Have you heard about or watched the Netflix series 13 Reasons Why? Suicide Prevention information for Parents, Kids and Counselors

If you have a child, niece, nephew, family friend, or teenage student, chances are they are one of the millions of viewers who are talking about this thought-provoking, disturbing, and at times horrifying story of the suicide of a teenage girl named Hannah.

Each episode of “13 Reasons Why” outlines a different reason Hannah decided to take her own life, ranging from being “slut shamed” to experiencing sexual assault firsthand. A powerful commentary on the complex cultural moment teens are forced to navigate—and a haunting portrayal of the escalating problem of teen suicide in our society—the series quickly became a polarizing cultural phenomenon.

Viewers questioned whether the television show helped or hurt suicide prevention efforts. Some even attributed the show’s popularity to suicides in their schools—right here in Colorado, in fact, the Mesa County Valley School District decided to pull the book the television show was based upon from the shelves after a shocking rash of suicides swept the community. While their decision was ultimately temporary, their rationale pointed to the larger questions at hand: What are the most effective and impactful steps we can take to keep teens from taking their lives? How can we help our youth with their emotional needs and show them that there is always a way out?

Suicide is the third leading cause of death among 15-24 year olds. There’s no way around it: this is slowly becoming an epidemic in our society.  I appreciate shows and books like 13 Reasons Why for starting a national dialogue—but the conversation can’t stop here. Parents, teachers, counselors, and medical professionals need every resource at their disposal to help teens before it’s too late.

As a psychiatrist who works frequently with teens, I am compelled to do my part to move this dialogue forward. With that in mind, I’ve created the following guide to help adults recognize and effectively manage signs of depression. I call it the Four E’s of Suicide Prevention:

Step 1: Evaluate.

Pay attention to the changes in your child’s behavior. Has your child become withdrawn, sullen, or persistently angry? Have they become more introverted and less involved with friends and in school activities? Are they showing symptoms of insomnia, a decline in school grades, rule-breaking behavior, spending much more time in their bedroom, crying spells, and quitting sports teams or after-school activities that they previously enjoyed? Write down any and all observations that describe these changes and the associated timeline for each. What are some of the possible triggers for what you are observing in them? What life experiences may be contributing? The answers to these questions will help you empathize with their plight and feel less scared and confused. If your child is still in high school and two or more of these behavioral changes is present contact their teachers or coaches to get on the same page about these changes. Consider contacting their friends as well. When it comes to preventing suicide, the more eyes and ears open and aware, the better

Step 2: Empathize.

Communicate your emotional support. In trying to communicate with and understand your child, approach them with humility. Ask for their help in getting to know them, for example, “Will you help me try to ‘get you’?” Let them know that your goal is to understand. Tell them that they are right when they feel you misunderstand them, and admit that you feel inept at times when you try to understand what they are living through. Ask them to be patient with you and that it is really important to you to understand them. Ask instead of argue, and listen with empathy and compassion. Questions like, “What’s happened to make you feel that way?” Ask if you can help. Let your child know that you are there to support and help them during this time of great transition and that they should not be afraid to report to you when they have done something they feel is stupid or shameful or that you would be angry about. Reassure them that you will not abandon or harshly judge them but will, instead, be constructive in finding a solution. Will this be difficult to discuss with them? If so, what gets in the way? How might you remove the obstacles?

Step 3: Enlist Help.

Act Quickly. It is important that your child’s condition be promptly evaluated before it worsens to a crisis point. Early intervention is the key to preventing suicide attempts and accelerating the recovery process. The more embedded the depression becomes, the longer it will take to effectively treat it, and the higher the risk of dangerous behavior. In selecting a professional to evaluate and treat your child, choose one whose treatment style includes parental involvement. It does not make sense to have your child living at home and treated in isolation from family dynamics that contribute to their depression or anxiety. What are some of the possible family dynamics that are tangling up your child’s life? Write them down to present to the therapist. If your child will be transitioning to college soon, or is already in college, make sure there’s a method in place to easily continue treatment and medication.

Step 4: Emancipate and Communicate.

Trust, but verify. If your child is in high school, begin trusting their judgment, and letting them make mistakes. Don’t rush to the rescue unless those mistakes threaten to seriously derail their lives. Grant them more freedom as they take on greater responsibility. Establish an atmosphere whereby you gradually and progressively let go, lengthening the leash while trusting them. Recalibrate when they slip up with a nonthreatening conversation about what happened, and apply fair punishments that fit the “crime.” If your child is living away from home, let them know that you don’t want to infringe on their independence, but you expect regular communication with them—at least once a week—and you want to establish a regular time for this (e.g., Sunday evenings). Skype and FaceTime are wonderful technologies that will enable you to feel that you are in your child’s dorm room with them during the weekly calls. At a time like this the normal reflex is to take charge and protect your child. It’s important to remember that a teenager’s developmental task is to emancipate. Tread carefully. Emphasize that you believe in them and their ability to take on these new challenges. Let them know that you will always be there for them—no matter what—for emotional support and guidance.

This is undoubtedly an anxious time for you, particularly if your child (or student) has been in crisis. Don’t try to handle this all by yourself. Please consider taking the steps I’ve outlined above—and for a more complete guide, see my blog at www.drbrucekehr.com.

A Suicide Prevention Guide for Parents, Teachers, and Counselors

Bruce Alan Kehr, M.D. has served as Founder and President of Potomac Psychiatry since 1981. Washingtonian Magazine awarded him their “Top Doctor” designation from 2012 to 2017. He practices psychiatry and psychotherapy using “The Biopsychosocial Model” to treat the “Whole Person,” by understanding each individual’s unique genetic, biological, psychological, social, and life-stage characteristics. You can pre-order his new book, Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, by clicking here.

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