“Even with all the knowledge and experience I hold, I am still taken aback by how difficult it is to manage in your own home and how easily knowledge goes out the window when it is your child who is experiencing thoughts of suicide and self-harm behaviors. It is a terrifying, confusing, and scary time,” Yoder says. Thoughts of suicide and self-harm are on the rise in adolescents, according to a new study published by the American Academy of Pediatrics (AAP). This research shows an increase in emergency department visits for youths related to suicidal ideation, which the National Institute of Mental Health defines as the thoughts someone has about considering or planning on taking their own life. A second study released in JAMA Pediatrics indicates one of the possible reasons. As mental health care professions experience shortages on the county level, suicide rates among youth increase.
More Kids Going to the ER for Suicidal Thoughts
The latest AAP study on suicidal ideation and subsequent hospitalizations shows an increase in emergency department visits for children between the ages of 5 and 19 years old. Researchers analyzed emergency room visits throughout Illinois between January 2016 and January 2021. They found ER visits increased by 59% from 2016-2017 to 2019-2021. A troubling 23.3% of those ER visits that were classified as a “mental health code” resulted in a hospital stay. The majority of these come from teens aged 14 to 17. For all age groups, there were two large spikes of emergency department visits related to suicidal ideation: through the fall and winter of 2019, and then during the initial year of the COVID-19 pandemic. The highest monthly visits peaked in October 2020. The findings of the study in Pediatrics suggest the trend in hospital visits for suicidal ideation in children is not entirely linked to the pandemic. In fact, the mental health landscape fostering these issues existed even before these difficult years.
Suicidal Thoughts Not Just A Pandemic Problem
Mental health providers say this crisis has long been a concern. “I cannot remember a time during my career when there was not a mental health crisis,” says Scott Roth, PsyD, a licensed clinical psychologist in New Jersey. “The issues that children are facing are becoming more and more complex. Increased suicidality and suicidal ideation are only some of the tragic outcomes that we see.” While the pandemic might have increased isolation in children, Dr. Roth explains there are many reasons children experience suicidal ideation. Social media, for example, is not an inherently harmful thing, but the wrong messages can often be amplified to children. “[During the pandemic] responsible and limited internet use turned into unsupervised internet use for many families,” Dr. Roth says. Dr. Roth makes another point corroborating the AAP study’s findings. He says the lack of access to high-quality mental health care has reached a crisis point in America. Between January 2015 and December 2016, well before the COVID pandemic, the youth suicide rate rose 4% for every 1-point increase in the mental health professional shortage on a county level. There were 5,034 youth suicides in that time in the age group between 5- to 19-years-old.When Mia Yoder experienced suicidal ideation and self-harming behaviors, Candace Yoder insisted on working with her school, especially after her time with Southern California Counseling Center. “I felt helpless even though I refused to give up,” Yoder says. “I worked with her middle school endlessly and recognize the privilege I held in having them as a resource to the degree they are. Most school districts do not have the same resources, and I run into that issue regularly throughout my work.” Access to mental health staff at schools is vital especially as other professional resources come up short. Unfortunately, even school districts with mental health professionals and counselors often do not have the resources to adequately care for student populations. “Mental health staff in schools are often at the front lines of identifying and triaging during mental health crises,” Dr. Roth explains. “The American School Counselors Association (ASCA) recommends a 250 to one student-to-counselor ratio. The average ratio across the country is almost double this at 415 to one.” It’s true that the pandemic might have exacerbated these already challenging issues for children. However, the conditions for an increase in emergency department visits for mental health crises were already brewing because of incomplete access to health care for children. Peer pressure from social media usage, in conjunction with isolation, illness, and fear, exposed the limitations of the healthcare system in the United States.
What Signs Should Parents Look Out For?
Parents and caretakers want to keep their children safe from harm, especially self-harm. Mental health crises are often preceded by several signs. “[A] sudden change in academic performance, socialization, withdrawal, eating, and sleep are red flags that are worth investigating,” Dr. Roth explains. “Depression in children and adolescents also looks different than it does in adults. In children, depression can look more like increased irritability and anger.” Yoder’s daughter Mia experienced exactly this. “She was always an extremely mild-mannered child with a very kind and empathic heart; she never wanted to disappoint anyone,” she says. But when Mia became suicidal, Yoder saw a major personality shift.“She was very vocal, and her signs were loud, which can easily be missed and labeled as behavioral issues or puberty by someone who is uneducated in mental health/suicide awareness. Any major changes in behavior [are] a warning sign of distress. Many of us normalize it as puberty, but behaviors don’t change that quickly,” Yoder explains. Dr. Roth encourages parents and caretakers to keep an open dialogue with their children about how they’re feeling. An open channel of communication is key to removing the stigma against seeking help, especially in teens. This may also help your child react when one of their peers experiences a mental health crisis. Children are often more open with their friends than parents, especially in the early stages. “Parents should also note that they might not be the first person their child tells that they are struggling. Many prevention programs are actually aimed at teaching children how to respond when they hear their friends are struggling with depression or suicidal thoughts,” Dr. Roth says.Yoder emphatically points out that adolescents and teens struggle with problems just as adults do. “We can’t write off a normal teen experience as something that they will simply ‘get over,’” Yoder says. Even so, she is proud to report Mia is in recovery. “She has now graduated high school, works for our foundation, and is an advocate for mental health, equality, and social justice,” Candace says. Prevention and recovery are possible for kids and teens who experience suicidal ideation.
Suicide Prevention Programs for Kids and Teens
In light of this national emergency, President Biden spoke about the national mental health crisis during his State of the Union address in 2022. There, he announced his “unity agenda.” This addresses ways to strengthen the mental healthcare systems in this country. This is where the 988 National Suicide Hotline came from. Locally, Dr. Roth says there are many schools that list suicide prevention programs on their websites. In his state of New Jersey, Dr. Roth suggests a suicide hotline for children and adolescents called 2nd Floor, where they may call, text, or chat with mental health professionals. Yoder suggests her own foundation, Matthew Silverman Memorial Foundation, as a place for resources for parents with children experiencing suicidal ideation, as well as the National Alliance on Mental Illness (NAMI). She calls it one of the best support groups in the country. If your child is in the midst of a suicidal crisis, call 911, or the National Suicide Hotline at 988.
