Preventing Teenage Suicide – PediaCast 515

Show Notes


  • Dr Meredith Chapman visits the studio as we consider teenage suicide. We explore the scope of the problem, risk factors, screening tools and prevention strategies, including organizational efforts such as Zero Suicide. We hope you can join us!


  • Preventing Teenage Suicide
  • Zero Suicide Initiative




Announcer 1: This is PediaCast.




Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.


Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio.


It's Episode 515 for April 5th, 2022. We're calling this one "Preventing Teenage Suicide". I want to welcome all of you to the program.


So, we have a very important topic for you this week. And it's one that is so important we cover it to some degree every few years. And that topic is teenage suicide.




Of course, the problem is not limited to teenagers. Many children and adults also die each year by suicide. But the problem really takes a tremendous toll on teenagers. Suicide is the second leading cause of death among 10 to 19-year-olds in the United States. And nearly one in six teenagers have seriously contemplated suicide in the past year.


So, think about that in your little block of the neighborhood. It is likely that a teenager has thought about ending his or her life. Suicide affects teenagers from all backgrounds, regardless of sex, race, ethnicity, or wealth. And suicide is complex and tragic, yet often preventable if communities are provided with the right tools.


One of those tools is an initiative called Zero Suicide, which we will explore today. The big idea behind Zero Suicide is that prevention is not just the responsibility of an individual provider or parent or patient. It's really an organizational responsibility. It's a community responsibility.




Why? Because suicide is not just a mental health problem. It's a community problem. It's a social justice problem. It's a public health issue.


So, Zero Suicide establishes buy-in from the top levels of leadership within organizations and from there permeates into the culture. Healthcare workers of all types commit to helping patients navigate the complex landscape of mental healthcare. And they're trained in the competent and confident use of standardized evidence-based tools, tools that help identify and assess suicide risk. And they stand ready to intervene when that risk is established to be there.


Zero Suicide also places an emphasis on tracking data and using that data to continuously improve efforts. So, it's an organizational approach.




And in the words of the medical director of the Center for Suicide Prevention and Research at Nationwide Children's Hospital, Dr. Meredith Chapman, she says a lot of people who died by suicide, including youths, have had contact with the healthcare provider before their death. And mostly, it is not mental healthcare providers. It's primary care doctors and emergency room staff. So as healthcare providers, we all have the opportunity to ask directly about suicide, show people we care and intervene meaningfully.


Our guest today is the author of that quote, Dr. Meredith Chapman and she'll be here shortly to help us the traverse the landscape of teenage suicide and strategies for preventing it.


Before we get to her, don't forget, you can find us wherever podcasts are found. We're in the Apple and Google podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music, and most other podcast apps for iOS and Android.


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So, let's take a quick break. We'll get Meredith Chapman connected to the studio. And then, we will be back to explore the prevention of teenage suicide. It's coming up, right after this.






Dr. Mike Patrick: Dr. Meredith Chapman is a pediatric psychiatrist at Nationwide Children's Hospital and an associate professor of Psychiatry at the Ohio State University College of Medicine. She also serves as the medical director of the Center for Suicide Prevention and Research at Nationwide Children's.


That's what she's here to talk about today, preventing teenage suicide. We'll also explore an initiative called Zero Suicide.


But first, let's give a warm PediaCast welcome to Dr. Meredith Chapman. Thank you so much for stopping by today.


Dr. Meredith Chapman: Absolutely. Thank you so much for having me.


Dr. Mike Patrick: Yeah, really appreciate you stopping by and taking time out of your busy schedule.


So, I mentioned that you are the medical director of the Center for Suicide Prevention and Research. What exactly is that?




Dr. Meredith Chapman: Absolutely. The Center, which we like to call it, the Center for Suicide Prevention and Research here at Nationwide Children's is really a unique endeavor between our research institute and our clinical services at the Big Lots Behavioral Health Pavilion, where we're really focused on research that both helps prevent suicide in youth, as well as really helps further efforts at treating and…


So, we think about treating suicide, but we also think about preventing it. And then, in the event that there is a tragic death from suicide, we think about how we respond to that in the most helpful way. So, we really focus on all of those efforts.


Dr. Mike Patrick: So, you're not only supporting the patients and teenagers who have suicidal thoughts or who have a suicide attempt but also the whole family, right?




Dr. Meredith Chapman: Absolutely. And even it goes beyond families. We work with schools. We work with community agencies. So, for example, the boys and girls club. We work closely with organizations in the realm of suicide prevention. So, for example, in the state of Ohio, the Ohio Suicide Prevention Foundation.


Nationally, we work with organizations. So not only just youth and families but really, the much broader community as well.


Dr. Mike Patrick: Yeah, very important work. So, let's start with just an introduction on suicide, especially as we think about teenagers. How common is this? How big is the problem of teenage suicide?


Dr. Meredith Chapman: Absolutely. I'm sad to say, and probably people hear this all the time, that suicide really at this point in time is the second leading cause of death in young people in the United States between the ages of 10 and 24. And sadly, given that shocking number, there are even some risks that are higher in youth. So, we know that particularly, for example in Black youth, the rate of suicide in Black youth is increasing at a faster rate than in any other racial or ethnic group.




And then, people who live for example in our state, in rural areas, are at even more risk. Or youth that are sexual or gender minority, they are also at increased risk.


Dr. Mike Patrick: How has the pandemic affected teenage suicide?


Dr. Meredith Chapman: Yeah, so that's really an interesting and hard question. And I think some of the information is still out. So, part of the challenge in data related to suicide is there's often a delay in the data that we received. And so, some of the preliminary data suggest that early in the pandemic, the rate of suicide actually went down in certain populations.


However, I think, we also know that during the pandemic, we saw great increases certainly in people's distress, their anxiety, their depression, their social isolation. And so, I think some of the long-term effects of the pandemic is still yet to be seen.




Dr. Mike Patrick: Yeah. It's really tough. At first, you can see where schools really not quite in session. People are isolated, especially if the primary stress is outside of the home, you can see that that will be helpful. But then, it started to get kind of toxic just being at home and then, not having those relationships. And then, of course, when we start connecting back online, bullying and those kinds of things can start up again. And so, just really been a thought time for everybody.


Dr. Meredith Chapman: And access to resources has been…


Dr. Mike Patrick: Oh, yes.


Dr. Meredith Chapman: Challenging. So, it's been both sides, right? In some ways, telehealth has really increased the availability of resources to a lot of people that they didn't have before. And then, there's certainly people who have really struggled with that transition to telehealth and trying to not have those face-to-face visits.




Dr. Mike Patrick: Yeah, absolutely. We've mentioned some of the risk factors for teenage suicide. You'd mentioned Black race, also LGBTQ youth are increased risk. And those in rural communities may be at increased risks. Are there other risk factors that we should be thinking about?


Dr. Meredith Chapman: Yeah, so certainly we think about people who have experienced suicidal thoughts or suicidal behavior at increased risk. We also think about certainly having sort of a mental health disorder or mental health diagnosis, things like depression.


But also, I always like to point out that some people sort of have suicidal thoughts or suicidal behavior without any of these risk factors. And for teens, in particular, sometimes, suicide sometimes just appears as a solution to a problem that they don't otherwise see a solution to. So that gets tricky.




Dr. Mike Patrick: Absolutely. And I imagine that that same sort of thing is true in all ages. So, we're kind of focusing on teenagers. But really, we see it even before the teenage years and certainly into adulthood, right?


Dr. Meredith Chapman: Absolutely, right. When people feel hopeless, when they feel despair, when they're stressed and don't sort of see any other options. And that can occur from age 5 to age 85, absolutely.


Dr. Mike Patrick: And I would imagine that changes in life circumstances, is that also an increased time when you can see suicidal ideation? After divorce, job changes, or moving to a new place or starting a new school, those kinds of things?


Dr. Meredith Chapman: Yes. You're doing a really job about talking about the difference between what I consider a warning sign versus sort of a precipitating event. So, something like that, a change a life circumstance would often be what I consider are precipitating events.


So, something happens. You break up with a significant other. You lose your job. You learn that you're going to be incarcerated. You received a diagnosis. Those are all things that cause significant distress, socially, emotionally. And those often can precipitate a suicidal crisis.




Dr. Mike Patrick: And so, from a parent's point of view, if you have one of those things happening in your family, it's something to have in mind to be thinking about could your kids be thinking we call it suicidal ideation in the medical world. What does that term mean?


Dr. Meredith Chapman: It's really just thoughts of suicide, right? It's this idea that someone starts to think about killing themselves. They start to think about death as an option.


Dr. Mike Patrick: But they don't necessarily have a plan. I mean, they may have thought it through but not always, right?


Dr. Meredith Chapman: Not always, right.


Dr. Mike Patrick: It's just kind of imagining what the world might be like without me. Maybe it would be better for other people.


Dr. Meredith Chapman: Right. Sometimes it's, "I think about going to sleep and not waking up the next morning." Sometimes it's wishing that I never been born. Oftentimes, I hear teenagers tell me, "My family would be better off without me." That's I think a really common one.




I think when it gets more severe, teenagers may start thinking about methods. Maybe they're not planning but they're thinking about things that could cause their deaths. Or maybe they're thinking about just different methods.


And then, sort of the next step is that people do actually start to plan out what they would do with those methods. And then, sort of as it intensifies, then you move from sort of thinking about a plan to actually taking action.


Dr. Mike Patrick: When you talk about suicide being the second leading cause of death in young folks, if it's a second leading cause of death, if we're just thinking about suicidal ideation, that must be a huge number. It's pretty common to think about this, right?


Dr. Meredith Chapman: Absolutely. So the rate of just thinking about suicide is something like 250 times greater than the number of people who actually die by suicide. So yeah, it's astronomical, the number of people that actually just have suicidal thoughts.


And then, somewhere in between is the number of people who engage in some sort of suicidal behavior. They maybe make a suicide attempt. They don't die from that suicide attempt, but they do have some sort of action.




Dr. Mike Patrick: So, I think this is an important point to kind of pause on. That would you say it's safe to say that probably more people have thought about suicide or thought about what life would be like without them than haven't thought that at some point during their life?


Dr. Meredith Chapman: Oh, absolutely.


Dr. Mike Patrick: So, it's normal. It's normal to the point that if you are having those thoughts, you're in good company because most people have had those same thoughts, especially if you're really lingering on those thoughts or you're starting to think about a plan, you definitely want to reach and get help for sure. But I think that we need to normalize this conversation because it really is a normal thing for people to think about.


Dr. Meredith Chapman: Absolutely. I think there's an annual, no it's not annual. Every two years or four years, there's a suicide risk behavior survey that happens among high school students.




And it looks at the number of high school students who experienced suicidal thoughts, who experienced suicidal behavior, who experienced a suicide attempt that requires significant intervention. And if you look at those numbers, it's far more common than what I think people would even wager to guess.


And I think the other thing is that oftentimes, I've been in a number of professional meetings where the question gets asked, "Raise your hand if you've been impacted, if you've experienced your own suicidal thinking, you've experienced a suicide attempt or you've been impacted by the loss of someone personal in your life or someone you've cared for."


And there isn't a person in the room who doesn't raise their hand. So, I do think normalizing this conversation and people realizing how just common this is and that we all have a part to play in really preventing.




Dr. Mike Patrick: As we think about suicidal ideation or thinking about suicide being so common, and then actually coming with a plan is a little less common, and actually doing it and especially dying from it is being less common. Are there risk factors for that progression? So, in other words, to go from suicidal thoughts to actually developing a plan and then carrying it out, are there certain characteristics that would make you think that that could be more likely?


Dr. Meredith Chapman: Yeah, I think that's a really really great question. And I think that's a lot of the works that we do in pediatric psychiatry and certainly in mental health is how do you prevent people from getting from thought to action.


So, I think we do spend a lot of time thinking about that and trying to research that and trying to work on that. So certainly, that's what we think about. We think about untreated health conditions. Certainly, we think about the disinhibiting effects of drugs and alcohol.




So, if you think about people that are maybe experiencing suicidal thoughts but also using substances that maybe lower their impulse control, that's a risk factor. I think this is where having access to dangerous or what we call lethal means come in to play. So, we know often that the time between the decision to having the thought and acting on it sometimes can be very brief, a few minutes, for example.


And in those few minutes, if you have access to something like a fire alarm or medications for example, that can be lethal in those few minutes.


However, if you don't have access to those things, that can really be lifesaving. So certainly, one of the things we focus on is working with youth and families in terms of that are experiencing suicidal thoughts is really restricting or removing as much as we can access to those dangerous things.




And then also, knowing who to ask for, for support, in the moment of crisis I think is another huge thing. Oftentimes, in that moment, people feel very alone and that they don't have support. So also knowing that things like the National Suicide Prevention Lifeline. Here at Nationwide Children's, we have a 24/7 crisis line. And then, local communities have those same things, there's a crisis text line. That those sorts of resources exist. That there's always someone that you can reach out to and ask for support in a moment of crisis.


Dr. Mike Patrick: And we'll put some of those resources in the show notes over at so that folks can find those easily. I wanted to go back to firearms here really quickly. We're going to talk about warning signs that a teenager might be thinking about suicide. But sometimes, there aren't any warning signs, right?


They may be thinking about it. And so, as a parent, I wouldn't assume without talking to your child that they haven't ever had those thoughts.




And so, that just shows the importance of really locking up firearms, keeping firearms separate from the ammunition to different locked places, to really make access a little bit difficult. Because every kid that kills himself with a firearm, and there are lots of them, those parents have regrets that they haven't kept the firearm locked up, right?


Dr. Meredith Chapman: Sure. Yeah, I think that thinking about universal precautions that we could take, or prevention really are, yeah, we know that in terms of youth who die by firearm suicide, the firearm belongs to their parent. That's the majority of the cases. And so, this idea of storing firearms locked with ammunitions stored separately and just making that a practice is I think a good just universal precaution to take.


Sort of this similar concept to we take safety precautions like we wear seatbelts. We have stoplights, a dangerous intersection, those sorts of things to sort of universally protect all of us. That's sort of the same approach.




Dr. Mike Patrick: Yeah, absolutely. One other idea that I wanted to bring in is self-harm that's not necessarily lethal. But we see lot of kids who cut, who may harm themselves in other ways. Is that related to suicide? So, if you have a kid who's cutting, are they at an increased risk for that behavior then to spread into suicidal or are they two different things?


Dr. Meredith Chapman: So yes and no is the answer to this question. So, they are two different things. So self-harm or non-suicidal self-injury is really just act of deliberately harming your body in some way. It can be cutting. It can't take a lot of other various forms too. Hurting, hitting yourself, there's lots of other forms of self-harm.


And certainly, self-harm is associated with increased suicide risk, we know that. However, they aren't sort of mutually exclusive. So, a person can self-harm for reason than with the intent of sort killing themselves.




And I talked to a lot of teenagers who engaged in self-harm actually to sort of help manage or decrease their suicidal thoughts or their suicidal actions. So, the complicated question that I think requires a little bit of inquiry.


I think the thing for parents often, and the take-away probably for other adults working with or caring for and interacting with, oftentimes, I think self-harm is a signal of distress. It's sort of a way of people coping in a way that maybe isn't the healthiest and isn't the safest. And its sort of communicating that distress and if we can help identify that and then sort of help youth figure out ways to cope with more safe effective healthy ways, that's the goal.




Dr. Mike Patrick: So not being a psychiatrist myself or an expert on this in any way, it would seem for some of those kids, you may have trouble making the leap between how is hurting myself helping me cope? But pain and the act of doing it really does kind of change by brain chemistry, right?


Dr. Meredith Chapman: Oh, it's biological.


Dr. Mike Patrick: So if you think about it like the feel-good chemicals…


Dr. Meredith Chapman: Yes, endorphins.


Dr. Mike Patrick: Yeah. Maybe hitting highs when you're cutting. Then you can start to understand why this may help folks feel better.


Dr. Meredith Chapman: Yeah, we really work on teaching sort of alternative crisis survival skills because the thing with cutting is, for a lot of people, it really does work in a way that other coping skills don't. So, we often hear, I often hear teenagers tell me. "Well, coping, it helps me when I'm feeling numb. It helps me feel something." Or "If I'm feeling a lot of emotional pain, it's better to feel physical pain instead of emotional pain."




Not just teens, in this instance, not necessarily teenagers, but a lot of people experience people who've been through trauma or really anxious where they experienced times when they sort of feel out of their bodies. And cutting actually helps bring you back into your body. It's grounding.


And so, we really work a lot on skills that people can sort of get that same release of those endorphins or they can engage there, I'm going to get scientific, parasympathetic nervous system, their rest and relax nervous system through some much healthier safe coping skills like some breathing.


Intense exercise is another way you can do that, progressive muscle relaxation, and even a really wild thing where you sort of dip your face in cold water called mammalian dive reflex.


Dr. Mike Patrick: But things that aren't necessarily harm you to the point like you could get infection and scarring and physical effects evident in that way.




Dr. Meredith Chapman: So much safer ways to achieve the same.


Dr. Mike Patrick: And I think when we understand like why that's happening, so from a parent standpoint, you have a kid that's cutting, it may be really easy to be like, "Why are you doing this? We got to get you help and I'm really worried." And those are important things that you should be worried, and you should get help. But also have some empathy for like why your teenager is doing that and trying to get into their head a little bit and understand where they're coming from is also important.


Dr. Meredith Chapman: It's kind of like the ABCs. You have to understand the Antecedent, and then this is the Behavior that's happening, and then sort of what are the Consequences of that.


Dr. Mike Patrick: Yeah, and alternatives that are safer.


Dr. Meredith Chapman: Absolutely.


Dr. Mike Patrick: And to do that, they need to see someone like you, right?


So, let's move on to warning signs that a teenager may be thinking about suicide. When should parents be particularly concerned that this could be something their kid's thinking about?


Dr. Meredith Chapman: So definitely if a youth, a teenager, a child, and adult even, so we can talk about everybody, if someone's talking about suicide, so if they're openly talking about, if they're certainly posting, I'm not a social media person, so I'm not going to do justice to this. But if people are communicating on any of their social media platforms, I think that's definitely, certainly, the biggest warning sign.




But I also think there are lots of other more subtle things. So, if people stop really talking about or planning for their future, that's sort of a signal of hopelessness. So that may be something to look for. Certainly, also then, we look for other things that may sort of signal worsening of depression or mood. So, if people are not sleeping or just changes in their sleeping habits. They're not eating. They're not taking care of themselves, those sorts of things.


Also, sort of withdraw from normal activities, normal engagement with people, so if you're engaged with your family, your friends, that can also be a huge warning sign. Also, sort of changes in schoolwork, your performance at work, those sorts of things would be something to look for.




Also, if people just really change their actions, they'll go from usually behaving one way, but now they're sort of interested in very different things. I think that would be another thing to look for.


Dr. Mike Patrick: Absolutely. And then, if parents are noticing these things, what should they do?


Dr. Meredith Chapman: Well, I think, certainly, if your child or adolescent is talking about death or dying, we'd recommend immediately seeking mental health evaluation and support from certainly qualified mental health professional. I think it's important to note, when we sort of started out this conversation, with people feeling uncomfortable, often talking about this topic, about suicide, so I think probably even before that, the first thing to do is just talk is to ask.


If you notice something's off, if you feel that gut feeling that something is off, directly, and openly start that conversation with your child or with that student or that youth in your life. I notice you're down. I notice you're different. Seems to me like you're not sleeping so well. What's up? Have a direct and open conversation. It's probably the first place to start.




Dr. Mike Patrick: Very important. Some parents may feel if I talk to my kid about suicide and they weren't thinking about suicide, like maybe I thought they were, but here they weren't, and now I put that idea in their mind. Is there any indication that talking about suicide could cause someone to start thinking in that direction?


Dr. Meredith Chapman: Yeah, that's one of the biggest myths I think that still persists. And really, it's a huge barrier to even in behavioral health care to the work that we do, is this idea that if you talk about suicide, you're going to plant that seed in someone's head, right? That if I bring it up, maybe they weren't thinking about it, but now they're going to. And that is just not been proven the case.




Dr. Mike Patrick: No indication that that happens at all. So please talk about this.


Dr. Meredith Chapman: Please, yes.


Dr. Mike Patrick: Yeah, absolutely.


Dr. Meredith Chapman: Openly and directly.


Dr. Mike Patrick: So then how should parents talk to their teens about suicide? So, you said openly and directly. How do you normalize that conversation? I would think one way is just starting at a young age.


Dr. Meredith Chapman: And I think it's about sort of listening. And I'm guilty of this too, not trying to immediately rush to problem solved, right? You got to determine sort of the time, the place, the location, sit down. Dedicate some actual time to listen.


Try to avoid judging. Nobody really likes comparisons. And again, not jumping to fixing or problem-solving.


I think as much as you can, maintain confidentiality. So that you're like, "I'm not going to spill the bean or blabber." If you can unless there's a crisis and then you need to sort of enact those crisis steps and seek care immediately.




But yes, I think starting early. Maintaining that open… And I think having repeated conversation is the other key to this. This isn't a one-time conversation. It's a repeated conversation and a repeated check-in.


Dr. Mike Patrick: And you want your kids to feel comfortable being able to come to you if they do start to have those thoughts. And I think the more you normalize that conversation and you talking about it when they're young… I'm not talking like when they're five years old. But as they're approaching teenage years and life is suddenly becoming more complicated and there are stresses between relationships and schoolwork and things that are expected at home, as kids transition from the young years to little more independence, that's kind of the time to start asking about these things too, right?


Dr. Meredith Chapman: Absolutely. We talked a little bit about as we were starting sort of those at-risk groups and one of the things in the pandemic, we definitely saw was a significant increase in the rate in the younger age group, sort of that under 12. So, the like 5 to 12-year-old age group has also seen a pretty significant increase in the rate of suicide.




So, I think even, starting in it, it's a different conversation certainly with a 5 to 12-year-old than it is with a high schooler and being able to ask these questions.


But just having conversations about feelings and being able to model for your kids, how to talk about I'm feeling angry right now. So, I'm going to take five minutes to calm down, I think even that's a really great basis.


Dr. Mike Patrick: Yeah, to role model.


Dr. Meredith Chapman: To role model, yeah.


Dr. Mike Patrick: Absolutely. Let's say a parent does have a kiddo who says yes, I've been thinking about hurting myself. You'd mention, okay, it's time to get help." How urgent is getting that help? How do you know if this is something that we can call our doctor the next day and find out is there a counselor or something we can talk to or even get appointment to see them versus I need to get an emergency evaluation right now?




Dr. Meredith Chapman: That's a hard question. I think that probably the best course of action, if you have any questions, is to reach out and get some professional guidance.


So, the good news is I think that you're not in this alone. And so, there are a lot of resources that doesn't mean necessarily to pack up and get in the car and go to your nearest emergency room and go to a hospital. But there are resources available sort of in crisis situations. So many communities have crisis lines, have crisis resources that you can reach out to and actually talk to someone on the phone. And they can give you a little bit more information and do actually a little bit of an assessment that can help guide next steps.




And so that's often something that I will discuss with families and youth in terms of guiding what needs to happen. Sometimes, through those resources, people can work to develop sort of a plan to stay safe at home.


Other times, it's an emergency and people need to have emergency resources actually deployed to their locations, sent to their location. Or it's safe for them to sort of plan to access emergency services.


Dr. Mike Patrick: Yeah, here ins Central Ohio and specifically at Nationwide Children's Hospital, we have a place called the Psychiatric Crisis Department which is in our Behavioral Health Pavilion.


Dr. Meredith Chapman: We do, yeah.


Dr. Mike Patrick: So, it's like an emergency room for psychiatric problems. Kind of walk us through what an evaluation there would look like. So, if someone, if their child says they are having suicidal thoughts, maybe they reach out to their primary care doctor, they call a crisis line and someone tells them yeah, you need evaluation right now. So, you go there to the Psychiatric Crisis Department. What can families expect in a place like that?




Dr. Meredith Chapman: Yeah, I work there. Couple of times a week, actually. So, in our Crisis Department, really, the goal is to, as best as we can, assess the situation, whatever is going on. And people come forth for different reasons.


But upon arrival, you'll sort of be greeted and enter the Crisis Department. Safety is our number one priority for our youth, our families, and our staff. So, you enter through what we call a magnetometer. It's a little bit different than a regular emergency department. So, you're sort of greeted by our Protective Services Officers.


And then you go through sort of a nursing triage. We decide sort of what's going on. One thing I do share with folks often is sort of, and it may be similar to the physical health ED that I know you work in, we sort of go through a triage process which is really identifying what's going on and the level of need or severity of the problem.




And we tend to see people who arrive to our Crisis Department based on that level of severity or need. So, it's not sort of first come, first serve, but it's based on sort of that level of severity or need.


People are seen usually first by a clinician who is a licensed professional counselor or social worker. Sometimes the assessment takes up to several hours. And really, what we're trying to do is get as best as we can a full picture of what's going on in this child and family's life. So really not only sort what brought you in today and what are you hoping to accomplish, but the sort of what’s been also going on up to this point?




So how have you been functioning in your family? How have been functioning at school? Ultimately, our goal is to really determine what is the best next step for this child and family? For a youth that may be experiencing suicidal ideation, we spend a lot of time trying to understand those thoughts. We may spend some time understanding if there's been a history of any behavior.


We try to understand what has been sort of the events kind of that precipitated maybe that previous behavior. And then we spend a lot of time working on what we call a safety plan or crisis plan, if we can do that. Things that maybe are known warning signs or triggers, things that a youth can do on their own to sort of manage, things the family can do to help support that youth, sort of crisis resources that are available.




If we're able to do that, then we often looked at the sort of youth and family being able to go home. If we're not able to do that, that's when we may be look at a more intense level of care, like staying in the hospital.


Dr. Mike Patrick: Great. When you say safety plan, so you're really coming up with a plan for the family that would keep that child safe. And so, that would include making sure that there's not lethal means of hurting yourself in the house.


Dr. Meredith Chapman: That's part of it, mm-hm.


Dr. Mike Patrick: That there's some that's there with your child, and you feel good that the child and whoever their caregiver is can have good conversations and be open with each other.


Dr. Meredith Chapman: Yes, communication is a part of that.


Dr. Mike Patrick: And the child is saying, yes, I do want help. And so, I will reach out if that's happening. But then again, you may have a teenager that's like, "No, I really do want to kill myself. And if you send me home, I'm going to kill myself." And then, you would not be able to make a safety plan.


Dr. Meredith Chapman: Yeah, you won't get to make a different plan, right? And so that's often when sort of a higher level of care like hospitalization is indicated.


Dr. Mike Patrick: Absolutely. And then, treatment from there, I would imagine involves both counseling and perhaps medication, especially if there's depression or anxiety, that's a part of it, an ongoing therapy, those kinds of things.




Dr. Meredith Chapman: Yeah, another big part of our treatment, we use a follow-up intervention called Caring Contacts. So that's something that has been used across all age groups, but it's essentially, a non-demand. Meaning the person who receives this contact, or this message doesn't have to do anything with it.


But they receive pretty regularly for actually a year now, we've expanded the timeframe over which this occurs, just messages. They're text messages that a teenager gets, just a message of sort of hope and encouragement. So, it's a visual image but a message as well that we send after a youth has been to our crisis department or been admitted to several of our program. And so, it's a message of hope and inspiration. It also gives sort of reminders about how to access our crisis line and the crisis text line.




And we have gotten some really positive feedback since we've been doing this program. But sort of the literature or the evidence suggests this is a really powerful intervention for suicidal individuals.


Dr. Mike Patrick: And what's that called again?


Dr. Meredith Chapman: Caring Contacts.


Dr. Mike Patrick: Caring Contacts, that's a really cool idea.


Dr. Meredith Chapman: Yeah, we're really proud of it.


Dr. Mike Patrick: So, we've talked a little bit about when kids have those thoughts and we're trying to prevent them actually carrying out a suicide plan. Is there a way to prevent suicidal thoughts to begin with?


Dr. Meredith Chapman: Oh, wouldn't that be?




Dr. Meredith Chapman: If we could do that, that would be great. So, I don't know that there's a way to prevent suicidal thoughts. I think that we know that there definitely early risk factors for suicidal thoughts in people experiencing suicidal behavior. And these are things that I think we all have a part to play.


And so, these are things like children who experience abuse and neglect at an early age. So, these are our adverse childhood experiences.




So, when we talk about where I think there's a lot of opportunity for improvement and if we really want to prevent people from experiencing suicidal thoughts, I think we need to start really thinking and talking about preventing childhood trauma. I think we need to really address properly. We need to make sure people have, that children…


So, one of the most promising interventions is there's something called the PAX Good Behavior Game, which in elementary school, kids are… It's a social emotional learning intervention. And so, kids who are able to learn about their emotions, identify and express emotions in healthy and safe ways over the course of their lifetime are much less likely to experience suicidal ideation or behaviors.




So, I think it's those things, in my mind, in my beliefs, that are really going to really help prevent suicidal thoughts.


Dr. Mike Patrick: Yeah, absolutely. We have done several past episodes on suicide here on PediaCast. And one of the things that I came across a long time ago was an article in the Palo Alto online, their newspaper, the online version of their newspaper. And it's actually still online so I'm going to put a link to it in the show notes again.


But it's written by Adam Strassberg. He's a psychiatrist in Palo Alto. It's called Keep Calm and Parent On. And he had seven thoughts on preventing teenage suicide. And in a nutshell, we've actually covered a lot of them. One is just the importance of sleep and that sleep deficiency and depression link. So, getting enough sleep is really going to be very important.


Talking to your teen intentionally and starting early. Modeling mental health treatment, yourself. So, if as a parent, you feel depressed or anxious, get help yourself. And that's going to be important.




Always seek the best for your child, but don't strive for your child to be the best, but the best that they're capable of. Encourage that but don't put too much stress on them or too many expectations on them. Keep it realistic.


And then you and your child's teachers are on the same team, partner with the school.


This one, I'm not sure about, consider getting a pet. That may help. That may cause more stress in the house, I don't know. That one, your mileage may vary on that one.


And then, just keep calm. So anyway, seven thoughts on preventing teen suicide, Keep Calm and Parent On. Yeah, I'll put a link to it in the show notes. It really struck me when I read it. It was kind of simple and some simple steps that folks can use.




All right, so there is an initiative here at Nationwide Children's Hospital and really across the country, I think, called Zero Suicide. Tell us about that.


Dr. Meredith Chapman: Yes, we have been here at Nationwide on this journey. So, Zero Suicide is a national, really, priority that focuses on health and behavioral healthcare organizations. And it's both sort of an aspirational goal and a framework for achieving really the goal of zero. So hence the name, Zero Suicide, but really achieving the goal of zero suicides in organizations that provide care to individuals who are at risk of suicide.


Dr. Mike Patrick: So, in other words, it's not just the responsibility of individual providers or parents or families or even teens. It's really an organizational approach to preventing suicide in the community.




Dr. Meredith Chapman: Yes.


Dr. Mike Patrick: What does that look like on an institutional level?


Dr. Meredith Chapman: Well, it can look like a lot of different things. So, this really also started out of an initiative to provide better care for depression at the Henry Ford Healthcare System many years ago. And they sought out to really develop a way to take care better care of adults at that time experiencing depression in their healthcare system.


And it really evolved into they determined that they had a lot of patients in their care who were dying. And they were able to sustain over a period of seven or eight years zero deaths from suicide and from a pretty high number. Sorry, I can't quote you, but a fairly high number and they drove that number down to zero.


And so, taking lessons learned from them, there has been a lot of work done to really identify seven key elements of that practice essentially that were important for either healthcare or behavioral healthcare organizations to implement.




And so, the Zero Suicide framework sort of suggests that an organization, to really achieve best practice suicide safer care, should implement these elements. Some of them include like leadership, being able to assess patients or individuals, clients at risk of suicide, having suicide specific treatments.


It's also about training the workforce so that you have individuals who are confident and competent in taking care of individuals at risk for suicide. And there's a huge emphasis on continuous quality improvement, so that you're really on an ongoing basis assessing what you're doing and striving always to improve that.




Dr. Mike Patrick: And community education awareness is part of it. And certainly, Nationwide Children's having a podcast that talks about suicide is part of Zero Suicide.


Also, just something simple like we know that kids with chronic illnesses have increased risk of anxiety and depression which increases your risk of suicidal thoughts and suicide. And so, as we think about chronic kids being seen in specialty clinic, you may have a kid who has diabetes and they come into Diabetes Clinic. And just that the nurse asking some screening questions and identifying folks that way and then getting them plugged in to help that they need. That maybe the parents didn't even know that their child was thinking about those thinking about those things, but it may be elicited when they come in for their routine health care.


Dr. Meredith Chapman: So, we've really been on a journey focusing on the aspects of screening, so what you're speaking to, the importance of detecting suicide risk. And if you do detect it, then following up to really confirm that risk with a more thorough assessment that further inquiries about suicidal ideation and behavior. But also assesses really risk factors that ideally, once you know what the risk factors, you can minimize, protective factors that once you know what those are, you can also enhance.




And then, you can use that to sort of overall assess the person's risk and then determine sort of what your next steps are. That's really what we've, as an institution, been focused on over the last of couple of years.


Dr. Mike Patrick: Very important. I'm going to put a link to an article that was published in Pediatrics Nationwide called Zero Suicide: A Comprehensive Framework for Pediatric Hospitals. So, folks can read more about what Zero Suicide is all about. And again, we'll put a link in the show notes over at


Before you go, Behavioral Health Services here at Nationwide Children's is a big deal. We really, as an institution, have taken mental health services, behavioral health services for kids very seriously. Tell us a little bit more about the services that you guys provide.




Dr. Meredith Chapman: Oh, my goodness, it is a big deal. Yes, so we have really comprehensive and certainly proud to be a part of that big deal, I have to say, so comprehensive services. And I think that one thing that I would like to say is that we do have this really amazing facility called the Behavioral Health Pavilion that opened in March of 2020, that I'm sure a lot of people are familiar with.


But that is just the tip of the iceberg of the services that we offer across our entire service line. We offer a full continuum of outpatient services. We offer a number of prevention services in the schools. So, in our center, we offer suicide prevention program called Signs of Suicide. I talked a little bit about the PAX Good Behavior Game. That's really across the state of Ohio at this point.




Certainly, within the Behavior Health Pavilion, we offer a lot of the different acute services. We talked about some of psychiatric emergency room, the Psychiatric Crisis Department. We have an outpatient crisis clinic called CATC clinic, Critical Assessment and Treatment Clinic. We have our Youth Crisis Stabilization Unit, our in-patient units.


So, we have a full array of services. But don't want to lose the fact the BHP is just really the tip of the iceberg of all the incredible work that we do here at Nationwide.


Dr. Mike Patrick: Yeah, absolutely. And we'll put a link in the show notes to Behavioral Health Services at Nationwide Children's Hospital, sponsored by Big Lots. It's really the Big Lots of Behavioral Health Services.


Dr. Meredith Chapman: Behavioral Health Pavilion and Service line, yeah.


Dr. Mike Patrick: And we'll put links to that in the show notes. We also have a national initiative called On Our Sleeves. And we'll put a link to that. We have a show coming up very soon on anxiety and we're going to talk a lot more about On Our Sleeves during that episode. But we will put a link to it in the show notes for this one.




And then, really, lots of resources for you, the National Suicide Prevention Lifeline, the National Hopeline Network. You can even text "Jason" to 741741, which again we'll put a link for that in the show notes. Not really a link, but that number that you can text to.


Dr. Meredith Chapman: That's great.


Dr. Mike Patrick: And of course, the Nationwide Children's Crisis…


Dr. Meredith Chapman: Text line, or just our crisis line?


Dr. Mike Patrick: Yeah, we'll put links to that, too.


Dr. Meredith Chapman: Great.


Dr. Mike Patrick: so, lots of resources for you in the show notes over


So once again, Dr. Meredith Chapman, pediatric psychiatrist at Nationwide Children's Hospital, thank you so much for stopping by today.


Dr. Meredith Chapman: Thanks so much for having me.






Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.


Also, thanks once again to our guest this week, Dr. Meredith Chapman, pediatric psychiatrist at Nationwide Children's Hospital.


Don't forget, you can find us wherever podcasts are found. We're in the Apple and Google podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music, and most other podcast apps for iOS and Android.


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Don't forget about our sibling podcast, PediaCast CME. That stands for Continuing Medical Education. It's similar to this program. We do turn the science up a couple notches and offer free Continuing Medical Education credit for those who listen. That includes doctors, nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists.


And since Nationwide Children's is jointly accredited by many professional organizations, it's likely we offer the exact credits you need to fulfill your state's Continuing Medical Education requirements.


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Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So, long, everybody.






Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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