Suicide is the third leading cause of death among youth between the ages of 10 and 24, according to the Centers for Disease Control and Prevention. About 12 percent of adolescents think seriously about killing themselves in any given year. It's an issue that's not well understood and fewer than a dozen large research studies have focused on treating suicidal youth.
Dr. Guy Diamond at The Children's Hospital of Philadelphia has long been a leader in finding treatments that help suicidal youth. Diamond is currently testing an approach that brings together the whole family to heal a young person. Rebecca, a Philadelphian and single mom of two, says Dr. Diamond's team saved her daughter, and her family.
With her daughter safe at home and doing better, Rebecca says she is ready to talk about what happened last year. "Late September, my daughter and her father had a falling out," she recalled. In the weeks after, the 13-year-old became depressed — and suicidal. "She was kind of retreating from society, and then families told me she was posting things online about wanting to hurt herself," Rebecca said.
As she talks about that time, Rebecca stays calm at first, but the horror and the desperation flood back as she recounts trying to find help. Rebecca begins to cry as she describes being worried sick, and asking her daughter's pediatrician for help. She found more than just help for her daughter.
Her pediatrician referred her to Dr. Diamond at CHOP, who uses a family-centered approach to treating suicidal youth.
"If the family is not causing the problem, we're assuming that they are impacted by the problem, and our goal is to help them restablize," Diamond explained.
Diamond directs The Center for Family Intervention Science at CHOP. He says many things can lead a teen to think about suicide. Depression, anxiety, social pressures, bullying, physical assault, witnessing violence — and problems at home. "Sometimes kids unfortunately have conflict within the family, parents are depressed," Diamond explained. "There's alcoholism, there's marital conflict, there's divorce."
Diamond says whether the family is hurting or helping the situation at the moment, family members need to be at the table. It's the first thing he discusses with parents or caregivers. He tells them that he can't help their child without them.
"Parents are the medicine," is how he explains this to families. "I know there has been conflict, I know there's been problems in the past, but you have a huge role in restabilizing this kid." Often, parents are reluctant, says Diamond. "They say 'oh no, I'm done, she doesn't want me, I'm finished,' and we go after that belief and convince them it's not true."
Diamond works with Dr. Stephanie Ewing, who says a lot of the early work with families is to reset their perception of the issues because a lot of times, the suicidal teen has been labeled as "the problem."
"They are the ones with the symptoms, they are the ones with the troubles," Ewing said. "What we need to do is reframe this as a family issue, it's not just the teen who is behaving badly or feeling down, it's a family-based issue."
Diamond has worked on this family-centered approach for years and has seen solid results in clients — significant reduction in depression and fewer suicial thoughts. Together with Ewing, he is currently running a five-year study comparing this approach to individual therapy for youth.
"We're examining what it would take to provide comprehensive, intensive services at a critical moment, where the suicidal crisis becomes an opportunity."
Families enrolling in the trial are referred from local emergency rooms, pediatricians, doctors and schools. Many parents need help dealing with the stress of it all. Parents also end up working through their own histories — often including abuse and depression.
Rebecca says the first day she took her daughter to see Diamond's team, they spent several hours in separate rooms answering questions, and she felt cared for. "Knowing that they wanted to hear what I had been through, what my goal is, why I'm there, what I wanted to know, what I want for my daughter, other than, 'okay you have 45 minutes, spill it, and we'll see you next week.'"
Rebecca says throughout the 18-week-long therapy sessions, she and her daughter addressed tough issues and became closer.
"Not only was she beginning to heal, but we were learning how to communicate with each other," Rebecca said. "Not just 'How was your day? Fine.' The questions were deeper. Even yesterday, she came home from visiting her father and she said, 'Mom, I need to talk.'"
Rebecca says she was able to work through some of her own difficult family history and has learned to be a better listener for her daughter.
Diamond says creating a more supportive environment at home is what makes this family-centered approach effective. "Without addressing some of these family conflicts, kids go back home into a lot of chaos, and whatever they learned in the therapy session on their own just may not stick as well."
Rebecca says her daughter is doing well — thriving in school and engaged in social activities. Rebecca says another sign that her daughter is healing is that she recently told a friend about the program - somebody she was worried about and felt needed help.