Jan 6, 2015 — Are you worried that your teenager is considering self-harm or even suicide? It can be difficult to bring up the delicate matter, but Dr. Tom Miller and Dr. Jim Ashworth go through several “what if” scenarios to help you know how to approach the subject and what to ask your child. They also provide useful information regarding resources and what you can do as a last resort.

Interview

Dr. Miller: How do you have a conversation with your adolescent about suicide? I'm here with Dr. Jim Ashworth. He's an associate professor of psychiatry, in the Department of Psychiatry. We're going to talk about that next on Scope Radio. I'm Dr. Tom Miller.

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Dr. Miller: Jim, thanks for being here. Tell us a little bit about how a parent might begin a conversation with their adolescent about suicide, if they were concerned about it? What things would they say?

Dr. Ashworth: So, a little tricky, just because every parent's relationship with their adolescent varies a bit. But I feel like it's always a good policy to be as calm and as straightforward as possible. I would start out by saying, "Look, I've noticed lately, things have looked like it's been different. You're not hanging with your friends anymore, you get angry really easy, you're stealing things."

Dr. Miller: "You're staying in your room. You've got your headphones on. You're not interacting."

Dr. Ashworth: Exactly. It's like, "What's going on?" "Nothing." Then you're going, "Well, something is going wrong, Johnny, because . . ."

Dr. Miller: "I've noticed a change. Your teacher called. You're skipping school." He goes, "So?"

Dr. Ashworth: Exactly. Okay, yeah, I have had adolescents. Then you go, "Well, here's the deal. I noticed on your arm, the other day, that there were some scratches there. What was that about?" "I don't know." Then, "Is it were you maybe thinking about hurting yourself to feel better or trying to kill yourself, or what?" You may have to just flat out dig in there and ask it, and they may, like I sort of mimicked there, not really want to talk about it. But you've got to just press forward.
Do it calmly, do it caringly and say, "Look, I'm worried about your safety." If they say, "Yeah, I'm thinking about killing myself," then it's like, "Well, we need to go talk to somebody, because I care about you. I'm your parent, let's go. Let's go right now and we'll just go to the emergency department, and find out what the deal is. Let's do this."
Hopefully, they'll go, "Okay." Or if they don't want to go, and you really can't get them, one option, though it's really drastic, and I'd reserve it for the very end, but literally a parent could call the police and say, "Hey, I'm worried about my son's safety. He's refusing to go talk to anybody. He's saying he wants to kill himself. I need help". They could come and help get him to an emergency department where he could see a crisis worker and they could really talk about it.

Dr. Miller: What about the parent who is concerned about suicide-proofing the home? What things should they do if their adolescent comes clean and says, "Yeah, I'm worried that I might harm myself"?

Dr. Ashworth: A couple of things. One is weapons of any kind, firearms, are really the most lethal thing out there.

Dr. Miller: Are not most suicides in teenagers committed by firearms?

Dr. Ashworth: Yeah, completed suicides. Attempts, it might be a lot of different things. It might be cutting, or it might be overdose. Of course, firearms, there really isn't a second chance usually. A lot of times, people who are thinking about killing themselves are ambivalent about living, rather than really wanting to die.

Dr. Miller: An important distinction.

Dr. Ashworth: Oftentimes at one point they might want to die, potentially hours later, they don't want to die, and they're glad they didn't kill themselves. If you have firearms, they need to be locked up, seriously locked up. Most adolescents are smart enough to know your combinations or whatever. You need to change the combination if you have a safe, get them out of the house, have all the firearms go to a trusted family member or friend, or whatever. That, to me, would be one of the most important things that you could do.

Dr. Miller: What if the teenager opens up to you, as a parent, and says, "I'm really concerned. I am frightened," and it took a while to get this out of them, but once it's out, what is the next step? Sometimes I think a parent might be so startled, they wouldn't know what to do next because they were worried they might make the situation even worse by acknowledging that this was a possibility. "How could my little Johnny ever want to commit suicide," or Judy.

Dr. Ashworth: Right. I would say, to me, that's actually a more positive sign, because they are willing to come clean and open it up.

Dr. Miller: That's true. And you have to admit to yourself the possibility of it really happening.

Dr. Ashworth: Yeah. As a parent, I would say, "I really appreciate you telling me this. I want you to know I care about you. I'm here for you. We will get through this. Let's get some help. Let's get some professional help. I will help take you anywhere. To the emergency department, right now. Let's just do this, and let's get this sorted because there are lots of treatments out there that can be really effective at making you feel better. We just need to get it started."

Dr. Miller: Do you think it helps to have more than just one parent having that conversation?

Dr. Ashworth: Depending on the relationship, yeah. If there's a strained relationship between the adolescent and, say, the other parent, you probably still need to tell them if they're all living in the same house.

Dr. Miller: Right.

Dr. Ashworth: But, I'm thinking of maybe divorced parents, and the patient is clearly close with the person they're talking to, maybe not so close, I would say the parents need to know. But at that moment, I would try to get him into see somebody first. Then later would be like, "Look, we really need to tell your mom, or your dad, about this. This is a big deal, they need to know too." That can be very helpful because they can see this parent that they, up until then, have, maybe not had a close relationship with, begin to see how that parent is concerned appropriately and that sort of thing. So it can be useful.

Dr. Miller: Do you think the troubled teenager would talk more closely with siblings than the parents?

Dr. Ashworth: Sometimes. Yeah. Particularly an older sibling, that's often the case. It just get's so varied. Or if they are irritable and depressed, they've alienated their siblings. Right? I've seen that, as well.

Dr. Miller: It sounds like the main thing is, number one, have concern and then do not be afraid to ask questions. Ask the right questions, and then act on the answers to those questions.

Dr. Ashworth: Don't let them throw you off the track by saying, "I don't know," or whatever. Just keep at it in a positive, supportive way. "What are you really doing here? This is different." Keep underscoring "why" and then ask them exactly, "What's exactly going on?"
They could still lie to you, that's true. My experience has been adolescents tend to be really open, once they get to the right part. I just haven't had much experience where an adolescent has come to my office and they've just started to really lie to me. They tend to open up.

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