The Impact of a Trusted Adult in Youth Suicide Prevention

By Sue Coyle, MSW

In 2017, suicide was the second leading cause of death for youth aged 15 to 24, as well as those aged 10 to 14. It followed only unintentional injury for both age groups, according to the Centers for Disease Control and Prevention (CDC). While this standing was new as of 2015 and 2016 respectively, it was not shocking; for at least the 10 years prior, suicide stood at number three.

Thus, it should come as no surprise that prevention—specifically prevention targeted at young people—has been an ongoing focus of researchers, clinicians, and other professionals. “Suicide is preventable and treatable,” affirms Maureen M. Underwood, LCSW, clinical advisor for the Society for the Prevention of Teen Suicide.

There are numerous prevention techniques and models implemented throughout the country, including school-based educational programs and, clinically, the use of safety plans that ask youth to identify warning signs, coping strategies, and people/settings that can provide distraction or help.

One preventive measure in particular that has shown positive impact is the presence of a trusted adult in a youth’s life.

A Study Revisited
This impact was most recently seen when researchers at Michigan Medicine revisited a study completed approximately 12 years ago. The initial study worked with youth aged 13 to 17 who had been psychiatrically hospitalized for suicide risk. “The youth either had a recent suicide attempt, or if they didn’t have a recent attempt, they had substantial suicidal ideation within the last four weeks,” says Cheryl King, PhD, a professor and clinical psychologist in the department of psychiatry at Michigan Medicine.

Half of the youths received the standard level of care while the other half received somewhat more—they were asked to identify a trusted circle of adults. The youths were encouraged to nominate up to four adults, including a family member, an adult from their school, and someone from the community. With parental permission, those selected received education and training specific to the youths, as well as about suicide risk and warning signs. Through their training, the adults learned about the youth’s treatment plan, why they had been nominated, and what it meant to be a caring adult.

As an added support, for the next three months, the adults received weekly phone calls from the researchers.

At the time, researchers were unable to follow the youth and their trusted circle long term. However, more recently, King and her team accessed the CDC’s National Death Index. With this information, they were able to see that in the past 12 years, 15 of the youths had died. Only two of the 15 were from the group that had been assigned a circle of trusted adults.

Though a small sample, this information suggests that access to caring adults may help decrease the mortality rate among youth at risk of attempting suicide, King says.

The Adult
To best understand why this impact is possible, one must first understand exactly what a trusted adult represents. A trusted adult is an individual identified by a youth as willing and able to provide support and understanding.

There are a few key factors to being such a trusted adult. The first, intuitively enough, is adulthood. Peer support is lauded and relied upon in many instances; however, there are cases in which it may not be as appropriate or effective to rely heavily on peers.

“There is a wisdom that comes from age and experience,” Underwood says. “Having the long view of life, which is impossible for teens whose perception of the future is limited because of the way their brains process the concept of time, leads to a more resilient perspective in problem solving.”

Additionally, “Troubled youth often have difficulties in [peer] relationships,” King says. As a result, friendships with peers can be less stable, particularly as the lives of both friends continue to change.

There is also of course the gravity of suicide and how a trusted peer might react should their friend die by suicide. “We had an uneasy feeling that the youths might feel responsible no matter what we said,” King says. Based on their prior experience, the researchers did not include any peer nominations.

The adult should also be identified or nominated by the youth, not assigned by others. This gives the youths who may have recently attempted or be at risk of suicide a sense of empowerment. “The youths were saying they trusted those adults and would like them to be more involved in their lives. They were giving permission for those adults to come in and learn about the reason they were hospitalized, their problems, their treatment plan,” King says.

“We want to give them permission,” Underwood adds, “to say, ‘That youth minister at church, he really listens.’”

That permission also allows for youths to identify individuals outside of their parents—people that many would assume are the default supports. While parents and other family members may be nominated, they are not always, and that fact needs to be respected. Underwood, laughing, remembers when her own child made a list of trusted adults. She wasn’t on it.

“We all talk to different people about different things,” she says. “As long as they tell someone, that’s critical.”

Finally, the adult should be someone willing and able to provide the needed support. There will be people who, for a variety of reasons, choose not to be or should not be on a youth’s team.

Underwood provides trainings in schools, working with educators and other school professionals. She encourages those who can and should to advertise their willingness to be a trusted adult. However, she also encourages them to think honestly about their own abilities to be that person, even on a day-to-day basis. “There are probably going to be days when you’ve got enough on your plate, so take that sign down in your office,” she says. “You don’t have to be there all of the time.”

Supporting the Adults
Additionally, it should be noted that the trusted adults in King’s study were not, once nominated, left alone to determine how best to support a youth. The team of adults received weekly phone calls for three months to monitor their relationship with the youth, on top of an initial training.

For the best chance at positive impact, the adult should have education and support surrounding their role.

Underwood notes that one of the first things adults need to understand is that asking about suicide won’t lead to suicide or suddenly create suicidal ideations. “This is one of the most worrisome myths about suicide, since not asking the question often results in the suicidal thoughts remaining secret and the door to intervention staying closed,” she adds.

Further, adults should be encouraged to actively listen to the youth. Once the question is asked, they need to not only hear the response but also be prepared to say, “Tell me more.”

“They are usually the hardest words to say when someone tells you they feel so miserable they wish they were dead, but they begin the process of validation,” Underwood says.

After education, support remains important, as supporting the adult helps that adult feel capable of supporting the youth.

When a team of researchers is unavailable to call the trusted adult or provide individualized training, there are resources that the individual can turn to. Underwood recommends the Society for the Prevention of Teen Suicide.

Moving Forward
Understanding what a trusted adult is, the type of support they need before and after being identified, and the impact they can have on youth, it seems evident that this is a prevention measure that should be more widely utilized.

“In some ways, it sounds quite simple,” King says. “Why wouldn’t we all be doing this?”

However, she also notes that the study should be replicated on a larger scale. Doing so will allow researchers to understand better the impact a circle of trusted adults can have, as well as what factors might affect that outcome.

Such an understanding will not stop all suicides. As Underwood says, “Every suicide is multidetermined.” But it will help more youth and perhaps be one of many steps aimed at pushing suicide further and further down the CDC’s list of causes of death.

— Sue Coyle, MSW, is a freelance writer and social worker in the Philadelphia suburbs.