sleep and not wake up” kind of a thing to like, “I’m really thinking and considering about how I wanna do this.” And so as a parent, it’s hard to have those conversations and not allow your emotion to be involved, and so this is a place where I think reaching out to the professionals is really important and getting a sense of like, okay, which direction do we need to go?

Cindy Lopez:
Yeah and to our listeners you can contact us at chconline.org. You can contact our care team careteam@chconline.org. They can set you up with a free 30-minute parent consultation just to advise you and guide you about next steps – that might be a place to start. I also wonder does substance abuse play into these risk factors at all or not?

Jenn Leydecker, LMFT:
It can. Yes. I think with substance use sometimes there’s kind of that recreational side to it and then there’s also the piece where we do see teens that use it to self-medicate. So they’re using things like cannabis to kind of regulate their own anxiety and it definitely doesn’t work the way that they are hoping it does, right? There’s kind of that bandaid effect where the wound is still there, and it’s just kind of covering it up. And so that kind of overlap between the two can definitely make someone that’s already suffering worse when they are sometimes sober versus using. And then other times there is the effect of like increasing impulsivity when they’re under the influence, and so you do have sometimes that kind of overlap teens who are already suicidal and then they’re using and that increases their suicidality, where they may choose to act in a moment where if they were not using, they could logically kind of think through or have something where they can use as a reason not to act.

Cindy Lopez:
So from what I’m hearing, substance doesn’t mean that they’re automatically at risk for suicide or even mental health issues, right?

Jenn Leydecker, LMFT:
Yeah, it depends.

Cindy Lopez:
But it does play into it. So let’s talk for a minute about protective factors. It’s not just teens who are dealing with suicidal thoughtor attempts, but children do too. Are there protective factors against suicide or suicide attempts?

Jenn Leydecker, LMFT:
Yes. So one of the big protective factors is having access to mental health supports, which is what we’ve seen both in terms of the number of therapists and providers in the Bay Area are pretty significant in response to the deaths by suicide that we had seen historically in the community of adolescents. And then also the schools really ramped up their mental health supports on campus the last I think 10 to 15 years, right? So really making it much more accessible, I think is, is a really key protective factor in terms of they can go in and talk to anyone. We also have a lot of teens that use like the Crisis Text Lines or the Trevor Project is one that a lot of our teens use where they’ll reach out and talk to a counselor on the phone, and they don’t know this person. They just know that they’re a safe place to talk through what they’re needing in that moment.The other piece is having like another trusted adult. It doesn’t have to be a mental health based worker. It can be a coach, it can be a mentor, it can be a teacher that they really connect with at school and that’s a protective factor as well. And then having something that drives them. So something even in those dark moments, we call it like a life worth living goal or reason for living. So what are the things that really keep them going? And so sometimes that’s like, I want to do this very specific career when I get older or I can’t imagine leaving my cat, right? So sometimes our animals are one of our biggest protective factors and then family is also a big piece for a lot of our teens. And so those ones we focus on and the other big protective factor that we’ve found is that if they can problem solve on their own, even when they’re having a really hard time, if they can see some sort of light at the end of the tunnel, that is really helpful. And so some of the skills that we talk about in DBT and RISE is like just getting through this moment to like tolerate this. So then you can see that light at the end of the tunnel and be able to work through what’s happening and so the other side, right, is where everything is dark and nothing seems like it’s going their way, but for us really working on that problem solving is a really key factor that we take into consideration.

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Cindy Lopez:
Being an educator I always think early intervention, right? I’m wondering, what would early intervention look like for parents and kids as they think about this idea of suicide prevention?

Jenn Leydecker, LMFT:
I think having conversations about our emotions. So opening the door to talk about when we’re sad or when we’re angry, and really using emotional vocabulary I think is really a big piece. So building early on the idea of talking about your emotions and being heard and having those emotions validated in a way where you feel like as a growing child somebody understands you and can speak your language. And so I think having those conversations really early on is important to give them the vocabulary and to also talk through, like, if you don’t feel like you can talk to me, it’s okay to talk to your teacher. It’s okay to talk to your counselor at school or whomever that you need to talk to. So allowing for them to share when things don’t go their way, and I think the really key piece that we found is as parents, we jump in to fix because we want to end whatever suffering, small or big that the child is experiencing. And it’s really about sitting with them in the moment and experiencing that emotion with them in a way that’s validating. You can make that connection with them and also in some ways co-regulating with them. So showing them in those moments, this is how we can calm down, not telling them, but really showing them like, we’re gonna sit and we’re gonna watch the clouds. Small things like that can really give them those skills that then they can pull on when they’re not sitting with anybody, and they’re noticing that they’re starting to get really ramped up can be really helpful early on. One of my four year olds, I have four year old twins, and he feels all the feels is what we’ve kind of tagged it as. And so sometimes we just sit and we take our deep breaths together. We don’t talk about anything for a minute until we get to that place of like, okay, I can have a conversation with you around what just happened.

Cindy Lopez:
It’s so interesting too cause I think especially as kids get older, but even younger children can pick up on parents’ emotions, and so if there’s something going on they may feel like they don’t wanna talk to their parents because it’s gonna add to their parents’ anxiety, worry is that accurate?

Jenn Leydecker, LMFT:
Yes, I would say that comes up sometimes. It’s like, well, I didn’t say anything cause I didn’t wanna worry anybody and our kind of challenge to that is we are worried and we’re rightly worried, right? You’re in a lot of pain. You’re suffering. You’ve been doing this alone and we don’t want you to do this alone, and so I think the idea is as human beings, we emote, like that’s where we start from in a lot of our connection with other people is our emotional response to them and the events that are happening. And sometimes we are effective at holding that and making it look like, okay, kind of like the duck on the water, right? The top of the duck, super still, underneath that those feet are kicking super fast. And so I think in those moments, even if we feel like we are keeping it together, our kids are paying attention and they do see those things. And so talking with them of like, yes, this is happening, and I have time for you.

And so we talk about like sometimes we invalidate as parents and we don’t mean to because there’s thousands of things as a parent, as an adult, that we have running through our brain and so in that moment, our teen may come to us, and we may miss the mark, and it is totally okay to come back to them after and say, “you know what, I realized you needed me and so let’s sit down, let’s talk about it.” And I missed it, and so I’m noticing I wanna give you space, so I’m gonna sit here. I’m gonna listen. Sometimes that conversation is better to have in the car or like on the couch where you’re sitting next to each other, but you’re not like face to face. So those kind of like informal, going for a walk where you can just talk and sometimes it’s just us parents listening.

Cindy Lopez:
Yeah. And I think that idea that some kids feel like they have to hold their parents’ worry or their parents’ fear or their parents’ anxiety, everything you just said can help parents kind of negate that for their child, right? And I really like what you just said too about parents coming back and saying I missed that or I messed this up. I want to talk about this. I think that those do-overs are good for everyone. So what can parents do if they believe their child is at risk for suicide or their child’s having suicidal thought?

Jenn Leydecker, LMFT:
I think opening the door with the teen and so we use the term like non-judgmentally or like being really compassionate in terms of like, “I’m noticing this is happening. I’m noticing like school has gotten a little bit more difficult for you or these things are going on,” and seeing where it lands. I think sometimes too as parents, we might have a lot of anxiety cause we’re noticing things and our brain will sometimes put pieces together and really kind of catastrophize and go to the nth degree. And so sometimes talking that through with somebody first, right? The 30-minute consult at CHC that you talked about or even talking with the school counselor if you’re comfortable going and asking questions and talking through, okay, how do I have this conversation and playing it out ahead of time because sometimes we only get like one and a half shots of doing this with teens. And so trying to be the most effective at the start. And then I think also saying like, “I’m willing to do what you need me to do.” So if I’m not the person can I really try hard to find you a person that you can talk to that’s not one of your friends. Cause that’s the hard part, like our teens they are incredible peer support to one another sometimes and there are really great things that they do for each other as friends. And then sometimes they are in the mud with their friend and it’s really heavy and then sometimes teens will say no and so we talk with parents at that point of, you know what, you can find someone for you to help you support the teen.

Cindy Lopez:
So resources for families that are in the middle of this kind of crisis are really important. I think most people would get okay if this is how my child is verbalizing suicidal thought they’re attempting suicide. It seems like that’s obvious, like call 911, go to the ER, right? But what happens after that? How did they follow up? It seems like there is a little bit of a gap between that point at which suicide attempt occurs, cause that’s just a point in time, right? So then what happens after that is really important. What are the resources for parents who are in that situation?

Jenn Leydecker, LMFT:
So sometimes the inpatient unit that the teen lands in post-hospitalization, if they are concerned about safety or the emergency department they will provide some resources and sometimes they’ll help you land in a place. So like we get referral packets pretty consistently from different places for teens that they’re recommending come to us in RISE. In the Bay Area there are so many teen based therapists that have access. At CHC we have our own set of really skilled and incredible therapists that work with teens, and we also have a wide resource library of providers in different parts of the Bay Area that we sometimes connect families with to help them. Reaching out to your pediatrician also is a key piece cause sometimes within your insurance network they’re able to help support you in connecting with a provider ‘cause it is a lot of legwork sometimes to find a program or to find a provider. And so your pediatrician’s office can sometimes support with that, but then also your insurance company if that’s the direction you wanna go, can really help. And so I think those are the places and then your school. I think because professionally I grew up in a school and so for me being a previous school based counselor, I think your school is an incredible resource because your child is spending a significant portion of their day there. And so going in and talking with the school, seeing how the school can support the teen onsite – opening the door around starting to meet with a counselor, if it’s a 504 plan to really help support them in terms of academics and reducing some of the stress, or if it’s something that needs a higher level, like an IEP, the school is really there to provide support for the teens. Sometimes we think like school is academic, home is different, but with mental health, it’s 24 hours a day, and so having that as a resource is also I think a really key factor.

Cindy Lopez:
Those resources I think are really important for parents who are in the thick of it. I have had friends of mine who are parents who have been in that position, and they’re so thankful for the resources they’ve been able to find. I really appreciate all the ideas you had: your school, reaching out to your pediatrician. Lots of times, as you noted the Ed or the ER has, referrals. We’ve referenced a few things too. We’ve talked about DBT a couple of times, dialectical behavioral therapy that’s an approach to counseling and therapy that really teaches kids skills and even parents skills about communicating with each other and that’s really important. And again, you can find some of that information, our podcasts, in our resource library at CHC. So Jen, as we wrap up I’m wondering what final advice do you have for parents who are worried about their kids right now?

Jenn Leydecker, LMFT:
One piece that I share with parents is sometimes you need to take a deep breath and ask the really hard questions of your teen. I think dancing around subjects because of our discomfort or the teen’s discomfort doesn’t allow for change. And so if we really notice that something’s going on, if they’re struggling in one direction or the other, really kind of taking that deep breath, calming your nerves a little bit and then asking them directly, in a way that’s not accusatory or judgmental, but just with compassion coming to them, I’m concerned. I’m noticing these things, like are you thinking of suicide? And it’s what we talked about at the start, that worry, that stigma that goes with mental health and with suicides specifically, the more we talk about it, the less stigma there is.

Cindy Lopez:
Thank you Jen so much for spending your time with us on this really important topic and to our listeners thank you for listening in and if you want to reach out and you need some help, chconline.org. You can reach out to our care team, careteam@online.org or call us (650) 688-3625. Thanks again and to our listeners, we’ll hope you’ll join us again next time.

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