An eleven-year-old camper is in her first year with us at our all girls' resident camp. During the first few days of camp, she was shy, somewhat reserved, and occasionally cried a few tears of homesickness. Once, when she was talking with one of her camp counselors, she casually mentioned how the thought of killing herself occasionally crossed her mind. The counselor, understandably and appropriately concerned, told one of our nurses. Since our nurses are trained to call in a mental health professional when a child says they want to kill themselves, our nurses advised that we get a consultation. When I spoke with the child she said she really never said she wanted to kill herself, just that she thought about it once in a while. She said she had seen a TV show called 20/20 where they had talked about how some people hear voices in their heads and sometimes listen to what those voices are saying and even do things the voices tell them to do. The show about the "voices" had made her a little upset and was what got her thinking about suicide. She also said she had been worrying about doing something to "hurt" her mother, but when probed about this she wasn't able to be more specific.
I am not against the idea of calling in a mental health professional. I am just concerned that doing so might cause more alarm in the child than is necessary and might make more of a "big deal" out of this than would be productive. My nurses, being the thorough and professional folks they are, insist we follow through and get an outside person to evaluate her. Meanwhile, three days into camp, she has made friends, is no longer homesick, and seems very engaged in the program. What's your professional opinion?
— Phil Hurt, Camp DeSoto, Mentone, Alabama
Your nurses are correct in getting you to think seriously about the responsibility you have for this child and her well being at camp. I would agree with them and suggest you contact a mental health professional if this young lady had indeed said she wanted to kill herself. She didn't.
In this case, I would do what I call "shifting the burden of responsibility" for that decision to the girl's parents. Admittedly, a call to the parents is something that will require tact, sensitivity, and skill. However, the risk of not calling is greater than the possibility that they might become overly distressed and do something impulsive. First of all, parents do not want to be left in the dark about such behavior on the part of their child and they certainly do not want to hear about it from anyone other than you. Second, by calling the parents, you are actually partnering with them, thus exercising greater "due diligence" in this situation than by doing nothing. Doing nothing is not an option here. Third, this girl's parents know her much better than you do and they may be able to shed some light on something that will help in setting a wise course of action.
When you call, you will need to say their daughter is doing fine and give them some specific examples of both the friends she has made and the activities she engages in. Explain that during the first day or two of camp she mentioned that the thought of killing herself had crossed her mind and that when she brought up the topic she did not seem agitated or upset. Point out that many children think about suicide, which is very different from thinking about doing something about suicide. Tell them that as far as you can tell, her thoughts seemed to have been stimulated by the TV show she referenced. By the way, it is typical for eleven-year-olds to see a show about something like "hearing voices in one's head" and take that statement literally. (Even though someone who is psychotic would argue with us that those "voices" are truly there! For someone who is psychotic, auditory hallucinations are not uncommon.) It is also not unusual for a child this age to "worry" about thoughts of "hurting" her parents. Her worry is her unexpressed anger at her parents for not being there at camp to comfort and soothe her in her homesick moments. The thought of being openly angry with her parents is probably hard for her to admit because it is hard to be angry with someone you love and count on for comfort and support! It is not so unusual that children, therefore, "worry" that "something bad might happen" to their parents back home or have worries about somehow "hurting" their parents when they are homesick during the first few days at camp. When explaining all this to the parents, you must take care not to talk the parents out of their ultimate right to look further into the matter. You should explain that your nurses have advised that you follow through with a consultation from a mental health professional, which is proper protocol when a child says they want to kill themselves, but that this is somewhat different and you wanted their input. Whatever direction you ultimately take, if the child remains at camp you would do well to keep a close eye on her and casually check in with her from time to time. If you continue to hear about her "worries" about hurting her parents, I would advise that you tell the parents and recommend that she see a mental health professional after camp. If she continues to think about killing herself or actually says she wants to, then you must at that point consult a mental health professional immediately and get a "clean bill of health" from them in order for her to stay at camp. In that