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We speak with Shivana Naidoo, a child psychiatrist, about the critical steps parents can take to prevent youth suicide. Shivana shares practical advice on recognizing early warning signs, creating a safer home environment with the GO SECURE framework, and empowering families to support children dealing with suicidal thoughts.
Shivana Naidoo is a child psychiatrist.
She discusses the KevinMD article, “Prevent youth suicide: essential steps for parents to secure their home.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Shivana Naidoo. She’s a child psychiatrist. Today’s KevinMD article is “Prevent Youth Suicide: Essential Steps for Parents to Secure Their Home.” Shivana, welcome back to the show.
Shivana Naidoo: Thank you, Kevin. Thank you so much.
Kevin Pho: So let’s jump straight into this article, “Prevent Youth Suicide: Essential Steps for Parents to Secure Their Home.” So, before talking about it, what led you to write it in the first place?
Shivana Naidoo: Sure. So, you know, part of my mission as a child psychiatrist is working with the really tough kids, right? The kids that are really struggling with lots of severe mental health issues. And as a psychiatrist, we’re trained in therapy, we’re trained in group therapy, we’re trained, of course, in psychopharmacology, which is medication.
In addition to that training, we’re also trained in how to talk to parents—how to provide education, how to provide information in a way that’s understandable. Because that basic education we know, as physicians and medical providers, goes a long, long way to help people know better, then do better, and then feel better.
So, as a child psychiatrist, I often will see really high-risk youth. Right now, I work at the Bradley Reach Virtual Partial Psychiatric Hospital Program, which is kind of like a PHP. It’s a step down between inpatient psychiatry—the highest level of care for mental health concerns—and then outpatient. So we’re kind of an in-between. I see a lot of kids with high-risk activities such as self-harm, having had a suicide attempt, chronically thinking about suicide, as well as my decades of work in the outpatient setting, where I worked with kids one-on-one after they stepped down from the hospital within three to seven days, and I was really seeing them after they’d gone through a severe crisis.
So I came up with an acronym that could help parents really think about, “How do I safety plan and keep my home safe?” because the top concerns parents have when they learn their child had attempted suicide or thought about suicide is, “What do I do? What can I actually do to help my child be safe?”
And when it comes to suicide prevention, one of the things that only parents can do is risk mitigation, which means reducing access to lethal means. So I came up with the acronym GOSECURE, which I’ve been using with my families for years. And I thought, well, I guess I should put this in an article and share it. I’ve done a couple of presentations on suicide prevention, and this is one of the key things that I do share because I think it helps when you think about, “How do I keep my house safe? What do I do?” There are so many things in my house, and I think this acronym helps you very quickly think about the main points to protect your child from.
Kevin Pho: Thank you. All right, and you wrote that oftentimes parents first learn of their child’s suicidal ideations during an initial psychiatric assessment, right?
Shivana Naidoo: Yeah, it’s very eye-opening for a lot of parents. And I think, you know, as psychiatrists, as medical providers and mental health care providers, when we are asking about risk assessment, we have to ask about certain things. We always ask about substance use. We always ask about sexual activity. We should be asking about social media, and of course, we always ask about suicide risk and homicide risk.
So, we sometimes will ask very specific questions—that’s part of the art of psychiatry, right?—in a way to help young people who may not actually be aware that they’re having suicidal thoughts realize that they are. Or very often, you know, kids feel really ashamed; they feel really bad about admitting they have these thoughts. Suicidal thoughts are uncomfortable; they’re very upsetting. And the last thing kids want to do is upset their parents.
So, very often, kids may not feel comfortable sharing with their parents that they’re having these thoughts, but they may divulge it to a psychiatrist, or a pediatrician who will regularly do depression screenings, or in the ER—they may have come in for a twisted ankle or some other issue. But when you do your screening, you find that they have actually also had suicidal thoughts.
So, yeah, if we, as medical providers, catch this, we want to find a useful way to empower the parents who—maybe it’s the very first time they’ve heard about this, or maybe they’ve been dealing with this for a long time—but still, I think we miss those little key points that parents can latch onto and remember. Because, you know, when I speak to parents, I am just flooding them with information, and they can only retain a certain amount. So, I find that acronyms can be very helpful, or little stories can help parents latch onto and remember it.
Kevin Pho: So let’s talk about your acronym itself. You, of course, talk more about that in your article.
Shivana Naidoo: Yeah, so the acronym is called GOSECURE, because we want to “go secure” the following items to really mitigate the risk of suicide and reduce access to lethal means. And that is an evidence-based intervention in preventing suicide.
Sometimes when we talk about suicide, it brings up all sorts of emotions within parents, within youth, within medical providers. But one thing we all want to do is to do something really helpful. And if we can “go secure” these following items, we can dramatically reduce suicides and completed suicides.
So, G—I have the article on KevinMD, and I also have a podcast episode on this, on Thinking It Through with Dr. Naidoo, Child Psychiatrist, which goes into greater detail. But in brief, G stands for Guns, because guns are the number one way that youth complete suicide.
O stands for Overdose Options, so things like prescription pills, over-the-counter pills, vitamins, cleaning agents. That’s the number one way that youth will attempt suicide in America. So, GO is the first part of the acronym.
Then, SECURE stands for a number of things. S stands for Sharps—knives, things that kids can self-harm with. Kids who self-harm don’t necessarily mean they want to end their life, but those who self-harm tend to have a higher risk of suicide. And those who self-harm will very often have suicidal thoughts or even think about self-harm as a way to suicide.
E stands for Electric cords, scarves, belts, ropes—things that you could hang yourself with. This is the number two way youth in America complete suicide.
C stands for Car keys, because kids might take car keys, especially if they’re able to drive, and drive off in the middle of the night, or use carbon monoxide poisoning by turning the car on. So if you have a youth in your home thinking of suicide, definitely keep tabs on your car keys and their car keys.
U stands for Underage drinking. Lots of American homes have alcohol readily available, and if we drink alcohol, we know that it causes disinhibition and poor judgment. Many youth that come in with a suicide attempt also have alcohol in their system, along with other substances.
R stands for Reattempt. So, if you have a youth who has used one method, like cutting or overdose, they are more likely to try again. Sixty percent of youth will reattempt within the same year if they had a failed attempt. Within three months of a hospital visit or suicide attempt, we need to be most cautious about a reattempt.
And the final E in Go Secure is Exits or Entrances, like for elopement or kids who think about jumping off roofs. You want to be mindful of how they can leave your home and secure those areas.
Kevin Pho: Now, a lot of parents may feel overwhelmed or powerless when they discover their child is struggling with suicidal thoughts. Once they discover that, what are some immediate next steps they can take to support their child?
Shivana Naidoo: Fantastic question. One of the reasons why I came up with this acronym is that this is something you can implement now—like today. You don’t have to wait to see a pediatrician or call 988. If you’re concerned your child is having these thoughts, without any other medical intervention, go secure the items in this acronym to help reduce access to lethal means.
But, it is overwhelming, right? And you might not be in a place where you can take action; you’re still reeling from the thought. So, the first thing I would try to do if you learn of this is really try to engage your youth. Have a conversation with them and let them know you hear them, you see them, and you want to help them. They may not be ready to share with you, but you want to create a space that’s helpful.
I actually have a workshop on my website, DoBetterMD, where parents can learn how to talk to their youth if they have suicidal thoughts and they don’t know how to start. Frameworks really help with these difficult conversations, especially when high stakes are involved.
So, you first want to understand what’s happening with your child. The second thing is, make sure your youth sees a medical professional. Always start with a pediatrician. If your child is admitting to having active thoughts of ending their life or saying they want to hurt themselves, you want to call 988 or bring them for an assessment at an emergency room or with their pediatrician.
As an ER doc, Kevin, you know our ERs are flooded with kids in mental health crisis. So, if there’s another way to divert that, like going to your pediatrician or calling 988, that’s the goal. But, if your child has thoughts without action, start with your pediatrician or call 988, or contact a mobile crisis team to do an in-home assessment.
If your child has already taken action to harm themselves, get them assessed at the ER without delay. But in cases where it’s just thoughts, starting with your pediatrician is a safe first step.
Shivana Naidoo: But very often, I think it’s the wondering, you know—you might hear from a friend that your child said something concerning, or maybe someone found a post online, or a teacher found a note on their paper. If something like that is brought to your attention and you talk to your child, they might deny it. They might say, “I don’t know what they’re talking about.”
I think that’s where it’s important for you, as a parent, to also reflect on any changes you’ve seen in your child. Have you seen things that seem concerning? Are they withdrawing socially? Are they experiencing a decline in school performance? Are they more irritable? Have they had changes in behavior? Sometimes, they may not say things directly about suicide, but they may say things like, “You guys don’t really care about me,” or “It doesn’t matter if I’m here anyway,” or “I guess you don’t even love me.” Statements like these, especially if they’re out of character for your child, should be warning signs and signal the need for further assessment. Again, start with your pediatrician if you can.
Kevin Pho: Sometimes suicidal ideation coincides with major life stressors—things like school exams, breakups, or cyberbullying. How can parents stay alert and responsive to these stressors without adding additional pressure or anxiety to their child? How do they strike that balance?
Shivana Naidoo: I think that, as parents in today’s society—and I’m sure our kids will say the same thing when they become parents—it’s really hard now because we’re all very busy and, at the same time, very distracted. So sometimes we miss signs because our lives are so busy.
The first step is to reopen communication with our teens. We know teenagers will grow and develop and begin to distance themselves from us because, during this stage, friends become more important than parents. But we are still important, and knowing that our kids know we care about them—that we are open to listening—can go a long way in keeping that door open for engagement.
I often encourage parents to have regular, quality time with their teens. This could be just five minutes of pointed, active communication or interaction each day, similar to how we encourage parents of younger kids to have floor time. Maybe this is at dinner time, or when you’re driving them to practice or picking them up from school. Find some time every day, if possible, or at least weekly, where you focus solely on them. No phone, no spouse, no work—just be there, be present, and let them know they have your attention.
Another approach I suggest is to share experiences with them—kind of like reverse psychology. For example, you could say, “You know, I had a really stressful situation at work today, and this is what happened. What do you think I should do?” This not only makes them feel involved but also lets them know that you trust them to help you. Sometimes, kids and teens feel good about helping us, and that can open the door for them to share their own stresses with us.
Kevin Pho: Do you ever encounter scenarios where parents may be in denial about their child’s mental health issues and may resist taking safety precautions or engaging in a safety plan?
Shivana Naidoo: Yes, it does happen quite often. I think you probably see this a lot in emergency rooms as well, Kevin, where parents may have been made aware of concerns but aren’t quite ready to accept them. There are many layers to denial. Sometimes it’s because of past trauma that adults themselves have experienced—not just trauma in the sense of physical, sexual, or verbal trauma that we think of as psychiatrists, but also trauma from engaging with mental health care in their own past.
Many parents may have had experiences when they were younger, where they were forced into treatment or put on medications against their will. They may carry a negative view of mental health treatment as a result, and they don’t want that for their child. Or, perhaps they went through the system themselves—maybe they had outpatient therapy or an inpatient stay, and it didn’t help them. So because it didn’t help them, they may believe it won’t help their child either.
There’s also a perception that “young people today have it easier,” and this idea that they should be able to manage without intervention. Parents may feel that previous generations were tougher or less “coddled,” and so they sometimes dismiss symptoms of mental health struggles as just “normal teenage behavior.” Mental health stigma is also a big factor, and some parents may be resistant to acknowledging issues like anxiety, ADHD, depression, or substance use. They may want to normalize what is actually a significant problem.
And, sometimes, parents truly don’t know. Especially when it comes to high-functioning youth—straight-A students, kids who are doing everything they can to excel, those aiming for med school or Ivy League schools—these teens often do an excellent job of hiding their feelings of hopelessness and fear of failure. For them, even something small, like a 97 instead of a 99 on a test, can feel devastating. The stakes feel so high to them.
Youth today are also very skilled at putting on a “happy face” for the outside world, which can mask their internal struggles. Social media adds another layer to this because it encourages youth to create an image of themselves that may not be real. They may become disconnected from their true emotions as a result.
For example, I’m currently working with a teen who has made several suicide attempts and genuinely struggles with understanding her own emotions, understanding why she feels the way she does, and identifying the triggers for her behavior. She has been so focused on “performing” a certain way that she’s become out of touch with her real self. Unfortunately, this kind of disconnection is not uncommon in today’s youth.
Kevin Pho: We’re talking to Shivana Naidoo. She’s a child psychiatrist. Today’s KevinMD article is “Prevent Youth Suicide: Essential Steps for Parents to Secure Their Home.” Shivana, as always, we’ll end with some of your take-home messages to the KevinMD audience.
Shivana Naidoo: I guess my take-home message is that if you have a child who has mentioned to you at any point that they may have suicidal thoughts or may be at risk for suicidal action, please don’t wait. Don’t hesitate. Go secure those following items in your home, because you, as the parent, are the only one who can do that. A pediatrician can’t do it. A psychiatrist like me can’t do it. A therapist can’t do it. Your child’s teacher can’t do it. You are the only one who can secure your home.
I’ve worked with so many teens who have had suicidal thoughts, and they often don’t act on them until they know that their parents have “slipped” or become less vigilant. Then, they find that one item and make an attempt. So, don’t be that parent. If you’re aware of a risk, go secure those items.
And if you’re concerned about behavioral changes in your child and want to get them checked out, start by talking to your pediatrician. They can conduct a confidential assessment and help guide you from there. There’s always help. You can call 988, the National Suicide and Crisis Lifeline, or text 741741 for support for you or your child.
Lastly, if you’re interested, I have a podcast called Thinking It Through with Dr. Naidoo, Child Psychiatrist. For September, I did a series of episodes on suicide prevention and suicidal thinking, including an episode that speaks directly to youth about how they can think through these difficult feelings. Please check it out; it’s free information that I hope will be helpful.
And Kevin, thank you again for having me as a guest on your podcast. Thank you for opening up the opportunity for health care professionals to share their mission with the world.
Kevin Pho: Shivana, thank you so much for coming back on the show and sharing your perspective and insight.
Shivana Naidoo: Thanks so much. Be well.
