If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741.
In the Wolcott public schools in Connecticut, a tiny therapy dog named Gizmo provides a path for elementary students to talk about something adults often find unthinkable: children experiencing thoughts of suicide.
Teachers use a curriculum built around the dog to lead 5th graders though discussions of mental health, signs that they may have unhealthy feelings of sadness or hopelessness, and ways that they can both self-calm and find help for themselves or friends.
The program, launched in 2019, is one of the few in the nation focused on suicide prevention and mental health for the youngest students. It’s a crucial but often missing piece of mental health support in schools, experts say. While rates of suicide among children 5 to 11 have risen on average 15 percent a year from 2013 to 2020, school districts often provide less support at the elementary and middle school levels to help students with serious mental health issues, including severe depression, suicidal thoughts, and self harm.
“A lot of adults view elementary school-aged kids as incapable of experiencing the level of emotional distress that could lead someone to consider suicide, but we know very objectively that’s not true,” said John Ackerman, a clinical pediatric psychologist and the suicide-prevention coordinator with the Center for Suicide Prevention and Research at Nationwide Children’s Hospital.
While risk of suicide and suicidal ideation rises with age, and most suicide-prevention programs in schools focus on teenage suicide, as of 2020, suicide has become the second leading cause of death for those 10 to 14 and the 10th leading cause of death for those ages 5 to 9, according to the most recent data from the Centers for Disease Control and Prevention.
Suicidal behavior among children can look significantly different from that among adolescents.
“Research shows now that young kids, as young as 5 or 6, understand that killing oneself leads to death, but they don’t always understand the permanence of that,” Ackerman said. “We know that young kids absolutely can be in deep, emotional pain. They can have a desire to die but not always fully understand the implications of that. So their behavior can be a lot more impulsive; moving from thought to action happens more swiftly.”
Children with attention deficits or depression had a higher risk of suicide, but the National Institute of Mental Health found less than a third of children who die by suicide had a previously diagnosed mental illness. By contrast, about 40 percent of the children had family instability such as divorce, parent depression, or substance abuse, and a third of the children had experienced school disruptions—both problems that have worsened during the pandemic.
“Along with school shutdowns, … the pandemic disrupted [parents’] livelihood, employment, and that family stability that younger children really need in their lives,” said Ellyson Stout, the director of the Education Development Center’s Suicide Prevention Resource Center. “So, you know, I think there’s a lot of added stressors for younger populations.”
Those stressors have heightened both the need and impetus to boost mental health supports and training for children and preadolescents, who historically have fewer school-based mental health supports than students in high schools. For example, in the first eight months of the pandemic alone, the CDC found the share of mental health emergencies—including suicide attempts, self-harm, and serious panic or depressive episodes—jumped by about a quarter for children 5 to 11 and nearly a third for those 12 to 17.
Communities of color and low-income communities have experienced disproportionate illness and financial instability during the pandemic and historically have had less access to mental health support. Suicides among children of color have risen disproportionately quickly both before and during the pandemic, prompting congressional concern. Compared to teenagers, preteens and younger children who die by suicide are more likely to be Black or male.
Averting early mental health issues
Nine states have enacted new suicide-prevention legislation involving schools since 2019, according to the Education Commission of the States, but only a few apply to younger children. Mississippi now requires all elementary and middle school teachers to receive training in children’s mental health every two years, while Illinois, Washington, and Wisconsin require public schools to include contact information for suicide prevention on all student-identification cards. Several states have also moved to allow students to take excused mental health days.
“I do think early-childhood screenings should be asking about self-harm and suicide,” said Deanna Barch, a professor and the chair of psychological and brain sciences at Washington University. “Asking can reveal the need for intervention and supports for a child with such thoughts even when they might not appear to be clinically depressed.”
Barch and her colleagues found that is often the case; adults typically only know about a quarter of the times children have suicidal thoughts.
You should train anybody that kids have access to, because kids don’t necessarily go to a teacher.
A study by the National Institute of Mental Health finds that nearly 80 percent of 5- to 11-year-olds who died by suicide between 2013 and 2017 had mentioned killing or harming themselves in the past, but only about 1 in 10 of them talked about killing themselves close to the time they did so.
“Not surprisingly because of their age, children tend to be less able to verbalize thoughts of not wanting to be alive,” Ackerman said. “A lot of times, younger kids think they’re going crazy. It’s a source of shame for them that they’ve even had [a suicidal] thought. They don’t understand what’s going on and so they hide this.”
Children experiencing suicidal ideation may talk about “not wanting to be around anymore” or “going away and not coming back” rather than explicitly mentioning hurting or killing themselves, he said. Even more often, they may say nothing at all but instead show themes of violence or death in play or experience somatic behaviors like anxiety and irritability, stomachaches, and headaches.
“In a school setting, and certainly in an elementary school setting, mental health distress or stress can come out in certain behavioral issues in those students,” Stout said. “And we know from the evidence that that kind of acting out often receives some more-punitive response if the young person is a person of color.”
Moreover, Stout noted that many teachers have experienced trauma, stress, and burnout in the last few years and “teachers who also have experienced trauma, I’m not sure they’re as equipped to bring a trauma-informed lens to their work with kids. … So for kids acting out, the adults in the school may not be prepared to respond as constructively as they need to.”
Experts say adults need to talk about mental health risks
Training adults to be more comfortable discussing suicide, self-harm, and other severe mental health challenges can help avoid such problems as children get older. Prior research has found that children who attempt to kill themselves are six times more likely to try again as adolescents.
If conversations are held in a developmentally appropriate and sensitive way, “it’s not distressing for children to have an adult ask about [suicide], but typically adults avoid this topic. So if an adult is willing to be a trusted support, then it allows children to not hide these thoughts,” Ackerman said.
That’s why, in addition to providing suicide-prevention curriculum to elementary and middle school students, the Wolcott district trained all staff, from teachers and paraprofessionals to bus drivers and custodians, on how to recognize signs of depression and suicidal ideation among children and ensure every student has a “trusted adult” at school listed in case of emotional distress.
“It’s a gatekeeper program. If a student comes up and has suicidal ideation or is talking about self-harm, [staff] are not really doing the counseling, but it’s for the staff to recognize some of the language and the concerns and then refer to a counselor or a school psychologist,” said Kevin Hollis of the Wolcott public schools.
“You should train anybody that kids have access to, because kids don’t necessarily go to a teacher,” Hollis said. “They may feel more comfortable and have a relationship with a custodian or somebody in the cafeteria or the bus driver.”
In a nationally representative survey of school and district leaders conducted in January and February, 1 in 4 told the EdWeek Research Center that their districts have begun or expanded suicide-prevention training for staff and teachers since the start of the pandemic.
Studies do show that one suicide can raise the risk of other suicides among children and teenagers who knew or identified with the person in the community. Experts say it is important for educators and school leaders to actively respond to the death and give students the chance to grieve and discuss it.
“The fear of [suicide] contagion often causes schools to sort of go silent after there’s a suicide death in the community,” Stout said. While experts say memorials should be brief and not sensationalize the way a student died, “the best response is to act as you would if a young person had died of a car crash or cancer; allow the collective grieving.”
Educators also can take the opportunity to make students aware of how they can get help if they have similar feelings of hopelessness.
“Young people who are in that level of distress usually feel a lot of relief at being able to talk about suicide. So asking, ‘Are you thinking about ending your life?’ it opens a door to a young person being able to express what they’re going through,” Stout said. “I think we all intuitively don’t want to go there and are worried that we might be introducing the concept, but talking about suicide does not cause suicide.”
