BACK TO BLOGAngela McMillan is an accredited counsellor, trainer, coach and researcher, working mainly with neurodivergent young people and their families. She is Director of Elemental Health where she provides counselling, support and training for youth professionals, young people and their families. She works with foster children and carers and has her own lived experience, including anxiety and trauma.
World Suicide Prevention Day (WSPD) is an awareness day on 10 September every year, in order to provide worldwide commitment and action to prevent suicides.
We asked Angela McMillan to write an article to help you navigate the issues that children in your care may face regarding suicide and suicidal thoughts.
“I don’t want to be here anymore. You’d be better off without me!”
Words that can fill our hearts with fear and dread when we hear a child say them out loud.
Thoughts of suicide and suicide behaviours can feel like they come out of nowhere and when they show up, we can often feel helpless and afraid. Scared that if we say too much, we might get it wrong or make things worse.
As a foster carer, you play a crucial role in the lives of the vulnerable children and teenagers you support and while this can be incredibly rewarding, it also comes with huge responsibility.
Note ** If you have recently been bereaved by suicide, I would like to invite you to only read this if you feel sufficiently emotionally resourced and that you have the support around you, to help you navigate through this. Everything in this article is for the what ifs of the future and not the past.**
The impact of trauma in all its forms can be devastating and long lasting. As foster carers you are often in a position of not knowing the full extent of what has happened to the children in your care. The first few months or even years (depending on your caring responsibilities), can result in you feeling like a detective,trying to put the pieces together, to fill in the gaps, to help your child share their story so that you can offer the best possible support.
When a child experiences thoughts of suicide, they often believe that this is the best possible option for everyone and that the world would be a better place without them in it. They are often in a huge amount of emotional distress and turmoil and the thought of continuing to live can feel too painful.
Whilst you will feel totally differently to them; because you can see how they have so much to offer the world, it can be incredibly hard trying to persuade someone in the depths of despair that their life is worth living.
As a child and teenage therapist, who has worked with thousands of suicidal young people, what I want, is to offer some hope to you because I believe that anything you try to do, can and will make a difference and has the potential to save someone’s life.
I would like to say that whilst the warning signs can often be there, they can be far more subtle and difficult to spot if we don’t know what we are supposed to look for.
As a wise supervisor once said to me:
“We can only do what we can with what we have”.
What to look out for
We don’t always have the luxury of knowing a child well, especially if they have just come to live with us. Here are some common risk factors for a child or young person experiencing thoughts of suicide:
1. Risk Factors
- Previous Trauma:
Many foster children have experienced abuse, neglect, or other forms of trauma, which can contribute to feelings of hopelessness or worthlessness.
- Mental Health Issues:
Pre-existing conditions such as depression, anxiety, or PTSD increase the likelihood of suicidal ideation.
- Neurodivergence:
Our neurodivergent children are at increased risk of experiencing thoughts of suicide and of suicide behaviours.
- Family History:
A history of suicide attempts, a recent bereavement by suicide, mental health issues,or substance misuse in the child’s family can be significant risk factors.
- Social Isolation:
It is no surprise that many of our children will have attachment and developmentaltrauma. They may find it difficult to form relationships, or understandably, to trust others especially in a new environment, which can lead to feelings of loneliness and despair.
- Bullying:
Children who have been or are currently being bullied, either in person or online, are at greater risk.
- Relationship breakdown
This can be partner relationships, friendships or family breakdown. Other risk factors include substance misuse, poverty, addiction including gambling, homelessness or being at risk of homelessness.
2. Warning Signs
The term “tacit knowing” describes not just your intuition but all your life experience and knowledge, along with all the training and experiences you may have had as a carer. These combine to having a gut feeling or a sense that something isn’t right.
Trust this.
If you get it wrong the worst that will happen is your child or teenager will look at you as if you have grown a second head. Better to ask and to ask twice “Are you ok really?” than to not say anything at all.
- Talking about death or suicide:
Direct or indirect statements about wanting to die or feeling hopeless are red flags.
- Changes in mood:
Sudden shifts in mood, especially towards despair, hopelessness, becoming agitated, or angry, including starting fights with others or causing physical harm to themselves can be clues.
- Social withdrawal:
A child who isolates themselves from others, showing little interest in what they used to enjoy, may be struggling.
- Changes in appearance:
A significant decline in self-care can be a sign of distress or you may see theopposite, with increased time being spent on appearance or make up as a way of masking what they might be feeling inside. Any change is worthy of a conversation.
Giving away possessions:
If they start giving away their belongings, it could indicate they are preparing to end their life.
3. Language
The language a child uses can provide clues to their mental state:
- Hopelessness:
Phrases like “What’s the point?” or “Things will never get better” can give clues that they are feeling helpless or hopeless.
- Burden:
Statements such as “You’d be better off without me” suggest they may feel like a burden and see suicide as a way out.
- Finality:
If a child speaks as though they are saying goodbye or planning for something final, this should raise immediate concern.
4. Behaviour
Certain behaviours can also indicate thoughts of suicide.
- Risk-taking:
Engaging in dangerous activities, such as recklessness, not caring about safety and substance abuse, can signal a disregard for life.
- The media they are accessing:
Song lyrics, films, TV shows along with social media (if they have access to this) can all provide valuable information as to how they might be feeling. They may not be able to tell you in words but might be able to show you or want you to hear.
- Researching methods:
If you notice that they are researching ways to die, it’s a clear sign that they need immediate help.
- Sudden calmness or unexplained recovery:
If a child who has been distressed or suicidal in the past suddenly appears calm, it may be because they have resolved to take their own life.
5. What to Do
If you suspect a child in your care is experiencing suicide thoughts, it’s vital to act quickly:
- Meet them where they are:
I often describe this as standing waist deep in the mud with them. We don’t want it to consume us but we need to get in there with them to understand what’s going on and so they don’t feel completely alone. We also need to be able to offer a helping
hand to get them out again.
One of the biggest fears people have is not knowing how to start a conversation. If you are worried that your child is experiencing thoughts of suicide help them share their story with you. It’s unlikely they will just come out and say it, so we might need to go slowly.
- Listen to what they are telling you:
Whether that’s through their words, behaviours, language, actions or even how they are in relationship to others can help to build a picture.
- Ask them directly:
“Sometimes when people feel like they are all on their own they feel like they don’t want to live anymore.”
“When you say we would be better off without you, do you mean you don’t want to be alive anymore?’
Ask them directly about their feelings. Talking about suicide does not put the idea into their head but it can provide an opportunity for them to share their struggles.
Finding the words that suit your own way of speaking can be useful. “When you say you just want to die do you mean dead now or dead forever?” Your child doesn’t need therapy speak or long words. They need your voice!
- Listen without judgment:
You are likely to feel upset, scared, angry or any other range of big emotions. Offer a non-judgmental, supportive space and make sure you take time to process your feelings too.
It can feel hard to not say things like “try not to do anything silly” or “things will get better” but in this moment what they need more than anything is to know that you get how hard this is for them right now and that you’re going to do everything you can to get through this together.
- Make sure someone stays with them:
An obvious one but worth sharing, make sure you are very nearby if not directly with them.
- Remove potential means to harm themselves:
Ensure that any means to harm themselves including medications, alcohol, and objects are inaccessible.
- Seek professional help:
Contact mental health professionals like CAMHS immediately.
In an emergency, don’t hesitate to go to A&E.
There are some great helplines too like Childline for them, Papyrus for them and you and CALM.
6. What to Say
Express concern:
Let them know you care about them and that they are not alone in this.
Reassure them:
Let them know it’s okay to feel what they are feeling, and that help is available.
It can be useful to think about how to have these conversations. I cannot recommend the Suicide First Aid or Applied Suicide Intervention Skills Training (ASIST) training courses highly enough – if your agency offer this training this is a really great opportunity to practice with like-minded others. It can offer stability in a crisis.
7. Short Term Support
In the immediate aftermath:
- Create a safety plan:
Work with mental health professionals to develop a plan that includes coping strategies, emergency contacts, and safe places the child can go. I love the Stay Alive app which you can adapt if they don’t have phone access. This helps you create a toolkit so they know what to do if the thoughts come back.
- Increase the amount of time you spend with them:
Ensure they are not left alone for too long, and that they are in a supportive, environment. This can be tricky for young people. They may feel as if the crisis has passed whilst you are very likely to be on high alert. Try and make a safety plan together so that you work towards them having some privacy whilst recognising that you will be wanting to check in on them more frequently.
- Communication:
Something that can work well is having a shared approach so you can communicate with each other. Not every child wants to talk but they may still want you to know that they are having a bad night. Whether it’s putting an item of clothing on the door handle to signal to you that it’s been a terrible day or whether you communicate using an agreed set of emojis if they have a mobile phone, working together takes the pressure off both/all of you.
- Encourage connection:
Help them connect with others who can offer support, whether it be friends, trusted adults, support workers or professional counsellors.
8. Longer Term Support
- Therapy:
Long-term therapy, including play therapy, life story work, or trauma-informed therapy, can be invaluable.
- Show them you care:
Many children do not believe they are loveable or that adults can be trusted. Telling them you care about them is often rejected as it can feel too painful to open up and to trust, especially if they have recently started living with you. Instead show them they are important, from buying their favourite foods to letting them know you have their favourite movie on standby you are letting them know that you have been holding them in mind. This may be their first experience of having a safe and caring adult in their world.
9. Your Self-Care
- Seek support:
Don’t hesitate to reach out to your own support network, whether it’s fellow foster carers, a therapist, or a support group.
- Practice self-care:
Ensure you’re taking care of your own mental and physical health. This might include movement, healthy eating, or taking time for yourself. I know this can sound like a throw away comment and when things are in crisis it’s difficult to take more than a minute, but even if this is a few big deep breaths with the window open or staying up for an extra ten minutes to catch a few moments of a book or show it’s crucial to pick out pockets of time to self-care.
- Supervision:
Your agency and supervising social worker are there to support you. Take time to process with them about how you are feeling.
Supporting a child or teenager experiencing thoughts of suicide is challenging, but with the right knowledge and approach, you can provide the support needed to guide them through this difficult time. By being open, compassionate, and proactive, you might just save their life and help change the way they think and feel about themselves.
Remember, you’re not alone.
As a FosterTalk member you have access to our free counselling service. Please call us on 0121 758 5013 and we will transfer you.
If you or someone you know if feeling overwhelmed or needs someone to talk more urgently, please call Samaritans on 116 123.
