Parent and Caregiver Perspectives on Youth Suicide and Systems of Care

Background and Purpose: Suicide is the second leading cause of death for Canadian youth aged 15-24, and most youth who die by suicide have at least one mental health concern. Canadian youth have the highest rates of mental health (20%) and substance use (12%) concerns, and the most unmet mental health care needs. Parents of youth who die by suicide describe challenges finding appropriate youth mental health care, poor quality of care, and inadequate involvement in their youth’s treatment. For sexual and gender minority youth and Black Indigenous People of Colour, there are higher suicide risks associated with racism and discrimination. Half of Ontario youth who die by suicide visited emergency in the year preceding their death with increased risks post-discharge partly because of the lack of continuity of care and limited referrals to community mental health care. The aim of this study was to examine how parents/caregivers describe systems of care that engaged with their youth prior to the suicide to improve service access, quality of mental health care, and reduce the rates of suicide in youth.

Methods: This qualitative study used an interpretative phenomenological approach (IPA) which recommends samples of 5-15 to provide a deeper understanding of the phenomenon. Participants were eligible to participate if they were an Ontario parent/caregiver of a youth under 26 who died by suicide in the last 5 years. Recruitment was through bereavement centres, and we conducted virtual semi-structured interviews. We analyzed data using an iterative process for IPA which identifies meaning statements and connections across the sample to generate themes.

Results: The sample included 13 participants (n=9 mothers, n=4 fathers). Ten parents had a son and three had a daughter who died by suicide aged 12-25. We identified the following themes from parent statements: (1) it is important to make our youths’ voices heard, (2) to reduce stigma and improve treatment, mental health concerns need to be treated as an illness, not bad youth behaviour or a parenting problem, (3) schools need to listen to youth and adequately address bullying, (4) there are anti-racism school policies, but they are not consistently applied, (5) suicidal youth are often too low risk for hospital and too high risk for community agencies, (6) there is a need for more compassionate care for youth and caregivers, (7) gender norms negatively affect youth, (8) youth are dying because of a broken system, (9) consent and privacy laws exclude caregivers who are usually the most important source of support, and (10) there is limited support for parents until after our youth die.

Conclusion and Implications: Our study identified 10 themes connected to bullying, racism, stigma, discrimination, quality of care in different systems, inequitable access to services, family involvement in treatment, inequitable policies, and service gaps. These findings have implications for social workers who are one of the largest mental health professions in the U.S. and Canada. It is important to strengthen social work education and training to improve policies and services for youth in distress and their families.