Lucy Daniels Center clinicians are often asked by parents to help them assess how worried they should be about their child's threat of self-harm, or stated wish to be dead. This is a very complicated issue, and unfortunately we cannot give clear guidelines that are likely to resolve the question one way or another in any particular situation. Hopefully, through, the following thoughts can be a beginning help for parents in this situation.

Consider the context of statements: Any statement cannot be understood without looking at the context. For example, people can mean different things when they say, "I love you," depending on to whom and why it is said at a given time. Parents should consider the context when their child makes a comment indicating a wish or intention of self-harm. If their child says these comments only when he or she is frustrated or mad, and it happens only occasionally, these would suggest (but not prove) that she or he is expressing anger and even possibly a wish - at that moment - to sting their parent. In that case, the chances are that the child does not intend to take any action but is just finding the most upsetting words that she or he can think of at the moment. It could also be possible that the child is trying to elicit their parent's concern at a time when she or he might be frightened by their own anger at their beloved and needed parent.

Sometimes, however, children say, "I wish I was dead" or something similar when they are hurt or sad in a more sustained way, not just reacting at the moment. This may or may not indicate an actual (at least current) intention to harm themselves, but it can be a window into some deeper unhappiness that is being expressed at this moment of pain and remains present in some form even when not expressed verbally.

Look at the broader picture: Another way that parents can think about whether statements such as "I wish I was dead" are expressing something that they should take seriously is to think about their child in the bigger picture. How is she or he doing in general? Does the child seem satisfied with her or his life? Does she or he generally seem to have a pretty good mood? Is the child able to participate well in school, both academically and socially? Does she or he get along well with family members, at least most of the time? If all the answers to these questions are that the child is doing reasonably well (understanding that all children face challenges and good and bad days in these areas), then it is much less likely that the statement is indicating something worrisome. If the child truly felt so upset that she or he truly wished to be dead, the causes for this concern would probably be wreaking their havoc in other aspects of the child's life as well.

Another way to think about the broader context would be to ask whether the child has other worrisome signs. For example, does he or she have significant signs of anxiety, act out behaviorally, or have food-related symptoms that appear to be in the direction of anorexia or bulimia? If these issues are present, we would more likely to afford more importance to a child's comment about self-harm.

Another set of issues that would lead us to take the comments more seriously would be a history of particularly difficult circumstances, such as trauma or abuse. In addition, currently stressful situations can lead to depressive reactions that show up through such comments. For example, parental separation, loss due to death and other disruptions can upset a child's equilibrium and lead to genuine and deep despair.

What to do?: If a parents feels confident that their daughter or son's comments are likely based on a momentary feeling, we would recommend that they do several things. First, at a calm time, parents could revisit the situation with their child. They could convey their understanding that their child was upset, but also convey their expectation that their child express upset in ways that are appropriate. There are other and better ways to express outrage.

We would also encourage parents to ask themselves some hard questions: "What do I (we) do when I (we) get upset? Do I (we) say things that are a little over the top, even if I (we) don't say what she is saying?" If the answers are yes, it is not quite fair for parents to ask their daughter or son to respond to difficult situations in ways other than what is being modeled for them. So, if parents have blazed such a path, we recommend that they work on this themselves and perhaps explain to their child that they get a little carried away, too, and that this is an area that they too will be trying to change.

If parents are still unsure whether to be worried based on this guidance, they should ask their daughter or son. Perhaps parents could tell her or him that they are concerned and want to know if she or he is concerned about these statements as well. Parents can ask their child whether she or he says these things at times of being mad, and means them only then, or are these feelings that show up at other times. (Parents shouldn't say or imply that their child really doesn't mean them; she or he most certainly does at the time, even if they don't carry the worrisome meaning of true intention of action.) Children may well be able to help parents sort out this situation.

Finally, if a parent is concerned that their child's statements may be signs that their child is struggling emotionally, parents should seek professional help. The only exception from this suggestion might be if parents feel that their child is reacting acutely to some life changes, and make the judgment to give the situation a little more time to see how it goes.

If parents are concerned that their child's comment about self-harm are indicating some deeper concerns, they should also remember that their child's statement does not necessarily mean that she or he does not want to live; it is their child's way of communicating pain and distress. Children will be deeply grateful to their parents when their concerns are not trivialized and parents seek good help, because seeking assistance at this time in a child's life could make an important difference in the future.

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