Dear David Coleman: My 10-year-old son says he wants to die. Please help.

Q I have a 10-year-old son who is very intelligent and intuitive. He has loving parents, gets on great with his friends and is very happy in school. He and his 14-year-old sister fight a lot and he gets upset when I tell him to figure it out between themselves (as they don’t listen to me). Recently, he has said he wants to die. He has said this more than once; that he has nothing to live for. This worries me a lot, as my brother took his own life 14 years ago. My son actually asked me to bring him to a doctor. Can you help me please?

A I think it is really important to listen to your son. You’ll know already that my immediate advice to you, when I got your email some weeks ago, was to go to your GP and seek a referral to your local Child and Adolescent Mental Health Service (CAMHS) for their urgent opinion about the level of risk that your son poses to himself.

It is impossible for me, at this remove, to know how serious your son is when he says he wants to die. However, it does seem that he is very distressed if he is saying that “he has nothing to live for” and has repeated his desire to die on more than one occasion. That alone is reason enough to get a referral to CAMHS. So, hopefully, even as you are reading this, you will already have received an emergency screening assessment.

At that assessment, the clinician will be trying to make some judgement about the risk of harm with which your son presents. When children have a clear plan for how they might kill themselves, or have taken any steps towards activating a plan, that will significantly increase the level of concern. If they have thought about what might happen after they are dead (like how you or their friends might react, or what their funeral might be like) that too will raise concern. If, on the other hand, a child has simply stated that they wish they were dead, but in an abstract sense, then that is less of an immediate risk.

What will be important for your son, irrespective of the level of risk of him killing himself, is that he has the opportunity to speak about the emotional distress that he feels. Perhaps he might be able to speak to you or his dad, or maybe he will need to speak to someone outside the family. Perhaps this is what he wants when he asks you to bring him to a doctor. He may feel that his thinking is out of control and this might worry or frighten him too.

It is really important that we adults try not to panic if a child takes the brave step of voicing their feelings about wanting to die. Ideally, we can give them a calm, compassionate and understanding response. That response will be trying to open up a direct conversation about suicide and their feelings of wanting to die. Allowing them the freedom to talk more about their feelings can be really supportive.

We need to let them know that we are willing and able to listen to them; and that we will help them to find the right help if we feel we can’t offer it ourselves. So, bringing him to your GP, as he has requested, will show him that you hear him and that you are taking his feelings seriously.

The fact that your brother died by suicide is not, in itself, a risk factor for your son. However, your experience of your brother’s death, no doubt, heightens your own anxiety about the possibility of suicide. I think you might really benefit from some supportive counselling for yourself, beyond anything on offer in CAMHS, to help you make sense of the complexity of feelings that you are probably having in response to your son’s suicidal thoughts.

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