Advice from child psychologists about approaching the topic of suicide with pediatric patients

Health care professionals pursue medicine in the hopes of helping patients grow up happy and healthy. Yet, many children and teens struggle with their mental health. In 2021, there were an estimated 1.7 million suicide attempts, according to the American Foundation for Suicide Prevention. And, nearly 20% of high school students report serious thoughts about suicide and 9% report a suicide attempt during the prior year, according to NAMI. 

One way providers can help children and teens with their mental health is to simply talk about it – don’t be afraid to ask. If during a visit you feel concerned for your patient, don’t delay in starting the conversation. 

Below are tips from Children’s Minnesota psychologists about how to approach these important conversations along with resources that may help. 

Approaching the topic of suicide  

Suicide can be a difficult topic to broach. You may even be concerned that the conversation could make things worse. But, the fact of the matter is, asking about suicidal thoughts, behaviors and/or the stressors that may be present will not escalate present concerns or cause a suicide attempt.  

You do not need to be a mental health expert or provider to ask patients about their thoughts and feelings, particularly if you are concerned. However, make sure you are aware of and connected with mental health providers and resources available through Children’s Minnesota to support you and your patients. 

We encourage you to create a safe space for conversation starters with your patients about suicide. Here are some ideas for conversation starters. 

Conversation starters: 

Start with an observation.

Start with something you’ve observed and add in a direct question of well-being, for example, “I’ve noticed you’ve been [insert concerned behavior here] in recent visits. How have you been feeling lately?” This highlights that you are not asking ‘out of the blue’ but have been noticing signs that are concerning to you. Refer to specific answers on questionnaires for the visit that may have also raised concerns for you as a provider. 

Then, make sure to take note of ‘conversation-enders’. If the child or teen is dismissing your concerns without openness to communication, make sure you alert their parent or guardian to continue to monitor and find moments where they seem more open to having a discussion. Documenting concerns to ensure follow-up at next visit, especially in primary care, is also recommended.  

Prepare for the conversation.

To prepare for the conversation with your patient, remember to stay calm and listen. Also, be prepared with resources if their response is ‘yes’, but also if their response is ‘no.’  

If they say ‘no’, encourage them to talk about how they are feeling since you noted their behavior changes. Here’s how: 

• Support their coping. 
• Ask what helps them feel better.  
• Remain vigilant. 
• Continue to check in on a regular basis.  

Avoid judgmental comments.

During this conversation with your patient, we recommend avoiding comments that might worsen their feelings of isolation, such as: 

• Get over it. 
• Others have it worse. 
• Stop trying to get attention. 
• Suicide is selfish. 
• Why didn’t you tell me sooner? 
• I know how you feel. 

The last two comments, although well-intentioned, could be harmful in making them about you and not how difficult this is for your patient. 

Reassure they can trust you with anything shared.

Remind your patient that they can trust you with anything they have shared or will share with you now or in the future. They may be worried about you sharing this information with their parents or guardians, make sure to talk through that process with them as well to gain trust and provide openness on your end as well.  

Having set wording that feels comfortable to you when discussing patient confidentiality can help you remain grounded within the discussion and steadfast in the patient’s safety being top priority regardless of discomfort.  

Ask directly about suicide.

Sometimes when people feel extremely stressed, alone, tired, sad or whatever feeling or behavior you are perceiving, they are thinking about suicide. So, try asking them directly, “Have you been thinking about suicide?” or, “Are you thinking of ways to end your life?” 

Listen and express concern.

Make sure you stay calm as you listen to what your patient says. Also, it’s OK to express concern. For example, say, “I’m deeply concerned for you and want to work together to make a plan to keep you safe and find you the help you need.” 

We also recommend reassuring them that they will not feel like this forever and that help is available. 

Suicide resources

Here are resources you can provide to the child or teen, or their parents or guardians.