This article discusses suicide. If you or someone you know is at risk of suicide, please call the US National Suicide Prevention Lifeline at 1-800-273-8255, text HOME to 741741, or go to SpeakingOfSuicide.com/resources for additional resources.
Muir Wood Adolescent and Family Services provides gender-specific behavioral healthcare for adolescents and teens 12–17 years of age. Like other specialized care providers nationwide, Muir Wood is on the front lines of an intensifying mental health crisis affecting young people. While epidemic rates of depression, anxiety, mood disorders, and suicidality among teens are well-known problems that make national headlines, the specialized resources needed to treat these conditions are scarce, and individuals and families affected by these conditions can have difficulty finding the help they need. Across the country, teens and parents are finding themselves waiting in hospital emergency rooms after being admitted for suicidal thoughts or attempted suicides. These families often wait days or weeks for an available bed in a psychiatric hospital or specialized treatment program before the children can be assessed or treated for the issues and conditions that led them to feel suicidal.
“We have never witnessed this level of need for mental healthcare,” says Scott Sowle, Founder, and CEO of Muir Wood Adolescent and Family Services. “We saw increased demand for treatment services before the pandemic, and now we may be seeing just the tip of the iceberg. We are concerned that many young people either have not made their condition known to others who are in a position to get them help or are unable to find care.” According to the 2022 State of Mental Health in America report, sixty percent of youth experiencing major depression do not receive any form of treatment. “The number of young people and families seeking help for suicidal ideation is staggering.”
The current generation of Americans born after 1995 is “at the forefront of the worst mental-health crisis in decades, with rates of teen depression and suicide skyrocketing since 2011,” wrote psychology professor Jean Twenge in her 2017 book iGen. That assessment was made before the traumatic COVID pandemic was added into the mix.
The Centers for Disease Control and Prevention (CDC) reported in June that the proportion of mental health-related emergency department (ED) visits among adolescents aged 12–17 years increased 31 percent during 2020 compared with the year before.
In May 2020, during the initial COVID-19 surge and the resulting lockdowns, “ED visits for suspected suicide attempts began to increase among adolescents aged 12–17 years, especially girls. During February 21–March 20, 2021, suspected suicide attempt ED visits were 50.6 percent higher among girls aged 12–17 years than during the same period in 2019; among boys aged 12–17 years, suspected suicide attempt ED visits increased 3.7 percent.”
The numbers are particularly troubling as the increase occurred following the declaration of the COVID-19 pandemic as a national emergency and a concurrent 42 percent decrease in the total number of US emergency room visits.
The latest CDC data are “consistent with past research: self-reported suicide attempts are consistently higher among adolescent females than among males, and research before the COVID-19 pandemic indicated that young females had both higher and increasing rates of ED visits for suicide attempts compared with males. However, the findings from this study suggest more severe distress among young females than has been identified in previous reports during the pandemic, reinforcing the need for increased attention to, and prevention for, this population.”
In September 2020, the CDC issued a National Vital Statistics Report on suicide rates among adolescents and young adults aged 10–24. The summary is grim reading:
“Between 2007 and 2018, the national suicide rate among persons aged 10–24 increased 57.4 percent. The increase was broad, as it was experienced by the majority of states. Forty-two
states had significant increases in their suicide rates between 2007–2009 and 2016–2018, and eight states had nonsignificant increases. Most states had increases of between 30–60 percent.
Suicide rates in 2016–2018 were highest in Alaska and lowest in New Jersey.”
The CDC report broadly confirmed a 2019 study that found that the number of children and teens in the United States who visited emergency rooms for suicidal thoughts and suicide attempts doubled between 2007 and 2015.
Members of the Muir Wood team have been touched personally and professionally by the issue of adolescent suicide. Muir Wood Chief Operating Officer, Bryan Bowen, recently discovered that a close friend had been suffering silently with his child’s attempted suicide. In addition to causing anguish for many people who know suicide victims, the issue of suicide carries a heavy stigma that leads people to keep it a family secret. “Even though I work with teens and the increased prevalence of suicidal ideation and teen suicide, recently I have had a personal experience that speaks to the difficulty parents face and the shock of hearing about a teen you never thought was suffering. Recently a dear friend of decades, with many years of their own recovery, shared with me about his daughter, a dear smart, and witty young girl, who is a senior in high school. He hasn’t been able to share with anyone, not even his father, that his daughter had a month earlier taken all of her depression meds in an attempt to end her life. He was stricken with confusion, fear, worry, and some misguided shame about his parenting. This is a nationwide epidemic amongst teens, in my opinion, and as the COO of Muir Wood, a crisis that we are continually expanding our clinical and psychiatric robustness around.”
While the CDC has refrained from offering a cause for the dramatic increase in adolescent suicidal ideation, others have picked up on Professor Twenge’s suggestion that social media platforms are an important element of the mental health crisis.
The CDC reports are just the latest among many red flags about teenage mental health that have appeared in recent years. According to research published by the American Psychological Association (APA) in 2019, the percentage of teens and young adults with depression, anxiety, and other mental health problems has increased dramatically over the past decade—a pattern not seen in older adults. The APA research found that the rate of adolescents reporting symptoms consistent with major depression in the last 12 months rose from 8.7 percent in 2005 to 13.2 percent in 2017. In young adults aged 18 to 25, it increased from 8.1 percent in 2009 to 13.2 percent in 2017.
The reasons for this escalating mental health crisis are complex. For Professor Twenge, one main reason for the perpetual angst of today’s young people is their relentless use of smartphones combined with a lack of face-to-face interaction. “The number of teens who get together with their friends every day has been cut in half in just fifteen years, with especially steep declines recently,” notes Twenge.
At the same time, there is enormous pressure to “perform” for peers on social media and exposure to cyberbullying if they do not conform to expectations. The effects of social media on mental health “seem to be strongest for the youngest teens, social media can inflame anxiety among those who are susceptible, and those who truly crave the ‘hit’ of likes are often those who are the most vulnerable to mental health issues,” warns Twenge.
News coverage and social media feeds increasingly connect real and perceived threats to safety and well-being to adolescent anxiety. Troubling themes, including the climate crisis, school shootings, rising college loan debt, and a variety of other major social challenges have become prominent. Because teenagers and young adults rely heavily on mobile devices and social media for information, they may experience a significantly higher number of negative news story impressions than previous generations who relied on traditional media for their news.
“Climate change can be considered an additional source of stress to our everyday concerns, which may be tolerable for someone with many sources of support but can be enough to serve as a tipping point for those who have fewer resources or who are already experiencing other stressors,” the APA stated in its 2017 report on the impact of climate change on mental health, co-authored by Climate for Health and EcoAmerica, both environmental organizations.
Teens in many areas of the country have been directly affected by ecological disasters like the wildfires in California and gun violence at school. Safety drills that aim to teach children how to respond in the case of school violence may increase stress and anxiety for some students. Increased attention to current and potential sources of stress may play a role in the development of anxiety disorders.
Untreated mental health conditions frequently lead teens to self-medicate with drugs and alcohol. While some families are aware that their children are consuming alcohol, marijuana, or other substances, it often comes as a surprise to parents — especially among parents of young teens.
The co-occurrence of mental health disorders and substance use disorders is common. Muir Wood Adolescent and Family Services specializes in treating these “dual-diagnosis” conditions. It is important for parents to know that substance misuse is not simply the result of making poor choices. It is often an attempt to control symptoms of anxiety, depression, trauma, learning disabilities, and other conditions in order to relieve discomfort and feel normal. Effective treatment must address the root causes of the mental health conditions to reduce the perceived need to self-medicate with substances.
Substance use is also one of the warning signs of suicide, now the second-leading cause of death in 15–19-year-olds. Northwestern Medicine offers the following risk factors and warning signs:
- Existing mental health or substance use disorder
- Impulsive behaviors and tendencies
- Romantic breakups
- Peer or social conflict
- Firearm in the household
- Family history of suicide
- Exposure to suicidal behaviors of others
- Prior suicide attempt(s)
- Changes in eating and sleeping behaviors
- Alcohol and drug use
- Withdrawal from friends and family members
- Neglect of personal appearance
- Lack of response to praise
- Sadness or crying spells
- Posts on social media suggesting feelings of isolation or depression
- Talking about or otherwise indicating plans to commit suicide or self-harm
Muir Wood Executive Clinical Director, Maxwell Keller, LMFT, discusses some of the ways that the program helps clients and families learn to address suicidal ideation. “It is normal to expect that our clients will experience moments of crisis at some point in the future because stressful situations that can trigger feelings of crisis are normal parts of our lived experience. Our goal is to provide clients and parents with the knowledge and tools to reduce the severity and frequency of these episodes and get the help they need to feel safe and resilient. During treatment, we teach clients how to effectively communicate, self-advocate, and self-regulate so that they can get the support they need when they need it. We also teach parents and family members to recognize signs of a potential crisis and how to ask the right questions and take appropriate actions. It can be very hard for parents to talk to their children about suicidal thoughts. However, we know that asking people directly if they are having suicidal thoughts reduces the chances that they will attempt suicide. When it comes to addressing suicidal ideation and reducing risk, learning how to communicate effectively and how to listen effectively is key.”
If your teen is in imminent danger due to a suicide threat or attempt, call 911. The National Suicide Prevention Lifeline at 1-800-273-8255 offers around-the-clock, free, and confidential support.
If your teen is suffering from anxiety, depression, phobias, a personality disorder, substance use disorder, trauma, PTSD, or disordered eating, call Muir Wood at 866-705-0828 to find out how we can help.