This blog contains information about youth suicide which may be triggering for some readers. If you or a loved one is experiencing suicidal ideations, please seek attention from your own medical provider, call 988, or text 741741 for guidance and professional support.
As a child and adolescent psychiatrist, I spent a fair share of my day speaking to parents about suicide prevention. Oftentimes, when a parent is thinking about how to keep their child safe, it is overwhelming. Sometimes our conversation after my initial assessment is the very first time they were made aware that their child was dealing with suicidal thoughts. When a pediatric provider uncovers that a youth is experiencing suicidal ideations, intentions, or plans, we always need to involve the parents or guardians so that they can be a part of safety planning and suicide prevention. In my humble opinion, we, as pediatric providers, need to do better at helping educate parents about what steps they can take to help support and protect their child if they are experiencing mental health care concerns in an effort to prevent a crisis.
The most important step and the most evidence-based intervention to mitigate the risk of completed suicide is to “reduce access to lethal means.” In plain English, this translates to making it much harder, if not impossible, for people with suicidal thoughts to carry out that action. This is a task that only the parents and guardians of a minor can complete. No psychiatrist, therapist, counselor, or teacher can come into your home and protect youth from items that could be harmful or lethal.
My hope is to empower parents to prevent suicide through action-oriented steps. I know this may sound like a daunting task. To make it more manageable and easier to remember, I have created an acronym to make it a bit easier to remember the plethora of items that need to be secured in order to mitigate the risk of a suicide attempt in a child. The acronym GO SECURE helps parents remember what must be stored safely to keep their home and their child out of harm’s way.
G- Guns
O- Overdose Options: prescription pills, OTC pills, vitamins, cleaning agents, chemicals
S- Sharps: knives, pencil sharpener blades, razors, etc.
E- Electric cords, scarves, ropes: things that could be used for hanging
C- Car keys: monitor for suicidal thoughts involving cars, carbon monoxide poisoning
U- Underage drinking: alcohol use/nicotine use/marijuana
R- Reattempt of prior suicide attempts
E- Exits and entrances: for thoughts of jumping or elopement
So first things first: the most important thing to GO SECURE is guns. Guns are the number one cause of completed suicide in youth, typically by adolescent males. Very often, young men will make a suicide attempt and successfully execute it because they’re using guns. So if there is a gun in your home, the safest thing to do is to remove it. That is the safest thing to do, but if you are unable to do so, the next safest thing to do is to secure it with a gun safe that has a biometric code and/or keep the ammunition separate from the gun and continue to ensure it is in an area that is not accessible by your youth. The risk of lethality is very high with a gun, so that’s why, in our acronym GO SECURE, reducing access to guns is first on the list.
O stands for overdose options. In American youth, overdosing on pills is the number one most frequent method used to attempt suicide. There are several overdose options: prescription pills for your child and for any other family members, over-the-counter pills such as Tylenol, Advil, Benadryl, vitamins such as melatonin or iron, liquid cough medicine, and even cleaning agents. In many other countries throughout the world, overdosing on cleaning supplies, bleaching agents, and pesticides are very, very high lethality options. So, if there’s a suicidal youth or a youth who struggles with suicidal thoughts in your home, please do lock up overdose options. Please have the number for poison control readily available for you in case your youth tells you they have used any of these items in an attempt. Make sure you go through all the bathrooms or kitchens, any place where extra pills could be tucked away for safekeeping, and have all overdose options secured in a lock box or locked cabinet.
S stands for sharps: any item that can be used for self-harm and cutting—knives, pencil sharpeners, razors, blades, paperclips, etc. Youth who self-harm do not always self-harm with suicidal ideations. However, youth who self-harm have a higher risk than those who do not have suicidal thoughts and attempt suicide. If your child has a history of self-harm, it is wise to prevent access to these items. E stands for electric cords, ropes, ties, scarves, belts, and items that could be used for hanging, which is the number two method of completed suicide in youth. If your youth thinks of hanging themselves, consider removing any light fixtures, ceiling fans in their room, or closet poles that could be used for such an attempt. C stands for car keys. This critical step can prevent carbon monoxide poisoning and driving off to unknown locations or off the road. Keep your car keys with you in your room, and if your child drives, take the keys from them when they are finished driving so that they cannot turn on the car or move it without your awareness. U stands for underage drinking. Over 50 percent of youth who present to medical ERs with a suicide attempt have also ingested alcohol. We know that the effects of alcohol are disinhibition and reduction of impulse control. This can be a deadly combination with a youth who has suicidal thoughts. Most American households have easy access to alcohol. Teens often experiment with alcohol since it is readily available and are more prone to experiment with any substance if they are struggling with depression, anxiety, or ADHD. Protect your youth and reduce their access to alcohol, in particular, if they are struggling with a mental health care concern. R stands for reattempt. If your youth has already made a suicide attempt, they are highly likely to reattempt within that same year. This risk is highest within the first 90 days of their attempt. They nearly always retry the same method. If you become aware that your youth has tried to attempt suicide, please take the greatest precaution to protect them from access to that particular method. It could be life-saving. The final E stands for exits and entrances, as patients who have thoughts of elopement or jumping off bridges or roofs may benefit from locking doors and windows and potentially using an alarm if this is a persistent plan.
If you, as a parent or guardian, can use the GO SECURE acronym as a checklist weekly, and even more often if your child has just been discharged from a psychiatric hospital, you are well on your way to preventing suicide in your home. This list is not exhaustive—if your youth has made a suicide attempt or has had suicidal thoughts about using items not on this list, please do remember to include it in the R (reattempt) and reduce access to that specific item. The risk of a reattempt reduces substantially after the first year of an attempt or thoughts, so continue to monitor them closely during this time period. The prefrontal cortex—our brain’s editing and brake mechanism—matures typically by the age of 25. Continue to monitor and safeguard your home for any youth under this age if they have struggled with suicidal thoughts, particularly in times of change and stress, such as the start of the school year, testing/exam periods, moving homes, separating parents, cyberbullying, social embarrassment, or relationship breakups.
Equip yourself with this knowledge and action items to keep the youth you love safe and secure.
Shivana Naidoo is a child psychiatrist.
