Here are the warning signs of youth suicide and how to respond

If a child or teen is talking about mental health struggles, take them seriously, and don't disregard any significant behavior changes.

It's more common now than in previous generations for kids to talk about mood disorders such as depression and anxiety, and such talk should never be dismissed, said Paula McCall, a child psychologist and president of the non-profit Chandler-based Semicolon Society, which provides free mental health education and suicide prevention resources and supports.

"It is an opportunity for us to have a conversation with them," said McCall, who is nationally certified as a school psychologist. "If they are doing this to get my attention, my thought is great. I want the teens that I care about to get my attention if they need it."

The conversations adults have with kids who share such information need to be non-judgmental, McCall said.

"The conversation needs to be 'Tell me more about that. Help me understand.' And we need to listen rather than trying to change what they are feeling or fix it," she said. "I don't think we should dismiss it, especially if they are communicating it to us."

Some kids struggling with mental health issues may be at risk for suicide. The Semicolon Society identifies the following warning signs:

• Talking about or making plans for suicide.

• Expressing hopelessness about the future.

• Displaying severe/overwhelming pain or distress.

• Seeing oneself as a burden to others.

• Reduced feelings of belonging.

• Marked changes in behavior: social connections, goals, sleep, emotionality and even drastically improved mood. McCall said significant behavior changes are one of the biggest red flags for youth suicide and that adults should trust their instincts.

How should adults respond to signs of suicide in children and teens?

Here are some tips from the Semicolon Society for responding to suicide warning signs:

• If you are concerned, ask. Too often, we wait for the other person to come to us. If you have concerns it is okay to state them and ask directly about mental health and suicide.

• Asking about suicide will not put the idea in their head. Asking shows the other person that we are willing to have the conversation, and it can actually provide comfort and increased possibility of honest communication.

• Listen without judgment.

• Offer validation for feelings without trying to change their perspective.

• Communicate support with phrases such as "I love you" and "I am here for you."

• Focus on the next steps: "How can I help?" or "Together let's figure out what to do next."

Leaders with the Phoenix-based nonprofit Teen Lifeline, a peer-to-peer hotline, advise creating a safe environment for the child or teen: lock up medications, sharp objects and poisonous chemicals, secure all firearms, and store ammunition separately.

If you suspect a child is in immediate danger of self-inflicted harm or of acting on suicidal thoughts, call 911 or take the child to an emergency room, Teen Lifeline says. If immediate safety is not a concern, call Teen Lifeline or seek a referral to mental health services or counseling.

Adults tend to want to quickly solve kids' problems, Teen Lifeline Clinical Director Nikki Kontz said. They may think kids are being dramatic, unnecessarily turning small problems into larger ones, or they may believe kids are making bad decisions and try to redirect them, Kontz said.

"While that comes from a good place, it's not helpful and when we were teens we didn't want to listen to it, either," she said.

If a friend talks about suicide, here's what kids can do

Children, particularly teenagers, often only reveal struggles to their friends. So what is a teen to do if their friend expresses thoughts of suicide?

"That's so hard because they don't want to put their friend in a more uncomfortable situation," McCall said. "For adults and teens, it's about being proactive. I encourage teens to identify who is their safe, trusted adult for any situation that comes up. It might be a parent or it might not. It might be a teacher. It might be a coach."

She said it's important for kids to listen and not dismiss what their friend is saying. She suggests asking questions like, "How can I help?; How can I be here for you right now?; and What can we do together?"

Focus on one step at a time such as going to a trusted adult or calling the Teen Lifeline hotline together. McCall emphasized that the person in distress does not have to be the person who calls the Teen Lifeline. It could be a friend, a parent or other concerned person, she said.

Are there risk factors for suicide?

In a 2021 health advisory titled "Protecting Youth Mental Health," U.S. Surgeon General Vivek Murthy writes that mental health is shaped by many factors "from our genes and brain chemistry to our relationships with family and friends, neighborhood conditions, and larger social forces and policies."

Factors that make kids living in 2023 vulnerable to mental health challenges include aftereffects of the COVID-19 pandemic, as well as social media, climate change, income inequality, racial injustice, the opioid epidemic, and gun violence.

Risk factors for suicide mean factors that could make a person more vulnerable to suicide. Yet many people with multiple risk factors never have any mental health challenges, McCall said.

Some of the risk factors she cites include being part of the LGBTQ+ community and being in a family where domestic violence is present. Other factors include crisis events such as a relationship loss, death, divorce, moving, failing in school, or getting suspended or expelled from school, McCall said.

When kids go through crisis events such as a relationship loss it's an opportunity for adults to help teens and children to build resiliency by acknowledging the trauma and supporting them, McCall said.

Other suicide risk factors listed by the American Academy of Pediatrics include previous suicide attempts, mental health conditions such as depression, substance use, adverse childhood experiences, bullying, a family history of suicide, family or peer conflict, easy access to lethal means and systemic trauma or marginalizing experiences based on socioeconomic factors, race/ethnicity or gender/sexual identity.

Create a safety plan

One easy step for people, who struggle with thoughts of suicide is to fill out a "safety plan" that's part of the Stanley-Brown Safety Planning Intervention. The American Academy of Pediatrics says safety planning is an "evidence-based and effective technique to reduce suicide risk."

The Stanley-Brown plan was developed by Gregory Brown, who is director of the Penn Center for the Prevention of Suicide at the University of Pennsylvania, and Columbia University psychology professor Barbara Stanley, who died this year at the age of 73, the New York Times reported Jan. 29.

"The researchers often compared the written plans to 'stop, drop and roll' fire-safety training, or to the safety cards distributed on airplanes — a way to provide very simple instructions to help people make sound decisions in the midst of overwhelming emotions," the Times article about Stanley says.

The Stanley-Brown research found that acute suicide risk usually increases and then decreases over a short period of time.

Free mental health resources are available to anyone in Arizona. A statewide mental health crisis line is available at 844-534-HOPE (4673). Another resource for 24/7 help is to dial 988. The 988 Suicide and Crisis Lifeline in July replaced the National Suicide Prevention Lifeline. Teen Lifeline is for kids to call and get free, confidential and anonymous help from trained peers at 602-248-8336 (TEEN) or 800-248-8336 (TEEN) outside of Maricopa County.

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes.

This article originally appeared on Arizona Republic: Warning signs for teen suicide include significant behavior changes