Parenting a Depressed Teenager

Naturally parents would be extremely stressed if they realised that their adolescent child was self-harming and/or troubled by suicidal thoughts especially if they had actually made suicide attempts.

It is good practise to involve the parents in the treatment of their child's depression (NICE 2013 update) from a clinical point of view. However, we cannot break confidentiality unless there is clear imminent risk of death by suicide or homicide (committed by the patient or another) or a disclosure of sexual abuse. The mental health practitioner, either working alone or as part of a team, will need to judge whether confidentiality can be broken and also determine the level to which parents can be supportive and involved.

Often we meet young people who are depressed and suicidal who present as very angry and uncompromising in their outlook (e.g. that talking won't help), hopeless and full of depressive and nihilistic thoughts (nothing really matters; we are worth nothing; there is no point). The attitude of giving up can be expressed to us by a young person as anger from within. You may also be confronted with what feels like a wall of self-hatred. These words coming from children are very distressing for parents and a real challenge to clinicians. They are a clear sign that something has happened in this young person's life to bring them to this point. Most people will have fleeting thoughts about death, dying, and the meaning of life but the very depressed are stuck with these thoughts most of the time and to the extent that it impairs their ability to develop relationships, manage school/work and engage in life. This is a place of great suffering where you join your child.

Most often, parents can be helpful and supportive to their child in this situation. However, some may not be so helpful because they are absent, or unavailable, or deceased. In this last scenario, we may be dealing with step-parents, partners of surviving parents and the memories and idealised view of the deceased parent. In a setting of domestic violence and abuse it may not be safe to discuss issues with parents, unless the framework of child protection / social services are close at hand and directly involved in the case.

Sometimes we get clinical scenarios in which a young person is actually seeking a hospital admission and clearly manipulating the parents and the professional network to sort out a life saving hospital admission. Our discussion of the young person becomes narrowed down to the discourse around suicide risk, whilst a broader approach can help a young person create safety and hope for the future. We do not need to agree with their sense of futility. There is always hope and we must find a way, even if it means carrying hope for the young person for a while.

Strategies for parents:

  1. Be available to your teenager. Be around and show that you are able to listen and do just that. Consider what you have heard and talk it through calmly. Suicide is a rare event but suicidal thoughts and deliberate self harm are common. As you listen do everything possible to manage your anxiety. You must be there to listen gently and offer encourage to your child to say more.
  2. Consider what you have heard and think about it for a long time. Some questions cannot be answered quickly. If you believe the situation is too unsafe then just get help. Call your doctor/GP or go to the local hospital or local youth mental health service. We all have limits to what we can cope with and the depth of sadness and anger felt by your child will be felt by you too and should be addressed promptly.
  3. Keep thinking and talking about your situation with your partner and find ways to manage your own stress through exercise and mindfulness-based meditation techniques. Be careful not to spread gossip. Instead, be very selective in whom you confide. You may even wish to take on counselling for yourself as a means of verbalizing your natural anxieties. Use the session to find solutions for yourself that will help you manage your teenager with depression.
  4. Some parents will have a faith and will pray for hope and a way to love their child in their extreme distress. These parents will have supportive networks but, again, may need to be very selective about to whom they speak.
  5. Do not drink more alcohol or smoke more tobacco and cannabis. A number of children with depression have parents who suffer with depression, alcohol dependence and/or bipolar affective disorder. If parents can remain healthier in these stressful moments then it will help the young person, who needs you to be strong and resilient.
  6. You can still set boundaries and get them into school. Your teenager can be encouraged to take responsibility for the good things they do each day. Boundary setting and clear rules (e.g. on Internet and mobile phone use) may actually reduce a young person's anxiety and, therefore, reduce their suicide risk.
  7. You do not need to know everything that is going on in your child's head. In therapy, we do aim to help a young person take on more activities (behavioural activation) and take responsibility to structure their day (activity scheduling). Help your child do this.
  8. Look at increasing the supervision you give your child: Make them breakfast in the morning. Know what they are looking at on-line and figure out what is going on in their friendship networks by talking to your child and their friends. If they do not want to talk, show you will listen and not judge and then be persistent over the course of time - gently, not forcefully.
  9. Ensure your child is eating and sleeping enough and able to manage all the demands of school.
  10. Teach your child to be strong and resilient and, therefore, more able to handle the challenges of each day. By focusing on this every day your relationship with your child will progress. Each day provides opportunities to make choices to improve our moods through good conversations and different activities. A new insight may help a young person cultivate more positive feelings for themselves and others.

Being a parent of a child who is suicidal is similar to being a parent of a child with epilepsy in this respect: The first time a child has a seizure the parents are confronted with the reality that their child could have died. Then, over the course of time, these parents have to manage their anxieties as their child goes on to have more seizures. Their fear of death may abate slightly but over the course of time these parents are involved in administering treatment, anticipating seizures and managing emergencies. Eventually, your anxiety about your suicidal teenager will reduce and you will need to be a resource for them and help them find professional help promptly. 

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