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Dec 27, 20248 min read

Suicidal Ideation in Children

Listen, understand child experiences, double listening, discovering the problem, utilising strengths, connecting with others


Source: Emerging Minds.  (2024).  Understanding and responding to childhood suicidal ideation.  https://learning.emergingminds.com.au/course/understanding-and-responding-to-childhood-suicidal-ideation

Skill 1.  Listen and seek to understand children’s experiences

Using play is one of the most effective ways to engage children in therapy because it taps into their natural mode of communication, exploration and understanding. Unlike adults, children often struggle to articulate complex emotions or experiences verbally, making play a powerful, accessible tool for expressing feelings, fears, and desires.  Because play is inherently enjoyable and familiar to children, it reduces resistance, making therapy feel more like a nurturing and supportive experience rather than a clinical intervention.  This approach enables therapists to observe children’s behaviour and interactions, gaining insights into their inner world and identifying areas where support is needed. 


It is important to engage in ‘double listening’ where the practitioner looks beyond the presenting issue to discover the real problem behind that issue.  This occurs when the practitioner listens and seeks to understand children’s experiences of despair or distress.  Listen to the contexts and events that have made the child feel this way, as well as the stories of expertise, resilience and connection that have helped the child not ‘give up’ in the face of challenges.  But don’t jump in too quickly—listen carefully to the circumstances and dynamics of a child’s distress and despair before enquiring about their resilience, connection or strengths.


Double listening can be used with parents too.  Practitioners can be interested in what parents want for their children, their concern about their child’s distress, and their know-how about what helps their children. This approach moves beyond psychoeducation with parents, inviting them to explore and co-research understandings of their children’s experiences and concerns.


Examples of ‘double listening’ prompts


Child's statement: I just feel like giving up.

Practitioner curiosity about the effects of the problem

  • What is it like for you to feel like giving up?

  • What are the feelings in your body when you feel like giving up?

  • When are these feelings strongest?

  • Does this feeling of giving up get stronger when distress is more present?

  • When you are dealing with distress, what does it tell you about trying new things?

  • What does distress tell you about talking to your family when you feel like giving up?


Practitioner curiosity about the child’s know-how, resilience or connections

  • What did you do when that happened?

  • What is something important to you that has helped you not to give up?

  • What have you gotten to be good at through dealing with this?

  • What helps you not to give up?

  • If you weren't giving up, what would you be doing? Could it be perseverance, determination or maybe even guts?

  • You said you can't see a future for yourself anymore. Can I ask about what dreams or ideas you had for your future? How did those dreams help you keep going until now? What helped you to believe in those dreams until recently?


Child's statement: I am too much hard work for my family.

Practitioner curiosity about the effects of the problem

  • What do you notice about your family that makes you think you are hard work?

  • When you are dealing with distress, how do you feel about your relationships with your family?

  • Does distress lessen or increase the feeling that you are more hard work for your family?

  • What happens when you are thinking and feeling like you are too much hard work?


Practitioner curiosity about the child’s know-how, resilience or connections

  • What kind of relationships would you prefer to have with your family?

  • What happens when you don’t feel like you are hard work?

  • f you don’t want your family to be working hard with you, how would you prefer them to be?

  • What do you hope for your family? What have you done for your family in the past that has demonstrated that hope?

Skill 2.  Defining the problem

When a child names and describes the problem they are facing in their own terms and in ways that are significant for them, the problem becomes external to their lived experience.  The problem becomes the problem, rather than the child being the problem.  Some questions that can be used with children might sound like:  When you close your eyes, what does the problem look like? If you tried to draw the problem, what would it look like? What shapes or colours would you use? What words would you use to describe what it looks like?


Context and impact of the problem

Children might come to practitioners with understandings of themselves that locate their problems within their deficits. They might think that they need to be fixed, and this idea might even be shared with their parents. Practitioners who enquire about the social context of a child’s life can build a rich picture of their experiences and appreciate them as more than just their problem. This provides children with the opportunity to discuss the effects of the problem in their life and the circumstances that surround it.  Some examples of questions include:  Can you tell me about a time when this problem stopped you from doing something you enjoy? What was that like? What were you thinking at the time? Did the problem make you more angry or sad? Did the problem make you more or less likely to talk to your mum?  Does this problem make it hard for you to eat, sleep or do other everyday things?


Positions on the problem

It is important to always invite the child’s experience and views on why the problem is a problem for them. Asking children how they feel about the relationship between the problem and their life ensures that they are leading the discussion. This helps to avoid assumptions or judgements based solely on professional experiences and knowledge.  Some questions that can be used with children to understand their own position on the problem might sound like:

  • Why do you think the problem is a problem? Where did the problem come from? What are the effects of the problem? How does it get in the way of the things that you like doing in your life?

  • What effect is the problem having on your relationships? Does the problem get in the way of what you want in your relationships? How does the problem fit with the kinds of relationships you would like to have?


Hopes for the problem

It’s important to talk with children about times when the problem is not impacting on their lives, which can highlight what they’re doing to limit the problem’s impact. Some questions that can be used with children to understand their own position on the problem might sound like:

  • When the problem isn’t around, what difference does this make for you? What do you notice about yourself at those times? What are you doing to keep the problem away? How are you managing to do that?

  • What are you hoping for in being able to keep the problem away more often? What might help you to do that? Who in your life can help you to keep the problem away? What have they done in the past?


Skill 3.  Connecting values and actions

Through listening to children’s assessments of the problems in their own lives, a greater sense of their values, resilience and connection comes to light. Children are better able to identify their own skills, abilities and know-how, and the next steps may become clearer for them.  A strengths-focused practitioner will aim to uncover children's responses and explore the factors that were most important in shaping them.  The following questions may help practitioners to identify children's values and skills:

  • What thoughts and feelings were swirling within you before you did that [insert response]?

  • What was it that moved you to do something in that moment?

  • If that action had words, what would it have been saying?


As children begin to talk about their responses to the problems in their lives, they often describe actions they have taken to stay connected with others or to overcome the problems.  Understanding those aspects of children’s lives that they might be pleased about or proud of is more than just rapport-building or creating safety. It’s about being alert to the child’s strengths, skills and expertise, and what’s important to them. These might be skills that are connected to the problems in their lives, including strategies to keep themselves safe, such as caring for a pet or reaching out to a friend.


Helping children to own their stories and skills

As children grow in confidence when describing their skills or small successes, their experience with you, as a practitioner, can change. They can become proud of the skills that they are describing to you or in front of their parents.  Once children feel a sense of ownership over these stories and skills, they can be used in other environments and relationships, at school or at home. Children might notice that these skills are beginning to limit the effects of despair or distress in their lives. They might also notice increased agency in overcoming despair and distress.  Questions you might like to ask children include:

  • When did you first notice this skill? How have you used it in the past? Why is this skill important for you? Does the use of this skill say something about the kind of person you would like to be?

  • Who else might know you have this skill? What might they say about the ways in which you use this skill?

  • Has this skill helped you to help someone you know? How might your skill be important to them? Do other people you know have this skill? When did you first notice them using this skill?

  • If I was to ask your parents about how you use this skill, what do you think they might say?


Connectedness

Children experiencing mental health conditions often face isolation and exclusion from peers and teachers. Isolation can worsen children’s distress and despair, including thoughts of dying.  Practitioners can actively focus on highlighting and strengthening children’s relationships and connections with family, friends and communities. Supportive relationships with parents, caregivers and peers significantly lower the risk of distress, despair and suicide.

Even when things are not going well, children are often doing things that are really good.  It is important to highlight these things.  It is also important to connect children to people who love them and with whom they have a good relationship.  It’s important children feel valued by other. Look for ways the child has a positive view of themselves.


Addendum: Australian Emergency response resources


The following services are specifically set up to address crisis situations and suicidal ideation.


Suicide Call Back Service

The Suicide Call Back Service provides immediate telephone counselling and support to anyone affected by suicide, including clients at risk of suicide. They also offer a call back service that includes up to three sessions of ongoing professional telephone counselling with the same counsellor, at a time that suits the client. The Suicide Call Back Service is available 24/7, across Australia on 1300 659 467 or via https://www.suicidecallbackservice.org.au/.


National crisis organisations


Resources for practitioners

Young people – WellMob                https://wellmob.org.au/e-health-topics/our-mob/young-people/

Resources to help keep young Aboriginal and Torres Strait Islander people safe and well, particularly around topics of health, stress, self-harm, suicide, relationships and domestic violence.


Suicide Prevention Australia       https://www.suicidepreventionaust.org/

The national peak body for suicide prevention in Australia.


Mindframe           https://mindframe.org.au/

A program managed by Everymind and funded by the Australian Government. It supports safe media reporting, portrayal and communication about suicide, mental health, alcohol and other drugs.


Resources for families

StandBy – Support After Suicide: 1300 727 247    https://standbysupport.com.au/ 

Providing coordinated postvention support to individuals and communities affected by suicide, offering free, personalised assistance for up to two years and building community resilience through training and local advisory involvement.


Everymind                https://everymind.org.au/

A free online program to help family and friends supporting someone who has attempted suicide. Minds Together is a self-paced and interactive program that helps build the skills, knowledge and confidence to support family and friends, and look after yourself.


Listen. Just listen.          https://www.wmq.org.au/mental-health/child-youth-mental-health/just-listen

Listen. Just listen. provides parents and caregivers with simple tools to support children experiencing mental distress.


SANE    https://www.sane.org/ 

For people with recurring, persistent or complex mental health issues and trauma, and for their families, friends and communities


Family Drug Support Australia  https://www.fds.org.au/

Information on all aspects of alcohol and drug use relative to the families of people who use substances. Family Drug Support Australia also operates a national 24/7 telephone support service for families affected by alcohol and other drug issues.


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