- September 22, 2022
- Jennifer Salerno
I’ve been working with that young lady all year.
And she answered positively for suicidal ideation, and she had a plan.
And I just asked her. I said, “Why didn’t you ever say anything to me?”
And the young girl said, “Because you never asked me.”
Can you imagine? … Can you imagine working with a struggling youth for months on end only to suddenly realize your student had been having suicidal thoughts all the while?
Heartbreaking and terrifying are the first 2 words that come to mind for us.
Yet, this brief excerpt from above is true.
This is part of a reflection from Sandy Rowe, Executive Director of Pender Alliance for Total Health (PATH), a nonprofit that works collaboratively with schools and youth health centers. Her team was helping a partner school implement the Rapid Adolescent Prevention Screening (RAAPS) tool.
What we learn from this short story is what most of us already know:
We have to ask them.
When we are worried about a youth (or anyone, for that matter), we must be willing to have a conversation and ask direct questions. Talking about suicide is not easy for anyone, but moving past our discomfort and focusing on the struggling youth can make all the difference.
As many of you know, September is National Suicide Prevention Awareness Month.
It’s a time of year when mental health professionals make a concerted effort to bring light to such a heavy topic.
How do we ‘bring light’ to something as serious as suicide?
We talk about it. As a profession, we…
- Review current data to understand the prevalence of youth suicide
- Discuss evidence-based practices that decrease youth risk of suicide, including new resources and intervention tools
- Offer hope by asking questions of those who are struggling
Prevalence of Youth Suicide
Let’s start with our first goal – understanding the current data that describes youth suicide.
According to the Centers for Disease Control and Prevention (CDC), suicide is (still) the second leading cause of death in youth ages 10-14 and in ages 25-34. The rate of suicide among youth ages 15-24 is high – about 14 per 100,000. To understand the data another way, consider this: nearly 20% of high school students report having serious thoughts about suicide, and 9% report having made a suicide attempt. These numbers are sobering and frightening. Yet, if there is one thing encouraging about suicide, it is that we know it is preventable.
Evidence-Based Practices and Tools to Prevent Suicide and Reduce Suicidal Ideation
Let’s repeat it: suicide is preventable.
Although every youth who struggles with suicidal ideation has unique mental health challenges, there are evidence-based practices known to be effective in reducing suicidality for this population. To put it plainly – there are things we can do that work.
Psychosocial treatments include structured counseling or psychotherapy, psychoeducation, case management, and other aspects of care coordination. Specific types of psychosocial interventions that are known to decrease suicidality include:
- Cognitive-Behavioral Therapy (CBT)
- Dialectical Behavioral Therapy (DBT) and
- Collaborative Assessment and Management of Suicidality (CAMS)
These are suicide-specific psychosocial treatments that have been shown to reduce suicidal ideation, prevent the onset of suicidal ideation, prevent post-treatment suicide attempts and reattempts, decrease hospitalizations, and lower medical risks of self-injurious acts.
Brief Psychosocial Interventions (BPIs)
A brief psychosocial intervention (BPI) is another research-backed treatment for adolescent depression and youth suicide prevention. It involves a skilled assessment from a qualified provider, active listening, education, advising and problem-solving, developing a safety plan, and demonstrating care through empathy. When working with suicidal youth, a key part of the brief psychosocial intervention is the development of a safety plan. Safety plans typically include:
- Lethal means reduction
- Brief problem-solving and coping skills
- Increasing social support
- Identifying emergency contacts during a crisis.
Help youth develop a safety plan that includes getting rid of potential weapons, building coping skills, increasing support from family and/or peers, and identifying crisis contacts. These are things that work.
Risk Assessment and Coaching
The Rapid Adolescent Prevention Screening (RAAPS) is an evidence-based risk screening tool designed to help professionals identify risk behaviors in youth, including suicidal thoughts and behaviors. RAAPS is appropriate for use in a variety of settings, including school-based health centers, pediatric and primary care offices, mental health clinics, and community youth service agencies. Professionals of any background can be trained to use it effectively. Using RAAPS, medical assistants and attending physicians alike can quickly and accurately identify youth who are struggling with suicidal thoughts and behaviors and then make a plan to intervene.
As we saw from the brief excerpt in the introduction, RAAPS works alongside the professionals who are serving youth. It doesn’t replace the need for human professionals but works in sync to ask research-driven, responsive questions about risk behaviors. Immediately after the screening is complete, RAAPS compiles and analyzes the data so providers know exactly how to respond. Because it is a standardized tool, adults can be sure no one slips through the cracks because they know they are screening every youth the same way every time. RAAPS has been tested extensively in research settings and proves its effectiveness over and over. Check out a handful of recent research publications here to take a closer look at the data.
Engage Youth in Discussion by Asking Open-ended Questions (Intervening for Suicidal Ideation)
It may be very upsetting to hear someone say they are thinking about suicide or to hear them talk about things that make them sound like they are considering ending their life. This can be true even for highly trained and experienced professionals. Hearing such desperation and hopelessness in a young person may be all the more harrowing. As adults, it’s easy to think things like, “They have their whole lives ahead of them!” Yet, providing opportunities for further disclosure to suicidal youth means we choose to engage in the conversation and ask very direct questions. When we engage, we show that we care and that they are not alone.
Here are a handful of follow-up questions to consider asking:
- Who in your life do you trust or who feels safe to you – a family member, a friend, or someone else?
- How recently have you thought about suicide?Then follow up with:
- What kinds of thoughts are you having? Or
- Tell me more about what you’ve been thinking about or planning to do?
- What kind of access do you have to weapons or things that can be used as weapons to hurt yourself?
Remind yourself that asking questions like these or talking about suicide won’t push someone over the edge. Talking about it won’t cause someone to do something self-destructive. Instead, providing a safe space to share feelings can actually reduce the risk of acting on suicidal feelings.
A New Crisis Line: Call 988 to Get Help Now
In July 2022, the National Suicide Prevention Lifeline, a project led by the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services, was renamed the 988 Suicide & Crisis Lifeline. 9-8-8 is now the toll-free nationwide hotline number. To help prevent youth suicide, be sure to communicate this update to the youth you care for. Consider posting signs around your clinic or workplace with the information below.
If you or someone you know is struggling with suicidal thoughts, call or text 988 or chat 988lifelin.org to get help now.
As the end of September approaches and National Suicide Prevention Awareness Month comes to an end, our work with struggling youth does not.
Mental health practitioners, healthcare providers, school professionals – everyone who works with youth cares deeply about their wellbeing…as do you.
You are the ‘boots on the ground’ – the trusted adults who have the capability and responsibility to identify and intervene when youth are hurting.
RAAPS is in a league of its own as a cutting-edge mental health tech tool. It is the only standardized, validated risk screening tool that is (1) user-friendly; (2) quick to administer; (3) research-based; (4) immediately responsive to the data.
Wondering how RAAPS can help you care for the youth in your community? Good. Let’s work together to make sure no youth goes unnoticed in their time of need.
Schedule a call to learn more today.