Talking with your teen about suicide is one of the hardest conversations a parent can have, and one of the most important. In this episode, Jennifer Hargrave sits down with Dr. Kristin Kroll, founder of Little Dove Psychology in Austin, Texas, who spent more than a decade in academic medicine at Children’s Wisconsin focused on children’s and adolescent mental health.
Dr. Kroll explains why talking about suicide does not put the idea in your teen’s head, how early parents should start the conversation, and how to tell the difference between normal teenage moodiness and real warning signs. She also walks through what to do if your teen says they have had suicidal thoughts, how to help teens support a struggling friend, and why there is real hope for families facing this.
If you or someone you love is in crisis, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24/7. LGBTQ+ young people can also reach The Trevor Project at thetrevorproject.org.
Key Takeaways
- Talking about suicide does not increase risk. Research shows it creates a safe place for your teen to open up.
- Start earlier than you think. Some hospitals now screen children as young as 8 to 11.
- Use the word “suicide.” Avoiding it gives the topic more power.
- Watch for changes from your teen’s own baseline that last more than a few days, not just general moodiness.
- If your teen says yes, stay calm. A teen who talks to you about it is a good sign.
- Restrict access to lethal means at home, including firearms, even if they are locked up.
- Teach teens that telling a trusted adult about a friend in danger is being a good friend, not breaking a confidence.
- Teens are resilient. Suicidal thoughts are transient, and treatment works best when the whole family is on board.
Learn More About Dr. Kristin Kroll
Kristin Kroll, PhD, is a licensed psychologist and the founder of Little Dove Psychology, a virtual practice for children, teens, and college students. She completed pediatric hospital training at Children’s Wisconsin, served as Assistant Professor at the Medical College of Wisconsin, and is the author of a Cambridge University Press textbook on evidence-based treatment for children. Before the pandemic she was researching telehealth delivery of group therapy, and later helped Children’s Wisconsin build its telehealth clinical procedures. Little Dove Psychology provides therapy across Texas and the other PSYPACT states including ADHD, autism, and dyslexia evaluations for Texas clients ages 6 through 55. The practice is in network with several major commercial plans, including Aetna, Blue Cross Blue Shield of Texas, and Optum, for therapy and testing alike. Every family starts with a free 15-minute consultation with Dr. Kroll. https://littledovepsychology.com/
Introduction and Starting the Conversation
Jennifer Hargrave: When it comes to raising teens, there are lots of issues that make it very challenging, and one of those is how to broach taboo topics with your teen. Today my guest is Dr. Kristin Kroll. She is the founder of Little Dove Psychology in Austin, Texas. Before coming to Austin, she worked for over a decade in academic medicine at Children’s Wisconsin, and she has expertise in children’s mental health, especially when it comes to teens. I’m so excited to have her here with us today. Hi, Doctor.
Dr. Kristin Kroll: Hi, Jennifer. Thanks for having me on today.
Jennifer Hargrave: So we’re talking about taboo topics, and this is one of those things you and I were touching on, because it’s hard to even talk about how we’re going to talk about it. One of the big things a lot of parents are worried about these days is our children’s mental health: teens and self-harm, and teens and suicide. So I really wanted to talk with you as the expert and have you walk us through this. Talk to us about teen mental health. Where do we even begin, and what kind of conversations should we be having with our teens?
Dr. Kristin Kroll: Sure. For a long time, we’ve known that adolescence is a high-risk period. There are the developmental changes, and there are new stressors that come with the developmental norms of withdrawing from your parents, spending more time with friends, and establishing autonomy. So we know it’s a unique pressure cooker of high stress and high anxiety for our kids.
Unfortunately, what we’ve seen over the last decade, especially with the pandemic, is a significant rise in suicide attempts and deaths by suicide. A couple of years back, the Surgeon General came out with a focus on child mental health because it had reached such significant extremes. We’ve had a lot of great measures come out around suicide prevention, so there’s been a lot of work done, but there’s still a lot of work to go.
I think the most important piece is prepping parents to have that initial conversation with their kiddos about what suicide is, how we talk about it as a family, and that it is okay to talk about.
Jennifer Hargrave: So first of all, is it okay to talk about?
Dr. Kristin Kroll: Right. I think that’s the first question that comes up. I’ve helped Children’s Wisconsin with what they call their universal suicide screening. This is coming out nationwide, if it hasn’t already, to the hospitals and pediatrician clinics you’ve been to, where we’re screening all kids starting at ages 12 and 13 for suicide, using verified, evidence-based measures.
One of the questions I get most often is the fear that if I talk about suicide, I’m going to put that in my teenager’s head and they’ll then act on it. We call that iatrogenic risk. What we’ve found in the research is that this fear is actually unfounded. It is a natural fear, because we don’t want to reduce our child’s innocence by talking about it, but they’ve already heard about it. We are not introducing more risk. We’re just making it a safe place to discuss by talking about it.
Jennifer Hargrave: So let’s talk about that safe place and how we create it. But before we do that, how early should we begin talking to our children?
Dr. Kristin Kroll: I had the privilege of being part of this year’s suicide initiative through my collaboration with Children’s Wisconsin, and one of the hot topics of debate among the hospitals was what age to start screening. When this joint venture first rolled out, we started screening around ages 12 or 13. However, as more research has come in, hospitals are starting to screen younger and younger. I think Stanford was screening as young as 8 at my last recollection, and Children’s Wisconsin has dropped down to 10 or 11. That’s because the risk is present earlier than we might have thought.
Jennifer Hargrave: Okay. So we should start pre-adolescence, really, during the elementary years?
Dr. Kristin Kroll: As a mom of a seven-year-old, I’ve been thinking about that myself. I preach talking to your kids about this early on, so when am I, as a parent, going to talk about it? Frankly, I think it’s going to come up within the next year or so with my daughter.
The biggest thing I’m going to look for is natural conversation starters. If something comes up in a movie (hopefully not, hopefully I’ll screen for it, but if something slips by me), if she hears about something in the news, or if it’s talked about at school, I’m going to go with it from there. That’s my approach, not just as a mom, but what I would recommend clinically as well.
Creating a Safe Space and Recognizing Warning Signs
Jennifer Hargrave: So then let’s talk about how we make that safe space to be able to have that conversation.
Dr. Kristin Kroll: I think the biggest thing is making sure you’re okay saying it. I don’t care if you have to practice saying the word “suicide” in front of the mirror a million times. We all know we have to have tough conversations with our teenagers, and we prepare for them by staying calm.
It’s also helpful, and this might be nerdy, to write a few notes down and make sure you know exactly what you want to say and how you want to say it. It also depends on your own culture and belief system. Some people want to bring in their religious faith, and that’s a great support if it’s part of the family.
The biggest thing I would recommend, though, is using the word “suicide.” Not saying “died on purpose” or “just passed,” but using the word “suicide,” and taking away some of the power that comes from avoiding the word.
Jennifer Hargrave: Oh, I like that. Removing the power from it. So when we’re talking with our children, what is the message we need to be sending?
Dr. Kristin Kroll: The thing I would like to say is that it’s normal. Having a thought of suicide is normal. When I was in clinic, I would introduce it this way: “Everybody at some point in their life, whether they’ve realized it or not, or whether they haven’t lived long enough yet, will have a really dark thought in their mind. Those dark thoughts can range from ‘I wish I didn’t wake up tomorrow’ all the way up to ‘I want to kill myself, and this is how I’m going to do it.’ Where have you ever fallen on this range?”
I like to ask “where,” not “have you,” because it gives permission that you’ve had the thought, and that’s okay. It’s an acknowledgment of the human condition, that we can all have those thoughts.
Jennifer Hargrave: So really normalizing it as just part of what it means to navigate life.
Dr. Kristin Kroll: Right. And especially if they’re struggling with depression or anxiety, saying, “Hey, this is a common symptom that can come with it.” Just like anxiety can decrease your appetite, this can sneak in as well. So we want to treat it just like a symptom.
Jennifer Hargrave: What is the prevalence? I think what surprises me is just how prevalent it is. What you just said is something I was not aware of. I hadn’t thought of this as part of normal human existence. It’s a bit of a light bulb moment for me, but I definitely see the value in framing it that way. So is this something people generally struggle with during certain phases or stages of life?
Dr. Kristin Kroll: A little bit of both. We have two high-risk periods. We have adolescence, before impulse control and the prefrontal cortex are fully formed. We also have the geriatric population, where there are a lot of health concerns and there might be a lot of grief involved. Those are our two age populations.
There are also different risk factors. Has there been a new stressor, like starting a new school or the ending of a significant relationship? All those big transition periods matter.
We know there are static risk factors, which are inherent and can’t be changed, like being male or your age. Those are higher risk factors. Then there are more transient ones, like the recent loss of a friendship, or not making the football or lacrosse team. That kind of grief and loss can be a trigger as well.
So it’s about paying attention, which is easier said than done, because teenagers are moody, and that’s part of their healthy development. But look for any significant changes from their baseline. If a kiddo who is usually very particular about getting their hair and makeup just right for school stops doing that, starts wearing baggy clothes, or stops showering, that’s a number one flag. That’s a change in behavior I want to pay attention to.
Jennifer Hargrave: I was going to ask you about warning signs parents need to be attuned to. The thing that’s always a little bit scary to me is that when I look at the warning signs and then at a teenager in my household, I see sleeping all the time, moodiness, and all the things that come with being a teenager. It’s hard to distinguish between what’s a risk and what’s normal teenage behavior.
Dr. Kristin Kroll: Sure. They’re moody, their hormones are going wild, they don’t want to talk to you, and they’re isolating from family. I think the two biggest differentiators are these.
First, what is their baseline? Have they deviated from it? You might have one kiddo who naturally has a more reserved presentation and another who’s happy-go-lucky. Is this a change for them?
Second, has that change been sustained for any length of time? Is it abnormal for them personally, and has it been going on long enough that it’s not just two or three days of being out of whack before they start to recover from whatever the trigger was?
If Your Teen Says Yes: Next Steps
Jennifer Hargrave: So I’m envisioning having the conversation and being confronted with responses that maybe I’m not quite ready to deal with as a parent. What do I do if my teen says, “Yeah, I’m having these thoughts all the time”? How do we respond?
Dr. Kristin Kroll: I know this is going to be a hard one, and remind me of this when I talk to my own daughter: we have to switch our mindset. If a child is talking to you about it, that’s the best sign clinically that they’re willing to share. We get more concerned clinically when they’re not talking about it.
Again, it’s about reframing the idea that suicidal thoughts are very abnormal, or that if you have a thought of suicide, you’re at imminent risk. When we look at actual risk of death by suicide, yes, there needs to be ideation, the thought. But it also has to be active, meaning they want to act on it and have intent, and there has to be a plan. So those are the three factors that go into a comprehensive risk assessment. Don’t be afraid of them saying, “Yes, I’ve had a thought.” The fact that they’re talking about it is something to actually cling to.
Jennifer Hargrave: Good. And I’m assuming the conversation doesn’t end there, right? If I find out that my teen is, in fact, dealing with these thoughts, and maybe they’re pretty intrusive and happening with some frequency, do I just get them into therapy? What’s the next step? How seriously do I need to take this?
Dr. Kristin Kroll: It’s a very nuanced decision. The first thing is investigating more about how hard it is for them to ignore those thoughts. Do they feel like they can stay safe? Can they contract with you for safety? If they can’t, or they feel like, “I don’t know if I’ll act on it or not,” that’s why we have ERs, with social workers and psychologists who can do a comprehensive risk evaluation. That doesn’t mean they’re going straight to an inpatient unit. It’s a more thorough risk assessment and clinical formulation of whether ideation, intent, and plan are all present.
If the child is able to contract for safety, hasn’t attempted suicide in the past, and is willing to go to treatment, then the focus is on starting outpatient treatment as soon as possible.
One other thing I would say is to restrict any lethal means around the house. There may be a better analogy for this, but if you have someone who struggles with alcohol use in the household, you don’t keep beer in the fridge. It’s the same thing when a kiddo is struggling with thoughts of suicide. We don’t keep guns around, even if they’re locked up. We don’t keep sharp knives out. We remove any items that could be grabbed impulsively. We want to make sure it takes time and preparation for them to get access to the means.
Jennifer Hargrave: Okay. And you said “contract for safety.” What is that?
Dr. Kristin Kroll: Sorry, that’s a clinical term. I have to turn that off sometimes. Basically, it’s whether the child feels like they can stay safe. Do they feel like, “Hey, Mom, I’d like you to sleep in my room tonight just so I feel safer, but I don’t think I’m going to act on it. I feel confident I’m not going to act on it”? That’s what I’m looking for: the child’s or teenager’s own perception of whether they will or will not act on it.
When in doubt, the ER is there for a reason. But I’ve found that with many teenagers, once you get that conversation going and keep it normalized, they’re very honest and forthcoming. “Okay, you’ve had a thought. Let’s talk more. How long have you had it? How intense is it? Have you thought about how you would do it?” Once we get that dialogue going, keeping the conversation going is what’s so important.
Friends, Crisis Lines, Schools, and Faith Communities
Jennifer Hargrave: I want to talk a little bit about how we talk to our teens about their social group, because they may have friends who are sharing these things with them. I think about how difficult it is even as an adult to navigate these conversations. How do we empower our teens to be a source of safety, but also not take on the responsibility for everybody else?
Dr. Kristin Kroll: That’s a tricky part. Selfishly, or unselfishly, you don’t want your child hanging out with other kiddos who are really in despair and having trouble. You fear it’s going to rub off on them, or that they might react the same way. But at the same time, you want to empower your teen: “If you care about your friend, you’ll help keep them safe.” That’s not taking on their burden, and it’s not being their crisis line if they’re self-injuring or thinking of suicide. It’s alerting their parents, or the appropriate school personnel if it’s at school, to keep them safe.
With my seven-year-old daughter, we’re working on what tattling is versus when you need to tell a parent. The distinction I make with her is the same one I’d make for a teenager: Is there a safety concern? If there’s not a safety concern, we don’t need to come tell Mom. But if there’s a safety concern with your friend, you’re being a good friend by staying connected to them and also alerting the people who love them, so they can help that person as well.
Jennifer Hargrave: I imagine the bind is that loyalty bind, right? If your friend has disclosed something like this to you, you might feel like you’re violating their confidence. What would you tell a teen in that situation?
Dr. Kristin Kroll: I think the biggest thing is talking about it proactively when you’re having that conversation about suicide. Say, “Hey, if Tammy comes and talks to you about suicide, what would you say?” And rehearse it: “If Tammy says this, what would you say? Do you feel comfortable telling your parents? Do you know the crisis line number?” That’s 988, the nationwide crisis line. There’s also The Trevor Project for LGBTQ youth, which offers more specialized care for youth who identify that way. So it’s about having a plan in place before this happens to your teenager.
Jennifer Hargrave: So really giving them the resources. We will certainly put the hotline number here and make that available. But walk me through it. What happens when you reach out to the hotline?
Dr. Kristin Kroll: A lot of it is acute crisis stabilization. If someone is in crisis and near a gun, the counselor might stay on the phone with them while they walk away from the gun, or stay on the phone while they walk to their parent’s house, and just stay with them in that moment.
What we know from people who have survived suicide attempts is that there’s an impulse, and then regret right away. So calling 988 helps get them to a point where they’re stable enough to go to sleep or talk to their parents the next day. Or the crisis line may advise them that it’s time to call in some extra help right now.
Jennifer Hargrave: Now I want to talk about the role that schools, churches, and faith communities are playing or can play. These are places where kids are existing and living. What do you see schools doing to help?
Dr. Kristin Kroll: It varies by region and state, but a lot of schools now have school-based mental health counselors, so that when teachers or parents notice a change in a child’s behavior, there’s another person for the child to contact and talk to. Teachers are great at this, because they’re seeing a change in behavior not only for that child, but in comparison to their same-aged peers.
When we’re thinking about a safety plan with a kiddo, yes, we want them to be able to call their parents if they need to. But what if Dad’s at work, or Mom’s out of the country, and they’re having a crisis right now? Who do they talk to on campus at that time? So it’s about having a plan: if they’re in crisis, they talk with the counselor, the nurse, or whoever that trusted adult could be.
With regard to faith-based organizations, churches are a great way to help destigmatize this. This is a normal part of the human condition. It doesn’t make you sinful or evil. It’s part of being human, and God has given you resources throughout the community to be able to take care of yourself. Framing it from that perspective can help as well.
Jennifer Hargrave: Love that. And are we seeing more resources? What’s the trend right now? Are we still seeing avoidance, or is this opening up?
Dr. Kristin Kroll: I think it’s opening up. The Surgeon General’s advisory did a really great job of broadening the dialogue. There have been a lot of SAMHSA grants dedicated to suicide prevention research. And it has now become the norm at pediatric hospitals to do universal suicide screening, meaning everybody gets screened, not just kids who seem at risk, so that we start that dialogue. We’re seeing a big shift there as well.
I’ve also loved seeing how schools have started to integrate mental health into the curriculum. There’s a model called MTSS (Multi-Tiered System of Supports), and it’s shaped like a pyramid. At the top are the kids who really need individualized help from a psychologist or counselor. Tier two, in the middle, is for kids needing some support, like an IEP. The bottom level is universal prevention, the curriculum all students receive on things like what anxiety is and what feelings are. Those are the basic building blocks, so kids have the words to put around these things.
Parent Shame, Divorce, and a Message of Hope
Jennifer Hargrave: So kids know, and parents know, that you’re not alone in this. And as a parent, there’s no shame if your kid is struggling with this. I think there was a time when parents were more united as parents. As a parent, I’ve noticed that parenting through the teen years has become pretty lonely for a lot of people. It’s easy to share potty training tips for two-year-olds, but it’s a lot more difficult to share the struggles you’re having with your teens, whether they’re using drugs or whatever they’re going through. I’ve observed that a lot of people withdrew from communities they used to be part of during that time.
Dr. Kristin Kroll: I think it’s this fear of “I must be a bad parent if my child is having thoughts of suicide.” And that’s not the case. How suicidality develops is multifactorial. There’s a genetic predisposition we can’t help. There are static risk factors you can’t help. And there are triggers, like the loss of a friendship, that the best parenting cannot prevent. No matter how good a parent you are, you cannot prevent this. You can take steps to help protect your child and prepare your child, but you’re not at fault for them experiencing it.
Jennifer Hargrave: I always say there’s that tension of wanting to protect your kid. As they grow up, you realize the most important thing you do as a parent is prepare them, because you can’t protect them. There is no bubble wrap when they go off to college.
Dr. Kristin Kroll: You’ll have to remind me of that when my daughter goes off to college. But yes, it’s prepare, protect, and, more importantly, model. For example, just a small thing: when I’m nervous about something, I’ll tell my daughter, “I’m feeling really nervous this morning, so I’m going to get a good workout in,” or “I’m going to do some breathing techniques,” or “I’m going to say a prayer.” That way I’m modeling that it’s okay to have this feeling, and here’s what I’m going to do about it.
Jennifer Hargrave: Yes, the tools in the toolbox of life. You and I connected because, of course, I’m a divorce attorney, and we work with families that are going through that transition. I know that’s a high-risk time for teens. So I’m so appreciative of your resources and your outreach, and of wanting to connect with family lawyers, because it’s true: we’re dealing with kids in really tough times.
As we wrap up, I always like to ask my guests one final question. What is a message of hope you have for parents of teens, especially as we think about teen mental health and suicide?
Dr. Kristin Kroll: That teens are naturally resilient. I think we sometimes forget how resilient our kids are. Where we fall short is doing the prep work beforehand of making it okay to talk about.
I’ve had some of my best outcomes with kiddos who had multiple repeat attempts and hospitalizations. There’s a turning point when treatment becomes the focus and the whole family is on board and on the same page. So there’s a lot of hope for teens, or for anybody else. With suicidal ideation, we have to keep in mind that suicidal thoughts are transient. They pass. Knowing that this too shall pass is the biggest thing.
Jennifer Hargrave: I love that. Well, thank you, Dr. Kroll, for your work with kids and families and all that you’re doing. If you want to learn more about Dr. Kroll, her practice, and all the resources that are available, we’re going to include the link below, and we encourage you to reach out.
Dr. Kristin Kroll: Thank you.
