Can Suicide Prevention Start in Kindergarten?
The mental health conversation has been on the forefront of the coronavirus pandemic as studies suggest an increase in depression and anxiety symptoms in adolescents and young adults. Among those important conversations are concerns about suicidal ideation and behavior.
Suicide is the second leading cause of death in 10- to 34-year-olds, according to the Centers for Disease Control and Prevention (CDC). While suicide in elementary school-aged children is rare, the number of 6- to 12-year-olds who visited children's hospitals for suicidal thoughts or self-harm has more than doubled from 2016 to 2019.
Experts agree conversations about mental health should begin early on. "The sooner we can start having conversations with kids about mental health the better chance we will have to prevent suicidal behavior," says Arielle H. Sheftall, Ph.D., principal investigator at the Center for Suicide Prevention and Research at Nationwide Children's Hospital. "If we take the stigma away and normalize topics like mental health and suicide early on, children will feel more comfortable expressing themselves and be able to get the help they need."
But is there ever a time when it's too early to have these conversations? Here's what parents need to know.
Suicide Prevention in Schools
"Suicide-specific programs are typically not introduced until middle school," says Holly C. Wilcox, Ph.D., professor at Johns Hopkins Bloomberg School of Public Health. But some advocates say it should be earlier than that. The American Foundation for Suicide Prevention (AFSP), for example, says it "supports implementing regular suicide prevention and mental health education for K-12 students." It adds on Instagram, "Educating students on the signs and symptoms of mental health conditions and suicide risk will help empower them to know when and how to reach out for help for themselves and their peers." AFSP is also advocating for legislation that requires crisis hotline numbers to be printed on school ID cards, excused mental health absences for students, and accessible school mental health support for students.
While not all experts believe discussing the concept of suicide should begin earlier than middle school, many agree that evidence-based school programs like the Good Behavior Game and Fast Track for emotional and behavioral regulation are a good idea. "Targeting aggressive, disruptive classroom behaviors in early elementary school with the Good Behavior Game and Fast Track can reduce the incidence of suicidal ideation and attempt a decade later," says Dr. Wilcox.
Bills are also being introduced, including the STANDUP Act, which would increase suicide prevention training in schools for students in grades 6 through 12. It was reintroduced in the U.S. House of Representatives this year. But knowing that some teens make their first attempts of suicide in elementary school and that more elementary school-aged children are thinking about suicide, one could argue the bill should also include training for K-5.
California Governor Gavin Newsom did sign a bill into law that includes comprehensive suicide prevention policies and procedures for grades K-6, in addition to 7-12. The bill also includes annual training of all school staff and involves parents every step of the way. "Not all states have laws, and very few have suicide prevention efforts like California's," says Richard Lieberman, M.A., NCSP, suicide prevention consultant for the Los Angeles County Office of Education. "California law mandates schools to have comprehensive programs that include policies for prevention, intervention, and postvention." Suicide rates in California have traditionally been lower than many other parts of the country, and Lieberman thinks school programs like these will continue to make a positive difference.
The training of staff is essential to properly implement the evidence-based interventions shown to decrease future suicide attempts into the classroom, experts say. "It's important to train teachers and school staff to identify the warning signs and know the risk factors," says Kristy Brann, Ph.D., NCSP, assistant professor of school psychology at Miami University-Oxford. "Then, focus on promoting social-emotional competence—emotional awareness and regulation, healthy coping skills, self-management, and healthy relationship skills—when working with young children to enhance protective factors."
The executive director of non-profit Be Great for Nate, named after a teen who died by suicide in 2018, agrees about the importance of protective factors. "The simple formula to prevent suicide and mental illness is to decrease risk factors and increase protective factors," says Steven Peterson, LCSW. "And the most important thing you can teach a child is a sense of connection to their community. Hopefully, it will soon become more acceptable to create a foundation of social-emotional health before worrying about a score on a chemistry test."
What Parents Should Know About Suicide
Of course, parents also play an important role in suicide prevention. A February 2020 study of 9- and 10-year-olds and their parents discovered most caregivers were unaware of suicidal thoughts or self-harm in their children. It also found that family conflict and lack of supervision were associated with these behaviors. So, what can parents do?
Spot the warning signs
Warning signs can differ between young children and teens, but many are the same. Withdrawing from friends and activities, depressed mood or dramatic changes in mood, increased drug or alcohol use, and giving away possessions can be warning signs for all ages.
Young children may consistently draw dark or violent images. And they may vocalize that they want to hurt themselves. "One study we conducted comparing factors related to suicide in 5- to 11-year-olds to 12- to 14-year-olds found that about 30 percent of the 5- to 11-year-olds stated they wanted to kill themselves prior to dying by suicide," says Dr. Sheftall. "If a child says they want to kill themselves, no matter the age, they should be taken seriously every single time."
Understand risk factors
Risk factors can also differ by age but some include mental illness, relationship problems or family conflict, prior suicide among peers or relatives, a firearm in the home, and bullying.
Talk to kids about suicide
Parents should not be afraid to ask children about suicidal thoughts, but should do so in a calm, non-judgmental manner, according to the National Association of School Psychologists (NASP). Make sure the child feels heard. If, for instance, they are continually drawing violent images, try and get them to talk about how they are feeling.
Explain that it's normal to feel angry, confused, or sad. Instead of being accusatory, focus on your concern for their well-being and provide constant supervision, eliminating any means for self-harm like a firearm in the home. Parents should promptly ask for help from a school or community mental health professional.
"Building the foundation for hard conversations when they're young can lead to honest communication later on," says Dr. Sheftall. "It's important to be the parent that kids feel they can ask anything."
If you or someone you know is considering suicide, contact the National Suicide Prevention Lifeline at 800-273-8255, or the Crisis Text Line at 741741 (text HOME). For those struggling with other mental health issues, the National Alliance on Mental Illness offers mental health education, resources, and a helpline (800-950-6264).