Lisa Farmer, nursing director of Psychiatric Services at Cook Children's Health Care System, explains, “Just as with a medical emergency, we do not want to wait until somebody is in crisis to treat an illness.”

This proactive approach is critical, as research shows that 50% of people who die by suicide have visited a health care provider in the month prior.

A depression screening tool called the PHQ-9-M is now used in pediatric primary care, urgent care, and some specialty clinics to identify at-risk children as young as twelve. According to Farmer, this early screening is the most effective way to manage depression and suicide risk. These questions focus on whether a child is depressed and are asked to kids 12 and up. The ASQ tool is also used for children age 8 to 11 who present to urgent care with a behavioral health concern.

Through the screening tool, doctors can provide early intervention and treatment to reduce the likelihood of a crisis. Farmer says research shows the best way to manage depression and suicide risk is to provide early screening to identify those at risk.

“By seeking treatment earlier, either through psychoeducation, individual and/or family therapy and possible medication management, we are able to treat depression to decrease the risk of suicide,” explained Farmer.

According to the U.S. Center for Disease Control and Prevention, suicide is one of the leading causes of death in the United States. One person dies every 11 minutes due to suicide. Data by the CDC in 2023 shows 1.5 million people attempted suicide and 12.8 million have seriously thought about suicide.

Farmer understands parents may have concerns about talking about mental health issues and suicide with their child but emphasizes that having the conversation does not create suicidal ideation. The Academy of Child and Adolescent Psychiatry offers educational material for caregivers on multiple topics, including how to talk to your child about mental health concerns.

“At Cook, we have found that youth have expressed they feel relieved that someone has finally asked these difficult questions,” said Farmer. “It can provide assurance that somebody cares and will give them a chance to talk about problems.”

The Impact on Patients 

In 2024, Cook Children’s screened more than 36,000 patients who presented to the ED for non-behavioral health concerns with the ASQ tool. Of those, 848 screened positive for suicide risk.  Another 2,394 kids struggling with sadness and worrying were provided with a crisis contact information sheet.

This episode of Raising Joy tackles a tough but crucial topic: youth suicide prevention, particularly among young people of color. Kristen Pyrc, M.D. welcomes Martha and Chris Thomas, founders of The Defensive Line, a nonprofit on a mission to end this epidemic.

Martha and Chris tragically lost their daughter, Ella Elizabeth Thomas, to suicide at the age of 24. Inspired by Ella's vibrant spirit and the need for change, The Defensive Line is transforming how we communicate and connect about mental health.

Join us for a powerful conversation about:

• Breaking the stigma around mental health in communities of color
• Effective communication strategies to support young people
• Building a world where mental health resources are accessible and inclusive

This episode is a must-listen for anyone who wants to empower themselves and others to have open conversations about mental health and create a future filled with hope.

Learn more about The Defensive Line here.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple and Spotify.

By Heather Duge

Cook Children’s Emergency Department nurse manager Kara Dorman has seen an alarming trend – a significant increase in patients coming in with a seemingly invisible problem. Patients may enter the ED for an injury or illness but have a mental health concern that also needs to be addressed.

“As we track suicide screening numbers, it has been horrifying and mind-blowing to see all these kids who visit the ED for medical problems and screen positive for suicide risk,” Dorman said. “These are kids we wouldn’t have known about if we didn’t ask.”

Many times asking the hard questions is the most challenging part of identifying those who need help. That’s when Team HOPE, a specially trained group of 25 employees at Cook Children’s, enters the picture.

Dorman and ED chaplain Cameron Brown lead the team, which includes patient care technicians, paramedics, nurses, security officers, chaplains and child life specialists. The team meets monthly, participates in education and shadows the inpatient psychiatry unit for eight-hour shifts.

Dorman and Brown proactively round on patients using Trust Based Relational Intervention (TBRI) to build early rapport. TBRI is an attachment-based, trauma-informed intervention that is designed to meet the complex needs of vulnerable children. The team uses the Ask Suicide Questions (ASQ) screening tool and TBRI training has been instrumental in the screening process.

The ED screens patients during intake to ask questions about their mental health. From January through July 2023, 405 patients ages 8 and older who came to the ED for medical conditions were positive for being at risk for suicide and 19 were suicidal at the time. In 2022, Team HOPE assessed 32,000 patients ages 8 and over who came to the ED for medical conditions – 640 were positive for being at risk for suicide and 22 were suicidal at the time.

Building Early Connections

If a nurse in the ED feels like they need help, they can call Team HOPE. An intake therapist will perform a behavioral health intake assessment and provide tailored resources for the patient to get help.

Oftentimes, patients come in and don’t want to speak to anyone.

“A huge factor in saving lives when treating mental health illness is connection,” Dorman said. “Good eye contact and modeling a calm demeanor when entering the room is the first thing. We share power and control with patients such as giving them choices of what drink they would like to take with their medicine and offering green scrubs instead of an open gown. We talk about transitions of care ahead of time and introduce their new nurse before shift change.”

Behavioral health carts filled with games, clay, stress balls, model magic and journals are other tools the team uses for distraction and to get rid of nervous energy. Brown not only provides patient families with support but also the ED staff. She checks in during each shift with team members.

“I ask how they are coping and assess how they are handling things,” Brown said. “I help them when patients are dysregulated and give them permission to ask for help.”

Sometimes that means walking through a scenario such as thinking through how to go in the patient’s room while maintaining a calm presence. 

Suicide Prevention Training

Dorman and Brown attended QPR training, which is an emergency response training for someone in crisis, hosted by the Jordan Elizabeth Harris Foundation. This training helped them learn how to ask difficult questions when concerned about someone having suicidal thoughts.

“This has been helpful in having conversations with friends, family, fellow coworkers and when checking in on each other in different units,” Dorman said. “Team HOPE members are a resource for not only our patients but for ED staff members as well. The QPR training helped our team gain knowledge and feel empowered to role model that having conversations matters.”

Ellen and Tom Harris established the Jordan Elizabeth Harris Foundation in 2014 after their daughter died by suicide. They know how unexpected depression and suicide can be after experiencing it with their daughter.

Jordan was valedictorian of her high school class, a National Merit Scholarship winner, a Stamps scholar at the University of Michigan, an athlete, musician and a friendly, compassionate young woman. The JEH Foundation honors Jordan’s life by raising money to support research on depression and offering training to help people recognize signs of depression.

"Jordan was the kind of person you would never expect to take her life,” Ellen said. “She was a wonderful, kind, funny and loving person with loads of friends and interests.”

After Jordan developed depression during her senior year of college, Ellen and Tom brought Jordan home until she felt ready to go back. Her upbeat personality hid the severity of the depression. Ellen said the confusing part of depression is that people who take their lives don’t want to die – they just don’t see any other way out of the dark hole.

“The night before Jordan passed away, she was on her computer searching for a therapist,” Ellen said. “She was trying to find a way out.”

Ellen and Tom’s goal through the foundation is to help people out of the dark hole. They offer free QPR training to the public.

During the 45-minute sessions focusing on Question, Persuade and Refer, people build confidence in asking the hard questions about suicide, learn how to persuade someone to seek help and understand referral options.

The sessions also include myths and facts about depression, nationwide statistics about the depression epidemic, ways to be aware of someone struggling and verbal versus nonverbal cues. Dorman had the desire to bring their training to Cook Children’s and four months ago 25 employees at the hospital participated in a session.

“If we can save one life, everything we’re doing has been worth it,” Ellen said. “I’m thrilled to provide training for employees at Cook Children’s. It is critical hospitals have this training because the earlier you can catch depression and start treating it the greater the outcome.”

Dorman said one interaction in the ED can be the moment that changes the trajectory of a patient’s life – bringing them hope in a dark time.

“We want to connect with these patients and empower them to seek help,” Dorman said.

September is National Suicide Prevention Month. If you are concerned about a child’s mental health, please reach out to one of these resources or your child’s pediatrician. It is important to get help early so that children can get the support they need.

September is National Suicide Prevention Month. If you are concerned about a child’s mental health, please reach out to one of these resources or your child’s pediatrician. It is important to get help early so that children can get the support they need.

If you are not sure if your child is a danger to themselves or someone else, call the numbers below for advice or help.

Cook Children’s Psychiatry Intake Line: 682-885-3917 (press emergency prompt.)

Tarrant County MHMR Crisis Line:

• Call or text 800-866-2465. Available 24 hours a day.
• Provides face-to-face assessments to help families decide how to help their child.

If you need to talk or if you are concerned about someone, please view the following resources and call for advice or help.

National Suicide and Crisis Lifeline

• Call or text 988 for free and confidential support for people in crisis.
• Available 24/7, call or text 988 for access to mental health crisis services.
• Crisis Text Line (Text HELLO to 741741). These services are free and confidential.
• Please note: the previous 1-800-273-TALK (8255) number will continue to work as well.
• Lifeline (988lifeline.org)

The Trevor Project for 24/7 LGBTQ Crisis Support:

• Support line: 1-866-488-7386
• Text “Trevor” to 1-202-304-1200
• Chat online at www.thetrevorproject.org

 Collin County – Lifepath Systems

• Crisis hotline available 24/7: 877-422-5939
• Lifepathsystems.org
• Trained behavioral health professionals are standing by to assist you.
• This service is available for all adults and children living in Collin County, regardless of insurance or income status.

Dallas Metrocare

• Hotline available 24/7: 214-743-1215
• Metrocareservices.org
• Offers child/teen mental health services

Denton County MHMR Crisis Hotline

• 1-800-762-0157

Grant Halliburton Foundation Mental Health Navigation Line (Dallas/Denton/Collin focused)

• Granthalliburton.org/navline
• Mental health navigators can help find resources for you or someone else.
• 972-525-8181

Mental Health Connection of Tarrant County

• Mentalhealthconnection.org

RAINN: 1-800-656-4673

• National hotline for victims of sexual assault
• https://www.rainn.org/

Recognize & Rise

• Recognizeandrise.org

SafeHaven 24-hour hotline: 1-877-701-7233

• Tarrant County domestic violence service provider

SAMHSA: Substance Abuse and Mental Health Services Administration

• National helpline available 24/7: 1-800-662-4357

Transicare’s Mobile Crisis Outreach Team (MCOT) – Dallas

• Transicare.com/services/MCOT

Texas Youth Helpline

• Call or text 1-877-921-6780 for free, confidential services
• Dfps.state.tx.us/youth-helpline

Wellness Alliance for Total Children’s Health of Denton County

• Led by Cook Children’s
• watchdenton.org

Additional resources in North Texas: 

• The Jordan Elizabeth Harris Foundation: Suicide prevention training
• The Hope Squad: Students can help save a peer's life
• Hayden's Corner: Nonprofit established in honor of Hayden Hunstable to educate parents and children about mental health issues.

Resources from Cook Children's:

• Cook Children's Behavioral Health
• Cook Children’s Rees-Jones Behavioral Health Center
• Cook Children's Psychology
• Individual and family therapy
• Parent Education and Support
• Diagnostic Testing
• Childhood stress
• Helping kids deal with bullies
• Helping kids handle worry
• Helping your child deal with death
• Helping your child through a divorce
• Understanding depression

The JOY Campaign

The JOY Campaign launched in April 2021 as a suicide prevention communication initiative and aims to reach parents through honest conversations about the mental wellbeing of children and teens. Learn more about the Joy Campaign and available mental health resources here.

The Raising Joy podcast is part of the JOY Campaign. Our hosts Kristen Pyrc, M.D. and Wini King, Chief of Communications, Inclusion, Equity and Diversity at Cook Children’s, have heard incredibly impactful stories of personal struggle and resilience from our guests on the podcasts. Episodes are currently streaming on all major streaming platforms including Apple, Spotify and Google Podcasts.

Related stories on mental health:

Let's Talk: Seven Ways to Help Kids and Teens Open Up (checkupnewsroom.com)

Raising Joy: Conversations Matter With Brad Hunstable (checkupnewsroom.com)

Reunion: Suicide-Attempt Survivor Returns to Cook Children’s (checkupnewsroom.com)

4 Things Parents and Children Can Do While Waiting for Mental Health Services (checkupnewsroom.com)

Raising Joy: When Does a Child Need Psychiatric Care? (checkupnewsroom.com)

In Their Own Words: Three Parents Open Up about Losing a Child to Suicide (checkupnewsroom.com) 

Video: Child Therapists Share Six Ways to Cope with Difficult Emotions (checkupnewsroom.com)

More articles about children, teens and mental health | Checkup Newsroom

Grant Halliburton Foundation was established in 2006 in memory of Grant Halliburton, a Dallas teen who battled depression and bipolar disorder for several years before his suicide death at the age of 19. The Foundation that bears his name works to help families and young people recognize the signs of mental illness through a variety of avenues including mental health education, collaboration, encouragement, and information. 

On this episode of Raising Joy, we meet Sonya Parker Goode, CLC, CAMS-I, director of outreach and education with Grant Halliburton Foundation. She tells us how the organization has trained more than 300,000 students, teachers, parents, and professionals on how to recognize and respond to someone in major distress or suicidal crisis. Learn more about Grant Halliburton Foundation here.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Note: If you or someone you know is struggling or in crisis, help is available.  If you believe that your child is having a mental or physical health emergency, go to the nearest emergency room or call 911. Call or text 988 for the Suicide & Crisis Lifeline, a free and confidential resource available 24/7. If you have questions about your child’s mental health, contact your child’s pediatrician. 

**Content warning – this episode contains difficult subject matter. We advise you to listen with caution, knowing topics of child suicide, trauma, grief and mass shootings are discussed.

Suzy DeYoung didn’t plan on devoting her life to the subject of trauma, however, an accident involving her child led her down a path of exploring some of the most difficult subjects imaginable. For over a decade, she has studied and educated others as a trauma-informed parent. She was also one of the founding members of Sandy Hook Promise, which began after the horrific school shooting in her hometown of Newtown, CT. Most recently, she has conducted research on behalf of author Andrew Solomon, Ph.D., where she has interviewed dozens of families and experts impacted by child suicide. This discussion is enlightening, challenging and important, though it may be triggering for some.

We also want to hear from you. Please take our brief survey to let us know how we’re doing and what topic you want to hear discussed on Raising Joy.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Suicide is the third leading cause of death among people aged 15 to 24 in the U.S., according to the Centers for Disease Control and Prevention (CDC). During the first seven months of the COVID-19 lockdown, U.S. hospitals experienced a 24% increase in mental-health-related emergency visits for children aged 5 to 11, and a 31% increase for those aged 12 to 17.

On this very special episode of Raising Joy, we sit down in front of a live audience in Fort Worth, Texas, to interview acclaimed author, Andrew Solomon, Ph.D. Solomon is a Pulitzer Prize finalist, National Book Award winner, TedTalk presenter, as well as a professor of Clinical Psychology at Columbia University. 

Dr. Solomon spoke to us about his recent article in The New Yorker called, “The Mystifying Rise of Child Suicides,” and recounts what he has learned from conducting dozens of interviews with parents who have lost a child to suicide. 

This is a difficult, yet important episode for anyone interested in learning more about the mental health crisis affecting youth in America.

Thank you to all who joined us for the live show and thank you to all of our podcast listeners. This event was hosted in partnership with The Center for Children’s Health led by Cook Children's. The Cook Children's Raising Joy Legacy Leadership Award was presented to the Honorable Tarrant County Judge Glen B. Whitley for his tireless commitment and decades of service on behalf of the well-being of children throughout Tarrant County and beyond.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Seven in 10 young people say they would tell a friend if they are having thoughts of suicide. Research also shows that peers have a greater impact as protective factors during adolescence than parents do. This is why the Hope Squad program focuses on training students to help their peers in schools across the U.S.

On this episode of the Raising Joy, we’re talking to Guidance and Counseling Coordinator Kasey Holder with Mansfield Independent School District, MISD student Kaylee Berger and Kristi Wiley with the Jordan Elizabeth Harris Foundation. They share how the program has changed the culture at school and why they think giving students tools to help their friends is saving lives.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

This week on the Raising Joy podcast, hosts Wini King and Kristen Pyrc, M.D., are joined by Tom and Ellen Harris of North Richland Hills, who are the founders and co-chairs of the Jordan Elizabeth Harris Foundation (JEHF) named in honor of their daughter.

At the beginning of the pandemic, Tom and Ellen inspired the Cook Children's Health Care System JOY Campaign to understand suicide and raise awareness about mental health.

Many people's lives are touched by suicide and depression. Tom and Ellen were trailblazers in breaking down the stigma and creating mental health resources for Tarrant County. In the podcast, they share Jordan's story and their perspective as parents, as well as the impact that the Jordan Elizabeth Harris Foundation has made in the community.

Jo was valedictorian of her high school class, a National Merit Scholarship winner, a Stamps scholar at the University of Michigan, an athlete, musician, and most importantly a warm, friendly, compassionate young woman. The Harris family lost Jo to suicide on March 27, 2012.

Through their grief, the Harris family decided to create the JEHF, which provides suicide prevention and education for children and adults, as well as depression research funding. You can learn more about the JEHF at jordanharrisfoundation.org.

Raising Joy is part of Cook Children’s Health Care System’s JOY Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify, Google Podcasts and YouTube.

Partners from health care and other fields are teaming up in an expanded collaboration geared to brainstorm and implement strategies to prevent suicides in North Texas.

Participants represent a variety of vantage points including mental health, housing, poverty alleviation, youth services and education. Yet they share the same concerns about the escalating rates of anxiety and depression that can lead to suicide. The Center for Children’s Health, led by Cook Children’s, summoned the partners together earlier this year through the Adverse Childhood Experiences (ACEs) Task Force.

“It just works better from a community perspective if it’s really a community-driven need and a community-driven response, than if it’s just one organization pushing it out. We need everybody’s support in tackling this issue,” said Lenee Bassham, who oversees the ACEs Task Force in her role as director of child safety.

The Task Force has existed since 2017, working to mitigate the effects of trauma on children who live with domestic violence, neglect/abuse, a parent’s incarceration or other chronic adversity. The Center for Children’s Health last May bumped up the Task Force membership to about 25 people in an effort to address the implications of the COVID-19 pandemic.

In meetings over the spring and summer, the participants shared their observations, concerns and vision for improving access to mental health services in Tarrant County. Organizers hope that the dialogue will eventually lead to agreement on top priorities and a plan for action.

One theme that already has emerged? The need for a clear and consistent message that could be promoted by schools, medical providers, agencies or anyone who works with families. Bassham cited the Cook Children's Aim for Safety® initiative as an example of cohesive communication. Aim for Safety® simplifies the need-to-know message into three steps to prevent accidental gun injuries: “Safe storage. Safe children. Safe play.”

A similarly cohesive message when it comes to suicide, she said, could equip parents to know the warning signs and to find help for kids and teens who struggle with mental health. And the appeal broadens when multiple voices weigh in to shape the message’s content.

“When we have everyone’s buy-in, it’s much better to push messaging out in the community,” Bassham said. “We could take years on a messaging campaign, but we don’t want that to happen. We want to move as quickly as possible.”

The urgency stems from a dramatic rise in suicide attempts, which experts link to emotional distress during the COVID-19 pandemic. Cook Children’s, for instance, saw 261 patients hospitalized due to injuries following suicide attempts from January-July 2021. That compares to 143 hospitalizations for injuries in the aftermath of suicide attempts from January-July 2020.

In response, Cook Children’s has launched the Joy Campaign, a series of news articles and materials that spotlight the efforts being made to turn the trend around. The Joy Campaign focuses on avenues of hope and resiliency.

Bassham said the ACEs Task Force members plan to meet again in September to continue the teamwork approach. Their discussions could eventually pave the way for proposals that raise suicide awareness and improve the outlook for families in the Fort Worth area.

The World Health Organization (WHO) describes community engagement as an essential and effective aspect of suicide prevention globally. WHO advises that the process should involve stakeholders from diverse backgrounds who know the community’s demographics. Diversity improves the input by enlarging the group’s base of skills and creative thinking.

“Prevention of suicide cannot be accomplished by one person, organization or institution alone; it requires support from the whole community,” according to a WHO publication in 2018. “Each community can adapt and design its own plan, tools and activities to ensure that these best fit the community and are acceptable and appropriate to the local context.”

Bassham said it’s too soon to predict just yet what concrete action might arise from the ACEs Task Force talks. Each partner brings a unique viewpoint to the conversation. Let’s hear from three of the members.

Lachelle Goodrich, licensed professional counselor

Lachelle Goodrich suggested that the Task Force develop a process map that breaks down the path to treatment for suicidal kids in North Texas. She envisions a chart that directs parents when to act and places to turn, depending on the child’s age.

“Sometimes parents just don’t know the questions to ask or the signs to look for,” said Goodrich, who also serves as director of the Stop Six Choice Neighborhood Initiative for Fort Worth Housing Solutions. “Parents are stuck because we don’t know where to begin, where to start. ‘Do I call a therapist? Do I go to the hospital? What do I do?’”

She urges parents to have courageous and regular conversations about mental health. Be your child’s biggest advocate, and don’t be afraid to reach out for intervention, she said.

“The more I work with teens, the more they educate me. I feel like it’s my duty to turn around and educate the parents and the community.”

Ottis Goodwin, Fort Worth Independent School District

When an assessment finds that a student is considered at-risk for suicide, the Fort Worth Independent School District provides a list of area options for treatment. But that list doesn’t indicate which facilities have current openings for new patients, said Ottis Goodwin, director of Family & Community Resources for FWISD.

“When we give families that information, we have no idea who’s full and who’s not full,” Goodwin said. “The family may show up and not be able to be admitted.” He would like to see a system that tracks up-to-date bed availability.

Another suggestion from Goodwin: Closer ties between the district and the inpatient facilities, to ease students’ transition back to campus after hospitalization.

“Oftentimes we don’t know that they’re coming back into school, so we don’t really have a good support plan for their return, because it wasn’t communicated to us,” he said.

Last school year, Goodwin distributed magnets and crisis contact information sheets – developed by the Joy Campaign, in English and Spanish – to counselors and other staff throughout FWISD. He applauded the Task Force for tackling the weaknesses where improvements could be made.

“The fact that we’re together and having these conversations is huge. We need those people pushing and organizing like what Cook has been doing. If you get the right people at the table, then you can make the change.”

Virginia Hoft, Mental Health Connection of Tarrant County (MHC)

Through the Recognize and Rise education campaign at MHC, executive director Virginia Hoft shares information about healing in the aftermath of trauma. Hoft would like to see the Task Force find a way to identify gaps and duplications in local mental health services.

Hoft also recommends adopting age-appropriate curriculum that equips young children with skills for coping with stress. Don’t wait until junior high to talk about suicide, she said. “Just like we’ve done with ‘Stranger Danger’ and drug education, it’s information that kids need to grow up with.”

By working in tandem, the ACEs Task Force partners and other advocates can make a collective impact to prevent suicide and improve mental health in our region, Hoft said.

“What brings me hope is the open-mindedness around having collaborative conversations about how we can work on this in the most efficient manner, to get us all rolling in the same direction.”

The CDC found:

• That suicides increased by 56% during the 10-year span among people ages 10 to 24 years old.
• Suicide attempts among African-American teens increased by 73%.
• Suicide is the second-leading cause of death for teens from all demographics and the third-leading cause of death among black youths between the ages of 15 to 19 in 2017.
• In 2017, 2,200 teens between 15 to 19 years died by suicide.
• 1 in 5 high school students admitted to experiencing suicidal thoughts and 1 in 10 said they devised a plan to carry it out.
• The increase in the rate of suicides among 10- to 14-year old children have almost tripled between 2007 and 2017.

The CDC collected data from nearly 199,000 high school students by the CDC and Prevention’s Youth Risk Behavior Study.

Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s, realizes suicide in children and adolescents is a difficult topic for most parents. But she stresses it’s one that can’t be ignored.

“As a mental health professional, my worst fear is a child prematurely ending his or her own life,” Dr. Pyrc said. “As a mother, it is hard to comprehend the profound grief families must feel in the wake of a suicide.”

The American Academy of Pediatrics has updated its guidelines to recommend pediatricians routinely check for signs of depression in their young patients. The focus is to carefully screen patients ages 12 and over during annual checkups.

“I have found it is a good way to signal to kids and parents that we are open to talk about this and want them to ask us about it,” said Vanessa Charette, M.D., a pediatrician at Cook Children’s Magnolia office in Fort Worth. “Even if nothing comes up, often a parent will return with the teen later wanting to talk about anxiety and depression.”

While researchers say they aren’t sure of the exact causes for the rising suicide rates, experts point to a rise in depression among adolescents, drug use, stress and access to firearms might all be contributing factors.

Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Cook Children’s Behavioral Health Clinic in Denton, is simply fed up. She’s seen too many kids come into her office depressed, frightened or even suicidal because they can’t get away from their bully or bullies.

“I think that bullying is worse than ever before because of cyberbullying,” Elliott said. “Kids can’t get a break.”

No child is bully-proof. Elliott offers parents the following talking points when speaking to their child about bullying:

• Even people who say they're your friends can bully you.
• You should confront your friends when they're being hurtful to you or others.
• Retaliating may feel good temporarily, but refusing to stoop to the bully's level will win you more popularity in the long run.
• When you hear a false rumor, just ignore it and be yourself.
• You're most likable when you respect yourself and others.
• Bullies usually have their own insecurities. Returning meanness with kindness is the best way to break down their defense.

Elliott advises parents to monitor their child’s computer and cell phone, and encourage them to spend less time on social media. If bullying expands onto social media, then parents should talk to their child’s teacher, coach or another school official.

“Parents should watch for any change in a mood like sadness, depression, hopelessness, irritability, anger, and hostility,” Elliott said. “You may see more tearfulness and changes in activity level. Watch for more withdrawal from friends and family, change in friends and loss of interest in activities once enjoyed.”

Elliott says warning signs of teen suicide include:

1. Alcohol/Drug Use
2. Preoccupied with death (writing, drawings)
3. Talking about feelings of hopelessness
4. Talking about being a burden to others
5. Telling loved one's goodbye
6. Decline in performance
7. Giving prized possessions away
8. Isolating and withdrawing
9. Acting highly anxious or agitated
10. Acting reckless and taking risks
11. Rages
12. Changes in sleeping and/or eating
13. Dramatic changes in personality and/or appearance

If you would like to schedule an appointment, refer a patient or speak to our staff, please call 682-885-3917. 

Sources for this Topic:

• Cook Children's Behavioral Health Center
• Youth Risk Behavior Surveillance System (CDC)
• Report: Suicide Attempts Among Black Teens Increased by 73 Percent (The Root)
• Suicide attmepts increasing among black children and teens, study finds
• Youth Suicide Rate Increased 56% In Decade, CDC Says
• Suicides and homicides on the rise in young people (NBC News)

The number of children showing up in emergency rooms for suicidal thoughts and attempts is on the rise, especially during the school year.

According to a new study published by the American Academy of Pediatrics, kids ages 5 to 17 were admitted to children’s hospitals for thinking about or trying to kill themselves twice as often in 2015 as 2008. Researchers at Monroe Carell Jr. Children’s Hospital at Vanderbilt embarked on the study after noticing more pediatric patients being kept in the hospital with mental health issues.

They found that girls are attempting suicide more often than boys. They also found that suicide attempts were highest during the school year and decreased during the summer months.

“On average, during the eight years included in the study, only 18.5 percent of total annual suicide ideation and suicide attempt encounters occurred during summer months,” the research team wrote in the publication.

Half of the encounters examined in the study involved teens aged 15 to 17.

Numbers High at Home

This disturbing trend is also evident at Cook Children’s.

In 2016 and 2017, more than 390 children were seen by the Psychiatry department at Cook Children’s for an attempted suicide. The team was consulted on more than 1,040 total cases for issues including depression, anxiety and/or attempted suicide. The majority of the children who attempted suicide were female (317 female, 76 boys) and the average age was about 14 years old.

Also like the study, the majority of suicide attempts seen at Cook Children’s occurred during the school year.

Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s, realizes suicide in children and adolescents is a difficult topic for most parents. But she stresses it’s one that can’t be ignored.

“As a mental health professional, my worst fear is a child prematurely ending his or her own life,” Dr. Pyrc said. “As a mother, it is hard to comprehend the profound grief families must feel in the wake of a suicide.”

The American Academy of Pediatrics has updated their guidelines to recommend pediatricians routinely check for signs of depression in their young patients. The focus is to carefully screen patients ages 12 and over during annual checkups.

“I have found it is a good way to signal to kids and parents that we are open to talk about this and want them to ask us about it,” said Vanessa Charette, M.D., pediatrician at Cook Children’s Magnolia office in Fort Worth. “Even if nothing comes up, often a parent will return with the teen later wanting to talk about anxiety and depression.”

Suicide Attempts among Young Children

Another study published by the AAP found that younger children who die from suicide are more likely to do so impulsively while early adolescents tend to struggle with depression for some time then plan and carry out suicide. The researchers found that younger children were more likely to have experienced ADHD symptoms while early adolescents were more like to have experienced depression symptoms.

“What is important to realize is that in a young child, thoughts of suicide can occur without depression symptoms,” Dr. Pyrc said. “I have to wonder if some of the elementary-school-aged children meant to end their life, or if they act impulsively not fully appreciating the consequences. Unfortunately, the result is the same regardless of the child’s intent. A child’s life has ended prematurely, and family and friends are left with immense grief and a lifetime of regret.”

Dr. Pyrc said in childhood and adolescence, depression is more likely to present with irritability and angry outbursts than sadness. Young people are remarkably resilient and able to ‘compartmentalize,’ meaning they can feel deeply sad when alone but are able to socialize with their friends and appear happy on the surface.

Depression also manifests as changes in energy and sleep as well as social withdrawal, a drop in grades, or not engaging in activities they once enjoyed. If you see some of these signs and symptoms in your child, it may be time for an assessment. Starting with your pediatrician is a good first step because they can help assess for depression symptoms as well as rule out any medical problems that present similarly to depression.

Dr. Pyrc stresses it is vitally important to take children seriously when they say they want to die.

“I think it is easy to dismiss a statement like this from a child because it is hard to imagine that they fully understand what they are saying, but I would sure hate to be wrong,” she said. “I think it is important to believe our children and get help for them when they make suicidal statements. If you are concerned that a child may hurt him or herself or others, please seek professional help as quickly as possible. If you feel the threat is imminent, please take them to the Emergency Room for an assessment.”

But many experts are concerned the portrayal of the lead character Hannah’s death may not only be difficult to watch for young people, but it may also glorify suicide.

Alaina Everitt, a child psychologist at Cook Children’s, was first introduced to the book “13 Reasons Why,” 10 years ago through her mom, a middle school librarian. At that time the book was being pulled because it was “sensationalizing” suicide.

“Even though it was written 10 years ago, the types of bullying portrayed in the story remain relatable to the kids I see today, the only difference being the technology behind it. What sets this story apart from others is that it emphasizes the bystander. The effects of bullying trickle down from those who allow it to happen, who see it, maybe even disapprove, but do nothing,” Everitt said. “It’s easy to be a bystander, to keep things to yourself and not risk your own reputation. But just because they don’t throw a punch or post a pic, they are not innocent. The bystander is one of the 13 reasons.”

Local school districts have sent communication to parents to make them aware of the series. Some have encouraged an open dialogue with their child regarding the subject matter depicted in the series and book.

Lisa Elliott, a licensed psychologist and manager of Cook Children’s Behavioral Health in Denton, says children may watch the series and threaten suicide in an attempt to get attention.

“But it doesn’t matter,” Elliott said. “You must take the threat very seriously. If a child is talking about suicide, get help immediately. It’s critical not to ignore this cry for help regardless of their reasons.”

With the show so prevalent in the news, it may present parents the opportunity to talk to their kids about an extremely uncomfortable topic.

“Use it as an opportunity to discuss their possible feelings and be a listening ear and support them,” said Joy Crabtree, a licensed psychologist and clinic manager for Southlake and Northeast Clinic. “Additionally, parents can ask their child if they have ever had any extreme feelings of sadness or thoughts about hurting themselves. If current feelings about wanting to hurt themselves are acknowledged, parents should let their therapist or psychologist know right away. If they do not have a therapist or psychologist, or they are not available, they should be taken to a local mental health facility or hospital emergency room for an evaluation.”

Elliott says teens with chronic illness, such as depression, are no different than any other child and generally want to be treated just like any other kid. But they should receive professional help and be assessed for anxiety and depression.

“Parents should watch for any change in mood like sadness, depression, hopelessness, irritability, anger and hostility,” Elliott said. “You may see more tearfulness and changes in activity level. Watch for more withdrawal from friends and family, change in friends and loss of interest in activities once enjoyed.”

Elliott says warning signs of teen suicide include:

1. Increased use of alcohol/drugs
2. Preoccupied with death (writing, drawings)
3. Talking about feelings of hopelessness
4. Talking about being a burden to others
5. Telling loved ones goodbye
6. Decline in performance
7. Giving prized possessions away
8. Isolating and withdrawing
9. Acting highly anxious or agitated
10. Acting reckless and taking risks
11. Rages
12. Changes in sleeping and/or eating
13. Dramatic changes in personality and/or appearance

If you feel your child needs help, please click here to find a Cook Children's Behavioral Health location near you.

Cook Children's Behavioral Health Center

Growing up in today's world is hard and many children or teens may go through life experiences that cause them to feel anxious, depressed or even suicidal. As a parent or a caregiver, it can be hard to know when to ask for help. The Behavioral Health Center brings all services together in an expanded space that will provide a talented, dedicated team of caregivers, physicians and professionals with the facilities, resources, tools and programs they need to ensure that these most vulnerable children receive the high quality treatment they need and deserve. Click here to learn more about an appointment or referral.