Teen Suicide Prevention Part 2

By Dr. Eric Scalise

Teen Suicide Prevention: What to Do When You Don't Know What to Do

Teen suicide is preventable and knowing how to recognize the risks and warning signs, can literally become a matter of life or death. Sadly, our young people, especially those aged 10-24, represent one of the most vulnerable segments of our society.

In part 1, we looked at precipitating factors such as having a family history of mental illness or suicide, poor impulse and control behaviors, life threatening health problems, and self-esteem issues. As we dig a little deeper, here are additional risk categories that are important. In other words, if any of these dynamics are present in a teen's life/environment, then he or she would be considered as a higher risk for suicidal thinking and behaviors to develop.

• A history of physical or sexual abuse

• Excessive exposure to violence

• Problems with alcohol or drugs

• Persistent bullying (in person or online)

• Wrestling with gender identity issues and/or same sex attraction

• Facing an unwanted pregnancy or having a sexually transmitted disease

• Ongoing conflict with family members and/or peers

• A lack of or refusal to utilize available support systems

According to the American Foundation for Suicide Prevention (AFSP), over 70% of all people who commit suicide give some indication they are sliding into despair and hopelessness, and may be giving clues about their intentions before making an actual attempt. Here are the most common warning signs:

• Appetite disturbances—usually a loss of appetite (this is not the same thing as eating disorders such as anorexia or bulimia)

• Sleeping disturbances—this can manifest as the inability to fall/stay asleep (hyposomnia) or difficulty waking/getting up (hypersomnia)

• The inability to cry or grieve

• Blunted (restricted/constricted) emotions or a flat affect (nearly no emotional expression, speaking in a monotonous voice, and/or diminished facial expressions)

• A depressed mood and/or expressing an inability to cope any longer—not to be confused with normal adolescent hormonal moodiness

• Apathy, withdrawal, and isolation—no longer wanting to spend time with friends and family members or communicate via texting and other social media outlets

• A noticeable drop in school performance, grades, or interest in extracurricular activities

• Sudden outbursts of fury and rage—often seen without any obvious or apparent reason for the strong display of emotion

• Giving away meaningful, sentimental, or "treasured possessions," especially to family members and close friends. This can be a way of trying to create a sense of closure in life or of saying, "Good-bye"

• Preoccupation with the notion of death in movies, art, music, literature, clothing, social media, etc.—this can sometimes be confused with the Gothic subculture and its dark and morbid orientation

It's important to also bear in mind that one or two symptoms do not automatically imply that a suicidal gesture is imminent. The flip side of the same coin is to not overlook, minimize or summarily dismiss what's taking place.

Think of these risk factors and other indicators as being on a 10-point continuum from mild (1) to severe (10)—much like the pain scale that many doctors use today. Scores above a 6 or 7, especially across several categories, may necessitate contacting your doctor or other qualified mental health professional to help with a more thorough assessment. Worth noting are things like frequency (how often a particular warning sign is occurring), intensity (how intense the emotions and/or behaviors are when they do occur), duration (how long the effects last in terms of hours, days, weeks, etc.), and variability (how many different warning signs/indicators are being observed).

If an adolescent is able to articulate (verbally or in writing) a thought out and planned method/means in which to commit the act, including a set time frame, then the impending threat is much greater and may require immediate attention and action.

Likewise, teens who have shown warning signs accompanied by a period of severe depression and then display a sudden positive upswing of mood, may be very close to the edge. Unexpected calmness or a brighter affect can signal a teen has already made a final decision and let go of whatever burden/pain that has been carried around, so within his or her own distorted frame of reference, life is now deemed to be "OK."

Here is a helpful acronym to keep in mind—the S.T.O.P. principle—when intervention is necessary:

S – determine the specifics of any suicide plan/intention
T – determine the timing of any suicide plan/intention
O – determine the options that are available to the teen for committing the act
P – determine the proximity of help, intervention, and support

When confronted with a strong or imminent threat of suicide, it is important to communicate clear concern for the teen, awareness that he or she is capable of/serious about self-harm, and that help is available.

The National Suicide Prevention Lifeline is 1-800-273-TALK (8255).

Removing access to firearms, sharp objects, and other items (including some medications) should be discussed. However, it may also be necessary to call 911 or get the person to the nearest emergency room. Most ERs have trained psychiatric staff available at all times, and in many states, hospitals and can involuntarily detain someone for 24-72 hours if there is a threat of suicide. Sometimes, a local magistrate is also involved and a temporary detention order (TDO) may be issued against the person's will if further assessment is warranted and he or she is uncooperative.

As Christian parents, educators, ministry leaders, and caregivers, we have a sacred trust to respect and protect human life. In the New Testament, the Greek word, "metanoia," refers not only to the concept of turning around and changing direction, but turning away from darkness and walking into the light. As ones who help bear the light, our level of awareness, discernment, preparation, and wise counsel can help make all the difference in the world when we intersect the path of a hurting and desperate teenager.

Teen Suicide Prevention Part 1

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