As more teens talk about self-harm, here’s how to help, say experts

New data from parental control app Bark shows that suicidal ideation among teens is up significantly from last year. The data is in keeping with other statistics, including metrics from the Centers for Disease Control and Prevention, which revealed that teen girls in particular were showing up in hospital emergency rooms at a far higher rate during the pandemic than before. While the trend is disturbing, doctors say there are ways to combat the rise.

It’s not just about COVID-19-related stress: Between 2007 and 2018, suicide in the U.S. among 10- to 24-year-olds increased 57.4%, according to CDC data. But distress among that age group has intensified during the pandemic, as it has for most everyone else. The usual supports that kids turn to were even less available than usual. And there is a dearth of mental health care for kids in general, a phenomenon that has been exacerbated by the pandemic. Only 10% of kids ages 3 to 17 received professional mental health care in the past 12 months, according to the Kaiser Family Foundation’s analysis of the 2020 National Survey of Children’s Health, which represents a slight decrease from 2019.

New online services such as Brightline (which offers both tele-psychiatry and coaching) provide great promise for connecting kids with care. Experts also say that parents can take steps to help their kids by proactively talking to them about suicide and self-harm. There may also be an additional role for technology in schools.

Bark’s 2021 annual report shows 75% of teens engaged in self-harm or suicidal ideation on their devices, a 25% increase over 2020 (Bark defines self-harm as anything from text messages about cutting to an email draft of a suicide note). Dr. Free Hess, an emergency room pediatrician at the University of Florida Health Shands Hospital, who advises Bark, says she’s concerned that kids being forced to spend more time online as a result of the pandemic is leading to some of the increased distress.

Even before the pandemic, Hess says, there were two main online behaviors that were driving mental health issues among teens. One is cyberbullying (though at least one study last year showed that cyberbullying has actually decreased during the pandemic). “The second thing is the massive distortion of not only real life as the perfect life, but the perfect body, the perfect image, the perfect everything, because everything is altered,” she says. “Life is messy. Life is sad. Sometimes life is hard, but the majority of people don’t post those things.”

Hess acknowledges that social media and digital devices have provided a lifeline for kids stuck at home, but she warns that there is a subset of kids who are particularly vulnerable to manipulation and developing a negative self-perception based on what they experience online.

Talk to your kids

Dr. Jessi Gold, assistant professor of psychiatry at Washington University in St. Louis, says that while Bark’s data seems concerning, she cautions against catastrophizing. Certainly, there is evidence that teens are not coping well with the conditions of the pandemic. However, Gold notes, the jump in worrisome activity may be because teens are working through their feelings online, in messages and on social networks with their friends.

“Simply having [a suicidal thought] is not cause for the immediate emergent fear that you need to go to a psychiatric hospital,” she says. “It’s more of an indication that help is needed and support is needed and conversations are needed.”

To provide support, the American Foundation for Suicide Prevention suggests parents get in the habit of talking to their kids about their mental health. The organization recommends parents model these kinds of conversations by talking about their own struggles. They can also simply ask their kids how they’re doing. Asking open-ended questions, ones that can’t be written off with a simple yes or no, is a good way to get more insight into what a child is feeling. Rather than offering solutions, listen to what they’re feeling, ask them to expand on their experiences, and validate them. Experts say it’s also okay to ask your child directly if they are having or have ever had suicidal thoughts.

“There’s this belief that if you talk about suicide, that you’re going to implant the idea on someone and then they’re going to want to kill themselves and all the data on that is false,” Gold says. “If you talk about suicide with your kids, you’re actually helping them, because you’re becoming a person they can talk to about these things.” Through such conversations, a parent is better equipped to determine whether their child needs professional help.

In addition to talking about mental health, Hess advises parents to look at social media with their kids in order to understand what they’re seeing when they scroll through apps and social sites on their own. She says she does this with her own daughter. “I actually pick and choose things that we look at together, like a post on TikTok, for example,” she says. “She’ll be like, ‘Oh, that’s so cute, that’s great.’ And I’ll say, okay, let’s look through the comments.” Then they talk about any bullying they see in comments and how it might make the poster feel: “She’s seeing the things that I feel like she needs to be aware of before she experiences it herself, because she is going to experience it herself.”

What schools can do

Anthony Wood, chair of the board of directors for the American Association of Suicidology, says the burden of connecting kids with care shouldn’t rest solely on parents. He believes there are steps schools could take to ensure they’re providing the mental health services kids need.

“It all comes down to resources—it’s not just money,” Wood says. “And nobody wants to hear that. What they would like to hear is you’re going to a make a manual and you’re going to give it to the teachers and they’ll just add it on to what they do.”

With pandemic-related federal and state funding in hand, many schools are investing in student mental health. Their approaches differ, with some building out social and emotional training programs and others putting money into computer games that strengthen executive functioning. Many have tried hiring mental health professionals with limited success, given the overall dearth of available experts.

Wood believes that there’s also an opportunity to use big data platforms to both identify students in need and as a way to understand what kind of help to provide. He says that services like Bark, which monitors children’s digital behavior and serves up an analysis of potential behavioral red flags, could be deployed in schools to look for kids who may be having trouble. Wood contends that school is almost entirely digital now, even without the pandemic forcing classes online: “There’s no paper left,” he says. If schools were to use software to scan classroom interactions and changes in student behavior, he believes school administrators could not only help set up individuals with care but they also could see trends in needs among their student population.

“If you know that you’ve got a lot of kids that have a specific kind of problem that need a specific kind of intervention,” he says, “you can deliver it on time.”