Suicidal and homicidal thoughts deserve their own special category. In the practice of child psychiatry, the number one goal is to prevent
children and teenagers from taking their own lives or the lives of others. Unfortunately, homicide (#2) and suicide (#3) are the leading causes of death for 15 to 19 year olds after accidents. Even though most homicides may not be infl uenced by mental health issues, certainly every suicide in a teenager is preventable. After several high-profi le school shootings (the most famous being Columbine in Colorado in 1999), the United States Secret Service did a study of the characteristics of the shooters. They found that 71 percent of the per- petrators in school shootings had a history of being victimized.
There are many reasons why suicide remains one of the top causes of death for teens. Despite some recent advances in public awareness, there is still a stigma attached to mental illness that may make you hesitant to tell people that you are suffering. You may have told your parents or another adult that you were feeling depressed, and they may have minimized your concerns. It is common for caregivers to tell teens that they will “snap out of it” or “everyone feels depressed sometimes, you’ll get over it” and not take the time to actually sit down with you, ask about the depression, and come up with a plan for help. It is hard enough to even bring up the topic of being depressed or anxious, and then when your concerns are not taken seriously, it is less likely that you will bring them up again.
When you fi nd that you are constantly thinking about suicide, that you begin to do Internet searches on suicide, or are actually research- ing different techniques people use to kill themselves, it is time to get help. As mentioned earlier, having occasional thoughts of what it would be like if you were not alive is normal for teens. However, if you begin to have these thoughts more often than once every few weeks or you fi nd that you have left the “thought” phase and are actually exploring the “planning” phase, then you are in need of immediate assistance. If you get to the point where you feel that you cannot control the urge to harm yourself, you should immediately fi nd a family member to speak with, call a suicide hotline, or call 911. If you are in a situation at home in which you are being abused, another option for help is to call child protective services. Child pro- tective services can arrange for emergency housing to remove you from a dangerous home situation.
It can be scary to pick up the phone and call for help. What hap- pens when you call 911 varies from city to city, but there are usually some similarities. No matter what, some type of emergency response team will come to your house (or to wherever you made the call). This may be the fi re department, a paramedic team, the police, or a mental health response team. There is a brief assessment that occurs at your home, but then most often you will be brought to a hospital
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setting to meet with a mental health professional for a more intensive interview and assessment. If your community has a mental health response team, then you often do not need to leave your home.
The hospital setting you go to may be a standard medical hospital, or it may be a specialized mental health urgent care setting. These settings often are on the same campus as a hospital, but sometimes they are independent from hospitals. This typically depends on the size of your community. Once at the urgent care, you will often have an intake process completed by a nurse. The mental health profes- sional may be a therapist trained to work in crisis settings or may be a psychiatrist. Regardless of who you see, he or she will meet with you to decide the best treatment plan for the short term. If you have a supportive home environment, often you can meet with the professional and your parents, come up with a plan to get involved in outpatient treatment, and be discharged home from the facility. If your home environment is chaotic with poor support or your urge to harm yourself is too great to control, then you may be admitted to a psychiatric hospital. At a psychiatric hospital, you will usually receive more intensive short-term counseling, meet with a child psychiatrist and social workers, and have parent meetings as well. The goal of a
Missing school without being sick No longer caring about grades Feeling guilty over trivial things
Losing interest in activities he or she used to enjoy (for example, no longer interested in going out, listening to music, playing computer or video games)
Decreased care paid to hygiene or grooming
Self-harm behavior (for example, cutting legs or forearms) Using drugs or alcohol without caring about the consequences