Teens today face an avalanche of stressors that put them at risk for suicide – from exposure to suicidal behaviors of others, to being a sexual minority, to lack of stable housing and food security, to access to lethal means.

Suicide is the 10th leading cause of death in the United States, and the second leading cause of death for youth, according to PEF member Silvia Giliotti, the training and postvention coordinator at the Office of Mental Health’s Suicide Prevention Center of New York (SPCNY).

“Every year families and friends across the country lose more than 44,000 loved ones to suicide,” Giliotti said. “In 2019 alone, 1,705 New Yorkers died by suicide and many more attempted. The impact on family members, friends, schools, clinicians and communities is often profound and long lasting.”

Giliotti, a PEF member since 2000 when she worked at South Beach Psychiatric Center, is a family therapist by training and took an interest in the impact suicide has on families and communities, which led her to SPCNY.

“We have work to do and everyone has a role to play,” she said. “Over the past decade, rates of death by many other causes steadily declined as a result of public health efforts and improved medical treatment, but suicide rates continued to climb until 2019.”

Family and Community Support Saves Lives

There are many factors that may increase suicide risk for youth including exposure to suicidal behaviors of others, previous suicide attempts, access to lethal means, a history of adverse childhood experiences, mental or physical illness, barriers to health care, experiencing a loss, substance use, lack of stable housing and food security, being a sexual minority, and exposure to racial discrimination and trauma.

Suicide attempts rose by 73 percent between 1997 and 2017 for black adolescents and LGBT youth are almost five times as likely to attempt suicide compared to their heterosexual peers.

“Not surprisingly, having strong family support, being socially connected, stable housing and income, access to health care and, for some groups, religious and spiritual engagement, are powerful protective factors,” Giliotti said.

Evidenced-based practices to combat teen suicide, such as the Zero Suicide initiative, have been powerful tools.

“The foundational belief of Zero Suicide is that suicide deaths for those under the care of health and behavioral health systems can be prevented,” Giliotti said. “It is an aspirational goal and a commitment, but also a practical framework complete with a state-of-the-art toolkit packed with free tools, readings and videos to support organizations taking on the Zero Suicide challenge.”

Giliotti said the involvement of people with personal experience of suicide is also making a difference.

“The field has moved toward a greater recognition that survivors of suicide attempts and survivors of suicide loss have an important role to play in community suicide prevention education, in treatment, and in planning,” she said. “Including individuals with lived experience fosters hope, counters stigma and discrimination, promotes collaboration and connectedness, and is consistent with person-centered and recovery practices.”

The state-run Youth Power program is run for and by youth and young adults.

“It works to ensure young people have meaningful involvement in all aspects of services they receive and prepares peers to use their personal experience to support youth in their journey toward recovery and resilience,” Giliotti said.

Social media: Pros and Cons and the Crisis Text Line

The prevalence of social media in a teen’s life can have both positive and negative impacts on their mental health and, by proxy, the likelihood they attempt suicide.

“Today, social media and social networks play a big role in teen culture,” Giliotti said. “Some surveys show that more than 90 percent of teens have used social media and that most own mobile devices with Internet capabilities.”

Social media can keep teens connected, allow them to express their feelings and emotions at any time of the day, promote help-seeking behavior and even provide access to marginalized and hard-to-reach youth.

It does have pitfalls.

“On the other hand, social media also presents the potential for harm,” Giliotti said. “Young people might be exposed to content, such as graphic images, that can cause distress or lead to imitative suicidal behavior. Some experts believe that cyberbullying through social media may be a trigger for adolescents who present other risk factors and are contemplating taking their own life.”

There are a variety of ways social media can endanger youth at risk for suicide.

“Adolescents might come across expressions of suicide risk posted by peers and feel overwhelmed and not equipped to respond,” Giliotti said. “Guidelines for responsible reporting and portrayal of suicide can mitigate these risks; however, they are less impactful when young people produce content of their own.”

As part of Suicide Prevention Month in September, SPCNY developed and launched a social media campaign, the GOT 5 Challenge, targeting schools to raise awareness of the Crisis Text Line. The Crisis Text Line is a powerful tool against teen suicide – with 37,200 conversations with counselors (17 years old and younger) and 754 suicidal de-escalations.

“Participating schools distribute to students and faculty a link to a brief video about the Crisis Text Line, a free and anonymous text-based support available 24/7,” Giliotti said. “It connects students to a trained crisis counselor.”

COVID and Teen Mental Health

Everyone’s lives changed in March 2020, with widespread shutdowns amid the COVID-19 pandemic. For teens, that meant leaving the classroom and entering into social isolation, attempting to suddenly navigate a surreal world.

Mental health professionals worry that the social isolation, financial hardships and anxiety related to COVID-19 might worsen suicide trends, but according to provisional data from the Center for Disease Control (CDC) deaths by suicide declined from 47,511 to 44,834 between 2019 and 2020. While this decrease is hopeful, it is important to keep in mind that these are not final data and that we may not be able to understand the impact of COVID-19 for another year, or longer.

While the true impacts of COVID-19 on suicide and suicide attempt rates remain to be seen, it is clear teens lost out on the norms of school life and many lost loved ones to the virus.

“Young people may have been particularly affected by social distancing, lack of connectedness to peers and teachers, and concerns about family health, food security, and stable housing,” Giliotti said. “Social distancing might have had an impact on not only the number, but also the quality of social connections that normally provide adolescents a sense of connectedness and belonging.”

After-school activities, organized sports and churches no longer provided youth with opportunities to meet friends and peers, a known protective factor against suicide.

“Preliminary studies found an overall decrease in total number of suicides between 2019 and 2020, but the decline does not seem to reflect a decrease for all groups,” Giliotti said. “We have seen a rise in suicides among communities of color, the very same communities that we know have been disproportionally affected by the pandemic. Furthermore, emergency room visits for suspected suicide attempts rose in adolescents during the pandemic. This is especially true for girls aged 12 to 17.”

COVID-19 also claimed the lives of many loved ones, a stressor that understandably plays a huge role in suicide and suicide attempts. Less tangible losses include canceled celebrations like birthdays, graduations and vacations.

“I recently read that one in a thousand children lost a parent to COVID in the U.S. alone,” Giliotti said. “It is an enormous number and the most stressful event that can happen to a child. Although most adapt well, parentally bereaved children are at increased risk for suicide.”

What Is Being Done to Combat Teen Suicide?

Information is power and the state offers technical assistance and a full range of trainings and professional development for school personnel.

The Schools and Youth Workgroup of the Suicide Prevention Council at the state Office of Mental Health developed A Guide for Suicide Prevention in Schools, which recommends universal supports, prevention and a positive school climate for all students; targeted support for at-risk groups; and specialized support for students in crisis or at elevated risk.

“Pat Breaux, our Director of Schools and Youth Initiatives, is working closely with many school systems including the New York City Department of Education, which is the largest school district in the country with 1,094,138 students,” Giliotti said. The professional development tools she created facilitate customized plans and standardized policies, train school staff in recognizing the warning signs of suicide and refer students at risk, and clarify the process of assessing, intervening, safety planning and follow-up.

Parents and Family Can Play a Part, Too

Download the What Every Parent Needs to Know PDF from NYS Office of Mental Health

Suicide prevention can start in the home, with parents learning about suicide and modeling healthy habits for their children.

“Suicide is a reality for today’s youth, even those who come from a ‘good home’,” Giliotti said. “Parents can learn to recognize that their teen is struggling and invite conversations about mental health and suicide. Sometimes people are afraid that if they bring it up, it will make the child more likely to attempt suicide, but that’s not true.

“It is important to listen without judgment, resist the temptation to offer quick fixes, and validate their feelings,” she said. “It helps to ask open-ended questions, rather than questions that can be answered with a ‘yes’ or ‘no’.”

The SPCNY encourages parents to remember themselves when parenting a suicidal child.

“We encourage parents to eat well, get enough sleep, exercise, and find time for replenishing activities,” Giliotti said. “Just like in-flight safety briefings instruct parents to fit their own oxygen mask before helping their children, it is critical for parents to put on their ‘oxygen masks’ first: when parents ignore their own basic needs, they are less equipped to help their children.”

For assistance navigating teen’s risk of suicide, parents can turn to established mental health organizations, such as the National Alliance on Mental Illness (NAMI), the National Education Alliance for Borderline Personality Disorder (NEABPD), or local organizations. The National Suicide Prevention Lifeline (1-800-273-8255) and Crisis Text Line (741-741) are also resources parents can contact to talk with someone who is knowledgeable about how to help.

“As a family therapist, I am also excited about Family Connections-Managing Suicidality and Trauma Recovery, a free support group for family members of individuals who attempted suicide or engaged in self-injury,” Giliotti said. “This pilot program is co-led by a clinician and a family member with personal experience in navigating the distress and grief of having a child, a partner, or a relative who struggles with suicide.

“SPCNY recognizes that suicide prevention cannot succeed without community involvement and leadership,” she said. “In our state, almost every county has a coalition that brings together stakeholders such as law enforcement, education, health systems, clergy, Veterans’ Affairs, coroner’s offices, and substance abuse agencies.”