If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en español: 1-888-628-9454; deaf and hard of hearing: dial 711, then 1-800-273-8255) or the Crisis Text Line by texting HOME to 741741.
It was over a decade ago when Regina Crider's daughter first attempted suicide at age 10.
"As a mom, the thought of losing your child to suicide is overwhelming," says Crider, who is the founder and executive director of Youth and Family Alliance, a support group for families of youth with mental illness in Rantoul, Ill.
Crider was upset and confused and felt that she had failed as a mother.
"I felt like maybe I missed the signs," she says. "Because I work with families, why didn't I see it?"
Her daughter survived the attempt, but the fear of losing her kicked Crider into action. "I needed to understand why and what I could do [to help her]," she says, "because I didn't want to come home to her gone."
That started her years-long journey into figuring out how best to help her daughter with her mental health struggles — a journey that hasn't ended for the family but has gotten easier over time.
As the coronavirus pandemic has worsened the mental health of kids, more families are dealing with their children feeling anxious and depressed and thinking about and even attempting suicide. But mental health professionals say that suicide is preventable and that parents and family members can play an important role.
It's hard work that requires parents to listen to their children, acknowledge their struggles and help them find a way out of their darkness. And in the long run, it calls for creating a home environment where kids feel safe sharing their emotional lives and where families solve problems together.
Here are some specific things that parents or a family member can do to help.
1. Get support for yourself
This could be a long and difficult journey, so parents need to have emotional support themselves, Crider says.
"If it's a friend's house that maybe they can go to if they need to have a meltdown, to release all of that," says Crider. "They need to be able to talk about this, even if it's going to therapy."
When she was dealing with her daughter's suicidal behavior, Crider says she found support in her sister and her staff.
Reann, a mother of two kids in Illinois, sought therapy for herself so she could better help her daughter when she started to struggle with anxiety and self-harm last year. (NPR is using only her middle name to protect her and her daughter's privacy.)
"Definitely seeing a therapist really helped process just the pandemic anxiety in general," she says. "And then [it] gave me a way to feel like I wasn't screwing everything up with what was going on with my daughter."
Opening up about what's going on is the key to finding resources to help your child, says Dr. Richard Martini, a child psychiatrist at the University of Utah. "Parents need to feel comfortable reaching out."
Crider says peer counseling groups like her own are also a good source of support and education for parents.
The National Alliance on Mental Illness is a good place to find support groups in your community or region. The American Association of Suicidology also has a directory of support groups. And Suicide Awareness Voices of Education has a guide on how parents can be partners for their kids.
2. When a child shares they're in crisis, react calmly and be accepting
It can be hard for a parent to understand why their child is considering suicide — even so, parents need to resist reacting with shock or skepticism.
"As a parent, the first thing you think about is 'you have a place to stay, you have food, you have clothing, we love you,' " says Crider. "What could possibly be the issue?"
But someone who is feeling suicidal or depressed is already overwhelmed and may be unable to see a way out of their pain and problems.
Instead of getting upset, parents should respond calmly and "put their game face on," says Megan Hilton, a senior at Ithaca College, who has struggled with depression and anxiety and is a survivor of suicide attempts.
"When I've come to my parents, their reactions have been way over the top," says Hilton. "And I've felt like I'm responsible for their emotions now. It just adds a lot more pressure to things."
Hilton attributes a great deal of her recovery to her older sister's support, precisely because she was not phased when Hilton was in moments of crisis.
Parents should also "really try to listen to what your kid is saying," says Hilton.
When she first told her father she was depressed, Hilton remembers him telling her to "buck up, wipe it off, you're fine."
"To somebody who's genuinely depressed, [who] is really not able to get it together, it is a very difficult thing to hear from a parent," says Dr. Vera Feuer, a child psychiatrist at Northwell Health in New York.
Children who are struggling need their parents to tell them "that the feelings are valid and that these struggles are real," she says.
One way to do that is by asking more questions. "Parents should ask, 'Tell me more. What is it that you're having a hard time with?' " suggests Feuer.
If they aren't comfortable sharing with you, Feuer suggests you ask if there's someone else whom they'd rather talk to, like another relative, a teacher or a school counselor.
3. Help problem-solve and find reasons to hope
If your child confides in you about their struggles, offer them hope and reassurance, says Feuer.
As psychologist Ursula Whiteside told NPR, some useful things to say are: "I know how strong you are. I've seen you get through hard things. I think we can get through this together."
Feuer says it's important for your child to know that you think there are solutions to whatever they are grappling with. She suggests using language like: "We'll go and get whatever help you need so that you can feel better and you can be your best."
Hilton cautions that not everyone needs the same thing when they're feeling down.
"A lot of times, people try to comfort or fix things the way that they would want it," she says. "Like if you're feeling really depressed and isolated, some people might be like, 'Well, what gets me out of a depression is to go exercise and go for a run.' And it might not be someone's thing."
So, she suggests, ask them what they need and support them in getting that help.
4. Teach them a vocabulary for sharing their feelings — and model sharing your own
Kids who are struggling emotionally need help identifying their emotions and what's causing them.
This is "where you begin to do the work and start to heal around things," says Hilton.
"When I was younger, I would just get so stuck on the initial 'I feel so awful' or 'I'm feeling this immense emotion right now,' " she says. "And I couldn't get what's behind it. What is causing this?"
She says that this ambiguity used to make her feel helpless. But in therapy, she learned the vocabulary to identify her specific emotions, like anger or sadness, and explore what was causing them.
"The more you do it, the better that you get," she says.
And parents can lead by example, says Feuer, "by labeling and discussing our own feelings and our own struggles and really modeling for our kids how we talk about [emotions], how we cope in healthy ways."
This is especially important during the pandemic.
"It's OK for you to sit down with your kids and say, 'This is a very stressful time. We're all going through something. But we're a family. We love each other,' " suggests Crider. "We encourage there to be open communication."
Having conversations like these can help kids feel safe about opening up.
"It's the feeling of acceptance, it's the feeling of being supportive, it's the feeling of being heard, it's the feeling of 'our family is working together,' " says Crider.
And that family connection alone can buffer your child against stress, which is particularly important right now.
5. Seek professional help, starting with your pediatrician
Navigating the mental health care system can be daunting, especially if you have never done it before.
If you need immediate support for a child's crisis, call the National Suicide Prevention Lifeline. You can talk to a trained counselor about your child's symptoms and be connected with local resources.
Another good place to start is your pediatrician's office, says Dr. Sandy Chung, the medical director of the Virginia Mental Health Access Program, which trains and supports pediatricians to provide mental health care.
There are similar programs in more than 30 states around the United States. So your pediatrician may be able to treat your child themselves or at least refer you to the right person.
"It may be going to the emergency room if your child is in crisis," says Chung. "It may be referring to a child psychiatrist, if there's one in your area. ... So your pediatrician will know what to do."
You can also look for a therapist yourself using the online directory at Psychology Today, suggests Reann. That's how she found a therapist for her daughter last year.
6. Educate yourself and stay involved in your child's treatment
A parent's job doesn't end with finding their child a therapist; they have to stay involved in that process, inform themselves along the way and advocate for their child.
When Crider's daughter was 14, she was diagnosed with autism and severe anxiety.
Once they had the diagnosis, Crider learned more about autism and how it was affecting her daughter's emotional and social life. She finally understood why school had been such a source of stress and anxiety for the girl, who she says "had a hard time socializing with peers."
What also helped Crider's own education was going to therapy with her.
"We saw the same therapist," she says. "The therapist would talk with her, then she would talk to me and then she would share with me what was appropriate in therapy, how to support [her]."
Along the way, she learned about her daughter's triggers — her main one was school — and she was able to better advocate for her.
"I really began to work more closely with the school to help her to feel like she can come to the school and be in a safe space, not being judged or [criticized] by students or teachers," says Crider.
It's important to find a therapist willing to work with the parents, says Reann. Her daughter's therapist spends some time at the end of each session explaining to Reann what her daughter is struggling with and gives Reann tips on how she can best support her daughter.
7. Remove dangers from the home environment
Suicidal thoughts can span a range of severity. Occasional passing thoughts are common and don't necessarily pose an immediate risk to life. But more persistent thoughts that lead to someone making a plan and thinking about means puts that person at higher risk.
If your child has a specific suicide plan, prioritize removing the means from your home, say suicide prevention experts. It is one of the easiest and most well-proven ways to prevent suicide.
"A lot of the time, thoughts about suicide or ending one's life come as a wave," says Feuer. "And then if you have nothing to hurt yourself with, the wave passes and you feel better."
Guns and other weapons at home should be removed or safely stored, she says. And "medications — over the counter and prescription — should be out of reach and locked up."
And you don't need to do this discreetly, she says. Talk openly with your child about what you're doing and why.
You can tell them, " 'We're doing all of these things because for the time being, you're really struggling and we understand that it's hard,' " says Feuer. "Adolescents really respond well to honestly discussing with them what's happening."
8. Learn the early warning signs of a crisis
Look for sudden changes in behavior and mood, and listen for language that suggests they're thinking about killing themselves.
According to the American Foundation for Suicide Prevention, behavior changes such as withdrawing from social activities, sleeping too much or too little, and drug use are among signs to watch for. (See the AFSP's full list here.) Watch for irritability or anger. They are signs of depression too.
Also pay attention to how they're doing at school, suggests Martini, the University of Utah child psychiatrist.
"Most kids want to do reasonably well in school," he says. "I think particularly when they fall far behind, then they can easily get into feelings of hopelessness and helplessness."
Crider says that over the years, she and her daughter have learned to recognize the earliest signs of trouble bubbling up before it becomes a crisis — what she describes as "the rumbling stage."
"I can say during that time, 'Are you using your coping skills? Can we identify what's stressing you, what's challenging you?' "
Her daughter's coping skills include writing, singing, listening to music and going for walks. Those things "calm her down, bring her joy, take her away from whatever negative space she's in," says Crider.
9. Make room for family fun time
Helping kids with mental health struggles doesn't have to be all serious. It's just as important to make time regularly to have fun as a family, especially during stressful times like right now, say parents and mental health experts.
Whether it's watching a movie, cooking or baking together, going for a hike or doing any other activity, family fun times are good for several reasons, says Dr. Susan Duffy, a professor of pediatrics and emergency medicine at Brown University.
First of all, having fun together helps everyone destress, which, at a time like this pandemic, helps everybody.
And "it's allowing a positive interaction between a kid and a parent, instead of arguing over schoolwork," says Duffy. "It's reinforcing a bond between a parent and a child, which right now is more important than actually completing a lesson."
Reann says her family started doing regular gymnastics nights during the pandemic. "We would do movement challenges, like who can do the longest handstand or silly walks," she says. "Something fun, something totally ridiculous. It gave them something to look forward to."
These activities also create natural opportunities to talk.
"A lot of the reason that we're seeing an increased number of kids with suicidal ideations, it's a symptom of underlying anxiety and depression and hopelessness," says Duffy. "So by having conversations that are about something else, that leads to further conversation about 'What are the stressors? What's bothering you? What's going on in your life?' "
It can help parents gain more insight into their child's life and mind and also do something we mentioned earlier — create a safe space for kids to share their struggles.
Christine Herman of member station WILL contributed to this report.