“Mum, I’m okay,” were Josh’s last words to Ms Jenny Teo when they said goodnight on an uneventful evening. Seven hours later, she found her 20-year-old son dead in the study. Josh had died by suicide.

Watch this video for Jenny's story and an expert's advice:

According to the Samaritans of Singapore (SOS), suicide among youths rose by 23.3 per cent from 30 deaths in 2020 to 37 deaths in 2021. In addition, its crisis hotline saw a 127 per cent increase in calls between 2020 and 2021. This begs the question: How can parents and caregivers intercept before it’s too late? 

Reading the signs

SOS deputy director of training and development, Ms Charlene Heng, shares that warning signs of suicidal behaviour could come in the form of verbal cues, behaviour and mood. For example, the teenager could verbalise thoughts like, “My life is meaningless anyway” or “I just want to disappear”. 

While behaviours to watch out for include more obvious ones like posting suicide notes online or having past suicidal behaviour, Ms Heng says parents also need to take note if their child’s demeanour suddenly changes and they display a sense of calmness. This could be because they have actually resolved to end their life.

This hit home for Ms Teo, who had mistaken Josh’s lift in spirits for recovery. “I thought he was getting better, not knowing he was just coping,” says the 61-year-old. After being depressed for months, he wanted to attend a church meeting out of the blue. He also offered to head out and buy drinks for guests during Chinese New Year, which he didn’t usually do.

Self-harm as a coping mechanism

While there are many reasons teenagers choose to self-harm or take their own lives, they may not always be fuelled by a mental illness. “There are some factors that might increase a person’s risk of suicidal behaviour,” Ms Heng explains. “A history of trauma or abuse, stigma and social isolation, family history or exposure to suicide, as well as dealing with multiple stressors like relationship problems and cyberbullying over a prolonged period.”

These resonate with Ms Amy Lee*, who discovered her daughter, Alicia*, had been self-harming four years ago. On top of relationship issues, the then-15-year-old was also grappling with an eating disorder and being bullied in school. These culminated in acts of self-harm, leaving traces that went unnoticed under clothing and plasters for a whole year. Even more alarming to Ms Lee was how prevalent self-harm was among Alicia’s schoolmates.

“A few of my daughter’s female classmates also resorted to self-harm as one of their coping mechanisms, and it seemed perfectly normal to them,” says Ms Lee, attributing distress among teenagers to transitions such as hitting puberty, starting relationships, and embarking on a new and more challenging academic season. 

“If they are unable to cope with these changes or any issues they face, they may resort to acts such as self-harm. Many parents take for granted that so long as their child attends school, behaves ‘normally’, and doesn’t voice out any issues, everything is good.” 

To parents whose children may be at risk of self-harm, she recommends maintaining a close relationship and having open conversations about mental health. “After knowing about her self-harm tendencies, I sat down with my daughter to better understand the triggers and explored healthier coping mechanisms such as journaling, taking a walk, or listening to music. I also paid closer attention to her moods, temperament, and appetite.”

Navigating difficult conversations

Some parents may be hesitant to broach the topic of suicide with their child as they fear it might plant ideas instead. However, Fei Yue Community Services’ senior social worker, Ms Lim Tse Min, explains research has found that talking about suicidal thoughts can be helpful.

“Open discussion of suicide not only reduces suicidal behaviour but also improves mental health among those seeking help,” she says. “It is recommended to check in with youths on how they are coping and if they have thoughts of wanting to die or kill themselves.”

Agreeing, Ms Heng adds, “Using the word ‘suicide’ yourself lets them know it’s okay to talk about it. Don’t be afraid to ask directly whether they are thinking about suicide. Talking about it de-stigmatises the taboo topic and decreases social isolation. It can also promote better mental health.”

Should the child develop symptoms of depression and anxiety, treatment, which doesn’t necessarily mean medication, should be in order. Although some may be self-conscious about seeing a school counsellor, taking that step to see a therapist can help address their negative thoughts. 

“The professional can support your teen by guiding them to develop a safety plan at times when suicidal urges occur,” says Ms Heng.

Creating a safe space 

Parents themselves need to have a mindset shift in how they perceive their child’s suicidal thoughts. Ms Heng advises against panicking or jumping at the child’s mention of suicide. This is important because the parent’s first response will determine whether the child will continue to reach out or drift further apart.

Ms Heng adds, “Research has shown that the majority of people who have suicidal thoughts do not go on to make suicide attempts. Suicide ideation can linger in a person’s mind for a long time without them acting on it. These thoughts can be comforting for some as having this ‘option’ soothes their anxiety and pain.”

That said, she cautions that these thoughts should not be taken lightly either. “It is a cry for help. Your child requires your active support.”

It is also helpful for parents and caregivers to reflect on their own thoughts on suicide. Ms Lim says, “They need to be comfortable holding that safe space and not project their fears and anxiety on their children.” Instead, she proposes listening without judgement, empathising with the child’s perspective, and affirming them for having the courage to share. Finally, encourage them to seek professional help, connect them with resources, and stay involved in their journeys.

After Josh’s passing, Ms Teo uncovered a series of suicide notes. Some were handwritten letters; others were audio clips, but every single one spoke of ending his psychological pain. Since sharing their story with the public, Ms Teo has received no lack of messages from young people echoing Josh’s cry for help, saying their parents “would never understand”.

“The reaction from parents must be one of empathy. Where does it hurt? How can I help?” she emphasises. “The question asked should not be why suicide, but why the pain? Pain is the basic ingredient of suicide. Pain makes us want to stop it. It’s human nature.”  

Ms Heng adds that pain is at the heart of the issue. She says, “A person who has suicidal thoughts does not necessarily want to end his or her life. What they really want is to end the pain. For suicidal thoughts to go away, your child has to learn strategies to regulate the painful emotions that arise from the problems they are experiencing. They cannot do this alone or in isolation. They need our support and help.”

*Names have been changed to protect identities.

Getting help

Mental well-being

Fei Yue's Online Counselling Service: eC2.sg website (Mon to Fri, 10am to 12pm, 2pm to 5pm) 

Institute of Mental Health's Mental Health Helpline: 6389 2222 (24 hours) 

Samaritans of Singapore: 1-767 (24 hours) / 9151-1767 (WhatsApp chat, 24 hours)

Singapore Association for Mental Health: 1800 283 7019 (Mon to Fri, 9am to 6pm) 

Tinkle Friend: 1800 274 4788 (Mon to Fri, 2.30pm to 5pm)

Counselling 

TOUCHline (Counselling): 1800 377 2252 (Mon to Fri, 9am to 6pm) 

Care Corner Counselling Centre (Mandarin): 1800 353 5800 (Daily, 10am to 10pm)

Visit this website for additional resources on teen mental health and well-being.