Three months into the pandemic, a mother in Brooklyn found her daughter, Anna, throwing up in the middle of the night. Worried it was covid, she rushed the 11-year-old to the hospital, where the doctors were ready to send her home. But Anna’s mom told them she wasn’t leaving until they figured out what was wrong.

Eventually, a doctor tested Anna’s blood for toxins. She had been intentionally overdosing on an over-the-counter medication for three days. Had she not vomited, she would have died.

Anna is part of a disturbing trend during the pandemic. Between April and October 2020, the number of kids seen in U.S. emergency rooms for mental health conditions rose significantly, according to the Centers for Disease Control and Prevention. National statistics on suicide rates in 2020 are not available, but individual health systems are reporting they have been treating many more teenagers for suicidal ideation and attempts.

There was an epidemic of anxiety and depression in kids before covid, but the isolation of the past year threw gas on a fire. And we’ve lost one of the front lines in fighting it — watchful eyes of concerned teachers and school staff.

But one of the best ways to decrease suicide risk is connection to family, according to Jonathan Singer, president of the American Association of Suicidology. According to experts, here are critical ways parents and caregivers can help.

Parents need to be aware of the real risks of suicide, even if they think like so many parents do: Not my kid. The suicide rate for youths has been increasing annually since 2007, according to Singer. One reason is that’s when the iPhone came out “and our kids started burying themselves in screens,” says John Duffy, psychologist and author of “Parenting the New Teen in the Age of Anxiety.” “Kids are increasingly overwhelmed intellectually and emotionally.” At the same time, those screens keep them sedentary (a proven detriment to mental well-being) and hide their emotional and social lives away from their families.

There are so many things we want to warn our kids away from, but listening to what’s happening in their world is much more powerful. “When you have a teenager, and you know there are perilous things out there, it’s so tempting to lecture,” Duffy says. “But if you are always coming at your kid with an agenda, they are going to withhold.”

Instead, Katie Hurley, child and adolescent psychotherapist and author of “The Depression Workbook for Teens recommends tapping into “one of the best tools parents have in our kit: curiosity.”

Find ways to connect with your tween or teen in fun, low-key ways. Goof around, try that new TikTok dance together, share a funny meme. “Spend a lot of time talking with them about nothing,” Duffy advises. “You want to be this soft place where your kids can come to regress a little bit and reorient themselves.”

Pay attention when your teens bring up mental health. “Teenagers initiate these conversations more than we realize, but they tend to use indirect means,” says Lisa Damour, psychologist, author and co-host of the Ask Lisa podcast. Listen for comments about a classmate who is suffering or a question about mental health that comes out of the blue and get in there: That’s an invitation to talk. “Teenagers are going to shut the door over and over again, it’s what they do,” Damour says. “It’s our job to keep opening it a crack and let them know, ‘I am always here.’”

Being able to manage big emotions requiresfeeling them and learning how to deal with that feeling. But parents often want to fix their kids’ pain “without allowing the pain to exist,” says Ross Szabo, survivor of a suicide attempt in high school and now Wellness Director at the Geffen Academy at UCLA. “You have to be willing to listen to your kids’ pain without moving to a fix-it place.”

Allow them to have those feelings, and then empathize and ask questions. “If parents remain empathetic and compassionate and curious,” Hurley says, “kids are more likely to keep talking.”

Mental well-being is just as important as physical health, and our conversations about it have to happen there’s a problem. “We don’t wait until kids have diabetes to talk about eating healthfully,” Szabo points out.

This is especially important if there is a history of mental illness or suicide in your family, Szabo says. “Kids can realize ‘I’m not alone if they also have it.’” And, it opens up a family conversation about looking for warning signs. Hurley — who lost her father to suicide when she was 23 years old — has “been talking about mental health since my kids could talk.”

Just like flossing and brushing, there are daily tasks that strengthen your emotional well-being. When it comes to keeping kids emotionally healthy, Duffy’s top two are movement and limited screen time.

“Kids are just working and working stuff over in their minds without getting any physical release, which is crucial to their well-being,” Duffy says. “Movement realigns everything. They disperse their anxiety and realize, ‘I can go for a jog for an hour and that makes me feel differently.’” Give your kids options of what they can do, but make a rule that they have to move every day, Duffy says.

Help them find something else to do with their time than stare at screens — such as volunteering, writing for the school paper, joining a club or sports team. Do your best to also put your screen down for significant chunks of time.

Modeling good coping strategies will help. Tell your kids when you have had a tough day and what you plan to do to help yourself through it. Ask them to brainstorm ideas for you. Tell them if you go to therapy or use medication to manage your own mental health. “When parents are willing to be vulnerable, it shows kids and teens that humans have ups and downs,” Damour says.

Our kids’ emotional lives are taking place “in the shadows. On Snapchat, or on a group chat in the middle of the night. Most kids don’t tell their parents how they feel,” Duffy says.

Singer recommends asking your child which platforms make them feel better about themselves or worse, and how they and their friends communicate when they are having a hard time. Hebelieves in letting your child know that you will monitor — in some fashion — their social media use, so that if you are concerned about something, you can get information. “Tell them, ‘We have a right to take care of you, and that means knowing what’s going on online just like we know what’s going on offline.’”

Consider getting ahead of a serious crisis by introducing the idea of therapy early into a child’s struggles. It’s “one of the mightiest things you can do as a parent,” says Duffy. It helps that today’s generation of kids doesn’t seem to put the same stigma on therapy as past generations.

Cate Eppley, a college sophomore in Atlanta, has been going to therapy for social anxiety and depression since her mother suggested it when she was 15. “Some days I don’t want to go, and then once I get there, I feel such a weight lifted off my shoulders,” Eppley says. “I’m super open about it. I’m like, ‘Yes I go to therapy, I love it, and I am so grateful to have that opportunity.’”

Duffy’s bottom-line advice to parents: If you’re wondering whether your kid should see a therapist, that probably means they should.

If you see warning signs (here is a comprehensive list) — or your gut just tells you something is wrong — be direct and ask:

· “Have there been any times where you thought, ?

· “Are you wishing you would die?”

· “Are you thinking about hurting yourself?

· “Do you have a plan to hurt yourself?”

“Asking the question isn’t going to make your kid suicidal,” says Singer, “but just being able to answer may be a relief for your kid to know you are asking without judgment. Validate their experience with phrases such as, ‘that sounds terrifying, tell me more.’”

“You are never going to regret if you reach out for help early,” says Hurley, “but you are going to regret it if you wait too long.”

Anna — who was hospitalized and put on antidepressant medication — is now home, going to therapy and in a much better place. “Looking back now,” she says, “one thing that I know that could have helped, was texting or calling a person. Now, when I have an urge or I feel really bad, just texting with someone who I feel safe with helps.”

You can do all of the above and your child still may not go to you when they are in crisis. So give them what they need to help themselves, including the contact information of any professionals they are seeing and the numbers below.

· The National Suicide Prevention Lifeline (1-800-273-8255) answers calls 24/7.

· Teen Line isstaffed by other teens trained in crisis prevention who are available by text, phone, and email.

· The Trevor Project supports LGBTQ youth in mental health crises.

· Safe Place will provide help teens who are in crisis get to a designated Safe Place immediately.

· The Jed Project is a mental health and suicide prevention organization that you can text or call.

If you are immediately concerned about your child’s safety, call 911, take them to an emergency room, or call The National Suicide Prevention Lifeline (1-800-273-8255).

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