Latest / 20-Minute Health Talk / Kids in crisis: How to start the conversation about child suicidality

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Kids in crisis: How to start the conversation about child suicidality · 20-Minute Health Talk

• 0:03
  Vera Feuer: So you can start the
• 0:04
  conversation by saying things like,
• 0:06
  "I noticed lately there's been a change,"
• 0:09
  or "you haven't been wanting to engage with this activity.
• 0:12
  How are you? What is going on?"
• 0:15
  Sandra Lindsay (Host): That's Dr. Vera Feuer,
• 0:18
  a specialist in child
• 0:20
  psychiatry.
• 0:21
  Dr. Feuer: Oftentimes it's not a solution
• 0:24
  that kids are looking for,
• 0:26
  it's just listening.
• 0:27
  Sandra: And the advice she's offering is
• 0:30
  aimed at parents of kids who are
• 0:33
  struggling with suicidality, which is defined as the
• 0:37
  combination of suicidal ideation
• 0:39
  and a plan for ending one's own life.
• 0:43
  Conversations like this can be life saving,
• 0:47
  but many parents struggle to
• 0:49
  find the words to start as they
• 0:52
  fear the worst for their child.
• 0:54
  Now, new data from the CDC point
• 0:58
  to an alarming trend.
• 1:00
  More kids are struggling with
• 1:02
  suicidal thoughts and behaviors,
• 1:05
  raising the temperature on an
• 1:08
  already scary situation.
• 1:10
  While the suicide rate is still relatively low.
• 1:14
  The CDC reports that dying by suicide is the 8th leading cause
• 1:20
  of death in children aged five to eleven,
• 1:25
  and it's the third leading cause among adolescents.
• 1:29
  But Dr. Feuer explains that there are
• 1:32
  steps you can take to help a child in your care.
• 1:41
  Hello, and welcome to 20 Minutes Health
• 1:44
  Talk. I'm sandra lindsay.
• 1:47
  This is part one of our series
• 1:49
  examining a topic that, as a mother,
• 1:53
  I can say with certainty no
• 1:56
  parent wants to discuss and many
• 2:00
  simply do not know how.
• 2:02
  But the rising rate of child suicide in the United States
• 2:06
  is one that we must face.
• 2:09
  And we'll do that together over
• 2:11
  the next several weeks with experts and advocates who are
• 2:15
  finding innovative ways to address this problem and
• 2:19
  improve access to care.
• 2:22
  Here is my conversation with Dr. Vera Feuer,
• 2:26
  director of Emergency
• 2:27
  Psychiatry Services at Cohen
• 2:30
  Children's Medical Center,
• 2:32
  as she breaks down the potential
• 2:34
  causes, warning signs and
• 2:36
  solutions to this
• 2:38
  troubling trend.
• 2:42
  Dr. Feuer, a pleasant good afternoon to you again.
• 2:45
  It's such a pleasure to meet you.
• 2:47
  This is a very important topic.
• 2:49
  As a mom myself, I am just so concerned when I
• 2:55
  read anything about children harming themselves.
• 2:58
  It's every parent's Nightmare, child suicide and
• 3:03
  suicidal ideation is on the rise.
• 3:06
  Can you walk us through, please,
• 3:09
  some of the CDC data that was
• 3:11
  released earlier this year showing this drastic spike?
• 3:16
  Dr. Feuer: Sure.
• 3:17
  Thank you so much for having me.
• 3:19
  And thank you so much for
• 3:20
  covering this really difficult
• 3:22
  but very important topic.
• 3:25
  The numbers through the years
• 3:27
  have been increasing,
• 3:28
  and this is not a new trend,
• 3:31
  but new data has been released
• 3:33
  by the CDC about an increase
• 3:38
  from about 2007 to 2021.
• 3:41
  So more recently,
• 3:43
  that indicates a very
• 3:45
  significant 60% increase in
• 3:47
  overall suicidality in children
• 3:52
  and adolescents.
• 3:54
  Sandra: So you mentioned suicidality.
• 3:57
  Can you talk to us about the
• 3:58
  differences in suicidality,
• 4:01
  suicidal ideation, and suicide?
• 4:04
  Dr. Feuer: Sure, great question.
• 4:06
  Suicidal ideation is the term
• 4:10
  that we use that encompasses
• 4:13
  thoughts,
• 4:14
  maybe preparing behaviors
• 4:17
  towards an act of suicide,
• 4:21
  which then is the term that we
• 4:23
  mean by intentional self injury,
• 4:26
  aiming at ending in death.
• 4:29
  Suicidality, on the other hand,
• 4:32
  is an over encompassing term
• 4:34
  that includes all of that.
• 4:36
  So it includes ideation,
• 4:38
  behaviors, gestures, thoughts,
• 4:41
  as well as deaths from suicide.
• 4:45
  Sandra: So suicidality has increased by
• 4:48
  over 60% in the time frame
• 4:51
  you mentioned,
• 4:52
  and that's according to the
• 4:54
  National Center for Health
• 4:55
  Statistics report issued
• 4:58
  in June of this year.
• 5:00
  There was another CDC report
• 5:03
  called the Youth Risk Behavior
• 5:06
  Survey that came out in February
• 5:09
  that found similarly
• 5:11
  alarming numbers.
• 5:13
  Can you tell us more about that?
• 5:16
  Dr. Feuer: It is a survey that's done on a
• 5:18
  nationally representative sample
• 5:20
  of nine through twelve graders
• 5:23
  and is done in schools
• 5:25
  across the country.
• 5:26
  So it has been done
• 5:27
  for quite a while.
• 5:28
  So we have longitudinal patterns
• 5:31
  that we know. In fact,
• 5:34
  rates have been increasing,
• 5:37
  but we have been here
• 5:38
  in history before.
• 5:40
  We do know from this survey and
• 5:42
  other CDC data that in the past,
• 5:46
  in the 90s,
• 5:48
  before certain medications were
• 5:51
  available for the treatment
• 5:53
  of depression,
• 5:54
  certain evidence based
• 5:55
  treatments were available.
• 5:56
  Rates were higher even than.
• 6:00
  Currently.
• 6:00
  And then they dropped,
• 6:02
  and then they started
• 6:04
  increasing again.
• 6:05
  And we can talk more about
• 6:07
  those patterns,
• 6:08
  but this is obviously very
• 6:11
  concerning also,
• 6:12
  because in addition to suicide
• 6:15
  rates increasing,
• 6:17
  we're also seeing rates
• 6:18
  of depression,
• 6:20
  rates of serious suicidal
• 6:23
  ideation, so suicidal attempts,
• 6:27
  and then also, as mentioned,
• 6:29
  completion rates are
• 6:30
  also increasing.
• 6:31
  And there are particular groups
• 6:34
  that are at higher
• 6:36
  risk than others,
• 6:37
  including our African American
• 6:41
  populations,
• 6:42
  our BIPOC population,
• 6:45
  and our LGBTQ plus youth.
• 6:49
  There is some very recent
• 6:51
  provisional data from the CDC
• 6:54
  indicates that from
• 6:55
  2021 to 2022,
• 6:57
  for the first time
• 6:58
  in a long time,
• 6:59
  the actual suicide rate in the
• 7:02
  youth group of ten to 24 year
• 7:05
  olds has decreased about 8.6%,
• 7:08
  which is pretty significant
• 7:10
  overall.
• 7:11
  For the entire population,
• 7:13
  rates went up.
• 7:13
  But for this population,
• 7:15
  rates have dropped,
• 7:16
  which is very hopeful and
• 7:18
  promising and hopefully a
• 7:19
  beginning of a trend.
• 7:21
  But we are concerned
• 7:23
  and we should be,
• 7:24
  and there are many things that
• 7:27
  we can do as healthcare
• 7:29
  providers and as parents in
• 7:32
  terms of helping impact
• 7:34
  on these trends.
• 7:35
  Sandra: And we will talk about those
• 7:36
  things, and it is promising,
• 7:39
  and I'm happy to hear that bit
• 7:40
  of information that we're
• 7:41
  seeing a decline.
• 7:43
  Something else from the survey
• 7:45
  was that the biggest increase
• 7:47
  in percentage of youths who
• 7:50
  seriously considered suicide
• 7:52
  was among young girls.
• 7:55
  Can you talk a little bit
• 7:56
  about that?
• 7:58
  Dr. Feuer: Young girls ages ten to 14 has
• 8:01
  had the biggest increase in both
• 8:03
  emergency room visits for suicidal ideations,
• 8:07
  for behaviors, gestures, self injurious acts,
• 8:13
  and they had had this very sharp increase.
• 8:16
  And there's a lot of theories
• 8:18
  and a lot of thoughts and
• 8:20
  research looking at why that is.
• 8:24
  One that is commonly discussed is the impact of social media.
• 8:29
  And in fact, even the years of increase in
• 8:36
  both ideations and completions,
• 8:38
  which is most marked from 2007,
• 8:41
  is immediately the year after Facebook was available to
• 8:46
  high school students.
• 8:48
  And since that year, use of social media has
• 8:53
  skyrocketed youth, and there's a lot of research
• 8:56
  coming out how that impacts and how girls are
• 8:59
  different than boys in the way
• 9:01
  they use social media.
• 9:03
  Girls are much more likely to share things about themselves
• 9:06
  and post and with that, much more vulnerable to the
• 9:11
  feedback that they might receive.
• 9:14
  They're also much more prone to
• 9:16
  compare themselves in social
• 9:18
  expectations in way of looks.
• 9:21
  And we know that social media doesn't necessarily
• 9:24
  reflect truths.
• 9:26
  Sandra: So we know that social media
• 9:28
  plays a big role in this.
• 9:30
  Some other factors identified in
• 9:33
  these reports include academic
• 9:36
  and home pressures,
• 9:37
  lack of access to care,
• 9:40
  and economic factors.
• 9:42
  Listeners can find more
• 9:44
  information and a link to the
• 9:46
  full report in the show Notes.
• 9:49
  Dr. Feuer, beyond these reports,
• 9:52
  what are some factors that
• 9:54
  predisposes a child to suicidal
• 9:57
  ideation and suicidality?
• 10:01
  Sure. So, suicide risk factors are many.
• 10:05
  Depression, anxiety, different mental health diagnoses,
• 10:10
  previous suicidal ideation or attempts will also increase
• 10:17
  a person's risk.
• 10:18
  Family history of suicide is an important factor.
• 10:22
  And what they need to be really
• 10:25
  mindful of is that when you do
• 10:27
  see an impact on functioning,
• 10:29
  academic functioning, social functioning, family functioning,
• 10:34
  when you do see a significant
• 10:36
  change in any of that with symptoms of isolating poor
• 10:42
  sleep, changes in eating habits,
• 10:45
  changes in activities, dropping things that they
• 10:48
  previously were involved in or engaged in being impulsive if
• 10:53
  you're suspecting that they're
• 10:54
  starting to abuse misuse drugs or alcohol,
• 10:59
  giving away possessions, starting to talk about death,
• 11:03
  having hopeless comments of "there's no hope for me."
• 11:07
  "I'm never going to amount to anything."
• 11:09
  "I'm of no use," things like that.
• 11:13
  And I sort of listed them in
• 11:15
  escalating order to the point of
• 11:18
  then starting to talk about "I might want to end my life,"
• 11:21
  "I don't want to be alive."
• 11:23
  "This is what I would do to end
• 11:24
  my life. I thought about it,
• 11:27
  I researched it, I looked it up."
• 11:29
  These are sort of the escalating
• 11:31
  things that we are on
• 11:33
  the lookout for.
• 11:34
  Sandra: So what can parents do?
• 11:36
  What can grandma and aunties and
• 11:39
  friends and the community do?
• 11:41
  How can we pick up
• 11:42
  on these signs?
• 11:43
  Dr. Feuer: Asking is really important.
• 11:45
  Checking in, knowing your child,
• 11:48
  being attuned to when there's a change, which is hard.
• 11:52
  Adolescence is a time of change.
• 11:55
  The best way to pick up on signs is to from an early age
• 11:59
  fostering an environment of open communication and being able
• 12:04
  within the family to talk about issues and things.
• 12:08
  And what that means is that
• 12:10
  you're able to sort of just
• 12:13
  accept their experience and hear
• 12:15
  what they have to say without
• 12:17
  necessarily making comments
• 12:19
  about trying to make it all better with good intention,
• 12:23
  trying to make them feel or oh, it's not so bad,
• 12:26
  or other people have it worse. Those comments, in fact,
• 12:30
  are very invalidating to the kids because it really doesn't
• 12:34
  recognize and accept their
• 12:37
  experience of what they're going through.
• 12:40
  So what that results in is kids won't come.
• 12:43
  Who wants to hear that they won't come and talk.
• 12:46
  So the reason why it's so important to foster this
• 12:49
  environment from early on so that kids,
• 12:51
  when they have a hard time, will tell us about it.
• 12:56
  Sandra: So what are some of the things
• 12:57
  that we should never say?
• 13:01
  Dr. Feuer: When kids are talking to us about various
• 13:04
  mental health issues that
• 13:06
  they're struggling with,
• 13:08
  saying things like my daughter's
• 13:09
  schizophrenic is again equating
• 13:13
  the person with the illness.
• 13:15
  It's like saying my husband is a
• 13:19
  hypertensive and instead saying
• 13:21
  that they're living with
• 13:22
  schizophrenia or living
• 13:24
  with bipolar disorder,
• 13:25
  living with depression,
• 13:26
  it's a person with depression
• 13:28
  is really just a lot more
• 13:31
  appropriate and helps break
• 13:34
  these negative stereotypes.
• 13:36
  Sandra: It's a difficult topic to
• 13:38
  discuss just talking
• 13:39
  about feelings,
• 13:40
  especially if you're not a
• 13:42
  culture that talks about and
• 13:44
  asks your child about
• 13:46
  how they're feeling.
• 13:47
  How do you as a parent
• 13:49
  approach this?
• 13:51
  Even just some of the
• 13:51
  words we use.
• 13:53
  Dr. Feuer: It is really important to be
• 13:55
  mindful of language and
• 13:57
  the words that we use.
• 13:58
  Saying things like, "this must
• 14:00
  be really hard for you."
• 14:02
  "This must be scary or lonely."
• 14:04
  "I'm so glad you're sharing with
• 14:06
  me so that I can be there for
• 14:08
  you and understand it and
• 14:09
  be there with you."
• 14:11
  Saying things like "it seems like
• 14:13
  you're feeling really bad and
• 14:15
  you're having a hard time
• 14:17
  knowing what to do next."
• 14:18
  Let's talk together about how we
• 14:21
  might work through your problem
• 14:23
  and work together on it.
• 14:26
  Sandra: Should we be offering solutions
• 14:29
  like I think you should do this
• 14:30
  and that and this and that,
• 14:32
  or let them kind of come around?
• 14:35
  Dr. Feuer: I think first and foremost, listen,
• 14:37
  especially if you have an adolescent whose adolescents
• 14:42
  developmentally want autonomy,
• 14:45
  they want to be independent, they want to come up with as
• 14:49
  much of their solutions as they can or as much of the
• 14:52
  control as they can.
• 14:53
  So really even asking, "do you need my help?"
• 14:56
  "Do you want my suggestions?"
• 14:57
  And the answer might be no.
• 14:59
  And that's. Okay. And then you can say,
• 15:02
  "do you want to share with me
• 15:04
  what your solution is going to be?" Giving them autonomy,
• 15:07
  but support, it's really the key.
• 15:10
  Sandra: So at what point should
• 15:11
  the parents seek help?
• 15:13
  Dr. Feuer: If you feel that there's a
• 15:15
  significant change that's lasted more than two weeks,
• 15:19
  where there's a significant impact on your child's
• 15:23
  functioning in any of these area that we sort of covered,
• 15:26
  it's important to at least outreach.
• 15:29
  And in the first phase,
• 15:31
  I might recommend parents reaching out to their pediatrician,
• 15:34
  to their school psychologist or counselor or social worker if
• 15:38
  they have a relationship.
• 15:39
  Check in with others that know your child.
• 15:42
  Are they seeing the same patterns?
• 15:45
  Is your child also behaving this way in other environments?
• 15:49
  And what might they suggest
• 15:51
  as sort of the next step?
• 15:53
  So that might be a good first place to start,
• 15:56
  but certainly don't wait until
• 15:58
  things escalate to the point of
• 16:00
  them now talking about ending
• 16:02
  their life or researching things,
• 16:04
  which is those require immediate assessment.
• 16:08
  There's also ways to get to your
• 16:11
  insurance company and get a list
• 16:13
  of providers that are covered by your insurance,
• 16:17
  and that might also be a good place to start.
• 16:20
  It's certainly worth trying as well.
• 16:25
  Sandra: So we talk a lot about
• 16:28
  lack of access.
• 16:29
  We know that there aren't enough
• 16:32
  mental health care providers of any kind to meet the need,
• 16:35
  which seems like it's continuing to grow, coming out of COVID-19.
• 16:40
  What is being done at the state
• 16:42
  and at the federal level to help?
• 16:47
  Dr. Feuer: Yeah. So again, this is something that may be a
• 16:50
  little bit of a silver lining
• 16:51
  from COVID that it did ring the alarm bells everywhere on an
• 16:55
  already existing and then escalating crisis.
• 16:58
  And on the federal and on the state level,
• 17:00
  there has been a lot of money being allocated for mental
• 17:05
  health interventions for youth during this period,
• 17:09
  both to support programs that
• 17:11
  work with pediatricians as well as with schools and other
• 17:15
  programming that really helps support families.
• 17:19
  Sandra: I want to talk more about the
• 17:21
  program that you're leading. Dr. Feuer,
• 17:24
  can you tell us how Northwell
• 17:26
  has partnered with schools to not only help expand access
• 17:31
  to mental health care, but also to help families avoid
• 17:35
  the emergency room? We have several programs,
• 17:41
  Dr. Feuer: Sure, both at the hospital at Cohen's Children's Medical Center,
• 17:44
  as well as embedded in the community
• 17:47
  of programs that are called Behavioral Health Centers.
• 17:53
  They're essentially similar to what you would see in a medical
• 17:58
  urgent care. They're the. Behavioral health equivalent of
• 18:01
  an urgent care where you can go where you don't quite
• 18:04
  need the hospital, you don't quite need an
• 18:07
  emergency department, but you need quick access,
• 18:10
  and you need to be able to see a doctor, get evaluated,
• 18:14
  even on the same day. If it's a crisis,
• 18:16
  when there's a safety concern
• 18:18
  about your child and somebody tells you that or your
• 18:23
  child tells you that.
• 18:24
  These are places where you can get assessed,
• 18:27
  where you can see a psychiatrist,
• 18:28
  and then the team can come up
• 18:30
  with a plan for you of what
• 18:32
  you and your child need.
• 18:34
  And then we do our best to help connect with that care,
• 18:37
  whether that's within or outside of Northwell,
• 18:41
  figuring out what works best
• 18:43
  for the particular family with their insurance,
• 18:48
  with their physical location, with their preferences,
• 18:50
  linguistic, cultural, and otherwise.
• 18:54
  The School Partnership programs
• 18:57
  serve 32 school districts that represent 200,000 students
• 19:02
  who have direct access to the clinical care and all the other
• 19:06
  programming that the programs provide.
• 19:08
  Sandra: That is just awesome. The idea of having these
• 19:13
  behavioral health centers is just amazing for so
• 19:17
  many reasons.
• 19:18
  Do we have plans to expand those?
• 19:22
  Dr. Feuer: Yeah, absolutely. So it is our hope and plan to
• 19:24
  continue to work on expanding the programs.
• 19:28
  School districts are reaching out,
• 19:30
  and they want to collaborate, and we want to be able to help
• 19:34
  increase access overall everywhere that we can.
• 19:38
  Sandra: For our audience that is outside of New York, that's listening.
• 19:43
  What resources are available to them?
• 19:46
  Dr. Feuer: The American Academy of Child
• 19:48
  and Adolescent Psychiatry has an
• 19:51
  education pamphlet series called
• 19:53
  Facts for Families that provides education to families
• 19:59
  on various topics, including what to expect when
• 20:02
  you have to go to an emergency department,
• 20:04
  or how to approach suicidality
• 20:07
  with your child to many, many others.
• 20:09
  The American Academy of
• 20:11
  Pediatrics has a website called
• 20:13
  HealthyChildren.org
• 20:15
  which provides reliable education on various topics,
• 20:20
  including mental health, and the organization
• 20:25
  called Nami, which is the National Alliance on Mental Illness. Their mission is to support
• 20:31
  families with education
• 20:33
  and support, and their websites and their
• 20:36
  local chapters in each state are
• 20:39
  a wealth of resources for
• 20:41
  families to get connected to
• 20:43
  treatment, to get support, and to get education.
• 20:46
  So those are some organizations
• 20:49
  that provide reliable information.
• 20:52
  Sandra: Awesome. Thank you so much
• 20:53
  for being here.
• 20:55
  Dr. Feuer: Thank you so much for having me.
• 21:01
  Sandra: This has been part one of our
• 21:03
  series on the growing crisis in child suicide.
• 21:07
  The CDC data we discussed today is no doubt alarming to every
• 21:12
  parent, but I want to thank Dr.
• 21:15
  Foyer for helping us to better understand the situation as well
• 21:20
  as what caretakers and health systems can do to help.
• 21:24
  And as she told us,
• 21:26
  it's up to caretakers like us to start that conversation,
• 21:31
  do it early and hopefully save a life.
• 21:34
  Remember to check back with us
• 21:36
  next Wednesday, September 20, for part two of our series.
• 21:41
  We'll dig deeper into the impact
• 21:44
  the Behavioral Health Centers
• 21:46
  have on students in New York and
• 21:49
  how a fantastic nonprofit called Your Mom Cares is stepping in to help.
• 21:56
  We'll speak with its co founder
• 21:58
  and CEO, Sharon Feldstein,
• 22:01
  as well as one of its leading
• 22:03
  power moms, Robin Paul,
• 22:06
  about that and their larger
• 22:08
  mission to improve mental health and wellness in children.
• 22:14
  Until next time,
• 22:16
  I'm Sandra Lindsay,
• 22:18
  and this has been another
• 22:19
  episode of 20-Minute Health Talk.