Children too, can have mental health issues.

According to the Kansas Department of Health and Environment seven children aged five to 14 and 71 children and young adults aged 15-to-24 died of suicide in 2016 in Kansas — the last year for which numbers were available.

The same year, for children aged five to 14 years, suicide was the third-leading cause of death and is the second leading cause of death for 15 to 24 year olds.

Social Media

Crawford County Mental Health Center Director of Mental Health Michael Ehling said children’s mental health issues can mirror those of adults — but in a different way based on their brain.

“On the adults side, things that are risky are stressors in your life — loss of your job, or loss of somebody important to you,” Ehling said. “Maybe there has been some sort of life event that creates a crisis and there's a sudden decision that I can’t cope and things like that.”

For children, Ehling said, it is more in the “relational world” — particularly when it comes to social media.

“What kids encounter through social media is the difference for kids —  that particularly bathe themselves in the social media world is — as you know as an adult, you can't read face to face cues,” he said. “If I’m reading a text message I don't get inflection, I don’t get reading their body language, so a lot could get read into social cues that could get misrepresented when it enters when there are negative messages of a person.

“I think it ratchets up the risk factor because too many things could get assumed that are not intended.”

According to the Kansas Communities That Care survey given to Kansas youth in grades six, eight, 10 and 12 more than 56 percent of children who reported depressed feelings also reported they were bullied.

The survey is an optional depression and suicide survey given by school districts.

When children are working to find their identity, “a blast of negativity” on social media could be a stressor for them which they may not be able to “filter out,” as an adult would, Ehling said.

“When dealing with the relational world, and cyberbullying, things which matter to students such as appearance, who they perceive themselves to be and as you know, all that identity stuff has some fluidity to it when children are young,” he said. “They are forming, so if a real blast of negativity is thrown into that pool for that kid it could be a stressor that adults might have a way of filtering out.”

 

Brain development

This, Ehling said, is because of the development of the prefrontal cortex — the thinking and executive functioning part of the brain which is not fully developed until the age of 25 — or sometimes later.

“That’s what governs impulses,” he said. “It’s the rational part of the brain that can override the feeling part of the brain, so if it’s in development, kids are more apt to act on impulse ... than to think something through.”

This is the part of the brain which substance abuse impairs — particularly when it comes to to the use of substances as it relates to suicide, Ehling said.

“This could cause an adult to act on impulse, which they would have been likely to override if they hadn’t been using some sort of mind-altering drug or substances,” he said.

The prefrontal cortex is involved in choice making, decision making, judgement, and the only way that gets laid down is experience — experience children simply do not have, Ehling said.

“The brain is laid down in such a fashion that the more you use a connection, the stronger it gets,” he said. “With the prefrontal cortex, it only develops through experience, they make a decision and find out, ‘oh I can do it,’ then that pathway gets wired stronger.

“Children tend to be impulsive and action driven deeper in the brain because this isn't fully developed yet, that’s why it takes all this guidance and coaching in life to get them through tough stuff.”

Children also lack the words to express how they feel at this stage of life.

Sometimes, Ehling said, children may say things like “my life is a wreck, I’m better off dead,” but, he said, “that could mean suicide, but often it means I hurt so bad I don’t know what to do.”

Ehling said children who have been abused or had a crisis may use these words to express their pain.  

When it comes to the action of taking their own life, younger children have a harder time carrying out the action because their “brains are not developed to think something like that out,” Ehling said. For children who are not adolescents, he said, the incidents are often considered accidents. Adolescents are more apt to act on impulse.

“Adults have a hard time understanding the mystery of death, let alone children who — particularly younger children — are a little bit magical, because they see cartoons where a cartoon figure dies but they come back to life,” Ehling said. “They don’t understand the permanence about death.”

Adolescents dealing with mental health issues are known for self-mutilation, Ehling said, which is “often mistaken as being suicidal behavior.”
“People, when they discover child cutting on themselves, they think suicide,” he said. “A good part of time it is not suicidal ideation, it is to relieve anxiety.

“They don't have words to use to process through, think through.”

The act of self-mutilation produces an endorphin release which calms their physical system, Ehling said. Although it is often anxiety-driven, it is still recommended to talk the the child about their self-harm.

Asking the unspoken question

“One of the keys to helping prevent suicide is — when you are in that moment — is to pop the unspoken question, to pop the elephant in the room and just ask, ‘Are you suicidal?’” Ehling said.  

Being up front and clear about concerns of suicidal thoughts is the best way to prevent suicide, Ehling said.

“It doesn't cause somebody to do it and it certainly doesn’t insert a thought into their head,” he said. “It's actually a relief to most people that you care enough to ask.

“It would be better to bring it out in the open to be talked about than to make assumptions. Ask the question, be honest, be straight, get to it.”

Ehling said most people don’t want to ask about suicidal thoughts because they feel like they may not be able to handle the answer.

“You can certainly be a good neighbor and help somebody get help even if you don’t feel like you are qualified to do anything about it,” Ehling said. “What you do about it is getting to somebody who can help.”

When a child loses a loved one to suicide

When a child loses a loved one to suicide they may experience abandonment, a sense of betrayal, shame and anger, Ehling said.

“Children will often experience that as abandonment, ‘my parent left me,’ and then they will wonder, ‘is it something I did,’ and because of the nature of parenting, where there’s often difficult things that happen, (discipline) a child's magical thinking might lead him to think that, ‘Daddy was mad at me and that’s why he killed himself,’ or ‘I’ve done something wrong,’” he said. “Children can assume some responsibility because they can't ask the question anymore of someone who committed the act.”

As with adults, children may feel conflicted about their loss.

“One of the most un-acknowledged, most powerful emotions that really sends people into conflict internally in a wake of a suicide is anger … they are conflicted because they most likely loved the person,” Ehling said. “You will see kids acting out, they don’t have words for it, ‘I’m mad that they killed themselves.’”

Honesty is key, Ehling said, when it comes to sharing about how a person dies.

“Developmentally, you would figure out the word you choose on their level of understanding,” he said. “It would be better to be on the side of being honest, than to veil it in some sort of coated language that could mean a lot of things.”

Since a child’s brain is not developed enough to reflect on the loss or “think about feeling,” therapy through play, based on the child's development, would be the type of therapy to seek, Ehling said.

“Kids’ brains aren’t yet developed to do higher level processing assigning meaning to ‘okay my brother killed himself, what does that mean?’ they only know that their brother is dead,” Ehling said. “Children processing difficult emotions is better suited to play.”

Play therapy is where the expression of emotion is played out because it is the “natural medium for children, that’s how they process and problem solve most of difficult emotions,” Ehling said.

“Kids engaging their senses through drawing, playing in sand, doing something with their bodies helps them work through things as opposed to sitting down and having conversations as if they have adult understanding, because they don’t. Their brains aren't developed enough yet.”

What schools are doing about suicide

Director of Research Evaluation at the Southeast Kansas Education Service Center at Greenbush, Lisa Chaney, said suicide is a sensitive issue in schools and school districts.

Chaney connects school districts with research surveys, which include the topics of depression, suicide, drug and substance abuse and more.  

In 2005, a handful of districts Greenbush serves began participating in surveys regarding depression and suicide in middle and high school students.

After the state of Kansas passed the Jason Flatt Act in 2016, the number increased.

According to the Jason Foundation, the legislation requires boards of education in the state to provide suicide awareness and prevention programs to all staff. It also requires the district to notify parents and legal guardians of the training material provided in the programming which are to be available to parents and legal guardians.

“A lot more districts signed on after that and in 2018 we had a huge increase of district participation,” Chaney said.

Through a survey called the Kansas Communities That Care, an optional depression and suicide module, grades six, eight, 10 and 12 are given a series of questions regarding the topic. Parental consent is required before allowing the students to take the survey. The survey is completely anonymous and is password protected through the district.

“The purpose is to provide an overall look within the district, which might want to focus on and implement strategies into the school,” Chaney said.

The questions include: “During the past 12 months, did you ever feel so sad or hopeless almost everyday for two weeks or more in a row that you stopped doing some usual activities; have you ever seriously thought about killing yourself, have you ever made a plan about how you would kill yourself; have you ever tried to kill yourself?”

Chaney said it is not a diagnostic screening, is self-reported and there is no identifiable information. She said it provides “important information the district may not get any other way.”

The report can identify potential issues based on age level, building, district and county.

“It gives them an idea how widespread these issues and concerns are … they are able to track year-to-year at various levels,” Chaney said.

She said some of the school districts Greenbush serves have up to four years worth of data. The district superintendent may choose to share the results to add to the county and state statistics.

If there are “red flags,” districts can utilize training programs and resources to target those areas.

“The districts can make sure teachers are trained in early intervention and when to refer to counseling,” Chaney said.

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741741.

 

Depression in Children and Teens
If one or more of these signs of depression persist, parents should seek help:

Frequent sadness, tearfulness, crying

Decreased interest in or enjoyment of favorite activities

Hopelessness

Persistent boredom; low energy

Social isolation such as withdrawing from friends and family

Low self esteem and guilt

Extreme sensitivity to rejection or failure

Increased irritability, anger, or hostility

Difficulty with relationships

Frequent complaints of physical illnesses such as headaches and stomachaches

Frequent absences from school or poor performance in school

Poor concentration

A major change in eating and/or sleeping patterns

Talk of or efforts to run away from home

Thoughts or expressions of suicide or self destructive behavior

(Information from the American Academy of Child and Adolescent Psychiatry)

Suicide and children and teens

Thoughts about suicide and suicide attempts are often associated with depression. In addition to depression, other risk factors include:

family history of suicide attempts

exposure to violence

impulsivity

aggressive or disruptive behavior

access to firearms

bullying

feelings of hopelessness or helplessness

acute loss or rejection

Children and adolescents thinking about suicide may make openly suicidal statements or

comments such as, "I wish I was dead," or "I won't be a problem for you much longer." Other warning signs associated with suicide can include:

changes in eating or sleeping habits

frequent or pervasive sadness

withdrawal from friends, family, and regular activities

frequent complaints about physical symptoms often related to emotions, such as stomach aches, headaches, fatigue, etc.

decline in the quality of schoolwork

preoccupation with death and dying


Young people who are thinking about suicide may also stop planning for or talking about the future. They may begin to give away important possessions.
Parents, teachers, and friends should always err on the side of caution and safety. Any child or adolescent with suicidal thoughts or plans should be evaluated immediately by a trained and qualified mental health professional.

(Information from the American Academy of Child and Adolescent Psychiatry)

The following information can be found in the 2016 Kansas Annual Summary of Vital Statistics:
High School Youth Risk Behavior Survey, 2017 (during the 12 months before the survey)

Considered Suicide
Grades:

9th 662

10th 735

11th  535

12th 444

1,307 females, 1087 males

Made a Plan
Grades:

9th 657

10th 737

11th 532

12th 445

1,305, females, 1,084 males

Attempted Suicide

9th 555

10th 659

11th 447

12th 382
1,134 females, 923 m males

Suicide attempt resulting in an injury which required treatment

Grades:

9th 559

10th 661

11th 449

12th 382

1,137 females, 928 males

Warning signs
TALK
If a person talks about:
Killing themselves
Feeling hopeless
Having no reason to live
Being a burden to others
Feeling trapped
Unbearable pain

BEHAVIOR
Behaviors that may signal risk, especially if related to a painful event, loss or change:
Increased use of alcohol or drugs
Looking for a way to end their lives, such as searching online for methods
Withdrawing from activities
Isolating from family and friends
Sleeping too much or too little
Visiting or calling people to say goodbye
Giving away prized possessions
Aggression
Fatigue

MOOD
People who are considering suicide often display one or more of the following moods:
Depression
Anxiety
Loss of interest
Irritability
Humiliation/Shame
Agitation/Anger
Relief/Sudden Improvement
(Information from American Foundation for Suicide Prevention)

Suicide risk factors
HEALTH FACTORS
Mental health conditions
Depression
Substance use problems
Bipolar disorder
Schizophrenia
Personality traits of aggression, mood changes and poor relationships
Conduct disorder
Anxiety disorders
Serious physical health conditions including pain
Traumatic brain injury

ENVIRONMENTAL FACTORS
Access to lethal means including firearms and drugs
Prolonged stress, such as harassment, bullying, relationship problems or unemployment
Stressful life events, like rejection, divorce, financial crisis, other life transitions or loss
Exposure to another person’s suicide, or to graphic or sensationalized accounts of suicide

HISTORICAL FACTORS
Previous suicide attempts
Family history of suicide
Childhood abuse, neglect or trauma
(Information from American Foundation for Suicide Prevention)

What to do
If someone you know exhibits warning signs of suicide:
Do not leave the person alone
Remove any firearms, alcohol, drugs or sharp objects that could be used in a suicide attempt
Call the U.S. National Suicide Prevention Lifeline at 800-273- TALK (8255)
Take the person to an emergency room or seek help from a medical or mental health professional
(Information from American Foundation for Suicide Prevention)

Mental Health Resources
Local mental health resources and treatment options:
Families and Children Together (FACT)
(Crawford County Mental Health Children’s services)
411 E. Madison
Pittsburg 620-232-3228

Addiction Treatment Center of Southeast Kansas
810 W. Cedar
Girard
620-724-8806

Crisis Services
620-232-SAVE (7283)
24-hour crisis line
www.crawfordmentalhealth.org
Via Christi Behavioral Health
200 E. Centennial Drive, Ste. 13
Pittsburg
620-231-1068

Community Health Center of SEK
3011 N. Michigan
Pittsburg
620-231-9873

National Alliance on Mental Illness
Southeast Kansas Affiliate
620-240-3740

Free support meetings:
Second Monday of each month - 6:30 p.m.
Last Thursday of each month - 6:30 p.m.
Presbyterian Church
520 N. Pine, Pittsburg

Crisis (Distress Center)

Crawford County Mental Health

911 E. Centennial, Pittsburg

620-232-SAVE (7283)

Suicide Prevention Center

National Suicide Prevention Lifeline

800-273-TALK (8255)

— Stephanie Potter is a staff writer at the Morning Sun. She can be emailed at spotter@morningsun.net or follow her on Twitter @PittStephP and Instagram @stephanie_morningsun.