It can feel extremely scary as a parent or caregiver to hear a child or teen express anxious, depressed or suicidal thoughts.
It’s also relatively common, said Carly Beaulieu, an Issaquah-based licensed marriage and family therapy associate, “especially when we’re all going through this global trauma.”
Having suicidal thoughts does not always mean that somebody is going to attempt suicide, she said.
There are tools adults can use to assess the severity of the crisis. If a child has a plan to commit self-harm or a history of doing so, adults should take them to an emergency room for immediate professional help.
“But if they tell you that they’re having these thoughts and they’re scared, don’t want to act on them, and don’t have a plan, then it’s OK to just hold your kid and tell them that you’re there for them,” Beaulieu said.
It’s a good sign if a child is coming to talk to you. “Being able to articulate what they’re feeling is huge and trusting an adult with that is even bigger,” said Alex Campbell, a child and family therapist at Ryther, an organization that provides mental health support to young people.
By listening, it’s possible to create an environment where they feel comfortable sharing their feelings and you can steer them toward the help they need.
Here are some tips from child psychology experts on how to initiate and engage with children and teens about mental health.
Find a good time to talk
The responsibility should be on adults to guide the conversation, experts say. One way parents can prepare these discussions for success is by setting aside dedicated time during the week for family gatherings, said Yu Ding, an Issaquah-based clinical psychologist who works with children.
When a child gets home from school or practice and is feeling tired or irritable, they may not be in the best mental space for conversation. But on a Sunday evening, when the family is making dinner or playing board games together, kids may feel more open to talking.
A guardian might say, “Usually you seem to really enjoy playing basketball with your friends, but I haven’t seen you spend time with them in a while. What’s been going on?”
If kids brush off the question, keep spending time together. Leaving the activity can make kids feel like you are only spending time with them to get information, Ding said.
But leave room open for future conversations. Something like, “I know this is hard to talk about. I’m here whenever you want to talk. I think something might be going on, but I can’t really know for sure how you feel because only you would know that,” said Ravi Ramasamy, a child and adolescent psychiatrist at Seattle Children’s hospital.
It may take multiple conversations to get kids to open up. If they share one thing, like, “My friend is spending more time with other friends,” consider that a success. It’s OK to stop there rather than trying to dig more and get them upset, Ding said.
Help kids name their feelings
Sometimes younger children don’t have the language skills to describe what they are feeling, Ramasamy said. They may understand anger and sadness, but emotions like fear may feel and express like anger.
If a parent suspects a child might be feeling anxious but is having trouble expressing it, they might give their own examples by saying, “This is what makes me anxious and how it makes me feel,” he said.
Breaking down big feelings for kids can help them better describe and understand their emotions, said Dorcas Nung, a Bellingham-based licensed marriage and family therapist.
Parents can also routinely model good mental health behavior and communication.
For example, Nung said, a mother who snapped at her child after having a stressful day can say: “Mommy is having a hard time today. I’m feeling really big feelings. Let me take a deep breath. Do you want to take a breath with me?” For older children, parents can say “I’ve had a hard day today and I feel frustrated and tired. I don’t mean to snap at you.”
Regulate your behavior
When children approach trusted adults to share their feelings, potentially including thoughts of suicidal ideation, it’s critical for adults to regulate themselves, Beaulieu said.
“It can be really hard not to have a big emotional reaction,” she said. “But the way that you respond in the moment really guides how future conversations go.”
Approach the conversation from a place of compassionate curiosity rather than fear and despair, even if that’s what you’re feeling, she said.
Modeling that mental health communication, caregivers can say: “Wow, this is a heavy topic you’re bringing up. I believe you. I trust you. I’m here for you. I love you. And I need a minute to sit with this, to get my own thoughts together, because I want to be here for you and I want to respond after having a moment to think,” Beaulieu said.
Listen without judgment or defensiveness
After taking a moment to process, parents should begin by intently listening to their children’s needs.
“Helping them feel seen and heard and understood can be really powerful,” said Olivia White, a local Licensed Mental Health Counselor Associate. “Just be with them in that moment.”
If a child feels comfortable, parents can calmly proceed by asking questions without judgment. Allow them to share whatever feelings they are experiencing, even if they are disturbing or you disagree with the events they are describing.
Try to avoid phrases that downplay emotions like: “Why would you do that? You know we love you,” if they are describing desire to self harm, or: “Why are you getting so upset? You’ve switched schools before.”
Instead, observe what’s happened and reflect it back to them. “It sounds like when I did this, you felt this way,” White said as an example.
You can, however, ask direct and explicit questions about suicide, like, “Have you thought about hurting yourself or killing yourself?”
“Sometimes we feel like that question is harmful or put thoughts in people’s head, but it’s actually not the case,” White said. “They might respond, ‘Oh no, of course not.’ Or they say, ‘Actually, yeah.’ It doesn’t hurt to be open and direct.”
In some cases, kids just want to get these feelings off their chest. Avoid immediately jumping into problem-solving.
“You don’t necessarily have to fix it. Just listening and receiving information is powerful in itself,” White said.
When the conversation has reached its natural end, thank the child or teen for sharing and having the courage to be open about how they’re feeling, White said.
If you have initiated the conversation and kids are unresponsive, try expressing your observations.
You might say, “Hey, I noticed that when I asked you about such and such, you turned away and that makes me think there’s something that you don’t want to share with me,” White said. “I’m concerned about you. Would you be comfortable talking with a therapist or counselor at school?”
Frame therapy in a way that assures the kid it’s in their best interest, Ramasamy said, and be as upfront and honest as you can.
Often, children assume they’re going to a counselor because something is wrong with them, he said. Owning it as a family issue can help alleviate some of the individual burden.
Try: “Hey, sometimes you have really big emotions, and it seems like things are a lot to handle at times. I’m worried that I’m not able to provide the best help for you. And sometimes I worry I make it worse. We’re going to go to this person to help all of us learn how to better support you,” Ramasamy said.
Organizations exist in Washington state and online to help caregivers address their children’s mental health needs.
The American Academy of Child and Adolescent Psychiatry has a list of resources for families and young people on its website to help identify and seek treatment for behavioral health concerns.
The Washington Association of Play Therapy provides a list of therapists on its website to help adults seek specialized treatment for connecting with kids.
Conscious Discipline is a website that provides resources to handle conflict between parents and kids.
The Child Mind Institute has a list of videos on its website to help adults teach their kids mental health coping skills.
A group called Focused Kids gives parents and children resources to regulate emotions.
Parent Coaches, through Parent Trust, help caregivers with questions and issues involving kids, including providing referrals and support for families grappling with mental health issues. The free Family Help Line service is available at 1-800-932-4673.
A counselor from the organization Youth Eastside Services, based in Kirkland, provided practical steps on how to approach a conversation with teens about mental health in an educational video.
The group also created a suicide prevention resource guide for parents, which includes warning signs and tips on what to say if a child shares that they have considered suicide. It also lists other local resources that offer timely support.