September is suicide prevention awareness month, and for good reason. Research suggests that roughly one in four children and adolescents with bipolar disorder are at high risk for suicide attempts, and about half to 57% experience suicidal thoughts (Hauser et al., 2013). This can be common and frightening, not only to read about, but also to be the person feeling suicidal or the person seeing the warning signs. When a child or teen is having thoughts of suicide or showing warning signs, it’s natural for loved ones to feel scared, ‘frozen,’ or unsure about what to say. Many caregivers worry about saying the wrong thing or making things worse, but research shows that speaking openly about suicide does not plant the idea in a young person’s mind (Dazzi et al., 2014). In fact, asking directly can actually bring relief to a teen. It gives them permission to speak openly instead of keeping everything inside and helps them feel supported in what they’re going through.
Starting the Conversation
Simple phrases to start the conversation could be, “Are you ok?” or “You seem sad lately, how can I help?” Let your child or teen know you care about them, want them to feel safe, and that you are here for them no matter what. Put your focus on understanding their world. Ask follow-up questions such as "Can you tell me more about that?" or "Help me understand what that experience was/is like for you" or "I notice you've been struggling with so much lately. Have there been times when the pain felt so intense that you've considered hurting yourself or ending your life?”
Try to use open-ended questions that invite deeper conversation rather than yes-or-no responses. When teens share difficult experiences, validate their feelings by saying things like "That is tough. When that happened to you, how did it make you feel?" Resist the natural parental urge to immediately offer well-intentioned fixes or advice, as this often shuts down further communication.
When Your Teen Isn't Ready to Talk
Don't force the conversation if your child is resistant or shuts down. Instead, leave the door open by saying something like "I'm here whenever you want to talk, and I’m here to listen" or "No matter what you’re going through, my support and love for you will never change, and there’s no problem too big that we can’t get through."
Often, teens open up during unexpected moments - while driving together, during shared activities, or sitting side-by-side rather than in formal face-to-face conversations. When they do start sharing, listen, let them talk. If they begin to tell you things that are upsetting, remain calm, even if you feel extremely upset. Remind yourself that you can ‘lose it’ at another time. Avoid immediately jumping to solutions or saying "You should have..." or "Why didn't you..." These responses can make them feel unheard and less likely to continue opening up. Let them know you’ll help them get the support they need to get through this challenging time and that they aren’t alone in this.
It is also important to know the common warning signs indicating your teen may be having suicidal thoughts. However, when a teen lives with bipolar disorder, some of these warning signs are also symptoms of their mood fluctuations or episodes. That said, again, if something feels off, different, or more extreme than their typical symptoms, consider that it may be an expression of a more severe issue.
Warning Signs
Suicide Threats - Verbal statements like "I'd be better off dead," "I won't be bothering you much longer," "You'll be better off without me around," "I hate my life," or "I am going to kill myself." However, suicide threats are not always verbal, so if you sense something is very ‘off’, trust that.
Depression - Low energy, sleeping too much, too little or having insomnia. Isolating more, talking less, spending much more time alone and/or in their room.
Becomes Suddenly Cheerful after Being Depressed
Anger, Increased Irritability - Exhibiting unusually irritable behavior, more impulsive, taking unnecessary risks.
Lack of Interest - Suddenly losing interest in sports or hobbies they used to enjoy, such as a team captain no longer wanting to participate, a dancer leaving their team, or a music-loving friend quitting band, lack of response to praise.
Sudden Increase/Decrease in Appetite - Dramatically eating less than usual, skipping meals, or eating noticeably more without adding additional exercise to their routine.
Sudden Changes in Appearance - Not dressing as they typically would or showing lack of personal hygiene.
Dwindling Academic Performance - Model students suddenly failing classes or not turning in assignments; lack of concern for school, classes, and grades; grades dropping suddenly.
Preoccupation with Death and Suicide - Writing essays and poems about death; creating artwork or drawings depicting death; making social media posts and comments about death; talking frequently about death or dying, may express ‘strange’ thoughts.
Previous Suicide Attempts - Youth who have attempted suicide are eight times more likely to make another attempt, with one out of three suicide deaths not being the individual's first attempt.
Finding Support—for Them and for You
Peer support can be invaluable. The Depression and Bipolar Support Alliance (DBSA) offers free peer-led groups for parents and caregivers of youth under 17, for young adults 18+, and newly diagnosed families. Visit DBSAlliance.org to learn more.
For crisis situations:
988 Suicide & Crisis Lifeline (U.S.): Call or text 988 to reach trained counselors who can assess risk, listen with empathy, and help create a safety plan. They also support concerned parents or friends. The 988 hotline links callers to skilled crisis intervention specialists who are equipped to evaluate suicide risk levels, offer compassionate support, and collaborate on creating protective measures. Using your area code, the system routes your call to nearby crisis response centers that are part of a comprehensive national network. These professionals can assist concerned family members and friends, and when your teenager gives permission, they'll also engage directly with your child to provide counseling and helpful resources.
Text ‘TALK’ to 741741to message with a trained counselor.
Safe2Tell: An anonymous tip line available in Colorado and some other states where students and community members can report safety concerns for themselves or others and get connected to help. Visit safe2tell.org to learn more.
911: Calling 911 is best for situations when they are in need of immediate hospitalization.
Self-harm (like cutting) can sometimes—but not always—indicate suicidal thinking. It’s often used as a coping mechanism for emotional pain. Encourage healthier coping skills, remove access to dangerous items, and respond without shaming. If they are open to meeting with a counselor or therapist, help them find one they feel comfortable opening up to.
Taking Action at Home
Creating a safe environment is a cornerstone of suicide prevention:
Lock up or remove firearms. Guns are the most lethal method of suicide (Shenassa et al., 2003). Store ammunition separately.
Secure medications and hazardous items. Keep all meds—including over-the-counter pain relievers—in a locked cabinet. Give only one dose at a time if necessary. Lock up sharp objects and toxic chemicals.
Create a safety plan. Many caregivers find it helpful to create (with their teen) a written contract where teens agree to tell caregivers when they begin having thoughts of hurting themselves (self-harm). In return, parents promise to interrupt these symptoms with support rather than criticism or blame. This support might range from simple activities like sharing a meal together and talking, to higher-level stabilization steps such as taking them to the emergency room for a risk assessment and possible inpatient stay. The key element is ensuring your teenager understands they can turn to you without fear of judgment during their most vulnerable moments. A plan may also list their unique warning signs, coping strategies, supportive people to contact, professional resources (like 988), and steps to reduce access to lethal means. Download a free template here.
Remember, you are not alone in this—and neither is your teen. If you’d like to talk more or have other questions about suicide prevention, don’t hesitate to reach out.