How to talk to your college kid about suicide: An awkward conversation that could save a life

This story discusses suicide. If you or someone you know is at risk of suicide please call the U.S. National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or go to SpeakingOfSuicide.com/resources for additional resources.

Suicide is the second leading cause of death for college-aged people, and, as the Centers for Disease Control and Prevention reports, for people between the ages of 10 to 34. Experts say parents should discuss the topic with kids before they leave home for college.

But how? It's not an easy conversation to have.

"For some parents, when they use the word 'suicide' there’s a shift of energy in the room, (especially if) it’s not on the child’s mind or is anything they’ve considered," Christine Crawford, a psychiatrist and the associate medical director of the National Alliance on Mental Illness, tells TODAY Parents. "A child may be left wondering, ‘What did I say to make my parents think of this?'"

Related: 3 ways parents can help their kids build resilience, boost mental health

However, Crawford says ongoing conversations about mental health are too important to skip. There's never any guarantee, sadly, that having these conversations can prevent suicide. But it's a good thing for parents to know about.

So, what can parents do to bring up the topic of suicide with their college student, and make sure they are safe?

1. Start young

In a perfect world, parents would encourage children to express their feelings from a young age.

"It’s important for kids to grow up in an environment in which they see adults dealing with difficult moments so they have coping tools to relieve them of stress," says Crawford. So by the time college rolls around, "They’ve had years of watching family members navigate the complexities of being human."

Parents can share with young children how they handle stress to demonstrate how to identify and understand emotions. If your child is really frustrated, you might say, "I can see that you’re upset that I didn’t buy you a toy. What can you do to feel less angry or sad?"

"If you’ve had the privilege of starting young, (you’ve) hopefully continued into the teen years,” notes Crawford.

2 . Note any red flags

During college, students are responsible for their academic performance and self-care, which can be intimidating fresh out of high school. Crawford says college kids still need reassurance of their parents' support.

And, parents need to be able to recognize mental health alerts.

Related: Back in school, teens are struggling with mental health. Here's how to help them.

"It can be hard for students to know when they should talk to a friend or a mental health professional," Doreen Marshall, a psychologist and vice president of mission engagement at the American Foundation for Suicide Prevention tells TODAY Parents.

One sign that it's time to see a professional, she says, is when changes in sleep or behavior interfere with daily life.

Crawford specifies some warning signs: Your kid isn't interested in hanging out with friends, they’re spending more time alone in their room, they’re eating or sleeping less and it's harder for them to get out of bed and get ready for class.

3. Use these talking points

Crawford encourages parents to question themselves before mentioning suicide.

“If you feel you need to have an immediate conversation, take a step back and ask yourself what you’re responding to,” she says. Has your kid’s behavior raised red flags or are you driven by your own anxiety, whether it’s from something you saw in the news or your personal mental health history?

Crawford says parents can ask, “I have to share with you that I’ve noticed some behavioral changes in you. What thoughts do you have about how you can feel better?”

If your child reacts as if you sprung a second head or says, “I’m fine," use this reply: “All right. If things aren’t OK and they seem so painful and you think the only way to get out of the pain is to harm yourself, we can work together to find a better way to relieve you of that pain.”

Marshall also suggests these conversation starters: "Parents could say, ‘I just heard something on TV about kids and mental health. Do you or your friends ever have thoughts of suicide?'"

Otherwise, try: "Sometimes when people feel overwhelmed or have a lot on their plate, they may feel like they don’t want to be here anymore. I wonder: have you ever felt that way?"

If your college kid has a history of depression, dialogue can be ongoing. “You can ask, ‘How can I support you to make sure you’re (taking care) of your mental health (during college)?” suggests Marshall.

College kids who take medication might struggle to stay up-to-date on their refills, adds Marshall, so check in with your student more often, at least in the beginning of the year. And make sure they understand how to reach their doctor or use teletherapy.

Julie Cerel, a licensed clinical psychologist and a professor in the College of Social Work at the University of Kentucky proposes that parents listen closely for prompts from their student.

"If a kid says, 'I haven't slept all week' or 'I miss my friends' they become cues to ask more questions," she tells TODAY Parents.

4. Frame mental health care as a daily to-do

Mental health should be seen as a safety issue, like wearing a seatbelt, says Cerel.

"If you’re touring a college campus, you can ask, ‘Where is the mental health office?'" she tells TODAY Parents. “Or, ask your kid, ‘Do you know where the on-campus post office is? The athletic center? The mental health clinic?"

Related: Why mothers are bearing such a huge mental load during the pandemic

Nowadays, colleges are forthcoming about campus counseling resources and some incentivize students to care about their wellbeing.

"It’s very common for colleges to organize a ‘scavenger hunt’ type activity to raise awareness about different campus resources, including counseling," David Walden, a psychologist and director of the counseling center at Hamilton College, tells TODAY Parents. "For a counseling center, the challenges are usually somewhere between raising awareness and meeting demand. "

Cerel says the University of Kentucky’s suicide prevention program challenges students to take a photo outside the counseling center, write short journal entries about relaxation techniques, add the National Suicide Prevention Lifeline phone number to their phones or document proof of self-care habits such as sleeping for eight hours at night.

5. Explore these resources

Seize the Awkward is a campaign that addresses how, well, awkward it can be to discuss mental health, and identifies warning signs and conversation pointers. The initiative was created by the American Foundation for Suicide Prevention, the emotional health and suicide prevention non-profit The Jed Foundation and Ad Council.

The National Suicide Prevention Lifeline has tips for finding a therapist, building a community and templates for safety plans.