Preventing suicide among children in foster care

Jodi Flick

by Jodi Flick

Suicide among young people in foster care is uncommon, but it does happen—even in young children. What can we do to reduce the risk of such a tragedy and increase every child’s resilience?

Risk Factors
As a starting point, it helps to know the factors that put youth at risk for depression, anxiety, and suicide. These include the following:

1) Unrecognized, untreated, or under-treated depression and bipolar disorder. This is one of the greatest risk factors, especially among youth in foster care, who tend to suffer from mental illnesses at higher rates than other children. Unfortunately, many parents, resource parents, and professionals overlook or underestimate the amount of depression in children and teens. The experiences children have endured aren’t the only cause of mental disorders; genetics also has a big influence.

We know for a fact early intervention and treatment can save lives and lessen the impact of these illnesses for a child’s entire life. The most effective treatments involve both medication and Cognitive Behavioral Therapy, combined with efforts to decrease stress in the child’s life. Unfortunately, research shows that even when they receive medication, children often don’t get the therapy they need. In one study, three months after being put on medication for depression and anxiety, more than half of children had not yet seen a therapist.

2) Firearms in the home. This is a big risk factor for suicide. When a child is depressed, anxious, or suicidal, the lethality of firearms is an issue. Less lethal methods of suicide allow a person time to change their mind or for others to rescue them. With a firearm, this isn’t an option.

Gun owners should not be overconfident. Of children who die by suicide, 82% use a gun belonging to a family member. One out of three times the gun was locked, but the child knew the combination or where the key was kept. Studies also show it is not uncommon for children to handle their parents’ firearms without their knowledge (Baxley & Miller, 2006).

3) Peer suicidal behavior. This is a particular risk factor for adolescents. Teenagers who have had a friend attempt suicide are two to three times more likely to attempt it themselves. In youth exposed to suicide, even six years after the death, those with traumatic grief have five times higher rates of suicidal thoughts.

4) Untreated childhood trauma (especially physical abuse, sexual abuse, and severe neglect). This can have a lasting impact on the brain, both by disrupting normal, healthy, developmental experiences and by causing potentially lifelong changes in the brain. The more traumas you experience, the greater the risk. It’s true that there are effective treatments for trauma in children, including Trauma-Focused Cognitive Behavioral Therapy and EMDR, but many children in foster care never receive treatment to address this need.

Sources: SAMHSA, 2012; Goldsmith, et al., 2002

Protective Factors
Just as there are risk factors, there are also factors that lessen the risk of depression and suicide in children and adolescents. Some of these are outlined in the box at right. We boost protective factors when we teach children skills such as:

  • Social skills (how to make friends, how to read social situations, how to recognize emotions in others and respond appropriately)
  • Optimism (good humor and playfulness, seeing possibilities for hope/change)
  • Managing stress and emotions (how to calm yourself when you’re upset or angry, how to motivate yourself)
  • Assertiveness (being clear about personal feelings, setting limits without being aggressive)
  • Taking responsibility (apologizing, not blaming others when something really was your fault)
  • Negotiating (compromising, feeling some control and power over decisions)
  • Empathy (understanding how another person would feel)

Seligman, 2012; Goldsmith, et al., 2002; Hockey, 2003

One study found that when these specific skills were taught to 5th and 6th graders, they were half as likely to develop depression.

All of these skills foster social connectedness—one of the most important factors that protect children from suicide. For more on social connectedness, see this article from the current issue.

Protective Factors Matter

Having three or more of the following protective factors reduces the risk of suicide in adolescents by 70-85%:

  • Perception that an important adult cares about them
  • School connectedness (teachers treat them fairly, feels part of school)
  • School safety (feels safe at school)
  • Parental presence before and after school
  • Parent and family connectedness and caring
  • Good grade point average (GPA)
  • Religious identity (faith affiliation)
  • Counseling provided by the school
  • A number of parent/child activities (play games together, eat dinner together, engage in physical activities together)

Sources: Goldsmith, et al., 2002; APA, 2013

Know the Signs
To prevent suicide, we must be able to recognize the warning signs. Resource parents and other adults should be willing to act if they notice a child / youth:

  • Threatening to hurt or kill themselves
  • Seeking access to means (e.g., pills, weapons) to hurt or kill themselves
  • Talking, writing, or posting on social media about death, dying, or suicide
    Increasing alcohol or drug use
  • Withdrawing from family, friends, or society
  • Feeling hopeless, trapped, worthless, or a lack of purpose
  • Acting recklessly or engaging in activities with high risk of death
  • Demonstrating rage, agitation, anger, or seeking revenge
  • Having a dramatic change in mood

A common myth is that people who talk about suicide won’t act on it. Another is that asking a person if they are having thoughts of suicide will “put the idea in their head.” Neither of these is true (National Council for Behavioral Health, 2015).

Ask a child directly if they are having thoughts of killing themselves. If they say yes, immediately arrange for an evaluation by a qualified mental health professional. You could save that child’s life. Preventing suicide is everyone’s business.

Focus on Prevention
Children’s mental health has a tremendous influence on their risk of suicide. If we all commit to doing everything we can to ensure children and youth in foster care get trauma-informed mental health treatment and to teaching them skills to manage their stress (e.g., exercise, adequate sleep, spending time in nature, mindfulness, volunteering in activities that help someone else, expressions of gratitude), we can help keep them safe and promote their ability to learn, carry out daily activities, and have satisfying relationships.

Jodi Flick, ACSW, LCSW, MSW, is a Clinical Assistant Professor with the UNC School of Social Work and a counselor with the Chapel Hill Police Department’s Crisis Unit.