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Spot the warning signs

Life can get overwhelming for our teen at times. When it does, some might consider self-harm or other extreme means to end their pain. Let’s learn to spot the warning signs of self-harm and suicide so that we can provide them with the support they need. Take any mention of suicide seriously and remember that help is always available.

Helplines

If you or someone you care about needs a safe space and would like for someone to provide a listening ear, these helplines are available.

Samaritans of Singapore

24-hour

1-767

CareText

Institute of Mental Health

24-hour

6389-2222

What is emotional health?

Advice for parents of teenagers and teenage parenting tips

As parents, we always have our teen’s best interests at heart. We prepare them for adulthood by nurturing their social skills, helping them navigate the challenges of adolescence, and providing support for their emotional health and well-being.

Emotional health is an important part of mental health. Having good emotional health does not mean one is always happy; emotionally healthy people experience a variety of emotions too. However, they are able to cope with life’s challenges, keep problems in perspective, feel good about themselves and have good relationships.

Let’s read on to learn to identify the warning signs that our teen’s emotional health may be suffering and how we can help.

Learn more children's mental health and emotional health of teenagers

Understand what’s normal and
what’s not of teen behaviour

As our teen enters adolescence, many of them might experience some change in behaviour as they try to define their new identity. At this stage, their friends also become extremely important and have a great influence over them.

As our teen focuses more on their peers, it might become common for them to spend less time with us. This might leave us feeling a little hurt but it doesn’t mean that they don’t need our support and love.

However, if the changes are more unusual and extreme, it might be a tell-tale sign that our teen is struggling emotionally.

Typical teen behaviour

Experimentation

Teens might be tempted to experiment with new things…

Teens might be tempted to experiment with new things.

Some examples may include:

Trying new experiences like thrill rides (e.g. bungy jump)
Trying new looks to keep up with fashion trends
Playing new games to keep up with social trends
Dating around
Trying different diet fads

Typical teen behaviour

Defiance or rebellion

Teens can be more rebellious at this stage and refuse to take...

Teens can be more rebellious at this stage and refuse to take instructions like they used to. Some defiance is normal as teens increasingly seek independence.

Some examples may include:

Wanting to go out with their friends
Having differing opinions with parents which might lead to disagreements

Typical teen behaviour

Moodiness and irritability

Hormones and developmental changes during puberty often...

Hormones and developmental changes during puberty often mean that our teen might experience mood swings and display irritable behaviour from time to time.

Typical teen behaviour

Sleep habits

Teens have the tendency to sleep later due to various factors...

Teens have the tendency to sleep later due to various factors, including changes to biological clock during puberty.

Typical teen behaviour

Usage of electronics

Most teens would have access to smartphones or electronic...

Most teens would have access to smartphones or electronic devices such as tablets, personal computers etc.

It is common for teens to use social media or play online games to interact with their friends, and to learn more about their interests— these can have a positive impact on their well-being.

Typical teen behaviour

Omitting facts or lying

Most teens value privacy and are somewhat secretive about...

Most teens value privacy and are somewhat secretive about what they are doing.

It is also normal for them to want to make their own day-to-day decisions without parental input, which may be why some teens choose to occasionally keep things from us.

Learn more about the early signs that our teen is struggling emotionally here.

Signs and symptoms that our teen
may be struggling emotionally

If we notice any of these signs from our teen, it might mean that they need our support:

Frequent emotional or
anger outbursts

Social withdrawal

Deterioration in functioning

Significant sleep or
appetite changes

Low mood and low energy

Signs of
self-harm behaviour

What is self-harm?

Self-harm means to cause harm to one’s body on purpose. It is a form of maladaptive coping behaviour (poor patterns of behaviour to cope with the situation) that may accidentally result in serious injury or even death. Some common examples of self-harm behaviour are:

Scratching or cutting one’s skin

Consuming toxic substances
(e.g. bleach or detergent)

Swallowing sharp objects

Hitting parts of the body on hard surfaces or objects

Burning the skin

Consuming drugs or taking medicine in a manner or dosage more than what is prescribed

Pulling hair out

Binge drinking

Having casual sex

Starving themselves or purging

Scratching or cutting one’s skin

Consuming toxic substances
(e.g. bleach or detergent)

Swallowing sharp objects

Hitting parts of the body on hard surfaces or objects

Burning the skin

Consuming drugs or taking medicine in a manner or dosage more than what is prescribed

Pulling hair out

Binge drinking

Having casual sex

Starving themselves or purging

Why do people self-harm?

Some reasons why a person could harm themself:

Distracting oneself from difficult situations, experiences, or emotions

A form of relief from intense and painful emotional or psychological distress

To seek a sense of belonging

A form of self-punishment due to feelings of guilt or shame
from past traumatic experiences

A way of regaining some sense of control in their lives
(e.g. being able to decide when, where and how to hurt oneself)

School pressures
(e.g. heavy workload)

Relationship problems amongst family members/ friends/ romantic partners
(e.g. conflict, bullying)

Social isolation
(e.g. having no friends or not fitting in school)

Transitional changes
(e.g. changing schools, entering the workforce)

Low self-esteem

Confusion and insecurity about self, such as one’s identity and role

Bereavement and grief
(e.g. losing a loved one to death or breakup)

Mental health conditions
(e.g. depression and anxiety)

Past traumatic experience

Alcohol or drug use

Left unchecked, constant self-harming can become a habit due to the sense of relief it may bring. However, this sense of relief is only temporary. It cannot help with the issues that make someone want to hurt themself in the first place.

It is important to remember that self-harm is dangerous – a cut too deep or a bad reaction to a drug could put a person’s life at risk.

While people who self-harm usually do not intend to end their lives, constant self-harm can increase the risk of suicidal tendencies.

Let’s learn more about suicide,
an extreme form of self-harm

Before the act of suicide, suicidal thoughts and behaviours may occur. They include having thoughts of ending one’s life, planning suicide, and enacting the plan. However, some suicidal behaviours may occur suddenly and impulsively.

What increases the risk of suicide?

Some factors that increase the risk of suicidal behaviour can include:

Family history of suicide

History of trauma or abuse

Existing mental
health conditions

Dealing with multiple stressors over a prolonged period
(e.g. friendship/relationship problems, unrealistic pressure, financial worries, school/work difficulties)

Social isolation or rejection

Unrealistic expectations
from ourselves or others

Accessibility to means to kill oneself

While these factors do not necessarily cause one to attempt suicide, they can increase the risk of suicidal tendencies. A combination of multiple “causes” may also heighten this risk.

What reduces the risk of suicide?

Strong and supportive relationships with family and friends

Life skills such as problem-solving skills, coping skills, ability to adapt to change

Beliefs that discourage suicide
(e.g. cultural or religious)

Healthy self-esteem

Sense of purpose or meaning in life

Limited access to lethal means

How can we recognise self-harm and suicide?

Warning signs of self-harm

Most teens who engage in self-harm tend to hide their actions or injuries to avoid confrontation or rejection. They may feel ashamed, confused or afraid about their actions.

They might also worry that we may not understand their reason for self-harm, and as a result become angry about it or would reject them. This might make it difficult for us to know whether our teen is self-harming.

These are some indications of the possibility of self-harm:

Keeping themselves fully covered at all times
(e.g. wearing long sleeved clothing, pants or jackets even in hot weather, not wanting to change around others, avoiding physical activities such as swimming)

Having unexplained cuts, bruises, burns, bite marks usually on the wrists, arms, thighs and chest

Having unexplained bald patches

Having blood stains on clothing or tissues

Becoming withdrawn and not interacting with others such as family members or friends

Experiencing low mood, lacking motivation or interest in anything

Expressing thoughts that they are not good enough, feelings of failure or hopelessness

Blaming themselves for their problems or being useless

Having outbursts of anger or argumentativeness

If we discover that our teen is displaying some signs that they may be engaging in self-harm, it is important to remain calm and not jump to conclusions or confront them immediately. Understandably, as parents, we are worried but our reactions may unintentionally add on to their stress or cause them to be even more withdrawn. We should give them a chance to open up voluntarily.

Warning signs of suicide

There are warning signs to suicide. Here are some examples of what someone considering suicide may say or do:

“My family will be better off without me.”

“I’m a burden on my family.”

“My life is meaningless anyway.”

“Nobody loves me.”

Having past suicidal behaviour

Giving away treasured possessions and saying goodbye

Researching suicide methods

Writing suicide notes
(e.g. posts on social media/diaries/letters)

Feeling calm and positive after a long period of hopelessness or worthlessness can be a sign of someone deciding to end their life as opposed to them still struggling with the decision

Feeling hopeless

Displaying emotional outbursts

Feeling angry, sad, irritable, or reckless

Having lost interest in things they usually enjoy

Feeling humiliated or anxious

How can we support our teen emotionally?

As we grow with our teen, parents play an important role in showing them life skills, role-modelling and demonstrating to them coping, problem solving and help-seeking skills. Here are some tips that can help foster a stronger relationship with our teen.

Find opportunities to check in
Practise active listening
Observe for tell-tale signs if our teen is not keen to talk
Provide assurance and support
Respect their privacy and give them space
Schedule time to spend with our teen

Find opportunities to check in

Look for ways to check in with our teen and find the right time and moment to engage them.

Ask them how their day has been and what they have been doing.

We can also talk to them about their latest interests and hobbies. For example, we may want to invite them to join in a task, such as laying the table for dinner, so we can use the time to chat about their day.

Practise active listening

When our teen starts a conversation, we may wish to stop what we are doing to listen. Stay focused on the conversation and show genuine respect for what they are saying. This sends the message that we are genuinely interested in what’s going on in their life.

Observe for tell-tale signs if our teen is not keen to talk

If they prefer to keep to themselves, we may let them know that we are available for them whenever they need.

In the meantime, we could observe for tell-tale signs that they may not be coping emotionally. If we are concerned, we could proactively check in with them.

Provide assurance and support

We could remind them that we are always here for them and that we are interested to know how they are feeling and what they are thinking.

We can encourage them to reach out to us and let them know we are here to support them.

Mental health activities for children and teens include providing assurance and support

Respect their privacy and give them space

The desire for more privacy is a natural part of growing up as our teen is developing independence and new social interests.

We could give our teen the appropriate time and space to be on their own.

At the same time, we may want to balance this with ground rules such as curfews and that they should let us know whom they are going out with and where they will be.

Schedule time to spend with our teen

Take interest in what they enjoy doing and do it together. For example, we could go out for meals, or engage in sports with them. This not only shows we care about them but allows for opportunities for conversations to happen naturally.

Mental health activities for children and teens include setting aside time together

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Practising these tips on a regular basis can help us stay close, maintain open communication and a positive relationship with our teen, this way they are more likely to share with us when they are facing difficulties. It also makes it easier to notice warning signs when they are acting differently or struggling emotionally.

What can I do if my teen is struggling emotionally?

It is common for us to feel angry or at a loss when we see our teen struggling, especially if our teen has emotional outbursts or withdraws socially. Stay calm and think of a way to get our teen to share what is affecting them. These strategies might help our teen to start talking:

How to approach them

What can I do?

Share our concern and use open-ended questions to ask our teen to share whether a specific incident led to the distress.
As a start, we may approach them by stating our observation.

Try saying:

“I noticed that something seems to be troubling you. What happened?”

What can I do?

Share our concern and use open-ended questions to ask our teen to share whether a specific incident led to the distress.
As a start, we may approach them by stating our observation.

Try saying:

“I noticed that something seems to be troubling you. What happened?”

How to get them to share and open up

What can I do?

Practice active listening and show acceptance. Avoid judging and listen attentively to what our teen is saying.
Encourage our teen to describe how they are feeling.

Try saying:

“I had no idea things were so bad for you, how are you feeling now?”

Mental health activities for children and teens include getting them to open up and share

What can I do?

Practice active listening and show acceptance. Avoid judging and listen attentively to what our teen is saying.
Encourage our teen to describe how they are feeling.

Try saying:

“I had no idea things were so bad for you, how are you feeling now?”

How to respond to them

What can I do?

Be patient and let our teen know that we are here for them. Sometimes, it can be difficult for them to open up.
It may be better if we give them space and reassure them that they can reach out to us anytime they need to.
We could let them know that they can text or write a letter/note based on their preferred communication method.

What can I do?

Avoid saying things that may seem to belittle what they are going through. Those responses downplay their pain.

What can I do?

After gaining a better understanding of the issue(s), it is important for us to offer our teen emotional support.
Remind them that we love them no matter what and that we care.

Try saying:

“Things must be really hard for you. I want you to know that I’m here for you whenever you need help.”

Avoid saying:

“I think you’re overreacting.”

Try saying:

“You are not alone, I am here to help you now that I understand how bad things really are for you” and ask ‘what can I do to help?’.

What can I do?

Be patient and let our teen know that we are here for them. Sometimes, it can be difficult for them to open up.
It may be better if we give them space and reassure them that they can reach out to us anytime they need to.
We could let them know that they can text or write a letter/note based on their preferred communication method.

Try saying:

“Things must be really hard for you. I want you to know that I’m here for you whenever you need help.”

What can I do?

Avoid saying things that may seem to belittle what they are going through. Those responses downplay their pain.

Avoid saying:

“I think you’re overreacting.”

What can I do?

After gaining a better understanding of the issue(s), it is important for us to offer our teen emotional support.
Remind them that we love them no matter what and that we care.

Try saying:

“You are not alone, I am here to help you now that I understand how bad things really are for you” and ask ‘what can I do to help?’.

We can also reach out using these tips and check out Hi #JustCheckingIn to help us navigate conversations with empathy and care.

When should we seek professional help?

Youth counselling and other professional mental health services

When we observe our teen exhibiting the signs of distress more intensely, we could consider seeking professional support.

Just like how we would see a doctor when physically unwell, it is equally important to seek help from mental health professionals when in distress. Help-seeking is not a sign of weakness, but a sign of resilience and courage.

If our teen feels consistently down for 2 weeks or more, and if their mood has significantly impacted their day-to-day functioning, we may want to bring them to a counsellor or General Practitioner.

We may also choose to approach the School Counsellor if our teen is schooling. The School Counsellor is able to make referrals to mental health professionals at a subsidised rate.

For more mental health resources and services, we can find the help we need via CHAT or Belle, the Beyond the Label helpbot.

If we notice that our teen has engaged in self-harm behaviour (e.g. cutting themself on any parts of the body) or has thoughts about suicide, it is important to take it seriously and seek professional help for our teen.

We should not leave our teen alone if they are suicidal. Reach out to any of these 24-hour helplines – Samaritans of Singapore (SOS) at 1-767 (1-SOS) or chat via SOS CareText for support. Alternatively, we can choose to call Institute of Mental Health (IMH) at 6389-2222.

If our teen is in immediate danger, call 995 or 999.

Helping our teen stop self-harming

Provide a listening ear and support for our teen

Help them to cope with their thoughts and emotions

Encourage our teen to seek support from a healthcare professional

Sharing resources or tips that might help

Managing a self-harm relapse

Stopping self-harm can be challenging. Our teen may require some time to adopt effective coping techniques. Sometimes, they may relapse and go back to self-harming when they get overwhelmed with difficult or distressing thoughts and emotions. When a relapse occurs, this is what we can do:

Be calm and do not scold or judge them

Encourage our teen to seek support from a healthcare professional

What can we do to help our teen if they are struggling with suicidal tendencies?

If we notice that our teen has engaged in self-harm behaviour (e.g. cutting themself on any parts of the body) or has thoughts about suicide, seek support from a professional like a counsellor or psychologist. Take any mention of suicide seriously.

Our teen might need us now more than ever, and intervention is important to stop someone who’s undergoing a crisis in harming themselves or taking their own lives. We could do the following to de-escalate the situation and keep them safe:

Always prioritise safety first

Seek
professional help

Work with our teen and professional to devise a safety plan

Be patient with our teen

Give them hope that things can get better

Go easy with expectations

Encourage them to be kind to themself

Encourage them to practise gratitude

It might be very worrying to know that our teen is struggling, but as we care for our teen and juggle our own life demands, it is important that we also care for ourselves to avoid burnout. Visit here to learn tips on how we can better manage our emotions and care for ourselves.

We can consider enlisting help from other adults or family members that our teen trusts, and work with our teen’s teachers and school counsellors to support them.

If at any time we feel that we need emotional or psychological support and would like to speak to someone for further advice or information, please remember, it’s OKAY to reach out. Here are also some helplines that are available for us to reach out.

References