In our March blog post, Let’s Talk: Conversation Starters for Connecting with Kids and Teens about Mental Health, we explored ways to open up meaningful conversations about mental well-being with children of all ages. As your child enters the teen years, those conversations often take on new urgency and new complexity.
Adolescence is a critical window for mental health. According to the CDC, anxiety and depression are most likely to emerge during this time, and rates of self-harm and suicide also increase. As a parent or caregiver, it can feel overwhelming to know when something is wrong, and even harder to know what to say.
In this blog, we take a closer look at the mental health challenges teens may face, including suicide and self-harm. You’ll find key definitions, potential warning signs to watch for, and compassionate strategies for starting these tough but vital conversations with your teen.
Defining Self-Injury and Suicidal Behaviors
Self-Harm or Non-Suicidal Self-Injury (NSSI): Examples might include cutting, burning, or hitting oneself. It is not always a suicide behavior. Self-injury may be used as a coping mechanism or a way to manage emotional pain or emotional numbness. Understanding the motivation behind ones acts of self-harm is important to understanding more about that person’s situation.
Suicidal ideation or Suicidal thoughts: This ranges from thinking about suicide to planning to suicide. Suicidal thoughts may range from wishing to fall asleep and not wake up to making a detailed plan to end one’s life. These thoughts may stem from overwhelming emotional pain, mental health struggles, or external stressors. How frequent, strong, or intense the thoughts are depends upon the person and their situation.
Behind and Beyond Self-Injury and Suicidal Behaviors
Becoming a teenager comes with many changes. There are developmental and hormonal changes alongside managing new feelings, pressures, and challenges. Sometimes, these changes come with growing pains but sometimes they can be related to more serious emotional struggles or emotional pain. While there is no single, easy answer, the following are guidelines for what may be considered typical (or common) teenager behavior versus more concerning warning signs (Hollander, 2017; Rathus & Miller, 2015).
What’s Common for Teens?
Teenagers are figuring out who they are. As the teenage brain develops, teens begin to think more abstractly and about more complicated ideas. They are better able to appreciate other people’s perspectives and feelings. They also become more aware of how others might perceive them, how they want to be perceived, and their impact on others.
It is normal for teens to:
Become focused on developing their identity and finding what makes them unique (this may include values, actions, and goals)
Experience heightened self-consciousness
Have a desire to fit in with friends while still striving to be themselves
Spend more time with peers than family
Want to be more independent and have more autonomy
Have more parent-child conflicts as they try to become more independent and establish their own identity
Stay up late and sleep in. Teenagers' biological clocks changes and their sleep schedule shifts. (Did you know … 7:00 AM for teenagers is like 4:00 AM for adults! See: Later School Start Times.)
Possible Warning Signs
Instead of focusing on any single behavior or situation, it's important to look at the broader context of a teen’s emotional and behavioral patterns. Some behaviors and moods go beyond what is typical of teenage development and serve as signals to explore your teen’s well-being.
Warning Signs (not typical teenage behaviors):
Feeling very sad, worried, or angry for a long time
A sudden and significant change in behavior or mood that is unexpected and as though it “came out of the blue”
Engaging in high-risk activities (e.g., driving recklessly, promiscuous behaviors, impulsive actions, chronic drug/alcohol use to cope with emotions)
Frequently skipping school or refusing to go
Pulling away from friends or family
No longer following the rules and consequences that have been set for them (that used to be effective)
Moods or behaviors that last longer than you expected
Acting in ways that hurt others or scare people
Hurting themselves on purpose (self-harm behaviors)
Talking about or thinking about suicide
How to Talk to Teens About Mental Health, Self-Harm, and Suicide Behavior
If you are concerned about suicide, it is important to ask your teen.** Remember, asking about suicide does not increase the risk of suicide.
Here is a simple formula that you can apply to having this important discussion with your teen.
Observe + Label + Wait = Conversation Starter
1. Observe.
Body language and actions: Notice if your child has been more tearful, quick to yell, or less animated than usual.
Verbal cues: Pay attention to what they are saying-- or not saying. Notice their volume (is it louder or softer than usual?) and tone of voice (do they sound sad, irritated, angry?).
2. Label Out Loud.
Stick to the facts: Describe what you notice to your child. Stick to the observable facts. For example, "I have noticed you have not been spending as much time with your friends lately.”
Emotion dentification: Suggest an emotion based on your observations, but leave space for your child to correct you. For example, "I am wondering if you have been feeling more sad?"
3. WAIT (then Validate).
Wait (for your child to reply): Silently count to five in your head before saying anything more. This gives your child time to shift their attention and think about their feelings. Allow your child to express their feelings and even correct you (if they are having a different feeling than what you guessed). If they don't want to talk or their emotions are too strong, let them know you will be there when they're ready.
Validate: Listen and acknowledge your child's feelings or needs. You can validate your child’s feelings without necessarily agreeing with their actions.
A Few More Examples:
Example 1
Observation: You notice that your teen has missed first period every day this week and has been sleeping in later more often than they typically do. You have also observed that they are more easily upset and tearful.
Label: “I have noticed that you have been sleeping late more often than usual and missing your first period class every day, I am wondering if you have been feeling depressed lately?”
Wait (for your child to reply): count to five silently and … +Validate: acknowledge your child’s feeling or experience (not the action of missing a class*)
*While correcting their behavior or offering a consequence for missing class may be tempting, remember that in this conversation, your focus is on checking on their mental health and well-being.
Example 2
Observation: When your teen has been faced with challenges recently (e.g., a lower test grade than expected, not getting the part in a play, fighting with friends), they have mumbled to themselves things such as, “I can’t live through this again” or “it would be easier if I weren’t here.”
Label: “I have heard you make statements like ‘it would be easier if I weren’t here,’ this makes me wonder if you are having thoughts about suicide?”
Wait (for your child to reply): count to five silently and...+Validate: acknowledge your child’s feeling or experience
Tips and Tricks to Encourage Your Teen to Talk
Remain calm: Keep your own emotions in check and take deep breaths. Emotions are contagious –to help your child be in a calm place to talk, you need to model calmness. If you cannot, it is best to wait until you feel better able to manage your own feelings.
Look for entry points: Find opportunities to discuss wellbeing and practice the formula (Observe + Label + Wait). Do not wait to practice! You can use it for everyday situations, and starting with neutral or positive experiences may feel more manageable. Example: “I see you are smiling and jumping up and down (Observe). Are you feeling excited about getting ice cream (Label)?”
Be honest and direct: Teens appreciate honesty and being treated as the young adults they are becoming.
Self-care: Validate your own feelings and recognize the importance of your efforts.
Open conversations: It is important to be direct but compassionate instead of avoiding talking about difficult topics.
Encourage professional help: Therapy, counseling, and crisis resources can provide essential support to you and your teen.
Concerns about self-harm or suicide**: If you are worried about your child having thoughts of self-harm or suicide, it's crucial to seek immediate professional support. If you are concerned for your child’s imminent safety, take them to your nearest emergency room.
Resources
Virtual/in person therapy group. Supporting Parents of Youth with Suicidal Thoughts and Self-Harm is an 8-week group aimed at helping parents learn about youth suicide and self-harm, develop skills in supporting themselves and their child, and connect with others in a confidential, supportive space. Learn more and register.
LivingWorks ASIST and SafeTalk trainings. The Scanlan Center for School Mental Health offers evidence-based suicide prevention trainings to empower individuals to recognize and respond to those at risk. We host both LivingWorks ASIST, an intensive two-day workshop, and SafeTALK, a four-hour session focused on identifying and connecting individuals with thoughts of suicide to the help they need. A limited number of in-person trainings are held annually, and we are also available to collaborate with schools, districts, or community organizations to bring these trainings to you. View a list of upcoming trainings.
For further reading. Helping Teens Who Cut: Using DBT Skills to End Self-Injury, by Michael Hollander, PhD, Second Edition. A guide for parents to understand and support teenagers engaging in self-injury. Content includes information on the reasons teens engage in self-harm, how to talk to teens about this topic, seeking effective treatment, and how parents can care for their own needs.
Crisis resources. Access a list of crisis resources on our website or download a crisis resources flyer for more information.
References
Hollander, M. (2017). Helping teens who cut: using DBT® skills to end self-injury. Second edition. The Guilford Press.
Rathus, J. H., & Miller, A. L. (2015). DBT®skills manual for adolescents. The Guilford Press.
**NOTE: If you or someone you know is in imminent danger, call 911 and/or go to the nearest emergency room.