It’s incredibly difficult to know what the right thing to do is when you have a child or a teen who is experiencing depression. It can be hard to talk openly about scary topics like self-harm and suicide, and caregivers often wonder if mentioning them is the appropriate thing to do at all.
Another mental health myth is that asking your child about suicide or self-harm can increase the possibility for these risks, or even introduce these ideas to them. Overwhelmingly, this is not the case. If someone is experiencing depression, these thoughts will come to them whether they are verbalized by others or not. Asking your child about thoughts of self-harm and suicide does not increase the likelihood that these things will happen. What it does is signal to your child that you’re not afraid to have these conversations with them, and that you are a safe person they can approach if these thoughts ever do come up for them. While having these conversations, it is important to remember to stay calm. Kids and teens can pick up on our own feelings and reactions easily, and remaining calm helps them know that we can handle whatever they need to communicate to us.
Keeping open lines of communication at all times, and especially when your child is struggling, is the first step. But what do you do when your child is at risk, and you either suspect self-harm and suicidal ideation, or they have told you that this is something they’re experiencing?
If you know or suspect that your child is struggling with depression, or has struggled with it in the past, it may be helpful to engage in some safety planning. Safety planning is the term that mental health professionals use to describe an open conversation between a caregiver and a child, or a professional and a child, about thoughts of suicide and self-harm and action steps the child can take to ensure safety during hard moments.
What is a Safety Plan?
In an ideal world, safety planning is done with the individual at a time when they’re not in crisis. When a child or teen is in the midst of a mental health crisis, they are likely to feel very overwhelmed, negative, and emotional. It can be really hard for them to access the logic, skills, and support that they need to figure out a safe way forward. Waiting for a moment where they’re feeling better to talk about safety planning can be useful, since we want them to be involved in choosing the ways that they might access support as a part of the plan. The idea is that we take the skills and knowledge they have when they are feeling a little more regulated and put it into a written plan for them so they can access the same insight and guidance when their mental state may keep them from doing so otherwise.
Rightfully so, caregivers are often fearful of mentioning a child’s depression, self-harm, or suicidal thoughts when a child is feeling good. You might worry that bringing up these topics will drag your child back down or hinder any progress that they might be making. In practice, talking about hard things when a child is feeling better can actually help them to feel safe and supported. They will know that you are thinking about them and their safety, that you understand that healing isn’t always linear, and that you will be there for them if they do ever start feeling depressed again.
At school, kids have fire drills just in case a real fire ever does start in school. At home, you may have a fire escape plan so that you know what to do in case of an emergency. A safety plan is very similar. Just because you make a safety plan with your child, doesn’t mean that the emergency will happen, and in fact, it can help your child get through a tough moment without making it worse.
How Do I Make A Safety Plan?
A good safety plan is made up of identifying the following components: personal warning signs, coping skills, distractions, people to ask for help, professional support, environmental safety, and emergency contacts. Let’s walk through these components one by one.
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Personal Warning Signs
The first thing to consider when making a safety plan are the indicators that might signal that they’re headed towards having thoughts of self-harm or suicide. Some common predictors of a crisis include things like increases in interpersonal conflict or refusal to take prescribed psychiatric medications.
Each child and teen might have their own take on what their personal warning signs are. For some, it might be having a fight with a sibling, going through a breakup or being reminded of a loss they are grieving for. It could also be spending more time alone in their room, not being able to get off their phone at night or sleeping all the time. It’s important to ask your child what experiences they have or behaviors they display are signs that they are heading towards experiencing more intense depressive thoughts. -
Coping Skills
Next, we want to work with the person to identify things they can do to help them feel better in that moment where they start to spiral. Have your teen come up with a few ways that they can distract themselves with things that they like, practice relaxation techniques, or engage with self-care. It’s important to let your child know that using coping skills won’t fix the problem entirely, but it will help them manage their emotions and turn down the volume of their feelings a little bit.
If your child has trouble identifying coping skills, you can brainstorm together things that they can do based off of what you know they enjoy. Some common examples include reading a favorite book, watching a TV show they like, or journaling. Different coping skills will work for each kid. Something as simple as leaving their bed and moving to the couch or taking a walk around the block can help them get out of the depths of depression, even if just for a few minutes. -
People and Places that Provide Distraction
Once you have some skills lined up that they can use on their own, start to think with them about the people and places that they can go to for some healthy distraction and support. They do not need to talk to these people about their feelings, and the places don’t need to be related to mental health. The goal is to identify people and places with whom the person feels safe and can be distracted from the racing thoughts inside their heads.
Examples could be a close friend, a school counselor, the gym, or even an online forum if they prefer to engage with others online.* Consider with your kid if they feel comfortable telling the people involved that they are a part of the support system. This is not necessary, but it can help to have others aware of your plan and intentions. -
People I Can Ask for Help in Crisis
This component takes it one step further. Now, we want to identify people that the child is comfortable with approaching while mid-crisis. These are also people who will be able to intervene on behalf of the child. Likely, these people will be caregivers, school counselors, mental health professionals, or other close adults in the child’s life.
While making this list, prioritize including the names and contact information of these people. It’s important to make it as easy as possible for the child to reach out to them in the middle of a crisis.
Make sure to discuss how they can prepare the support people for moments of crisis and talk with your child about telling them in advance what they might need when they come to them for help later. -
Professional Agencies
You might take the lead in this section, identifying and laying out contact information for emergency support services for your child. Professional contacts can include therapists (if they provide on call services), crisis hotlines and text lines, and community mental health centers.
Discuss with your child which options they feel most comfortable with and answer any questions they might have about what will happen to them when they reach out. -
Make the Environment Safer
Caregivers may also take the lead on environmental safety. If you know that your child has self-harmed, or thought about self-harming, by a certain method in the past, you can address that environmentally. For example, a teen who cuts themself to self-harm might require that knives are locked in a cabinet above their reach to ensure that they can’t access a knife in the moment of crisis.
If your child has attempted suicide, or talked about a plan to attempt, by certain methods, you can limit accessibility to the materials they would need. For example, you can lock up all medications if there is a threat of overdose or ensure that there is no way a child has access to firearms in the household. -
Emergency Contacts
If previous steps in the safety plan have not been effective, emergency contacts are included to ensure that they get the immediate support they need. Include descriptions of the service and contact information for the child or teen’s ease.
Common contacts included are 911/988 (National Suicide Prevention Line) and a close behavioral health urgent care.
It may seem daunting to lay this all out, but a safety plan will provide a road map for your child to help them navigate their experience of a crisis and it will also provide you with some peace of mind. Mental health professionals can help you and your child create your safety plan, and if a child or teen is struggling with depression, consistent treatment and care can be really supportive.
Here are some additional emergency support contacts that may be helpful for your family:
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National Suicide Prevention Lifeline (Spanish available) - 1-888-628-9454
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Crisis Textline - text HOME to 741741
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Trevor Project (crisis intervention and suicide prevention for LGBTQ+ youth) -
1-866-488-7386, text 678678 -
Trans Lifeline (peer support line for trans people, run and staffed by trans people) -
1-877-565-8860, 1PM-9PM EST -
National Alliance on Mental Illness HelpLine - 1-800-950-6264, 10AM-8PM
* Please note that caregivers should monitor internet use and create open conversations around how to appropriately engage with the internet and online communities. Monitoring internet use is especially important during signs of increased symptoms/risk as there are online websites that encourage suicide.