A youth perspective on suicide prevention

Holmes and colleagues¹ have summarised psychological and social effects of COVID-19. The health-care system response needed to address these effects, up to and including suicide risk, provides an opportunity to align direct services (eg, crisis lines), individual providers, and universal population interventions to protect and promote mental health.² Therefore, it is useful to consider how alignment might look in practice. Effective youth suicide prevention requires collective action and values³ at all levels.⁴ YouthLine, based in Portland, OR, USA, is one of the few teen support and crisis lines in the USA that uses youth volunteers (appendix p 1). Many considerations arise when supporting a young person in crisis. These considerations exist for youth and adult helpers, on crisis calls or in a community. Using a youth-adult codesign process,⁵ the YouthLine wrote this Correspondence.

Working through mental health concerns is hard for those experiencing them and those helping, which is why it is important for young people in crisis and their peer supporters to have adults on their side. As a team, we can help each other and connect people to the resources they need. Young people should never feel like the sole supporter of a friend or loved one. Those providing peer-support are not professionals (even in the mental health field responsibility never exists to fix another person's problems). If the safety of someone you know is at risk, adults need to know. There are four main actions we recommend, as follows.

First, setting boundaries. A boundary is a limit we set for ourselves. Boundaries are part of taking time and space to address your own needs. Although we wish everyone had the space to communicate their needs and receive validation, it is important to acknowledge that many experience pushback related to others' experience. Developing strong boundaries is vital in spaces where your wellbeing is not prioritised. Since creating boundaries can be exhausting work, it is crucial to pair these efforts with effective self-care.

Second, asking for help. Asking for help when you need it is a way to take care of your own mental health. Reaching out and communicating with a peer, parent, or counsellor can better allow you to cope with your own challenges. Seeking help can include advocating for others who are not in a place to get care for themselves, whether they lack the words, supportive adults, resources, or security.

Third, being a role model. Being open about your own mental health issues and how you address them can help you feel better and might also support and encourage others who feel isolated, hopeless, or in crisis. By having your own boundaries, self-care routines, and avenues for fighting stigma, you can be an ally and show others what to do for themselves.

Finally, self-care—not putting too much on yourself. Setting boundaries and knowing when to ask for help are the first step to self-care. Beyond setting boundaries and asking for help, self-care might include activities you enjoy, taking care of tasks necessary for your physical health, and giving yourself space for your emotions. By practicing self-care, you not only help yourself, but you also better support for those around you.

There are times when, despite our efforts, the outcome of the situation is not what we would have hoped. Holding compassion for ourselves is as important as having empathy for the youth we support.

To contact YouthLine (USA only) call 877-968-8491 or text “teen2teen” to 839863, or access chat from anywhere globally via https://www.oregonyouthline.org

This online publication has been corrected. The corrected version first appeared at thelancet.com/psychiatry on August 28, 2020