In this episode of Real Talk, KJK Student Defense Attorneys Susan Stone and Kristina Supler are joined by Dr. Heath Hightower, the Senior Director of Suicide Grief Support Services at Samaritans in Boston. They discuss suicide among college students. The conversation includes how to prevent suicide, what to do when you suspect a loved one of being suicidal, and how to cope with the aftermath.
Links Mentioned In the Show:
- (03:02) An unfair expectation from parents about their children and suicide
- (06:15) A few common warning signs that your child maybe suicidal
- (07:59) How parents, coaches, teachers, and peers should address students exhibiting symptoms of being suicidal
- (10:00) How often are young adults honest about their suicidal thoughts?
- (12:25) Can you just bring your child to a mental health professional to confirm if they’re suicidal?
- (13:35) Are mental health screenings enough to know if your child is suicidal?
- (15:06) What is the difference between mental health screenings and assessments?
- (16:57) When should a student be screened for suicidality by a clinical professional?
- (17:21) Is there a relationship between suicide and substance abuse in young adults?
- (19:28) How to know if your child is just experiencing homesickness in college or needs to come back home?
- (23:22) How can parents let their college-age children know they’re worried about them, yet respect their independence?
- (25:40) How Netflix can help initiate a conversation with your child about their suicidal symptoms.
- (27:25) When do your children understand the concept of death and its permanence?
- (30:07) What can students do to help one another if a friend or a fellow student on campus takes their own life?
Susan Stone: So today, Kristina, we’re going to address something that we’ve been thinking about and talking about a lot because mental health is always a component of our podcast and since the pandemic, it’s really shed a light on. Mental health issues that we’ve addressed from a number, number of angles, but we really haven’t talked about suicide.
So today’s guest, we’re gonna talk about suicide prevention, screening, assessment, intervention, and postvention.
Kristina Supler: This is a, a topic that’s. Well, September marked National Suicide Prevention Awareness Month. This episode unfortunately won’t be released in September, but it’s a really important discussion that’s relevant year round.
And so we wanted to invite today’s guests to examine this topic with us suicide’s, the second leading cause of death for college students.
Susan Stone: And, and again, it, it’s a topic that sadly, that has affected and impacted our. And although we are not mental health professionals, we make a lot of referrals. And sadly, we have dealt with the issue in some of our cases.
Kristina Supler: So today we are pleased to be joined by Dr. Heath Hightower, who is the Senior Director of Suicide Grief Support Services at Samaritans in Boston.
Susan Stone: And just interrupt. He’s also recently became a doctor, so congratulations, Heath , and. Just as recently, my brother-in-law. Well, there you go. There you go.
So I thought I’d add that in.
Kristina Supler: Well, let me keep bragging. Dr. Hightower holds a doctorate in counseling and psychology and a master’s degree in social work. His clinical work has also included outpatient substance abuse counseling. Private, independent high school counseling and community college counseling, basically our population.
That’s right. Dr. Hightower’s research and scholarly writing has focused on suicide in the black and African American communities and reframing the SU suicide as a social justice issue.
Susan Stone: Welcome,
Heath Hightower: Welcome to you as well. Thank you so much for having me today.
Susan Stone: We’re really pleased to have someone who is so knowledgeable and works with this population.
The number one question I think for every parent is, what are the signs? And in particular, if you’re a parent, how do you separate depression, anxiety from thinking that it’s actually a suicide risk?
Heath Hightower: Yeah, so you’re asking a really important question, Susan, and it doesn’t have a very simple answer, unfortunately.
So one of the things that I think is important for parents to hear, Especially a parents who are parents in the United States is that you are all in what I like to call the American Parent Trap, which really means that there is this cultural expectation that you are going to be the expert in every aspect of your child’s life, and therefore should have some sort of special almost clairvoyant ability to predict when your child is going to be thinking about suicide, maybe planning a suicide and maybe attempting suicide.
And I think that that trap sets a really unrealistic expectation around suicide screening and assessment, especially when moms and dads are trying to do that. And they’re not trained professionals to do that.
So I wanna just start off by saying to moms and dads out there, There are unrealistic expectations on you about your ability to predict your child’s suicide. The other, I think, cultural piece that we have to also understand is that suicide is preventable, but that doesn’t necessarily mean that all suicides can be prevented.
And so, I think it’s important to say that out loud because it is possible for anybody to do or say all of the technically right things and still have an outcome that is a death by suicide. So that doesn’t mean we’re power. That’s pill
Kristina Supler: to swallow. Yeah, that’s a hard truth, but I think an important truth.
Heath Hightower: Well, this is called Real Talk for a reason.
Kristina Supler: That’s right. That’s right.
Heath Hightower: So let’s talk really about this then. So given that reality, there still are things that we can know, and when we know them, we can respond in a particular way. So the challenge though is that a lot of the indicators, the, the suicide risk factors and warning signs can also be indicators and warning signs of other things, right?
Unless your child comes to you, And says, Mom, dad, foster, ma, mom, foster dad, grandma, whoever is serving in that parental role, I am thinking about dying by suicide and here’s how I’m gonna do it and here’s when I’m gonna do it. If, if a child doesn’t do that, anything short of that is going to require you to do some follow up and to, to notice some things that are going on in your child’s life and then follow up by asking about that. So let me just give you a concrete example. I was gonna
Susan Stone: say, what do you wanna know?
Kristina Supler: What are the specifics that maybe parents should be on the lookout for?
Heath Hightower: Yeah. Or, yeah. So yeah, so a lot of the warning signs are expressing a desire to die. Certainly if your child is deleting their social media accounts, if they are getting into fights with people that they don’t. Usually get into fights with anger and rage at people that they don’t usually get rageful at. So it’s one thing for them to be pissed off at you. It’s another th thing for them to be pissed off at grandma and to call her all sorts of obscene names.
Right? That’s that’s really different. I think also if we start seeing our kids engaging in high risk behaviors like increased substance use, driving the car really fast, engaging in high risk sexual activities, All of that impulsivity stuff. If we see an increase in their usual impulsive behaviors, which again can be relatively typical for adolescents and young adults, if we start seeing that in greater proportions, those are the warning signs that moms and dads and coaches, and administrators and teachers really should be on the lookout for.
Pull the student aside and have a conversation.
Susan Stone: Should peers just confront it head on? I mean, that would be my M.O. Are you thinking about this? I’ve noticed.
Heath Hightower: Yeah, so I think you’re raising a really good point about addressing it head on. I think the, the question isn’t whether you should directly, uh, confront it head on.
It’s really how you do it. So I think the approach is important. I think if you barge into little Johnny or little Susie’s room and say, Hey, what the hell’s going on? Are you thinking about dying by suicide? I think you’re gonna get a pretty defensive answer, which is no, not at all. Right? But if on the other hand, you knock on little Johnny and Susie’s door, you ask for permission to come in and you say, Little Johnny or Susie, here’s what I’ve noticed.
Can you help me understand what’s going on? And then really, really listen. Right? Without responding, hear them out fully and then express what your concern might be. Right? So if your concern is, gosh, I’ve noticed you’re not sleeping, I noticed that, you know, you’re not talking to your friends, you, you’ve skipped gymnastics, or you’ve skipped track practice.
Can you help me? Can you help me understand what’s, what’s going on? And. If little and Johnny say, Well, here’s what’s going on. Depending on what’s actually going on, that then should guide mom and dad’s next reaction or response.
Kristina Supler: So that’s, that’s really helpful to hear. And it sounds like at the heart of it, an essential thing for parents or loved ones to do is listen really carefully.
But my question for you is this, you mentioned, uh, when we first started talking short of. The child, the teen, the college student coming out and saying, You know, I’m, I’m contemplating. dying, or even in the conversation along the lines of what you recommended. Now my question is this, how, how often are young adults actually honest and forthright about what their thoughts are?
Susan Stone: You took the question. I I thought of it at the same time. I mean, I, I would assume if someone’s planning this, don’t they lie and wanna cover it up that it’s what I was thinking,
Kristina Supler: Like how often do young adults actually come right out and say, Here’s, here’s what I’m thinking.
Heath Hightower: Yeah, so I think, so in my experience, if you ask someone directly and their response is, No, no, no, no, no, no, no, no. Then I think the follow up question is, Gosh, I’m, I’m hearing the No, no, no, no, no. And yet I’m seeing these signs. Can you help me, help me understand the disconnect between the, No, no, no, no, no, no, no. and what I’m seeing.
And so again, this is really about gently redirecting that you’ve heard what they’ve said, ” no, no, no, no, no. That’s not what I’m thinking.” And at the same time, you’re also pointing out that there’s this disconnect between what they’re saying, how they’re saying it, and what else is going on. So if they say, No, no, no, no, no. Then again, the question, the, the rejoinder, the, the follow up is, can you help me understand what made you decide to delete your email accounts or your social media accounts?
What made you decide to not go to practice today. What made you decide to drop out of the school play? What, you know, what made you decide to drive your car at 80 miles an hour in a 20 mile an hour speed zone. So I think that kind of going back and checking in will give your the child a sign or your student a sign that you really want to know.
That you, you, that it’s not a one and done. I asked you, you said no, I walked away for an accusation. Right. And it’s not an accusation either, right? It, it really is. I’m here, I’m concerned. I need to know what’s going on. And the story that you’re telling me doesn’t make sense to me, and so I need you to help me make sense of this because I love you, I care about you and I don’t want anything bad to happen to you.
Susan Stone: the instinct Heath is, that’s a lot of pressure on parents. So yeah. Would you agree that if a parent has any doubt, what’s wrong with just having them, the child or the students screened by a mental health professional? And if so, how reliable are those screens?
Heath Hightower: Yeah, that’s a really good question. So one of, So I think one of the things you have to think about is. Are you forcing the kid to go? Or is the kid going because they want to go talk to the mental health professional? I think we all know that if we try to make our, our teens and our young adults do things that they don’t want to do, they’re pretty skilled at telling adults, even train clinicians what they think the trained clinician wants to hear.
Right? And so I think that. I think that while I understand that your question is implying, this is putting a lot of pressure on moms and dads to figure this out themselves. It’s therapist. Right, Right. It’s, it’s true, but it’s also true that you are likely to know your child and have a better relationship with your child than anybody else in their life.
That is an adult. Now, there may be a coach, there may be a teacher that they would feel more comfortable with. And in that case, you know, you might want to enlist that adult’s help to try to get the screening done. So I think. Your other question is also to what degree are these screening tools effective?
Right, So the, Yeah, so I think that a couple of things depends on whether they’re effective or not. One thing that determines effectiveness is has the student or child been screened before? Right. So if a child already knows what the questions are and what the consequences may be, if they say yes to a specific question, then they may be less likely to be forthcoming.
Susan Stone: Which is fear of being put in a hospital.
Heath Hightower: Yes.
Susan Stone: Or put in a wilderness program or anter alternative therapeutic environment. They’re gonna game it.
Heath Hightower: Right. Exactly. Yeah.
Kristina Supler: But do the screening measures have a built in means to look for lingering or manipulation or, or something like that? Or, or perhaps not. Okay. Interesting.
Heath Hightower: No, no. No, I mean a lot. Again, screenings are about yes or no is, is someone positive or negative for suicidality. I mean, and again, these inter A screening interview is built for efficiency. It’s built to be administered in less than a minute. It’s all yes or no questions.
Kristina Supler: How do you make that assessment in one minute with yes and no?
Well, less than, yeah. Less than one minute. Yeah. That’s i’s blowing my mind.
Heath Hightower: Yeah. So I think it’s important to differentiate between screenings and assessments. So a screening. Oh, okay. Yeah. Yeah. So in, in professional parlance a screening is a, a brief tool simply to determine whether or not there is what probability that a person has a particular experience. In this case we’re talking about to what degree or to what probability does a child or an adult or a youth, how probable is it that they’re suicidal right at this very second.
If the, if they test positive, which is that, which is to say there is a real high likelihood that they are experiencing some form of suicidality, then the next step would be to do a much more thorough assessment.
Kristina Supler: So it. I’m just thinking through parents who might have a great relationship with their student or child or maybe not. And you know, a follow up question is when should they get screened? But I think it sounds like real sudden changes in behavior. I mean, is that fair? I’m thinking about before when you said getting off of social media, driving fast, the impulsivity,
Susan Stone: if you know they’re driving fast, Right?
Kristina Supler: I mean, Right. And that again, is assuming a lot of knowledge that as we see in our practice, there’s many parents out there, and I don’t say this with judgment, but just as a matter of observation who don’t have any clue
Susan Stone: or the last to know.
Kristina Supler: Right. Right. Yes. So I mean, are there, can you be a little more specific on mm-hmm. when a student should be screened or assessed?
Heath Hightower: Well, I think the shortest answer is, is when mom and dad are concerned.
Kristina Supler: I like that. Fair? Fair. Yeah. That seems to make good sense. So a follow up question as well that I had is Sure. What can you tell us about any correlation between substance abuse and suicide, particularly among the, the student young adult population.
Susan Stone: Which is, I just wanna follow up when we deal with our college kids Yeah.
The most of them are using some form of creation, recreational drug or alcohol use.
Heath Hightower: Yep. Yeah. So there’s a, there’s a strong correlation, right? There’s a, that one of, one of the risk factors is of course, substance use. And again, the substance use does two things potentially to increase that risk. It disinhibit people.
So it, it, it increases the probability of impulsivity. And at the same time, people often use substances to self medicate. So they are also using a substance as a form of self-treatment for an underlying mental health condition, or to manage their stress or to manage. The anxiety they might feel about performing at the track meet or at the football game, or at the volleyball tournament or the test they have to take the next day.
And if they’re using alcohol, which is in and of itself a central nervous system depressant, that’s gonna compound the depressive feelings that they might be having. So there’s a, there’s a strong association. Um,
Susan Stone: school just started.
Heath Hightower: Yes, it did.
Susan Stone: Homesickness, especially for freshmen. Yep. Is normal. Yes.
But it’s really scary when your kid might be across the country or in the next day and you don’t see your student every day and you get the call and home sickness. I’m lonely. How do you know when you should , get in the car and go see your kid. Or even say, You know what, Maybe it’s time to come home. Maybe you weren’t ready.
Mm-hmm. , because we actually do see a lot of cases where kids really, especially since the pandemic are struggling and you know, parents tend to say, Well, maybe they should just tough it out or go see the counsel settle in in a couple weeks. Yeah, we’ve heard that. Mm-hmm. . So what’s the point where you say, You know what, I gotta go? Gotta get in the car, get on that plane.
Heath Hightower: Yeah, so I think that if you are noticing a frequency of texts and calls from your kid, and again, different, different parents and children have different frequencies with which they communicate with their children.
So I would say that if you’re starting to notice kind of increased phone calls, Increased texts, and the theme of those are, Wow, this is really hard. Wow, this is really overwhelming. Gosh, I really miss my bed. Gosh, I really miss mom’s cooking. Gosh, I really miss, uh, the dog’s spot. I think that that’s probably the time to have a conversation about whether or not this is a good fit or not. Right. And
Susan Stone: communication is very different from family to family. I, I know in my own family, it’s been very interesting because my husband and his daughter will communicate mostly by text and maybe a phone call once a week where, How many times do my kids call me
Kristina Supler: Many, many, many times Per child. Per day. Yeah. Yes,
Susan Stone: it is great running conversation and also my kids. I tend not to hear from them when they’re happy. Uhhuh, when they’re miserable, they dump on me.
Kristina Supler: Well, that was that. I was gonna make that, that ask. That’s right. Sort of the, the follow up, idea about perhaps frequency of calls, texts, whatever, increasing or decreasing.
Maybe if it’s a very communicative family and then your child starts to withdraw or pull away, that perhaps is a sign for parents as well. Yeah. Would you agree?
Heath Hightower: Yeah. Yeah. Yeah. And I think along with frequency is also the content of that communication. Like if most of the communication is about sadness and like they’ve not made any friends and school is really hard and you know, they eat by themselves in the dining hall every night and you know, they aren’t doing the typical college engagement things like joining clubs or, you know, meeting new people and going to lectures or whatever it is.
If what, if all you’re really hearing is how miserable the experience is, how negative it is, how hard it is, I think, I think it’s important to pay attention to the content of the themes of what’s being communicated as well as the frequency.
Kristina Supler: So let’s take it a step further there. There’s a shift in communication between student and parents, such that parents or or loved ones say, Okay, let’s, let’s go visit. Let’s get in the car and go, as Susan said, Yeah, after you have that visit, and let’s say the the communication that seems a little off continues on, what guidance or, or I guess food for thought can you offer for parents who are wrestling with that decision of maybe is it time for my child to come home versus just having, I don’t wanna say just, I’m not trying to minimize, but coming home versus working with on campus mental health counselors.
Susan Stone: Mm-hmm. , which might I add is not always so accessible. We’ve learned that too. Well,
Kristina Supler: particularly in our, our pandemic world.
Susan Stone: Yeah. It’s not always easy to get a counselor.
Heath Hightower: Yeah. So I, I, I guess a couple of things. One thing that I think I would say about the, how do moms and dads discern between when to bring them home, when to have them stay, when to try to access resources locally, wherever their child is going to college. Again, probably needs to involve the student because now we’re talking about college age folks who are 18 years or older probably. Um, and maybe
Kristina Supler: who don’t sign a release for their parents to be in the loop. Right?
Heath Hightower: That’s right. That’s right. Exactly. So I so that, that’s a whole other kettle of fish. So in those instances where your child may not be communicative, they’ve kind of cut you out of the loop. I think the thing to do to both be respectful as well as to be proactive is to let your student, your college student know we’re worried about you.
We’re not hearing from you. We’re gonna be in touch with the hall director, with your RA, with your coach, with your,
Susan Stone: That’s practical.
Heath Hightower: Right, Exactly. And because, and again, I think it’s really always important for moms and dads to frame this as, We love you, we care about you, and we want you still here.
Keith, every family has had a conversation about death, whether it’s, God forbid, a dog, a pet, a grandparent, I would say the talk of suicide comes up and, And there are religious beliefs about it. Yeah. But what is a healthy family narrative, would you say, for parents to message along with obviously, that this is not something that is, should ever be an option?
This is something that there’s always a better path. There’s always, you know, the rainbow, but what is a real way to message this on a family position?
I think one of the things about the moment that we’re living in right now is that we’re, we see and hear suicide in the lyrics of music much, much more than we used to.
We are seeing television shows and Netflix specials that are kind of focused on suicide characters. Television shows, kind of central characters oftentimes have died places. What was the name,
Susan Stone: Kristina, that one, That teen show that just came out about the topic. Was it 13…
Kristina Supler: 13 Reasons Why on that Couple years ago.
And it was incredibly popular and I think Right. Hopefully opens, uh, a pathway for some conversations and families, but So what are your thoughts, Heath?
Heath Hightower: Any time the topic of suicide enters the popular cultural conversation, that’s the entry point. That’s the place to say, Gosh, you know, I just heard that there’s this TV show on Netflix called 13 Reasons Why. Have you heard about that?
And if they say, No, I’ve not heard about it, then you know, I would probably say, Well, gosh, you know, your mom and dad and I were flipping through Netflix and we saw this show and we thought we’d watch the first episode. And it made us realize that we’ve never had a conversation with you and your brothers and sisters about suicide.
And you know, as your mom and dad, we, part of our responsibility is to help prepare you for the world. We’d really like to talk to you about that and wonder what you and your friends might be talking about or thinking about as it relates to suicide. And kind of open it up as a conversation that way.
Kristina Supler: I think that’s great advice. I like that. Just approach stuff, not so much as a, a didactic moment, but rather, Right. Hey, I saw this on the news. Let’s, let’s have a conversation and sort of see, see where it goes.
Susan Stone: What age, developmentally do students understand that death is permanent? Because I don’t even think they process that in college because we see so much suicide.
Yeah. What is it? Contagion called? Contagion.
Kristina Supler: Yeah. So that when. Doing some reading and sort of getting thoughts in order for today. We came across this phrase that I, I hadn’t really heard, and yeah, I’m probably gonna mispronounce it. I think I did. Contagion. What is this phenomenon, or what does that refer to?
Susan Stone: And if you could answer the other, what question? When will students know it’s permanent? Go
Heath Hightower: a lot . No, that’s ok. So I’ll, I’ll try to take the questions in the order in which they came. So the age question I think is really interesting because it’s, it’s not just what chronological age is your child, it’s what developmental age are they at?
We know that, we know, for example, that. abstract thinking, which is something that typically starts emerging in adolescence is probably when people start beginning to fully grasp what that is. But again, it’s. It’s a process of learning what that is. It’s not a one day, you have no idea what death is the next day you do know.
I think depending on, when a family has had pets If you have pets in your house, when your children are fairly young, those pets will likely die when your children are still fairly young. So the topic of death is, Well,
Kristina Supler: we had a deceased fish in my house last year.
Sorry to interrupt you, but it was That’s okay. It it, it was a very significant event in our household. Yes.
Susan Stone: Still remember when my goldfish, Mr. Limpid died? Mm-hmm. , I still remember. Yes. It was bad right at that moment and
Heath Hightower: right, and, and again, there may be pieces of you that don’t fully understand why the fish died.
You’re not, you’re not willing or able to fully grasp that just yet.
Kristina Supler: Sure. Well, my, it was, you know, kidding aside, it really was a developmentally significant event for my son in particular. And so That’s right. Well, my husband and I are, are kind of chuckling about the fish that, you know, didn’t take it because Right.
The fish, but it was, yeah, it, it was a significant event that was an opportunity for a lot of discussion and so it’s Right,
Susan Stone: but the discussion on death versus suicide, It’s a different discussion, isn’t it?
Heath Hightower: Yes, and primarily because in our culture we have two categories of death, good deaths and bad deaths.
And suicide throughout human history, especially in our culture, has always been considered a very bad death.
Susan Stone: That’s interesting. To separate it out we have. Heath, I, we’re almost at the hour, and I feel like we haven’t even gotten through half our outline.
Kristina Supler: No, no. I I have one question that I think is really important for our listeners.
Sure. When there is something an issue of suicide, how can, on campus, how can students support each other after the death of a classmate.
Heath Hightower: Yeah, that’s a really good question. So I think the, the thing to remember is that simply being present and available to people is probably the most supportive thing. I think as someone who spends every single day of his professional life right now, talking to individuals and families who have lost someone to suicide, I more than anybody else know that there’s no magic words that I say because there’s nothing magic I can do to bring their loved one back.
The thing I can offer people though, Is my presence, uh, my willingness to listen to their story, to be patient, to answer their questions as openly and honestly as I know how to. And when I don’t know the answer to something, I don’t try to bullshit my way through it. I, I simply will say, you know, I don’t know the answer to that question. That’s an excellent question. Let’s try to figure that out together.
I think the, the one thing that I always wanna convey is that no one should grieve alone when it comes to a death by suicide. And because of the, and because of the stigma around suicide, many, many families, many, many individuals do grieve by themselves because there is so much stigma around a death by suicide.
Individuals and families are are afraid that others will blame them for their loved one’s death.
Susan Stone: Well, I love concluding with the message that nobody should grieve alone because that is definitely the most compassionate approach that we can take and that is real talk and a message that everybody needs to just pause on and reflect.
Heath, thank you. Thank you, thank you. I can’t say I enjoyed this conversation cuz it’s painful even listening to it, but it’s an important conversation for us to have.
Kristina Supler: Indeed. Dr. Hauer, thank you so much for joining us today. We really appreciate your time and your insights. Thank you.