10 things parents should know about suicide if your teen's watching '13 Reasons Why'
Posted April 18
Updated 8:25 a.m. Thursday
The new Netflix series, "13 Reasons Why," might be binge-worthy TV for many of its viewers, especially teenagers, but it's also controversial for the way it depicts suicide and a girl's decision to end her life.
Based on the 2007 young adult novel by Jay Asher of the same name, the series tells the story of Hannah Baker, a high school student who, before killing herself, sends cassette tapes to classmates detailing the 13 reasons behind her decision.
Actress and singer Selena Gomez, who has been vocal about her own struggles with mental illness, is the show's executive producer. "13 Reasons" has been heralded by many, including Forbes, which called it the best show on Netflix in years.
But others have called out the show for the way suicide and a struggling teen are portrayed. One story in the Washington Post said it could "do more harm than good." (The show did produce a five-minute video which explains their reasons for the portrayal).
Indeed, teen suicide is on the rise, particularly among adolescent girls. It's the third leading cause of death for those ages 10 to 24. And, it comes at a time of year when suicide is more common - spring - as teens grapple with, for instance, not getting into the college they hoped for, anxiety about final exams, dashed prom date hopes and other setbacks that, for some with mental illness, especially, can lead to hopelessness and depression.
What's more, research shows that teens who are struggling with suicidal thoughts and mental illness are more likely to attempt suicide when a family member or classmate has died by suicide – or even the lead character of a popular TV series.
Seeing somebody, especially a person who appears to have everything together, die by suicide can spur other teens, with already low self esteem and mental health issues, to make the same decision for themselves, said Ann Oshel, senior vice president of community relations at Alliance Behavioral Healthcare, which serves Wake, Durham, Cumberland and Johnston counties.
"We have heightened concerns about copycat suicide, especially if it’s somebody really popular in school – a cheerleader, athlete, student body president," Oshel said.
Mental health experts across the Triangle said Tuesday it's critical that parents have candid conversations with their teens, whether they are watching "13 Reasons" or not, about mental health and suicide and that parents and teens are aware of resources where they can get help.
Ninety percent of people who die by suicide have a mental illness, often depression, but it doesn't have to be that way.
"People who receive treatment for their mental illness are living meaningful and fulfilling lives," said Nicholle Karim, public policy director at NAMI North Carolina, pointing to author J.K. Rowling, Lady Gaga and Demi Lovato, who all have spoken up about their own past struggles. "You want to underpin the conversation with hope and recovery."
I checked in with Oshel; Karim; Lauren Foster, executive director of the Raleigh-based HopeLine crisis line; and Carolyn Zahnow, whose own son died by suicide and is founder of The Shore Grief Center, to get some tips on how to have these kinds of tricky conversations with kids and the kinds of things parents should be on the look out for.
Here's what they tell me:
Don't shy away from the subject: Just talking about suicide isn't going to lead anybody to kill themselves. "We know that is just not the case," Karim said. "You will not put that idea into somebody’s head by talking about suicide."
Said Oshel: "Just because you ask the question doesn't mean you’ve planted a seed in their head. It is far worse to ignore it than to openly address it."
Arm yourself with facts: Do your research before you start the conversation so you can offer your kids the facts, answer their questions and know where to look when they ask for more details.
Here are some places to look:
And remind kids that "13 Reasons" is fiction, said Zahnow, who listened to the book and is now watching the series. Because of the need, the grief center, which Zahnow founded, is adding a new support group for grieving parents in the Cary area next month.
"Parents should remind kids that it is fiction," she said. "It's not a true story. Usually people that do kill themselves aren’t going to write a story beforehand. They are just depressed ... very depressed."
Take advantage of teachable moments: While many mental health experts are concerned about the way suicide is depicted in "13 Reasons," the series is giving parents an obvious opportunity to bring the topic up with their kids. Schools also send home letters to parents when a student kills themselves. Oshel said those times are another critical opportunity to raise the subject with teens.
"Even if you think that idea has never occurred to your child, you should always talk to them when that’s been something that happened at school," she said.
Help them handle disappointment and stress: These days, teens have a lot on their plates.
"Unfortunately, we hear a lot from kids about all of the pressures and the struggles that they go through in school or in peer groups or in extracurricular activities," Karim said. "And we do know that suicide tends to happen sometimes when those things feel so overwhelming and they can’t handle those things. So, as a parent, talk with your kids about how they handle stress and what they do when they feel overwhelmed."
Help them determine the difference between a problem that they can solve on their own or with peers and issues that need adult intervention. Zahnow said a break up with a boyfriend or girlfriend can be a particularly difficult time for a teen, who already may be suffering.
"Teach them how to deal with disappointment and be able to move on and believe that good things are going to happen anyway," Oshel said. "At this time of your life, you’re just learning how to deal with disappointment that seems like it’s going to forever ruin your life."
If you suspect depression or another mental illness, get them help: Harvard Health offers a parents guide for identifying teen depression and offers some recommendations for how to help them.
"Do not think that this is just a passing mood or this is typical adolescent drama," Oshel said. Often, teens don't fully understand the finality of their actions.
"So what may start out as a cry for attention or just some superficial attempt ends up becoming lethal for them," Oshel said.
And Zahnow said you shouldn't wait for a teen with depression to ask you for help.
"The people who live with them and know them will have to get them help," she said. "If you see someone depressed for two weeks or more, get them help. Don’t ask them. Just do it."
Be on the look out for bullying and be aware of other risk factors: A Yale University study found that victims of bullying victims are between two to nine times more likely to consider suicide than non-victims. If your child complains about a bully at school - or online - get to the bottom of the situation.
Lesbian, gay and bisexual youth also are more than twice as likely to have attempted suicide when compared to their heterosexual peers, according to the Centers for Disease Control and Prevention. And, one study of 55 transgender youth found that 25 percent reported suicide attempts, according to the federal agency.
Check their social media and talk to them about it: Whether it's regular checks - or regular talks - about what they and their friends are chatting about online, it's important for parents to be aware of the conversations.
"There is this whole secret life that social media allows young people," Oshel said. "That's their main communication with their peers."
Talk directly with your kids about what they are seeing on these social media sites - what's OK, what's wrong and what makes them feel uncomfortable, Oshel said.
Know the warning signs: Isolation. Changes in eating or sleeping. Ending activities they once loved - and not replacing them with anything. Dramatic changes in their moods - from depression to feeling peaceful and happy. These are just a few of the warning signs that a person is considering suicide. The American Foundation for Suicide Prevention lists all of the warning signs.
If you're worried your child is considering suicide, be direct and ask: Don't beat around the bush. If you think your child may want to end their life, it's time for parents to take action. Don't just hope that it will get better.
"It is important to be straight forward," Foster said. "We say, 'Are you thinking about hurting yourself? Are you thinking about killing yourself?' ... Most of the time, asking them is going to be a relief for them. They don't have to say it. They didn't have to bring it up. You have opened the door for them to come to you because they know that you are paying attention and they know you care about them enough to ask."
Know where to get help: NAMI North Carolina and Alliance Behavioral Health are two places to get help for teens - or anybody. Family doctors, pediatricians and school counselors also are great places to start.
Those in need also can call or text the Raleigh-based HopeLine Crisis Line, which helps people across the country, at 919-231-4525 or 877-235-4525.
The HopeLine added texting capability on April 1 and, in just a few weeks, has seen a lot of use despite almost no promotion, Foster said. Most of the people texting the crisis line for help are kids as young as age 8 to young adults in their mid-20s.
"It's one of those double edged swords," Foster said. "I'm happy the program has been successful so far without doing much promotion, but it's also sad to hear that such young people are going through some really difficult things."
HopeLine's crisis line is open 24 hours a day from Wednesday through Sunday and 8 a.m. to 11 p.m., Monday and Tuesday. The text line is available from 9 a.m. to 11 p.m., weekdays. Foster said she'll expand the hours as more volunteers are trained to handle texts for help.
If you are thinking about suicide, you also can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the Suicide Crisis Line at 1-800-784-2433. Both are open 24 hours a day, seven days a week.
In fact, on Twitter, children's book author Marcie Colleen, who was in Raleigh earlier this month with her books for younger readers, has launched a campaign with the hashtag #HelptheHannahs to urge Netflix to include resources for viewers before and after each episode who might be struggling with suicidal thoughts. (An email to Netflix about the series and the possibility of including resources hasn't been returned at last check).
"That would be a great idea," said Karim about adding the resources to the episodes. "It’s really important for people to know where they can go to get help if they are having these thoughts and feelings."