Need community input on questions asking for help in determining if a child might be suicidal

Question

SE has a clear policy directed at moderators when it comes to users expressing suicidal ideation: close, comment (with resources), notify CMs who will follow up with the user, and delete. Users might not agree with the policy, but it is the policy handed down to mods.

There is no policy, though, when it comes to determining who may or may not be suicidal. So I am seeking guidance - and hopefully consensus- from the community on how we should handle this issue. This question was precipitated by this post.

It seems to me that the only reasonable response to this question is to refer the OP to a professional. Even a trained professional has difficulty in some cases determining whether someone is really suicidal or not, but they can rely on a thorough history and their vast experience with depression and suicidal ideation to make a hopefully reasonable determination. What can a stranger on the internet add? So I closed the question thinking it was prudent and in keeping with SE policy.

However, clearly there is disagreement with some users as there are 4 votes to reopen the question.

I would like for the community to decide how best to handle this and similar questions in the future before it is reopened and sets a precedent, so after seeking advice from other moderators (not from this site, unfortunately, due to time differences), I have put a temporary lock on the question.

When in doubt, I believe it is the community which should decide the policy of this site. So please have a look at the question and comments, and weigh in here.

Thanks.

Answer 1

I believe these questions are not suitable for this site at all. I'm very sorry that the OP of that question is going through this and I understand the desire of the community to help, but this is outside our scope and outside of the realm of help we can reasonably provide.

These questions are really requests for medical help where the OP may or may not know that they need medical help. Anyone who has worked in a social work, medical or other related profession will tell you that someone expressing suicidal thoughts and tendencies needs to get professional help yesterday. That's help we can't provide.

Since we aren't a child's (or any other visitor's) medical team, we don't know nearly enough about them and their history to be able to provide anything aside from words of sympathy and support (I realize these people probably need a lot of this, but alas that isn't what the site is for). I can't say what are good options for such a child, what kind of medications would be appropriate, what resources are available and what options would be suitable or not. We close medical questions with the same rationale. We should do the same here, because again, this is a medical issue and thus a medical question.

Even if we decided we were ok with taking such questions, the best we could do is provide a canonical question where the answer is "Seek medical help NOW!" and make every other question a duplicate of that. And I feel like that would be worse than explaining to people that we aren't equipped to help them. If it were me posting that question and it got closed as a dupe, I would feel that I got a very cold response from a community of parents, like no one was listening when I needed help, that my specific circumstances aren't important. I realize that closing someone's question for another reason also may not feel good, but there is a difference between "Sorry we aren't the place for that question because we can't help." vs. "Your question and situation are just like this other one (ie. your specific circumstances don't matter much) and here is your answer." This may be a nitpick, but I feel it's important.

Overall, these aren't appropriate because we can't help. We aren't a suicide prevention, intervention or therapy group. We can't diagnose or treat those problems (and even if any medical professionals among our members were able or willing to help, the OP would still need to see their doctors to get a formal diagnosis to be able to get treatment). The only thing left we could reasonably provide is support and encouragement. And unfortunately, the cold truth is that questions (as defined by StackExchange) aren't a place for a sympathy party. The best we could do there is in chat. So despite our empathetic feelings for another parent, we have to close such questions.

Answer 2

Despite the question being edited multiple times, I don't feel the principal matter of the question is clear. How to assess suicidal tendencies in an 11-year-old? Are we assuming this is indeed expression of suicidal ideation and so OP is interested in knowing what intervention strategies are being used with suicidal children? Is OP looking for socially supportive answers? Are answers comparing the efficacy of various therapeutic strategies in suicidal children expected? And, how does whichever of these intentions jive with OP's expressed intent of seeking in-person professional help, which IMO should be given precedence in clinical matters, such as the suicide risk.

Suicide risk assessment

In my personal opinion, this is firmly outside the scope of this site.

Most risk assessment measures for “youth” are intended for use with adolescents, and the nature of children’s developmental functioning presents particular challenges for accurate assessment. [1]

[...] assessment of childhood suicide [is] one of the most difficult of diagnostic tasks. [2]

Entire books could be written on suicidal risk assessment in children. There are various scales, with various precision, various internal consistency, various reliability or interchangeablity - but all are to be administered by a professional in the field. In the hands of a layperson, assessment strategies may provide some mental scaffolding for an adult to be able to tackle the concept of possible suicidal ideation in children, but in concrete terms, actual professionals need to be consulted. They will also be able to help when deciding how to frame a therapy visit to a child with history of resenting therapy sessions.

Intervention strategies with suicidal children

This topic is also encompassing enough to have books and books written on it. There are a great many therapeutical schools and psychiatric approaches; OP has expressed only 1 criterion - reluctance to employ pharmaceutical approaches. Upon closer look, it seems to only be with regards to anti-depressants. (Suicidal ideation and tendencies can of course be closely related to child depression, but as we cannot even remotely begin to assess depression in OP's daughter, we are considering all possibilities - an example in suicial children is hallucinations - is OP also opposed to anti-psychotics, or is asking the community to evaluate whether other psychiatric drugs have enough research-based factual support for him to agree to medicating his child?)

As the rules say,

And some subjects are considered off-topic because they're not directly related to parenting, for instance: specific medical issues (we're not doctors!)

Social support

I cannot think of any possible answer here other than "take your daughter's suicide threats seriously (keep her under supervision, remove dangerous objects so that she can't get to them), consult professionals to make a plan on how to address this, follow through. Seek a second opinion if you feel your concern is not taken into account."

Comparative efficacy of different approaches

This is not a parenting topic as the approaches themselves are not usually done by parents. I would recommend against employing parenting strategies to resolve suicidal ideation in a child. Unless the parent is causally involved somehow (the parent also suffers from suicidal ideation/depression, or an idealised view of death has been presented to the child, or the parent engages in destructive behaviors that are causing severe instability and distress in the child, etc) it is a question of the child's health, separate from the topic of parenting.

OP already seeking in-person professional help

IMO this is a case of:

avoid asking subjective questions where ... your answer is provided along with the question, and you expect more answers

If there is to be anything added within the scope of this site, it is only going to be an answer such as I outlined under the Social Support heading.

Depression and suicide in children is a difficult topic

It is bound to provoke an emotional response (also provoked one in me where I saw the topic in the queue, knew OP was asking for an exceptionally wide overview, but the topic of child suicide elicited a strong gut reaction to the point I emotionally perceived it to be so important, site rules could/should be disregarded). However, I think that no assessment should be done via Internet in such matters, not even weighing in saying "it looks like your child may just be trying to manipulate you". Even if it looks like it. Because it is desirable to err on the side of caution, I think disallowing such questions is the way to go, hand in hand with expressing an umbrella policy of taking children suicide talk/threats seriously by default.

Perhaps a short resource could be compiled for parents in shock after discovering their child talking about/planning suicide, pointing to mental health/suicide prevention websites, hotlines, professionals, or registers thereof, along with a basic instruction set of 1. keep calm 2. keep an eye on the child 3. seek help 4. keep your wits about you. Then again, such articles are most likely not difficult to find elsewhere on the internet (I have come across several after a cursory search.)

[1]: Barrio, Casey A. Assessing Suicide Risk in Children: Guidelines for Developmentally Appropriate Interviewing. Journal of Mental Health Counseling, v29/n1/p50-66/Jan 2007

[2]: Wise, Amy J.; Spengler, Paul M. Suicide in Children Younger than Age Fourteen: Clinical Judgment and Assessment Issues. Journal of Mental Health Counseling, v19 n4 p318-35 Oct 1997

Answer 3

The bottom line for me is that the OP needs help. We are not (and should not be used as) professionals at suicide prevention. None of us is capable to diagnosing anything over the internet. We can suggest and share experiences. We may even have the answer, but we cannot know that unless the OP says so. We provide a sounding ground, some support, some information and the value of our experiences. We cannot do more than that and we should not try, imo.

When and if a person asked for help along these lines, we must tell them that we are not qualified and that we support them and suggest that they call a suicide prevention hotline, or the local police or the local health department. I would go so far as looking up telephone numbers if they said where they were, but beyond that, sorry, I am not qualified.

I did a year during University at a call centre. We talked and tried to get info, and could get a supervisor to trace the call, if we thought suicide was imminent. Then the police took over.

Answer 4

Saying "I want to die" is expressing suicidal ideation. Moderators do not need to and should not be trying to assess whether anyone is actually suicidal, and in my opinion any moderator trying to do so is way overstepping their bounds. The policy, if worded the way you say it is - and most such policies are - is intended to provide no leeway for judgement; if someone says they are suicidal, assume they are telling the truth even if you think they aren't, and close the question with the appropriate referral.

The problem with that particular post is that a large majority of the word count deals with issues that aren't necessarily tied directly to the suicidal statement. If one wanted to save the post, the best way would be to remove any mention of suicide while leaving in the other issues. However, that might be a sufficient change to change the meaning of the post, and thus inappropriate for an edit, so it might be better just to suggest that the original poster ask a new question addressing those other issues.

Personally my reaction to that post was the the poster seemed to be looking for a reason to downplay the seriousness of the desire to die, which didn't seem to be wise to me, and I would be concerned that the comments and the answer were feeding the idea that maybe the issue could be addressed in other ways, and thus feeding the idea that the suicidal wording need not be taken seriously. That's a bad idea when the life of a child is on the line.