«Suicidal young people need to feel that their suffering is taken seriously.»

Mr Omer, the suicide rate among young people in Switzerland remains constant. However, in recent years there has been a sharp increase in the number of those who contemplate suicide or even attempt to take their own lives.

In general, it can be said that Switzerland's suicide rate is comparable to that of most Western countries. In adolescence, suicide is the most common or second most common cause of death, ahead of or behind traffic accidents. However, we are also seeing that the age at which adolescents contemplate suicide or attempt to take their own lives is falling.

People who spend excessive amounts of time on the internet and social media are at greater risk of anxiety disorders and depression.

Why is that?  

We don't know for sure. What is certain is that people who spend excessive amounts of time on the internet and social media are at greater risk of anxiety disorders and depression. These are associated with a higher risk of suicide. As younger children now often spend a lot of time on their mobile phones and computers, they are also likely to be more affected.    

In your book «Supporting suicidal young people: a guide for family, school and social environment», you often talk about teenagers who barricade themselves in their rooms and spend whole days on digital devices or in bed. Is this a typical manifestation of a suicidal crisis in adolescence?

When young people isolate themselves to such an extent, it is clearly a warning sign. However, not all of them withdraw and display typical symptoms of depression. There are also suicidal teenagers who behave very impulsively and engage in other risky behaviours, such as taking drugs.

Does it happen that parents are completely surprised by their child's suicide attempt?

In most cases, parents are the first to recognise the warning signs. They are also usually the first to seek help. Sometimes, however, other people in the child's environment are the first to notice changes that give cause for concern. Of course, a teenager's suicide attempt can seem to come out of nowhere for their parents. But this is not often the case.

In such cases, did the parents not want to see the signs?  

I don't think so. When a young person seriously considers suicide and their parents are unaware of it, it is usually because they have deliberately kept their thoughts to themselves. What often happens, however, is that parents recognise the risk but don't know how to respond. That's why psychologist Anat Brunstein-Klomek and I wrote this book.    

If the parents are not doing well, the teenager's condition cannot improve either.

When you read it, you soon get the impression that we parents do a lot of things wrong in critical moments.

I don't want to talk about mistakes, because this isn't about assigning blame. But yes, there are typical reactions from parents that are problematic. For example, some are overcome with complete helplessness when their child says they are thinking about taking their own life. They are paralysed and unable to think of anything except that their child should see a psychologist as soon as possible.

It is also difficult when parents react with accusations or start lecturing: How can you say such a thing? Do you realise what you are doing to us? Such a reaction leads to escalation, which increases the likelihood that the teenager will act impulsively. Sometimes parents also panic. All these reactions are human and understandable. But they do not help in such situations.  

How can mothers and fathers respond better?

Perhaps I should first add that our therapeutic programme is the only one that attaches equal importance to the concerns and problems of parents as it does to the suffering of suicidal young people. On the one hand, this is because parents simply have just as much right to help. On the other hand, we are also convinced that if parents are unwell and no longer feel comfortable at home, the teenager's condition cannot improve either. The mental well-being of parents and that of their children are closely linked.

The presence of another person reduces the risk of escalation between parent and child.

So what can parents actually do if their child is at risk of suicide?

The most important thing is that parents do not have to go through this situation alone. They can – and should – seek as much support as possible. This could be their own father or a good friend of the family, the child's aunt or godmother. The mere presence of another person reduces the risk of escalation between parents and child. When mothers and fathers are left to their own devices, they are more likely to feel pressured and react with fear or distress. With someone by their side, however, they are on more stable ground.

This involvement of the environment is very reminiscent of the concept of new authority that you developed.

That's right, and this is also the basis for our approach to suicide prevention. This is a major difference compared to other therapeutic programmes, in which the extended network is either not involved at all or only at a late stage. But we are convinced that this step strengthens the parents. Because they are the ones who need help most urgently at this moment – alongside the child. It also gives us more ways and opportunities to reach young people who may initially be reluctant to cooperate.

Are there other reasons why parents in an acute crisis should seek such support if possible?

Yes. In exceptional circumstances, parents are more willing to involve other people. Once the situation has calmed down again, even if only temporarily, this willingness usually diminishes. However, such supporters remain important even when the highest level of alert is no longer in place.  

In what way?

There is a groundbreaking study on this topic involving young people who have attempted suicide at least once. In interviews, researchers asked them to think of four people they could contact in the event of another crisis. They were asked not only to write down their names, but also the reason why they would turn to these people.

It became apparent that those who compiled this list showed a significantly lower risk of further suicide attempts. Simply knowing that it is possible to break out of one's cocoon of loneliness has a preventive effect. This is all the more impressive given that a previous suicide attempt is one of the strongest predictors of a person attempting to take their own life again.  

Why is that?  

The person has, so to speak, crossed the Rubicon with their first attempt. Once this barrier has been overcome, further suicide attempts are no longer as difficult. Of course, another factor is that the problems that led the young person into their desperate situation usually continue to exist even after the suicide attempt.  

So how can godparents, grandparents or best friends help in practical terms?

There are many ways, and they also depend on the individual. For example, I can start by regularly sending messages to the person at risk of suicide – even if this may be a one-sided affair at first.

I can invite her to dinner or suggest going fishing together again. I can also convey very important messages to her , in words and gestures: I love you. You are important to me. I have seen you overcome other challenges. You can do this, and I will help you in any way I can.

All of this tells the teenager: you belong. We must not forget one thing: a suicidal crisis is a spiral of increasing self-isolation. The longer it goes on, the more alone young people feel in the world. That is why it is so important to involve people with whom the child has a good relationship. They give them back a sense of belonging and stability.  

Doesn't culture also play a role in this involvement of the community? You live in Israel, where it is probably more common to visit aunts, cousins and friends. Can this approach be easily transferred to a country like Switzerland, where people are more reserved?

Of course, there are major cultural differences between the two countries. Interestingly, however, our concept has met with a much more positive response in German-speaking countries than in Israel, for example. Perhaps this is precisely because people in Germany and Switzerland tend to live more for themselves.

Our work is not limited to simply advising people to socialise more. Instead, we work with individuals to find specific ways to enable them to break out of their isolation, talk about difficult issues and ask for support.

Parents are an anchor that stabilises the child against their immediate impulses.

You often criticise us for attaching too much importance to privacy. So are concerned parents allowed to check the mobile phones of young people at risk of suicide or enter their rooms without asking?

Don't get me wrong: spying on your own child is a bad idea. Always. But if they give us reason to believe that they are contemplating suicide, then privacy has to take a back seat. And yes, that can mean that as a mother or father, you want to know what your teenager is doing in their room or on social media.

However, this is not done behind their back. We announce the step and explain it to them. For example, parents can say: We are very worried and do not want you to lock yourself in your room. Please give us the key. We will knock, but let us in. We are your parents. We cannot and will not leave you alone.

There is a high risk that the child will not respond to this.

No, it's not that big. Young people who are at risk of suicide have a deep need to be seen. They need to feel that their pain is recognised and taken seriously – but in a caring, not intrusive way. Of course, there are children who don't respond at first or refuse to let their parents into their room. Here, too, it helps if mums and dads are not left to their own devices, but have their grandmother or a good friend present.

At that moment, they may be more likely to reach the child. Once again: I can see how much you are suffering. I will do everything in my power to help you. Sentences like these are incredibly important for a suicidal teenager. Many young people with eating disorders tell us in therapy that their parents did not notice for years how long they disappeared into the bathroom each time to vomit.  

How could the parents not notice something like that?

I believe that the belief that privacy is inviolable also plays a significant role here. We may tell ourselves that our daughter's body belongs to her and that we should not interfere; that she alone decides how much time she spends in the toilet and what she does there. This privacy reflex is deeply ingrained.

In your book, you write that sharing food and possessions is one of the most fundamental foundations of belonging. Can something as everyday and almost mundane as eating have such a big impact?

It's not trivial at all. It's not like I just hand the suicidal teenager a tangerine and that's it. Let me tell you the story of a girl who had already attempted suicide several times by the age of 14.

Her relationship with her father was very distant, and at some point she hardly spoke to him anymore. One of the things her father did to get closer to his daughter again was to start bringing her tea and biscuits to her bed every evening before she went to sleep. His daughter decided that he could save himself the trouble. But her father continued to knock on her door every evening.

Giving in to the child out of pity says: You're already a miserable wretch.

One evening, about a month later, he brought the tea at eleven o'clock instead of ten; he had been attending an event with the girl's mother. «You're late,» his daughter greeted him. How happy the father was! The ritual meant something to the girl after all.

But even then, it took another two weeks before she welcomed her father with a hug for the first time. What I mean to say is: the tea is the first step in a long process. It is a small thing, but one that takes up more and more space. Because, of course, this is about something fundamental: the daughter is winning back her father. The ritual shows her that she can rely on him.

In this context, you also mention the so-called Parliament of the Mind.

Edwin Shneidman, the father of scientific suicidology, coined this term. According to this concept, there is always a debate going on in the mind of a suicidal person between the voices of death and the voices of life. How do we know that the latter exists? As long as we are alive, there is always something that speaks against suicide – be it simply the fear of death or a sense of responsibility towards one's little sister. This concept of the parliament of the mind is also important because when helping people at risk of suicide, we often think that we have to convince them once and for all that suicide is the wrong way to go.    

What's wrong with that?

In an acute crisis, we cannot persuade anyone to make a clear decision in favour of life. But that does not mean we can do nothing! If we focus instead on small but concrete factors – and that can even be a cup of tea every evening – we can give the side of life a few extra votes. In this way, we reduce the risk of suicide, at least for the moment, and above all, we gain valuable time to take further measures to protect the child.

As a mother or father, how should I react when my child threatens to harm themselves if they have to continue attending their new school or are not allowed to have their mobile phone in their room overnight? How can I take the feelings of a desperate teenager into account without giving in to their demands?  

This is incredibly difficult for parents, of course. At the same time, we know that making concessions here may temporarily defuse the crisis. In the long term, however, it will only make the situation worse. Giving in out of pity, as we call it, also tells the child: you're already a miserable wretch, so here, take this. This is not conducive to young people's self-concept either.  

What should parents do instead?

We help mothers and fathers not to give in to such demands. For example, you can respond to your child by saying: We understand how difficult it must be for you to settle into your new school. But we can't allow you to stop going. We'll think about what you've said and find a solution together. Let's talk about it tonight." Extending the time horizon is also key here. Parents are an anchor that stabilises the child against their immediate impulses. They demonstrate self-control.

It is the duty of parents to fight for their child's life.

Why is this so important?

We cannot control what our children feel and think – nor what they do. We can only control ourselves. Parents understandably think that it is their duty to rule out any possibility of suicide. But that is impossible. Their duty is to fight for their child's life. What helps them is to control themselves.

If we improve our self-control even a little, escalations are less likely and the relationship with the young person improves. That is already a gain. Self-control means that even in moments of crisis, I am aware of my role as a mother or father and fulfil it. The strength that parents radiate in this way contributes to the child's stability. And it tells the child: we will get through this together.