April 24, 2024
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. In today’s episode, we discuss the sensitive but critical topic of teen suicide. According to the CDC, suicide rates from 2007 through 2021 for Americans ages 10 through 24 rose 62%. In this conversation with CHC doctoral psychology intern Emily Raymond we discuss key risk factors that parents, educators and peers should be aware of, offering practical strategies for parents to create open lines of communication with their teens and recognize warning signs. By fostering a community of compassion and understanding, we can work toward reducing teen suicide rates and create a safer, more supportive environment for all adolescents.
So thank you Emily for joining us today. This conversation is really important regarding teen suicide. Before we actually get into it though, why don’t you tell us a little bit about yourself and why this topic is so meaningful to you?
Emily Raymond: I am a doctoral student currently at the University of Maine, but on my internship at Stanford and Children’s Health Council Consortium. I have been working in suicide prevention for the entirety of my graduate career. I have worked both in the research side and the clinical side, so doing research on how we can assess for risk factors of suicide and understanding differences in people who act with non suicidal self-injury, so things like cutting, burning, and things like that versus attempting to end their life. So that is something that’s been a big passion of mine throughout, and clinically, one of the places I have loved working the most and somewhere I plan to keep working in the future is working in the emergency room, in the pediatric emergency room, so helping assess when kids come in after an attempt or their parents are worried about an attempt, I am there to help them decide, “Okay, do we need to send this kid to the hospital? Is this fairly serious or is there a way we can send them home safely?” And I help the families assess what that risk looks like and ways to keep them safe if they do go home.
Cindy Lopez: Wow. That’s such an important role. Thank you for doing that. You know, it’s interesting, as I was preparing for this episode reading about suicide and teen suicide specifically and the data that I read said from 2007 through 2021 suicide rates for Americans ages 10 to 24 rose 62%, and that’s according to CDC figures. In Palo Alto here the youth suicide rate was four times higher than it was nationally in 2016, that was a CDC 2016 report. So, overall, I think since then there’s been a decline in suicide rates, so that’s interesting, too. I had to read several times that part of the article, I was like, it’s really declined? It’s declined? Because it seems like we hear every day in the media about the crisis around teen mental health and it is but at many levels, right? And not just suicide or suicide ideation or an SSI, self-harming behaviors, but across the board. So, let’s talk about that data for a minute, like what does today’s data tell us, actually?
Emily Raymond: When we think about this massive increase that’s happened over the past 15 years or so, and then this more recent decline, we have to think about it in that terms. We’ve gone up so much that a little bit down doesn’t mean that we’re out of the woods just yet. One of the reasons for this that’s been speculated is COVID-19. The social isolation that came from that, a lot of the acute stressors from that, really led us to a huge rise between 2020 and 2023. And then we’re seeing a slight decline now that students are back in school, they’re getting back to some social connectivity that they were missing before. It’s not the only explanation. I think that mental health work has also been an aspect of this, that we have been able to start the process of destigmatizing mental health, understanding that this is a huge problem and that the work is going towards this and the hope is that we keep going in that direction, but, yes, again, not out of the woods quite yet.
Cindy Lopez: Yeah. It’s a good reminder, like it had gone up so much in the past, going down a little does not mean that we have gone down overall.
Emily Raymond: Exactly.
Cindy Lopez: Are there populations that are more at risk?
Emily Raymond: Absolutely. So, Black youth in particular and Native American youth are at some of the highest risk compared to white and Asian youth, as well as members of the LGBTQ+ community. So, groups that are often marginalized and groups that sometimes have some cultural differences in how they view mental health. Particularly when we’re looking at racial differences, there are community differences in how their families might address mental health, how their help-seeking behavior might differ between different family groups and what suicide means to those groups. And in the LGBTQ+ while as a group typically are more mental health inclined, they’re facing a lot of intense discrimination, potentially even in their own homes in a way that puts them at a high risk, unfortunately, compared to others.
Cindy Lopez: For our listeners, just so you know, we have a couple of episodes that might be of interest to you related to what Emily was just talking about. One is around mental health and the Asian American community and how that is viewed and how they respond. And then we also did a Spanish episode, Demystifying Mental Health, all in Spanish. So those are a couple of episodes that you might be interested in as we look at certain populations, and how they respond to mental health kinds of topics and challenges.
Emily Raymond: In addition to the groups just mentioned, rural youth are also twice as likely to be dying by suicide due to access to firearms compared to urban youth. A particularly scary statistic and one I don’t think we talk about enough because usually we’re thinking about marginalized groups, whereas rural and urban are usually not groups that we’re seeing comparisons of, but that is an important one to think about as well.
Cindy Lopez: So as we think about this, you talked a little bit about some populations that are more at risk. What are the risk factors?
Emily Raymond: So there are several risk factors to consider, and they’re all ones that we consider when we are doing assessments as clinicians. So the first one that I think is really important to consider is impulsivity, engaging in an act of self-harm and an attempt to die by suicide comes usually in an impulsive moment. So we have to think about if your child is more likely to engage impulsively in behaviors, they are more likely to end up in a situation where they are unsafe, unfortunately. This can come from ADHD. It can be a part of depression that they’re experiencing that impulsivity, but other mental health factors in general can be more associated with impulsivity and suicide.
Cindy Lopez: And that’s interesting, Emily, because I also know from our IOP, our intensive outpatient program here at CHC that we run in association with Stanford, that’s the RISE IOP, you can find more information online at chconline.org, but when you talk about impulsivity, I’ve also heard from our folks in the IOP that it’s planful, like students have a plan. The kids who are in the IOP generally have a plan, and it’s pretty specific. So I wonder if you could comment on that because it sounds like it’s different then what you were just saying from impulsivity. So how do those two things kind of go together?
Emily Raymond: Yeah, and while they do seem contradictory, they do actually go hand in hand in several ways because the movement from a plan to an actual action, there is a far cry between those two things. A plan is something that is also really important in our assessment process, having a specific plan is a major risk factor for an attempt on one’s life, but the idea of having a plan versus acting on it is where the impulsivity goes from, oh, this is some pretty intense suicidal ideation to, oh, this person is a risk to themselves because they’re willing to act on it in moments where they’re at a high emotional level. So if we think about the RISE IOP, which I’m also a member of, and I do group therapy for, these kids a lot of the time are in situations where they both have these plans and ideation, but they also have the impulsivity when they’re in high emotional states to then act on these plans, whereas someone who has less impulsivity might not act on the plan that they have.
Cindy Lopez: And you just mentioned too students with ADHD because we think of impulsivity as a characteristic often of ADHD. Does that mean that there’s a higher risk factor if you have ADHD?
Emily Raymond: Yes, there is a higher risk factor for those with ADHD, both engaging in self-harm behaviors as well as behaviors that are risky in general that could even lead to accidental deaths.
Cindy Lopez: Well, thank you. What other risk factors, would you consider as we look at teen suicide?
Emily Raymond: Some of the other ones kind of play into some of the impulsivities, reaction to high emotional intensity. So that can look like having a romantic conflict, potentially, or having a social conflict in general. We’re seeing that a lot of times kids who are in situations where they are attempting on their lives are socially withdrawing from peers, having conflict with peers in which they don’t feel connected to their communities in a way that we would hope at this age. And while social withdrawal is really important, it’s not social withdrawal from parents, which I know parents are going to worry about a lot. It’s social withdrawal from peers that we’re most worried about because social withdrawal from parents is developmentally normative at this stage.
Cindy Lopez: Thinking about these risk factors, if you’re a parent or caregiver, even an educator, considering as you mentioned, the normative development for a teen would be and try to keep that in mind as you’re thinking about risk factors or looking at observing any behavior in your child or student. Are there additional risk factors we should be aware of?
Emily Raymond: Yes, one really important risk factor is access to means, which means access to things in which a teen could attempt on their life. This can look like access to firearms, so having firearms in the home can be a very big risk factor, particularly when they’re unprotected, but even when they are you’d be surprised at how many teens know the combinations on the locks for these safes. So it’s really important if you are worried that those lock combinations are changed, potentially moving the gun out of your home. Even just access to medications that could be at risk can be a big risk factor as well as access to sharp objects. Unfortunately, teens are very creative, and just because they’re interested in one mean of suicide doesn’t mean they’re not going to attempt others. So if you’re worried about any of those means, restricting as many of them as possible is going to keep your teen the safest. And some means aren’t restrictable, unfortunately. If you think about some things in the community that teens have access to, and you’re not always going to be with them. So it’s not always something that we can prevent through means restriction, but when it comes to the things that parents can do and educators can do is finding ways to limit the access to specific types of means.
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Cindy Lopez: So, you mentioned withdrawing socially. So thinking about withdrawing socially from peers, lack of interest, like things that they used to enjoy doing that they don’t anymore. Can you comment a little bit more on that?
Emily Raymond: One of the hallmark signs of depression, which is of course a major risk factor for dying by suicide, is a lack of interest in things that they previously enjoyed. And this can be seen in a variety of ways. This can be seen by not engaging in extracurricular activities that they used to enjoy. It could be, again that social withdrawal, not spending time with peers that they used to, and it can even look like giving away some of their possessions, that’s a risk factor across age groups that people will give away things when they don’t think they’re going to need them anymore because they don’t think they’re going to be alive anymore.
Cindy Lopez: So we’ve talked about the risk factors, we talked a little bit about the data. So I’m sure that our listeners are like, oh my gosh, okay now I have all this information, what do I do? If parents or caregivers are seeing some of these risk factors or signs in their kids, are these factors always, and you commented on this a little bit, but always a sign of suicide that need to be addressed. And how do parents know all that? What should they do?
Emily Raymond: It’s a very complicated situation to be in, and I recognize that parents are always in a situation where they’re trying to do the best they can for their teens. And just because you have these risk factors does not mean that you’re actually at a specific risk to die by suicide, and it is a more complicated system of which risk factors you have together and how those combine, which parents, you might not always know what that looks like, but the best way to understand that is to talk to your kids about suicide. It is a huge myth that talking to your kids about suicide will increase their risk because even if they’re not thinking about it, you’re not putting it into their brains by asking about it. So asking about it is really important. And approaching them without anger or any high intensity emotions is what’s going to be the most important because they don’t want to feel like they’re being punished. They want to have a compassionate ear to be hearing these things because otherwise they’re not going to share if they’re worried about a retribution. And if it does end up in a situation where you do think that they’re at high risk continuing to approach them with compassion and trying to keep your own emotions in check is going to be so important in them continuing to feel safe to talk to you about these things.
Cindy Lopez: We noted this in many recent episodes on our podcast about just listening and being curious. So as a parent, a caregiver and educator, like it’s so easy for us as adults to talk and talk and say, this is what you should do, right? Cause we kind of have the benefit of experience, but I think just thinking about that and how parents, adults can kind of step back and listen, ask a question, you know, pause. Don’t worry if there’s some silence to start with and then be curious.
Emily Raymond: Yeah, definitely. Yeah, I think approaching kids with curiosity and really just taking in what they’re saying is going to be the most important thing. And just because your teen is even thinking about wanting to die doesn’t even mean that they’re necessarily at risk for acting upon it. Having suicidal ideation is not an abnormal experience for a teen or even an adult. Many people experience suicidal ideation thinking about wanting to die without them being at risk for actually acting upon it, which is a really hard thing as a parent to hear and to sit with. And in those cases, of course, finding therapeutic resources is going to be your first step because these kids, a lot of the time, you’re not going to know exactly how high their risk is and that’s when professionals should be part of that conversation.
Cindy Lopez: Yeah. So if parents need to act are there specific steps they should take?
Emily Raymond: Yes, so the first steps that they should take is start by talking to their teen about their concerns and coming from a place of you just want them to be safe because at the end of the day that’s what we’re most worried about is keeping your child safe. And depending on how worried you are, that can look like just seeking out a therapist for your child and having them have someone to talk to that’s not just you. If you’re worried that they’re at really high risk, if they’re saying things like, “I have this specific plan, I’m wanting to act on it,” the hospital might be the right choice in those situations. And then a professional at the hospital then can determine how high the risk is. Parents shouldn’t feel alone in this process. Not only are a lot of other parents going through the same thing, but professionals are here to help, and we want to be there to make sure that you are feeling safe sending your kids home and sending them out of the house, and we want you to feel safe in your home with them.
Cindy Lopez: I’ve also read and heard that youth go to youth first. So, you know, they’re going to their friends and to their peers. How can peers help each other?
Emily Raymond: Yes, a lot of times teens will tell peers before they would tell a parent. As I mentioned earlier, it is developmentally normative for teens to drift a little bit away from parents during this time and really focus their social identities on their peers. And when that’s going on, it’s really important for youth to talk to an adult about what’s going on. Even if you’re worried that they might get angry at you, it’s much better for them to be angry at you than to be unsafe.
Cindy Lopez: Speaking of youth and peers going to peers and friends going to friends first, let’s talk about that social connectedness for a minute because I’m assuming that those students who are talking to their peers are socially connected, right? And schools are often the place where teens spend most of their days and schools can both be an initiator of stress, and I think act as a protective factor. So if there are educators out there listening to this right now, what would you like to say to them?
Emily Raymond: Yes, I think that the major role of educators is to be aware of when you’re seeing kids not be interactive with other kids their age. When you’re starting to see a teen start to isolate either by their own choice or by the choice of the people around them by being bullied and victimized by peers, that is the time when it’s important to go to them and ask them questions. And it doesn’t need to jump right to asking about suicide, but just asking how they’re doing and making sure that they feel like you are a safe person for them to go to when they’re having fears of that is going to be so important because school is one of the safest places for kids to be when it comes to suicide. The fact that they’re going every day, the fact that they’re surrounded by people who are really consistent in their lives and somebody who’s not a parent, frankly, they’re going to be more willing to talk to you potentially than talking to their own families about it. And that responsibility, it’s a very heavy one, and one that should be taken very seriously in this conversation because there’s a lot of schools in which there are really direct lines to the hospital depending on the school that you work at. Some of them might have a direct counseling line that goes right to the hospital to make sure that there are consults available with mental health professionals. And there should be ways to find the resources you need, even if you don’t really understand the mental health consequences yourself as an educator.
Cindy Lopez: Yeah, we work a lot with schools locally in our area, and I know that many schools and school districts have really intentionally increased their support and increased mental health resources available to students. It could be through additional counselors and mental health professionals available to students during the school day at the school in the district. I know there are wellness centers on many high school campuses. So I know that schools are being responsive and trying to create the conditions so students can ask for help, so students know that there are resources that are available to them within the school environment. I just wanted to say that because I know that for schools that has been a very big priority, especially in the past several years. So Emily, thank you so much for joining us today. I’m wondering what, if any, final words of advice or encouragement you’d like to leave with our listeners.
Emily Raymond: Well, the most important piece here is that suicide is preventable, and the best thing that we can be doing for our teens and children in general is to destigmatize mental health and talk about these topics because that’s the best way that they’re not going to feel alone. And that individual conversations with these teens, more than some of the broader initiatives, is going to be what makes the big difference here, is really talking one on one to kids and making sure that they’re feeling seen and heard as individuals when they are experiencing these types of thoughts and these types of urges potentially. Feeling connected and feeling like you are not one in a crowd. You are individually important and that we want you to be safe, and we want you to be alive, is going to be the biggest thing that we can do for kids.
Cindy Lopez: Emily, again, thank you for joining us. Thank you for sharing your insights and expertise on this really important topic. To our listeners: thank you for joining us. If you need to reach out, please do. CHC is here for you. If you have any questions, feel free to reach us at chconline.org. You can email our care team at careteam@chconline. org. You can also call at 650-688-3625. And we have mentioned this a few times during our conversation, the RISE IOP, it’s a comprehensive, Intensive Outpatient Program for teens. And you can find out more about that at chconline.org/rise. Also, we’ve talked a lot on this topic in the past on our podcast. So, please check previous episodes. There are also episodes on fostering teen mental health, so thinking about what are things that you can do just kind of every day to support your teen and mental health. So thank you all for joining us and thank you especially, Emily.
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