Maggie McKay (Host): In 2022, one of the leading causes of death for teens and young adults with suicide. Le Bonheur Children's Hospital has treated patients as young as five years old for self-injury, suicidal thoughts and suicide attempt. Those who attempt or die by suicide do so because they cannot imagine a better day.

Host: For more than 71 years, the journey to a healthier childhood has led thousands of children and their families to Le Bonheur. That's why Le Bonheur was one of only 16 hospitals in the country selected to develop a pediatric-specific approach to the youth mental health crisis through a grant made possible by Children's Hospital Association, Cardinal Health and Zero Suicide.

Le Bonheur's program is called Hope Journey. Senior Director of Emergency Services, Barbie Stewart, is here to talk about childhood suicide and how we can help in the fight to keep children safe. Welcome to the Peds Pod by Le Bonheur Children's Hospital. I'm your host, Maggie McKay. Welcome, Barbie. Thank you so much for being here.

Barbie Stewart: Hi, Maggie. Thank you so much for having me here today.

Host: These statistics and facts are so alarming and a very sad reality. For the caregivers listening, what are some warning signs that they should look out for in their child?

Barbie Stewart: It really varies a lot based on specific children and adolescents. In a short answer, I would say really any noticeable changes in behavior outside of an adolescent's norm, as well as paying attention to any major life events that may have occurred. Specifically some of the behavior changes might include or look like little interest or pleasure in doing things that they once enjoyed, feeling down, depressed or hopeless; if they're having trouble falling asleep or if they're sleeping too much, they may be feeling tired and having low energy; they may be having a low appetite or eating too much or more than they used to. Specific comments about feeling like a failure, letting people down, having trouble concentrating if they seem fidgety or restless or, on the other end of the spectrum, moving and speaking slowly. And then, some of those major life events to pay attention to are experiencing divorce, death of a family member, moving and changing schools, possibly relationship breakups or loss of friendships, bullying or exposure to violence.

Host: And what action should a caregiver take once they see these warning signs?

Barbie Stewart: Honestly, I think the most important thing is having open, honest conversations with your children or those children who are in your life. Ask direct questions about feelings, thoughts and experiences. And then, it's very important that whatever it is that they might say or share with you, that you do not react with judgment, defensiveness or dismissiveness. You can really work with your child or adolescent on what their specific triggers may be, what actions that you can do that feel supportive to them or how you can support them in the way that they need, and really talking about who their support systems might be and what are the healthy coping mechanisms.

I think it's also important to really consider your own mental health and wellbeing and lead by example. So for my own personal experience, it was my five-year-old who identified a time in my life that I needed to reach out for help. I had suffered several significant losses in a row and I found that I was experiencing signs of depression that I had not even admitted to myself at that time. And I was really just working to kind of just keep swimming, sort of speak, when one night during bedtime prayers, he prayed to God that he would help mommy feel better. And so, I kind of looked at him. I wasn't feeling sick, and I wasn't sure where that was coming from. And I told him, "Mommy's not sick, buddy." And he looked me in the eyes, took my face in his sweet little hands, and he said, "I know your body isn't sick, mommy. But I really wish your head could feel better." And it was just a very big reminder to me that our kids are watching us and they're taking their cues on how to address their mental and emotional wellbeing from the adults in their lives.

Host: And that's at five years old.

Barbie Stewart: Yes. I mean, they're watching everything we do, right? We teach them how to interact with the world and they're paying attention. So, I think it's a big deal that we make sure we're modeling those behaviors that they also need to model.

Host: Absolutely. We mentioned Le Bonheur has cared for very young children for self-injury attempts. What are you seeing in your emergency department and what's contributing to the increase of suicide risk for this population and teens?

Barbie Stewart: So, there has been a very large increase really at an alarming rate. I think it's a multifaceted issue. But one of the biggest things is that the youth mental health crisis right now is considered by many to be a secondary pandemic to the COVID-19 pandemic. So, we all know that socializing allows youth to build skills that help them be confident and autonomous. And those social interactions help them develop self-esteem and build resilience toward the unknown, and eventually create connections that make social interactions less scary.

So instead of getting to experience really that normal childhood and socializing, our youth were pulled out of social circles overnight. They were facing a scary worldwide pandemic just as everyone else was; a complete change in their routine, difficult educational challenges. And then when it was all over, we pushed them right back into their previous environments with very little time to adjust to it all. So, this time was extremely stressful and frightening for adults, but even more so for those who were in their formative years and maybe hadn't built up those coping mechanisms to fall back on. So then when you couple those life-changing few years with access to information and exposure to violence that's a click away of a button, along with a lot of unrealistic depictions of ideal clothing and body image and talents and relationships, that they're inundated with every day in their social media, you have a very serious recipe for disaster there.

So additionally, there's been a stigma surrounding health issues or especially mental health issues that make individuals reluctant to share their struggles. So, I think this is why it is so imperative that we start changing that conversation surrounding mental health and normalize talking about our feelings, our struggles and our mental wellbeing.

Host: Definitely. I was just talking to a friend yesterday and she was telling me how her little guy-- during the pandemic, he was in first grade, so now, what, he's in third, maybe fourth. And he was really scared of all the masks at the time. And ever since, even though we're kind of back to normal, she said she cannot get him to do even sports. He doesn't want to be with any groups because he's still nervous about it. And I thought, wow, just think how many other kids are in that same boat. So, just exactly what you're talking about. But tell us more about Le Bonheur's Hope Journey Program and how it's helping children in the Memphis community.

Barbie Stewart: Yes. And I'm very excited about this. So, Le Bonheur really has that longstanding mission and reputation in the community as an advocate and medical provider for youth and their families. So, we have a history of providing hope and support to families in their darkest days, especially when it comes to medical diagnoses and procedures. However, behavioral and mental health has never really been our specialty or focus area of expertise. And quite frankly, it's not really our mission at this time to become that expert because there are so many resources in the community to provide that expertise.

However, what we have been discovering and really identifying is that when the patients and families we serve really don't know where else to turn, but that they know they need help, they often turn to us. And it became more and more clear to us that we'd never wanted to be a close door. If you showed up on our doorstep for any reason, whatever the issue was that you were bringing with you, we feel like it is our responsibility to make sure we can connect you with people who can help. So, the vast numbers of individuals who die by suicide really make that attempt within an hour of first deciding to do so. And that is a staggering statistic to me. From the time someone decides that they do not have enough hope to keep living to the time that they do something about it is about an hour. And this is even further decreased in children and adolescents because they tend to be more impulsive.

And so, through the Hope Journey, what we recognize is that we cannot wait until someone's in a crisis because we might not have time to intervene or help. So, we are going to be implementing universal depression screening. So, whatever reason a patient makes contact with us, we are going to go ahead screen them for those early signs of depression and risks. And that way we can intervene and support an individual at risk for suicide attempt well before they reach that point of hopelessness.

Suicide is often thought of, and it's another stigma related to it, as a very selfish act, that they didn't think enough about the people in their lives. When in reality, it is completely an act of hopelessness. They cannot, in their minds, picture a day or a moment that is going to be any better than what it is right now. They can't think outside of that just despair that they're in. And so, we want to make sure that we can intervene well before they reach that point. So, that's really our first aim.

Our other aims are really to bring awareness to the issue, start changing that conversation surrounding suicide so it doesn't have the stigma attached to it, because it really is just another health issue that people might need to have support or medication or therapy or whatever it may be. We also really want to advocate for community resources. And so, we talk to the government and we talk to those who might be able to give us grant money or other community resources that are there. And we partner with those groups and agencies to make sure that every individual, no matter their socioeconomic status or where they live or what their family life is like, or what their background is, that they will have those same accesses to resources that others have.

Host: It's so heartbreaking to think that young children are so hopeless at that young age, but thank goodness for programs like Hope Journey. What other resources are available to families and when should parents reach out to their healthcare provider?

Barbie Stewart: So, this is so interesting. A few months ago when we started this journey, I really felt like there were not very many resources in the community. But with each new meeting I attend, each new individual that I meet, there are so many efforts surrounding this right now to really make sure that there's access.

I think part of the problem is, is that those who need access to these services don't know that they're out there. So, we actually have a Hope Journey page on the Le Bonheur website where we're housing a list of resources that both medical providers and families are going to be able to access just to see all the things that are out there. It'll be a living, breathing document because I feel like we learn about new resources every day. But if you're just looking for a place to start, you could go to that website, you could look, but also talk to your medical provider. They're a great resource. If you don't feel comfortable talking to a medical professional right away or that's not where your comfort level is, there are others that might be able to connect you with those right services, such as pastors of churches, school counselors and other community groups.

I would say the right time to reach out for help is the moment that you sense something has changed. And even more important than that, if a child or adolescent in your life has verbalized that they need help, don't brush those conversations or instincts off. It is often very difficult for someone to verbalize that they need help and that might be the only opportunity that you have to intervene. So, take it seriously, talk with them, treat it just as important as you would if someone told you that they had a medical condition that they were hurting or experiencing.

It can be difficult to really hone in on what's going on when there's behavioral and emotional changes, because we all know that puberty and impulsivity can create a really wide range of emotional and behavioral changes in youth. But remember that you know your child better than anyone. And so, really trust those instincts that you have if you're noticing a change in them.

Host: Barbie, this has been so informative. And I know we could talk a lot longer if we have the time. But in closing, is there anything else you'd like to add?

Barbie Stewart: I just want to say that it's going to take all of us to fight against childhood suicide and really help these individuals hold onto hope. They're often experiencing a time when they don't even know how to hold onto any hope for themselves. So I encourage you that together we can hold onto that hope to them until they're able to hold onto it for themselves.

Host: Thank you so much for your time, Barbie. I know it's a tough topic to talk about, but it's one of those conversations that needs to be shared and, like you said, we need to take the stigma out of it.

Barbie Stewart: Yes, absolutely.

Host: Again, that's Barbie Stewart. Do you know someone that needs help? Call or text the 988 Suicide and Crisis Lifeline if you're experiencing mental health related distress or are worried about a loved one who may need crisis support. 988 is confidential, free and available 24/7, 365.

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