Marc is an 11-year-old boy who was seen in our hospital’s Urgent Care Clinic after he was referred there from the Emergency Department (ED). His parents had taken him thereafter he told them he wanted to kill himself.
It wasn’t the first time Marc had told his parents he wanted to die. He said the same thing a year earlier after having cut his forearm with scissors and considering hanging himself with a belt. When the psychiatrist asked Marc how and when he was first exposed to self-harm and suicide, he answered, “I don’t remember not knowing about it; it’s everywhere—social media, online, television, my friends. Everyone talks about it.”
As mental health professionals, we feel privileged to work with children and families to address their mental health challenges and to see their return to health. But after a shared six decades working as a child and adolescent psychiatrists, we are alarmed, more alarmed than we have ever been in our long careers, as we see trends going in the wrong direction.
You may have already read that hospital EDs have seen unprecedented numbers of young people presenting with self-inflicted injuries, thoughts of suicide, and suicide attempts. More of them are getting admitted to hospitals—generally a last resort, given the necessarily restrictive nature of psychiatric inpatient units and the risk of “cocooning” the child to an extent that makes it harder to return to “real life” at discharge. Even more tragically, the rate of deaths by suicide is climbing among children and teens in the United States, particularly among females. We don’t have reliable national data in Canada at this point but are concerned there may be a similar trend.
As a child and adolescent psychiatrists working in a large Canadian urban children’s hospital with a busy emergency department, we are living with this new reality. As we—together with scientists, public health experts, other mental health professionals, children, and families—seek answers to the reasons for these alarming trends, we know one thing for certain. We need to come together as a community to address this crisis; no single family, no single mental health professional, no single school, no single policy, no single piece of legislation will be sufficient to push back against these alarming statistics without all of us working together.
There are a number of theories, many of them persuasive, regarding potential contributors to this increase in ED visits for self-harm and suicidal thoughts and behaviors. One, which has a positive side, is a new willingness among children and families to speak up about mental health concerns and to seek help. As mental health professionals, we are delighted by this and need to work with hospital leaders and policymakers to ensure that this courage is received with appropriate services and support.
However, the rise in admissions and completed suicides also has darker roots. We know the negative impact that high rates of social media use can have on mental health, particularly among young girls who are its most active users. The constant comparison to celebrities, to shiny images of social success, can be toxic for even reasonably confident adolescents. Social media and the internet have also permitted some sinister movements—cyberbullying on a 24/7 cycle and sites that promote self-harm and suicidal behaviors with encouragement, methods, and a sense of community. Indirect impacts of our children’s engagement with their electronic devices are their effects on sleep and levels of physical activity; disruptions to both are known to be major contributors to negative effects on mental health.