Aftermath of suicide attempts - helping families cope

When a child attempts suicide, these emotions hit families like a Mack truck. Some family members bury their feelings deep inside and refuse to accept the stark reality.

Others spring into action and vow never again to let the child who attempted suicide of their sight. But no matter how a family deals with the aftermath of a suicide, they are forever changed by it.

“The repercussions from a suicide attempt can go on for years,” says Daniel Hoover, Ph.D., a psychologist with the Adolescent Treatment Program at The Menninger Clinic and associate professor in the Menninger Department of Psychiatry & Behavioral Sciences at Baylor College of Medicine Houston.

Guilt and shame over a suicide attempt prevent many families from getting the help they need to work through the crisis, Dr. Hoover continues. An estimated 30 percent of families of children who attempt suicide seek family therapy, according to a study published in the Journal of the American Academy of Child and Adolescent Psychiatry in 1997, and about 77 percent of families referred to treatment after an adolescent attempts suicide drop out according to a 1993 Journal study.

Many families don't pursue treatment because they deny or minimize their child's suicide attempt. Teenagers who attempt suicide may also not admit they tried to kill themselves.

“Even when you see a young person in the emergency room right after he or she completed an attempt, very quickly the denial kicks in,” Dr. Hoover says. “She may say, ‘I never meant it,' or ‘it was an accident,' or denying she even made an attempt. Families do the same thing because of the intensity of the suicide issue.”

Complicating matters, teenagers may attempt suicide while in treatment for mental illness, such as depression or substance abuse. Families are reluctant to put their trust in the mental health system again--feeling it failed them.

That's unfortunate, Dr. Hoover says, because families desperately need support and direction after a child attempts suicide. Depression, which leads to suicidal thinking, affects the entire family unit. To move past the tragedy, families must address the issues that the suicide caused, and continues to cause, in their lives. Chief among the issues is the family's increased sense of responsibility for the child who attempted suicide. Worried about a repeat suicide attempt, family members, and parents in particular, feel that they have to watch their child constantly—in some cases, sleeping at the foot of the child's bed every night to make sure he or she won't attempt suicide.

“Parents feel a huge obligation to watch over their child,” Dr. Hoover says, “At first it may seem somewhat comforting to the child, but then the parents become so intrusive in the child's life he or she thinks, ‘I can't live like this anymore.”

Helping families reach that middle ground between protecting and smothering their children is a main goal for family therapy at the Menninger Adolescent Treatment Program, which treats adolescents age 12 to 17. Patients in the inpatient treatment program struggle with family, school and social difficulties because of depression, anxiety, or other psychiatric illness or substance abuse. Some patients also have attempted suicide once or multiple times.

Dr. Hoover recommends individual therapy as well as appropriate psychiatric medication for children who attempt suicide, as most are quite depressed and feel hopeless. Their parents and other children in the family may also benefit from individual therapy, especially if they found them after the attempt.

“Often siblings are just as stressed out as the parents because they find the brother after the overdose, or they are the ones in the background while Mom and Dad and the brother are having all of the conflict,” Dr. Hoover says. “So they have been traumatized by it and they need their own help.”

Working with therapists at Menninger, patients in the Adolescent Treatment Program learn to develop agency, or the ability to take action and exert control, over their mental illness and suicidal feelings. They learn skills to cope, ways to self-soothe and to seek out sources of support other than their parents. They also learn to share their thoughts and feelings with their parents, and to communicate with their parents if they are feeling suicidal.

Parents, in turn, learn how to listen and not overreact.

“When parents witness that their child is handling his or her feelings better, and knows when to seek help, it lowers their anxiety so much,” Dr. Hoover says.

Family therapy immediately following a suicide attempt may not be productive, Dr. Hoover says, because emotions are raw, and the suicide attempt is still fresh in the family members' minds. Once the child who attempted suicide learns how to deal with his or her hopelessness and depression, and the parents begin to deal with their own anxieties and guilty or angry feelings, then they may be ready for family therapy. Family therapy helps family members learn how to communicate better with each other and express their feelings more constructively.

Sidebar: Is my child contemplating suicide?

Even in the most open families, teens may still be hesitant to tell their parents they are depressed or thinking about suicide. However, an estimated 80 percent of individuals who attempt or commit suicide give out signs. Following are warning signs of suicide to watch for from the National Youth Prevention Commission:

• depressed mood;
• substance abuse;
• frequent episodes of running away or being incarcerated;
• family loss or instability, significant problems with a parent;
• expressions of suicidal thoughts, or talk of death or the afterlife during moments of sadness or boredom;
• withdrawal from friends and family;
• difficulties in dealing with sexual orientation;
• no longer interested in or enjoying activities that once were pleasurable;
• unplanned pregnancy; and
• impulsive, aggressive behavior, frequent expressions of rage.

Hoover adds that extreme distress over the breakup of a relationship, or conflict with friends, may also be a warning sign of suicide. If you suspect your child may be contemplating suicide, treat it seriously. Ask directly if he or she is considering suicide and whether he or she has made a specific plan and has done anything to carry it out. Then, get professional help for your child from a psychologist, therapist, primary care doctor, community mental health provider or call a suicide hotline or local crisis center. If your child has a detailed plan or you suspect he or she will commit suicide, seek help immediately, taking your child to a hospital emergency room if necessary.

The Menninger Clinic is a nonprofit international specialty psychiatric center, providing innovative programs in treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Houston in 2003 and is affiliated with Baylor College of Medicine and The Methodist Hospital. For 16 consecutive years, Menninger has been named among the leading psychiatric hospitals in U.S.News & World Report's annual ranking of America's Best Hospitals. Menninger is a 501(c)(3) charitable organization.

http://www.menningerclinic.com/