How to Recognize Suicidal Red Flags in Children with Bipolar Disorder

By Candida Fink, Joe Kraynak

Bipolar disorder is a potentially lethal disease. An agonizing fact is that some people with this disorder do kill themselves. Suicide is a leading cause of death in adolescents, and bipolar disorder increases this risk significantly. To prevent suicide, follow these guidelines:

  • Never ignore threats of suicide or self-harm. Don’t try to determine if your child really means it. Let an expert evaluate your child to assess the risk.

  • Pay attention to substance abuse. Alcohol intoxication dramatically increases the risk of completed suicide.

  • Watch for covert signs. Seek professional help if you notice your child organizing and giving away belongings (preparing for when he’s gone), experiencing sudden and extreme changes in activity levels or socialization, or talking of despair and hopelessness or death, even if you don’t hear him speak of suicide in particular.

  • When possible, keep an eye on social media, such as Facebook, especially with younger children. Kids may be more open about their thoughts and feelings in these contexts, even though doing so may not be advisable for many reasons. The older a child is, the more privacy is appropriate; monitoring his Facebook or Instagram page or Twitter feed without consent only causes more conflict. But some kids are comfortable with their parents or another trusted relative (maybe a younger aunt or uncle or family friend) accessing their social media, so don’t be afraid to bring it up as a possible way to help stay in their loop.

  • If you have concerns about your child, don’t be afraid to talk about them. Bringing up suicide won’t give your child the idea; you don’t create suicidal thoughts by talking about them. Not talking about your worries is much more dangerous.

If your child appears suicidal or out of control, your doctor may recommend hospitalization. Don’t panic if that happens. Psychiatric hospitalization is only for brief periods of time (often fewer than ten days) and is only for safety and crisis management.

Here are some things to do when considering hospitalization for your child:

  • Talk to your doctor about where he admits people or whether he uses a hospital where another doctor does the inpatient treatment. (Such policies vary regionally.)

  • Review hospital choices with your insurance company because it may contract with only certain hospitals.

  • Expect a long day during admission and plan to spend as much time at the hospital as you can during your child’s stay. Being present, even when your child says he doesn’t want to see you, is critical for getting good care and for improving your child’s wellbeing.

  • Ask the hospital staff about the policies regarding seclusion and restraint and prn meds — meds administered to a child who’s out of control. Find out what the protocol/staff training model is to deescalate crises and avoid seclusion, restraint, and involuntary medication. You may be able to get information on frequency of restraints on the unit, but that data is often kept out of public hands. Ensure that the staff understands that you expect to be informed if any of these measures are necessary. Create a big stink if you’re not contacted. Make sure they know you’re watching.

In some cases, children can’t stabilize at home and may require long-term care at a residential facility. This process is beyond the scope of this chapter, but you can obtain additional information from your doctor, your child’s school system, the American Academy of Child and Adolescent Psychiatry, or the Balanced Mind Parent Network.