Hearing a young person express a desire to end their life is extremely frightening. Often, parents are at a loss about how to respond. How can they protect their child? Will questioning them about their thoughts of suicide put ideas in their head? Is their child serious or just upset at the moment? Would calling 911 be an overreaction?

As a mental health provider, I urge parents to take any mention of self-harm seriously and to seek professional help – including calling 911 or taking their child to the emergency room when there is a chance they are in danger.

If you have reason to suspect that your child is considering self-harm, even if they haven’t said anything, you may want them to work with a mental health clinician to develop a personal suicide safety plan. This is a concrete tool to temporarily divert a young person from attempting suicide until help becomes available. (The Stanley-Brown Safety Plan, a common safety plan template for download.)

The safety plan is much like a contract where the individual agrees to follow a series of steps, one after the other, to deescalate powerful negative emotions. It does not replace medical and therapeutic interventions. Rather, it is intended to help a person in crisis get through the next few hours or days by creating barriers at a time when they are at the highest risk for acting on the impulse to attempt suicide, according to Joanna Stern, PsyD, senior director of the Mood Disorders Center at the Child Mind Institute.

According to Stern, developing a plan involves engaging the teenager in an in-depth discussion about their suicidal ideation. Typically, the therapist will question them about:

1. The triggers and warning signs that prompt suicidal thoughts
2. The means the individual might use to harm themselves
3. Activities, people and situations that could help calm or distract the individual from their negative thoughts
4. Their reasons for living
5. Trusted individuals who they would talk to when they are in pain
6. Professional resources that could help during a crisis

The steps of the plan are generally put on paper and copies should be easily accessible to the teen and their parents. Often the teen, their parents and the therapist sign the plan’s final draft. While it is not guaranteed that a young person who is in extreme distress will follow the plan, reviewing it and attempting to follow some of the steps may delay their urge to act enough to save their life.

6 Safety Plan Steps

1. Identify Triggers/warning signs — By understanding situations, experiences and thoughts that tend to preempt a crisis, the teen and their parents can spot the warning signs and begin going through the steps of the safety plan.
   
   Common warning signs include:
   • Feeling stressed or overwhelmed
   • Wanting to self-isolate
   • Experiencing fatigue, lack of energy, anger or irritability
   • Feeling hopeless
     
     Parents may notice their child talking about being a burden to others, having no reason to live, wanting to sleep and not wake up or being in pain. They may also witness their child sleeping too much, withdrawing from friends and activities or abusing drugs or alcohol.

2. Practice coping strategies – Once the warning signs are recognized, the individual should practice techniques that can help divert their mind and calm them. These could include exercising or going for a run, listening to soothing music, or practicing breathing exercises.

It may also help to seek out people or social settings that can offer a positive distraction. from negative thoughts.

3. Review a list of reasons for living – Looking over a list of things that make your teen happy can help shift their focus. During better times, what are they grateful for? What do they look forward to?  What do they love? Examples might be their pet, a favorite meal or TV show, or close friends. 

This list is a valuable reminder that their distress will not last forever and that it is worth tolerating their pain because of the items they have listed.  

4. Reach out to people who can help – Your teen should have a contact list at hand of people they trust and would feel comfortable talking to at a time when they might be distraught. These individuals can be peers or adults who are willing to listen without judgment. They must be capable of helping during a crisis and ready to always pick up the phone. (In addition to contact information, list hours of availability for each person).

5. Create a safe environment – Take the time to remove any potentially harmful substances or objects from sight. As the parent, you can work with your child to ensure that anything they might use to hurt themselves is taken from the home or secured. This could include any medications (both over-the-counter and prescription), weapons (firearms and ammunition), sharp objects (knives, scissors, razors), or other potential hazards.

During the development of the safety plan, the teen should be asked about the means they have thought about using to hurt themselves and what objects or substances they believe could put them at risk.

6. List of professional resources

This list will include contact information for your child’s health care provider, therapist or psychiatrist. It should also include crisis services like:

• The National Suicide Prevention Lifeline (Call or text 988)
• The Crisis Text Line (text HELLO to 741741).

Both provide 24-hour, confidential support to anyone in suicidal crisis or emotional distress. 

In a potential emergency, dial 911 or take your child to the emergency room.

September is National Suicide Prevention Month. To find additional resources, visit the National Alliance on Mental Health website.