Youth Suicide Prevention: Connection, Support, and Hope – PediaCast 617

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Show Notes

Description

Dr John Ackerman and Erica Mellinger join Dr Mike as we explore youth suicide prevention. We discuss warning signs in teens and preteens, how to ask about suicide, what to do when a child needs help, and how families, schools, and healthcare teams can work together. Join us for a practical conversation about safety, connection, treatment, and hope!

Guests

Dr John Ackerman
Child Psychologist and Suicide Prevention Clinical Manager
Center for Suicide Prevention & Research
Nationwide Children’s Hospital

Erica Mellinger
Fourth-Year Medical Student
The Ohio State University College of Medicine

Links

• Suicide Prevention Resources for Families — The Kids Mental Health Foundation
• Center for Suicide Prevention and Research blog posts — Nationwide Children’s Hospital
• 988 Suicide & Crisis Lifeline
• American Foundation for Suicide Prevention
• Blueprint for Youth Suicide Prevention — American Academy of Pediatrics
• Youth Suicide Prevention and Intervention: Best Practices and Policy Implications

Episode Transcript

[Dr Mike Patrick]
This episode of PediaCast is brought to you by Behavioral Health Services at Nationwide Children’s Hospital.

[MUSIC]

[Dr Mike Patrick]
Hello, everyone, and welcome to another episode of PediaCast. We are 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 617.

We’re calling this one Youth Suicide Prevention, Connection, Support, and Hope. I want to welcome all of you to the program. We are so happy to have you with us.

You know, as parents, we want our kids to know that they can come to us when life feels difficult, but sometimes it can be hard to recognize how much a young person is struggling or to find the words to start a conversation. Today, we are talking about youth suicide prevention. It is a serious topic and also a conversation about connection, support, and hope.

We’ll explore behavioral changes that parents may notice in kids and teens, how to ask directly about suicide, what to do when a child needs help, and how families, schools, and healthcare teams can all work together. You do not need to be a mental health expert to notice a concern and help a child connect with support. And young people can recover from a suicidal crisis with appropriate care.

Before we begin, and this is very important, if you or a young person needs crisis support in the United States, please call or text 988 or visit 988lifeline.org to reach the Suicide and Crisis Lifeline. And for immediate life-threatening danger, be sure to call 911. Of course, in our usual PediaCast fashion this week, we have two terrific guests joining us in the studio to discuss youth suicide prevention.

Dr. John Ackerman is a child psychologist and suicide prevention clinical manager with the Center for Suicide Prevention and Research at Nationwide Children’s Hospital. And Erica Mellinger is a fourth-year medical student at The Ohio State University College of Medicine. Before we get to them, I do want to remind you that the information presented in every episode of our podcast is for general educational purposes only.

We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you’re concerned about your child’s health, be sure to call your health care provider. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.

So, let’s take a quick break. We’ll get Dr. John Ackerman and Erica Mellinger settled into the studio, and then we will be back to talk about youth suicide prevention. It’s coming up right after this.

[MUSIC]

[Dr Mike Patrick]
Dr. John Ackerman is a child and adolescent psychologist and the suicide prevention clinical manager with the Center for Suicide Prevention and Research at Nationwide Children’s Hospital. He is also an associate professor of psychiatry and behavioral health at The Ohio State University College of Medicine. His work helps families, schools, and health care teams recognize suicide risk and connect young people with effective care.

Erica Mellinger is a fourth-year medical student at The Ohio State University College of Medicine. Before medical school, she spent six years teaching high school at KIPP Indianapolis. Her interests include adolescent mental health, primary care, and addiction medicine.

Together, they bring clinical and classroom perspectives to this important conversation. But before we dive in, let’s offer a warm PediaCast welcome to our guests, Dr. John Ackerman and Erica Mellinger. Welcome to the podcast.

[Dr John Ackerman]
Thanks for having us, Dr. Mike.

[Erica Mellinger]
Yeah, I really appreciate it. Excited to be on.

[Dr Mike Patrick]
Yeah, I am excited to talk about this. It’s something that we generally cover, you know, every year or two. And it’s an important thing to talk about.

So, John, let’s start with you. When we talk about preventing youth suicide, why does everyone have a role to play? I mean, why is this such an important conversation for all of us, even if you don’t have teenagers at home?

[Dr John Ackerman]
Suicide, especially among young people, is really complex. The good news is that we have ways to support young people when they’re in a crisis, but it does take literally the entire village. The broader we build a safety net, the better off we’re going to be because kids don’t always show every element of themselves to other people.

So, when we are able to prepare parents, teachers, coaches, healthcare providers to meet that young person where they are, we’re in a lot better position to support them. So, we really think about making sure that we have a wide range of trusted adults to make sure that if a warning sign is evident, if there’s a need present, each person is willing to be part of that pathway to support and hope. So, we can all have a role in that.

And that doesn’t just mean professionals who are equipped with specific clinical tools. It’s really our entire community.

[Dr Mike Patrick]
Erika, you are involved in an organization called T4CIP, which stands for Trainees for Child Injury Prevention. And we have had your group here on the podcast several times because you guys always have great programs and really trying to get the word out about particular things. I think we’ve talked about driving safety in the past.

We’ve talked about e-bike safety. Today, we’re talking about teen youth suicide prevention. Can you tell us a little bit more about T4CIP and what you guys are all about?

[Erica Mellinger]
Yeah. T4CIP is a national organization whose role is to train medical students, residents, and others to really become advocates and engage with our communities and learn through… We have monthly sessions, but we also have these days of action where, like, I personally have had a lot of opportunity through T4CIP, including going to the Capitol and advocating for my community.

So that was really special.

[Dr Mike Patrick]
Yeah, that is great. Now, you spent six years teaching high school, so you’ve seen firsthand what happens inside the classroom. What sorts of pressures can pile up for young people?

And why should we keep checking in, especially after difficult events?

[Erica Mellinger]
Yeah, I think it’s so important that we recognize that young people have the stresses of high school grades, scholarships, applying to colleges, or figuring out their future. At the same time, they also have social media and online experiences that can impact them, as well as family difficulties, bullying, and discrimination. All of these can come together and really add to their mental health.

And then depending on coping strategies, you know, if they turn to substances, that could also add to that burden. And so, there’s rarely one explanation for a crisis, in my experience. It’s often a buildup of various events where you start to see the child.

It’s not just like one thing, and then the child’s in a crisis. There are signs beforehand that I think teachers and community members and family can pick up on.

[Dr Mike Patrick]
Yeah, yeah. And it all adds up, right? It’s not just the pressures in the classroom, but also if there’s pressures at home, if there’s pressures in any social organizations and on social media.

And when those things really start to pile up, you know, even as adults, we can feel inundated with the things going on in our lives. With all of those pressures, John, what are some warning signs that parents should notice in their teens and preteens, you know, as we think about self-harm and suicide?

[Dr John Ackerman]
Yeah, when we think about self-harm and suicide, it’s usually someone trying to manage deep emotional pain. And so, it shows up in different ways. It could be from those multiple causes that Erica mentioned, but also, it shows up differently.

For some people, it shows up in their body. They have some changes in how much activity they can engage in; how much they eat or sleep. Sometimes it involves how hopeful they feel about the future.

They might feel like a burden or like things aren’t worth it anymore. And then other times you see it in their emotional response. They might feel more irritable, more distressed, more traditionally sad.

Like I think we all have an image of what a really down, depressed person looks like. What we know is that’s actually not always a clear indicator of suicide risk. So, we always want to check in and reach into people.

There are a couple other warning signs that we immediately want to respond to. If people are giving away belongings, if they are talking about wanting, they’re feeling like a burden and they’re saying goodbye to friends or kind of saying that they want to die, whether it feels like a joke or not. And also, whether they’ve been researching death or ways to harm themselves.

These are all warning signs that we want to take very seriously and then make sure we’re reaching into that person, not waiting for them to reach out and kind of ask them very directly whether they’ve been having thoughts of ending their life.

[Dr Mike Patrick]
When a teenager says that, and maybe offhandedly, jokingly, what should parents do in that moment? I mean, is that a stop? Hey, let’s talk about this right now.

That’s not something that you just throw out lightly and we need to have a bigger discussion.

[Dr John Ackerman]
It really is. So, when I think about it, when you’re trying to understand the risk that is present before you, you don’t have to be right when it comes to suicide risk. If you’re hearing a warning sign, whether it’s a fairly low risk or a fairly high risk, in your mind, since we’re not particularly good at predicting it, we want to reach out and we want to basically communicate to that young person that anytime I believe you might be expressing some emotional pain or distress, I’m going to be there for you, I’m going to walk alongside you, and I’m going to ask you a direct question. If you meant I’m really stressed when you said, I want to die, I want you to shift your language to say, I’m really stressed, I’m having a hard time, can you help me?

But if you’re saying, I don’t want to be on this earth anymore, this is really hard for me, I don’t know if I can make it through this time, I need to know that. So, I can also get you the right type of support. So, it’s also about helping as an adult or a parent or a caregiver or a teacher.

You don’t have to guess. You don’t have to go, a lot of people say, go with your gut. In some ways, I get it.

Like when they say that, like always reach out and so don’t make that error of just assuming someone else will have it. But do more than go with your gut, actually reach out, ask that direct question. What is it that you’re struggling with?

Are you thinking about ending your life? Because I will be there, I can hear that as a trusted adult, and I’m going to help you get to the right support, whether that be professional, pediatrician, counselor, crisis line like 988, all of those things are good options. But leaving it alone and not and assuming it’s a joke is probably the least effective and potentially most harmful thing that you can do.

[Dr Mike Patrick]
Yeah, yeah. Because it’s okay to be wrong in the sense that there’s something going on that you think that there is and you’re wrong about that. But you don’t want to be wrong in that, oh, I think it was just a joke and I’m not going to address this.

And then, you know, we can really regret that.

[Dr John Ackerman]
Yeah, lots of research actually that shows we’ve screened over 100,000 kids asking them very direct questions about, have you thought about suicide? Have you ever engaged in harming yourself in the past month? Things like that.

And we know that if folks are struggling, it’s a relief and actually removal of the burden to have someone who’s asking you that knowing that you can talk about it. And if they’re not struggling, they just go, oh, no, that’s not me, I don’t deal with that. And so, the risk of not asking is way more than the risk of asking, again, multiple studies.

It’s not putting the idea in someone’s mind and it’s not causing suicidal thinking or behavior. So that’s really important for families to hear.

[Dr Mike Patrick]
It really is because some moms and dads may be hesitant to address this topic like, well, I don’t want to, I don’t want us to dwell on it. Or like you said, I don’t want to put it into your head. Speak to that a little bit.

It really is safe to talk about these things.

[Dr John Ackerman]
Absolutely. So, I would say that it may be the biggest myth with respect to suicide is that if we talk about it and I introduce the idea to a young person, that will somehow give them the idea that I’m going to engage in suicidal behavior. And there have been three major studies to show that that’s not the case.

And it doesn’t even typically introduce any stress in the moment by asking them. It’s an uncomfortable topic. I appreciate that sort of the platform to even talk about this because sometimes folks do feel like it’s uncomfortable.

But parents should definitely hear that it’s okay to ask directly to a young person that I care about you. I want the best for you. If you ever feel like you’re in a place where you don’t want to be alive, I’m here for you.

Have you had thoughts of suicide? So, you might want to practice it in front of a mirror. You might want to talk to someone about, is this, you know, is this something I can do?

Because it is uncomfortable, but like most things, the more we try it, the more we do it, we realize that the benefits far outweigh the difficulties of that conversation. I have a 12- and 15-year-old. They had these conversations much earlier in life that, you know, when they were 8, 9, 10, it’s okay to actually ask directly and then you’re aware.

[Dr Mike Patrick]
And it doesn’t have to be because they said something. I mean, this is something just to have periodic check-ins and which we should be doing anyway. But, you know, talking about what kind of stresses are going on at school and, you know, on social media, anytime that they’re away from the home, playing sports, we want to always be sort of checking in and normalize that this is what we do in our family.

We talk about these things. And I guess the younger that you start that, the more natural it will seem, not just like coming out of nowhere.

[Dr John Ackerman]
Absolutely. I mean, Eric, you’re way into, but we had this, you know, this idea that once you open up the door to have these conversations, the young people know that you’re sort of setting the table. If they aren’t experiencing a crisis, and fortunately, many children don’t have thoughts of suicide, that’s a good thing.

But if they aren’t prepared or ready or feel safe to have the conversation, then they may not do that. And again, only one in four kids at this point will tell their parents that they’re struggling with suicidal thinking and or have attempted suicide. So, we need to actually reach in a little bit, and we have to be the proactive one.

If you’re feeling like a burden, if you’re feeling ashamed, if you feel are feeling weak, even though we know that’s not what mental illness is, young kids do have struggle to kind of reach out and reach forward. So, we need to do some of that work as parents.

[Dr Mike Patrick]
Erica, what are some concrete steps that both parents and schools can take, you know, on an everyday basis just to make it easier for a child or a teenager to feel like they can speak up about this?

[Erica Mellinger]
Yeah, absolutely. I think building relationships through early, regular, calm check-ins is really important. I think of my teaching experience and how every morning when I had a boy advisory in the mornings and so when the boys would enter my room, I was checking each and every one of them, their mood, their affect, like how they’re walking in, are they walking with a hoodie and headphones and kind of down?

I’m checking in with them, right? And this is just something regular. So, the more you normalize it, as John was saying, the more they’re going to be willing to say something when it may be more of a time of distress.

And they’re also more willing to say something when peers bring safety worries to them. And I think that’s really important. And so just checking in early and often.

I also think you don’t need to share a ton of background with students to connect to them. I often would see a girl’s nails done and be like, oh, my gosh, such a cute manicure. And that was the gate, right?

That was like my way into building a relationship with them. And then also just helping children identify several adults and safe, open, welcoming places in their communities and knowing that there’s multiple people that they can come to. I think back to the school days where we had social emotional learning and one of our data points that we would survey students was, do you have a trusted adult in the building that you feel like you can go to?

You know, schools really care and teachers want to be there for students and want to check in with them and make sure students are doing well as well. You know, something as simple as I would notice when a student’s grades were starting to drop and instantly check in. And sometimes it was I didn’t sleep last night.

I was playing video games all night. OK, that’s why you didn’t do as well on the test. But sometimes it was multiple, like you said earlier, multiple things piling up and then I can become a safe place.

And if I’m not a safe place, I would text the teacher that I knew was their safe place. Right. So just having multiple members of the community that they can identify is really important.

[Dr Mike Patrick]
Yeah. What was your policy in terms of like if a student disclosed to you that they were had thoughts of hurting themselves? Is that an immediate we let the parents know?

And then how do you sort of let the kids know, hey, this is a safe place. But part of being a safe place is making sure that your parents know that you’re having these difficulties. I’m sure that’s not an easy road to walk.

[Erica Mellinger]
It’s not because you do want to build that trust with them and you don’t want to break that trust by like revealing anything bad at the same time. I think when you build those relationships early and often, they know that when you take the action of involving parents that it’s for their best interest. It’s because you want them as safe as possible.

And I also there’s also help. I had a specific instance with a student once. I was actually at a concert, left the concert because he was in crisis.

And I involved the social worker right away. And there’s other people to ask, you know, what are my next steps? But that’s why it’s really important to also as an educator, I would build community with the parents as well.

So, the first time you’re reaching out isn’t in crisis. If it is, that’s OK, too. But just building those relationships.

Yeah.

[Dr Mike Patrick]
You know, teachers often work hand in hand with pediatric providers. For example, the one that really comes to my mind is ADHD, you know, because you have the forms like, hey, have your teacher fill out this form. And sometimes when I was in private practice, you know, I would get a note from a teacher about a particular concern.

What’s the role of the medical home in all of this? We talk about the school, we talk about the house, you know, the family. But what about the pediatrician’s office?

How can we make a difference in the medical field?

[Erica Mellinger]
I think making sure that you bring up changes in mood or behavior at any visit. Mental health concerns are just as important as physical concerns. And routine suicide screening recommended starting at age 12 with screening at ages 8 to 11 if concerns indicate it is really important.

And just knowing that a positive screen leads to safety assessment and next steps. But families can ask about coordinated behavioral health care and follow up. And so really, we do take those concerns just as seriously in the office as we do in the school.

[Dr Mike Patrick]
Yeah. You know, I’ll put in a plug here for my fellow pediatricians that we’re often busy. And, you know, we have a whole waiting room full of people.

You’re trying to move folks through. You don’t want people to feel like, oh, why am I waiting in this waiting room for so long? I know when I go to the doctor, you know, that’s the worst part is waiting.

And so, there is some pressure, especially if someone comes in for a sore throat. But you notice that something is off. Maybe this is a kid that you have seen many, many times.

And there’s just that little nag in the back of your head. Those are things that we should really pay attention to. Right.

And when it comes to being able to actually make a difference in a kid’s and a family’s life in such a big way as there is in suicide prevention, this is not a time to cut corners. Right.

[Dr John Ackerman]
And I can add to that. I think that I absolutely understand those time pressures. My wife happens to be an integrated psychology in a primary care office.

And so, one of the things that we know is that if a person is in a place where they’re noticing these signs, something seems off. They’ve had a positive screener. The amount of time that’s spent to follow up is proportionate usually to the risk that they’re experiencing, meaning if there’s high risk and the person might be at imminent risk for suicide, it does make sense to spend more time with that person just as we would with any emergent medical condition.

We know that suicide is the second leading cause of death among young people. So, there is a time pressure and there’s also a need to ensure that that child survives and thrives. And so, it does feel like sometimes mental health aspects don’t feel like the task of the day.

And some of our messaging with our primary care providers in partnership is that it has to be the task of the day. It has to be what we’re addressing in the moment to make sure that all of the other medical and health care concerns actually can be treated, can be supported in the future. So, it’s I know it is absolutely the hardest thing we do to combine those time pressures and get through it but also make sure that person is part of a pathway.

And it can’t all be the pediatrician’s job. It can’t all be the school counselor’s job. It does need to be a community addressing these issues.

[Dr Mike Patrick]
Yeah, yeah, absolutely. So, once we’re at the point where a child says, yeah, I am thinking about suicide, whether that disclosure is to a parent, someone at school, in the medical home, what do we do next? And when is it an emergency?

[Dr John Ackerman]
I would say that, you know, we Erica started to talk about the fact that this does need to reach a professional when you’ve identified a positive screen, when you’ve had suicidal thinking recently, whether there’s especially if there’s intent plan and these other components that elevate suicide risk. But if there’s any new disclosure, we’re, of course, letting the family know those folks that are going to support it. And then we would typically do what we call a suicide risk assessment.

There are a few of them. One of those is the Columbia Suicide Severity Rating Scale. But there’s a number of options to make sure you’re then sort of understanding both the thoughts that a person has had or the suicidal ideation and then the different suicidal behaviors that could be part of this young person’s experience with lower levels of intensity or sort of the idea that a person may be first considering whether living is important or not.

Sometimes call that passive suicidal ideation. And then it may be more specific, more intense, more detailed as you go through that assessment. And that helps you understand what are the ways that this person has thought about ending their life.

And can I have a plan that I move towards a safety plan that I can develop that really meets the young person where they are? Safety plans are not generic. After-visit summaries, go do these five things and you’ll be great.

We want to plan to keep a young person safe using the resources that they have. Those resources are internal and they’re external. So, you’ve got the ability to cope.

And as Erica said earlier, people cope in many different ways. Some of them have some go-tos that really work for them. Some young people have less developed coping skills that you have to help nurture.

So, your job as a clinician is to understand are the coping skills that this person is expressing, whether it be people, places and things, where to go to, trusted adults, crisis resources. Are these going to meet their needs when they do start to encounter a suicidal crisis? Or do we need to have external supports for them in the moment?

So how can we help? How can parents play a role? How can teachers and other trusted adults play a role to really support this young person where they are?

Your job really for a safety plan is to establish can this young person with the resources and in the community and in their family where they are stay safe, which is the primary goal. You don’t want to remove their autonomy. You don’t want to increase their intensity of care unless you absolutely have to.

And there are cases where you may say, oh, OK, based on all these factors, I don’t think we’re going to be able to stay safe in the home with the resources. And you might escalate the level of care. But going through that, you’re basically getting to a point where you want the person to have a plan.

Anytime they encounter a suicidal crisis, they can go down their list and work through the options and establish a baseline of safety and then ideally talk about it, say what’s working, say what’s not working and get to that point. Then they’ll have more confidence that if they experience a suicidal crisis, which may not be inside their control, they know what to do and they can then communicate with their provider, with the therapist, with the pediatrician where they are. And then we can gauge how much work needs to happen to keep them safe.

[Dr Mike Patrick]
You know, when your child discloses that, it’s not something that if, you know, it’s a Saturday afternoon and your doctor’s office isn’t open until Monday, this is really not something that you want to wait until you can get an appointment to see someone. Right. So how do you how do you get connected with the help that you need in a timely fashion when you feel like it’s urgent?

[Erica Mellinger]
Correct. So, in the United States, you can call or text 988, the Suicide and Crisis Lifeline, and parents can reach out about a child, too. It doesn’t have to be the child reaching out.

You can ask the primary care team, school support staff. Like I said, we were lucky enough at KITT that we had work phones to communicate with families and students. So, this was like I said, I was at a concert, and it was in the evening.

Right. Or community mental health agencies for a queer next step and ask for like a named contact there and just ask about support that continues to respect the person’s identity and circumstances. And then also who to contact if symptoms worsen before the appointment or the next assessment.

[Dr Mike Patrick]
Yeah, yeah. I love that there is now one phone number in the United States that folks can call 988. So, we’ve all we all know about 9-1-1, 9-8-8 is going to be the Suicide and Crisis Lifeline.

And I remember it wasn’t that long ago. I was given like three different phone numbers and putting them in the show notes. But now 9-8-8, everybody can remember 9-8-8.

So definitely give them a phone call if you don’t know who else to get a hold of. Erica, from a from a parent standpoint, you know, this is not only a trauma, of course, for your kid. It’s a trauma for you.

And so, as you’re getting your child help, what should parents think about in terms of their own mental health and dealing with the whole situation?

[Erica Mellinger]
Yeah, I think it’s really important in these conversations to also think about how we are modeling our coping skills and circumstances. I think to the effect like John has been saying, not to sweep it under the rug or not talk about it. But I, for example, am in therapy.

I take antidepressants and I never shied away from having that conversation with students if they brought it up because I’m modeling for them how I have developed coping mechanisms and what has helped me. And I also think, for example, students would come and when they needed a really when they really needed a break, they would sit in the back of my classroom and put in headphones and do meditations. Right.

So once again, just like modeling the coping skills that, you know, are good coping skills for your child as well.

[Dr Mike Patrick]
Yeah. Yeah. And I appreciate you saying that you have issues yourself.

And I will I will add that I suffer from anxiety, which many of us in emergency medicine do. But and I take medication for it. I have been in therapy.

I still have an open line to my therapist. You know, I’m kind of on a pause right now. But I think normalizing these conversations is so important.

And talking about that with your kids, like as a parent, I mean, you want your kids to feel safe with you, but it is OK to say, hey, I also have issues of depression or anxiety. And just making that a normal conversation in the family and being vulnerable while also being, you know, the parent. I think it’s a fine line.

But, you know, parenting is not easy and that is definitely an important an important component of it to be honest and transparent with our kids. As we think about safety plans, John, I just wanted to go a little bit deeper into that. You know, the idea of a safety plan is that, OK, you’re safe to go home, but we still care and we need to have some agreed upon rules in place.

What should be in a safety plan? Like what specific items or is it really different from kid to kid?

[Dr John Ackerman]
It is fairly consistent in terms of the categories that we want to address. So, it may it should be unique to the individual in terms of what they are incorporating into their safety plan to make them confident and comfortable that they’re going to actually use this. So, it should not be a prefabricated list of things or a checklist to do these things and you’re fine.

You want to develop a written collaborative safety plan. So, collaborative means I’m working side by side with the youth literally sitting next to them and we’re going to write this plan together and we’re going to identify what are the warning signs? What are the things that actually activate you that could put you in that danger zone?

I want you to know about it. So, if you’re approaching one of these warning signs, maybe it’s maybe it’s bullying. Maybe it’s having to give a big talk.

Maybe it’s doing things that really unsettle me. Meeting a certain person who I’ve had a difficult time with or getting called X, Y or Z. I know what that is.

And then I know to initiate some of my coping. That coping is probably the broadest category. We think about the internal coping ideas, whether it could be deep breathing, muscle relaxation, meditation, mindfulness, all these types of things that some kids like, some kids don’t.

We’re going to find something for you. And then some of the external coping. Who do I go to?

Who do I talk to when I’m distressed? Is there some trusted adult? Is there a friend?

Is there someone I can talk to if there’s a clinical need? We then also want to identify the adults that we want to help who can help keep them safe. And then we also want those crisis contacts.

We want to know what to do when we’re struggling, what to remove ourselves from. And then really importantly, we want to understand what are our reasons for living, what can we go to? And then we want to keep our environment safe.

This is something that every pediatrician, every family member, whether a young person is in a crisis or not, should already have some preparation doing and thinking about what’s in your not only home environment, but what are the other environments that you go to? We know, for example, over half of youth suicides are from a firearm. So that should be whether there’s a crisis or not, safe storage should be everyone’s priority.

That is something that will save lives. Full stop. The other pieces are, do I have things that can be adjusted that could be harmful?

Are there sharp objects? Are there things that can cause immediate harm to someone who’s rapidly escalates from thinking about suicide to taking action on it? The more we can create a delay, the more we can create a bridge from thinking to doing, the more chance we have to save a life.

And especially with those young kids, impulsive kids, it can go very rapidly from thinking about anyone’s life to taking action on it. So, we do want to we want to create some distance from that. So safe storage is a huge one.

But there’s also conversations that we’ve talked about, and we want to make sure people are viewing it as a reality for any child and not, oh, this is someone else’s kid. This is not the child who’s doing well. That is not how we think about reducing suicide risk universally.

We want this to be something almost like a vaccination. We want this to be something that everyone is equipped to take steps to reduce the chances of action being taken on a suicidal thought, since we’re really not great at predicting suicidal thoughts in young people. That’s even though we have tons of research to identify which categories of people might be at risk or which situations increase risk to pinpoint who and when someone’s at risk is actually not something we’re very good at in the field.

So, we need to make sure everyone is prepared to do this work well. And it’s doable.

[Dr Mike Patrick]
Yeah. Yeah. When we think about preventing youth suicide, I think, you know, we’re thinking about the actual act of self-harm or killing yourself.

That’s what we’re trying to prevent. Is there any way to prevent suicidal thoughts in the first place? Or is that just if they happen, they happen and there’s nothing I can do about it?

Or are there things that we can be doing as families to try to prevent that to begin with?

[Dr John Ackerman]
That’s a great question. I mean, in some ways, when I think of thoughts and maybe this is me as a clinical psychologist rather than a parent, thoughts do happen. And I think when a person feels trapped or like a burden and an emotional pain where they feel like things getting better or escape is not possible, that’s when suicidal thoughts are going to emerge.

So, yes, I think we can help people not get to the point where they feel like there’s only one pathway and that pathway is to harm oneself or end one’s life. So, things like cognitive behavioral therapy can be really helpful in helping a person reframe their situation, helping identify thoughts and feelings and how they work together. They can understand that the more options I have and the more people I can talk to and the more outlets that I have, the more active I am, the better sleep I have, the more I’m managing my social media effectively, all of these things can be helpful.

I don’t know that that is 100 percent going to eliminate the possibility of a suicidal thought, nor do I think it’s wrong or harmful to have a suicidal thought. It’s only when you feel like that action must occur because of it. So, I think we are doing universal prevention programs in schools and with community partners and increasingly like faith communities and pediatricians’ offices.

And I think we’re doing a better job of expanding to make sure people know what to look for and how to respond. And the most important thing is that a person understands that they are not flawed, weak, damaged, or something’s wrong with them if they have one of these thoughts and that they know that it’s a sign, it’s a stop, let’s kind of assess what’s going on and move forward in a pathway that will give me the support I need. And some people will experience that chronically.

It’ll happen again and again. So, they haven’t done anything wrong by continuing to have suicidal thoughts. It’s just a different condition that they’re managing.

Some people will quickly hear like, oh, OK, I’m not quote unquote crazy. Other people are going through this. And I actually feel a lot better now and I’m going to get therapy or counseling or support.

And they end up not having suicidal thoughts in the future. And that’s great. But it’s not for me.

It doesn’t feel like we have to prevent the possibility of someone having these thoughts because I’m not sure we’re there yet as a field.

[Dr Mike Patrick]
Yeah. So, you know, the thought happens, but it’s when you start dwelling on that thought and when you start making a plan and it’s starting to become more real than just a passing thought. And so that’s really what we’re what we’re trying to avoid and prevent.

Right.

[Dr John Ackerman]
Absolutely. And we try to create climates and environments where it is more understandable, more acceptable to get the support immediately and actually indirectly that will reduce the chance of suicidal thinking because you’re connected with people, you have those trusted adults in the schools, you know that other people, should you ever experience heightened anxiety and depression, a host of behavioral health challenges that it doesn’t need to escalate because, you know, you’re in a place where that’s understood and that’s safe to be yourself in those spaces. And that makes a world of difference.

It also makes a world of difference that both of you shared your experiences. We know that when leaders, when teachers, when the head of a construction site shares that they are navigating mental health challenges and they’re getting help for it, that reduces suicide greatly. I think so.

Sometimes media gets a bad rap because we talk about media suicide in a sensationalized way. And that does cause harm. But the idea of sharing stories, letting people know that you are human and you have a range of emotional experiences.

And sometimes I feel just really down and hard and I need to talk to someone about it. I’m spoiled. My wife’s a psychologist.

I have like internal resources here. But also, I would feel very comfortable if I reached a point of whether it be a suicidal crisis or otherwise needing mental support and a heartbeat. Absolutely recommend that.

[Dr Mike Patrick]
Yeah, absolutely. Erica, as if we broaden the lens a little bit and look at the whole community level, communities aren’t necessarily equal in terms of what resources and support that they have available. What sort of resources in a community make it easier as a system to sort of connect with all of this?

I mean, what you know, if you if you want to be prepared and think about something before it actually you need it, it may be a good idea for parents to start thinking about what community resources do we have in case this comes up. What are some of the options? And if there are ones that aren’t available in a particular community, maybe that’s something that someone could have a hand in creating.

[Erica Mellinger]
Yeah, absolutely. So, I think improving access to mental health care through schools and primary care, including teams that coordinate physical and mental health services. So, at KIPP, we did have a specific counselor who met with a handful of students at school, and they could leave the classroom and go meet with them and have a therapy session.

And it was very beneficial for those students because it took away the hills or barriers to care and to access. Right. Continuing to reduce practical barriers like cost, transportation, long wait times and difficulty finding culturally responsive care, especially for my students of color.

It was always important for me to find, like, for example, the meditation. It was also a woman of color doing the meditation, you know, someone who looks and sounds like them. So, they feel like they could access the services as well.

And then also supporting regular wellness visits and sustained school family partnerships. So, it’s just easier to find care before and after a crisis. Yeah.

[Dr Mike Patrick]
John, as we wrap up, what is your key message for worried parents out there?

[Dr John Ackerman]
I think the key message is that although identifying a specific situation where a young person’s at risk and having a conversation can be hard, it’s doable. And that by approaching the situation with the idea that if you create a warm space, an inviting space, in a nonjudgmental space to enter this conversation, you’re doing a world of good. Even if you’re the young person is not currently having thoughts of suicide, you’re letting them know that if you were to experience this or if one of your friends were to experience a suicidal crisis, I’m the type of person that’s OK having this conversation.

And I may need to practice asking those questions directly. I may need to work with my community. You know, maybe there’s some school counselors, some faith leaders, some folks who I work with, my pediatrician, that can help me navigate this.

But it’s really important that I do. And it then can have a ripple effect in a really positive way. That person can be there for their friends.

That person can reach out and create that safety net that I think we’re going to need. There are many different therapies that we’ve talked about or many different community and prevention approaches, but it really will take an entire community to help make mental health and suicide more specifically something that we can all approach and get the help we need. There is help forward.

There are treatments that work. There are crisis resources that you should always feel comfortable reaching out to. But young people often need a boost to get them to use these resources and to feel good about it.

So that modeling and getting that support can be really helpful. So that’s what I would say.

[Dr Mike Patrick]
And Erica, what is one thing that each of us can do as we move forward after listening to this episode? Sort of what’s our call to action for each listener?

[Erica Mellinger]
Yeah, I think the call to action should be checking in with a young person and listening with patience, kindness and genuine interest. And I really want to emphasize that there’s no necessarily correct way to do this or correct thing to say. I think of a student who sat in silence.

That’s what she needed. I didn’t know what to say to her. She didn’t really respond to my question.

So, I just provided a safe space for her to sit in silence. And then at the end of the year, I got a beautiful message that was like, thank you for being a safe space for me. Right.

And it wasn’t because I said or did anything specifically. It was just because I was present and I showed up for her. Right.

So that’s all that’s needed sometimes.

[Dr Mike Patrick]
Yeah. And support is not always about fixing things. I mean, obviously, in this case, we want to fix it to the degree that someone’s not going to act upon the thoughts that they’re having.

But sometimes support is just sitting in silence with someone, letting them know that they matter to you. And we don’t actually have to speak at this particular time. Well, this has been a fantastic conversation.

And we are going to have lots of links in the show notes. So, if folks head over to Episode 617 over at PediaCast.org, we’ll have links to Suicide Prevention Resources for Families from the Kids Mental Health Foundation, Center for Suicide Prevention and Research. They have a bunch of blog posts that are very useful and helpful.

We’ll have links to those as well. And of course, the 988 Suicide and Crisis Lifeline. You shouldn’t need a link to it, though.

It’s really easy. 988. You just got to remember that.

And then the American Foundation for Suicide Prevention has some great resources. Blueprint for Youth Suicide Prevention from the American Academy of Pediatrics and Youth Suicide Prevention and Intervention, Best Practices and Policy Implications. So, if you’re more in a policy type role, whether that be with government or with your school or wherever, really, you have some great information there.

So, lots of resources in the show notes over at PediaCast.org. Again, just find the show notes for Episode 617. So once again, Dr. John Ackerman, Child Psychologist and Suicide Prevention Clinical Manager at the Center for Suicide Prevention and Research at Nationwide Children’s Hospital. And Erica Mellinger, fourth year medical student at the Ohio State University College of Medicine. Thank you both so much for stopping by and chatting with us today.

[Dr John Ackerman]
Thanks so much for having us. This is wonderful.

[Erica Mellinger]
I greatly appreciate it. Thanks again.

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[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. We really do appreciate your support. Also, thanks again to our guests this week.

Dr. John Ackerman, Child Psychologist and Suicide Prevention Clinical Manager with the Center for Suicide Prevention and Research at Nationwide Children’s Hospital. And Erica Mellinger, fourth year medical student at the Ohio State University College of Medicine. Don’t forget, you can find us wherever podcasts are found.

We’re in the Apple Podcast app, Spotify, iHeartRadio, Amazon Music, Audible, YouTube, and most other podcast apps for iOS and Android. Our landing site is PediaCast.org. You’ll find our entire archive of past programs there, along with show notes for each of the episodes, our terms of use agreement, and the handy contact page if you would like to suggest a future topic for the program.

Reviews are helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show and we love connecting with you on social media. You’ll find us on Facebook, Instagram, Threads, LinkedIn, X, and Blue Sky.

Simply search for PediaCast. We also have a sibling podcast called PediaCast CME. It is similar to this program.

We do turn the science up a couple notches and offer free continuing medical education credit. That’s what the CME means for those who listen. And that includes doctors, nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists.

And it’s because Nationwide Children’s is jointly accredited by all of those professional organizations that we can offer the credits you need to fulfill your state’s continuing medical education requirements. Shows and details are available at the landing site for that program, PediaCastCME.org. You can also listen wherever podcasts are found.

Simply search for PediaCast CME. And then we also do a faculty development podcast from the Center for Faculty Advancement, Mentoring, and Engagement at The Ohio State University College of Medicine. So, if you’re a teacher in academic medicine or a faculty member in any of the health sciences, then this is a podcast for you.

You can find FAMEcast at famecast.org and wherever podcasts are found by searching for FAMEcast. 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.

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