Talking With Christine Lee, PhD

Shining a Light on Suicide Can Help Prevent It

Most of us have been touched in one way or another by the tragedy of suicide. According to the National Alliance on Mental Illness (NAMI), 4.8 percent of all adults have had serious thoughts of suicide. That number goes up for young adults, aged 18-25 (11.8 percent), high school students (18.8 percent) and LGBTQ+ high school students (46.8 percent). In fact, suicide is the second leading cause of death among people aged 10-34 and the 10th leading cause of death overall in the United States.

September is National Suicide Prevention Awareness Month. We sat down with Christine Lee, PhD, staff psychologist, Behavioral Medicine and Clinical Psychology, to talk about what Cincinnati Children’s is doing to address this issue.

Inspire: What is your role at Cincinnati Children’s? Lee: I complete crisis assessments and do short-term crisis therapy in our intensive outpatient programs. I provide a higher-level care for our kids and adolescents who are experiencing more severe mental health problems.

Inspire: Where are these patients coming from? Lee: They come from Ohio, Kentucky and Indiana—really, a large radius because there are not a lot of mental health resources in some areas. Fortunately, we’ve been able to use telemedicine to expand our reach.

Inspire: Are there “seasons” where suicide rates increase or decrease during the year? Lee: Yes. Typically, we see an increase in the fall when school starts and kids are facing a lot more stressors. The volume eases up over the holidays when kids are on break, but it inches back up in March and April and then slows back down during the summer. But during the pandemic, we did not see those ebbs and flows.

Mental Health Resources

Inspire: What was the effect of COVID-19 on kids’ mental health? Lee: We saw an increased need for services that remained pretty consistent. The kids were home all the time, many were socially isolated, and they weren’t able to engage in their normal coping activities. Being home all the time also meant there was more family conflict. And because they weren’t in school, they didn’t have access to school-based therapists or the services they offer.

Inspire: What have we done at Cincinnati Children’s to meet this increased need? Lee: Last fall we opened a mental health clinic at our Norwood location, which allowed us to focus on kids with more severe symptoms, such as those who are suicidal or engaging in self harm. We have a partial hospitalization program in Norwood, and we offer the Bridge Clinic, where we do outpatient crisis assessments and short-term crisis therapy. We also started a new intensive outpatient program where we meet with patients two to three times a week for three to five weeks and provide evidence-based care for those with more severe psychological problems. By adding all these different levels of care, we hope to increase the options for families in crisis and reduce the number of families who need to go to our inpatient psychiatric unit or our Emergency Department.

Inspire: Tell us more about the Bridge Clinic. Lee: The Bridge Clinic is run by Psychiatry and accessed through the Psychiatric Intake Response Center (PIRC). It’s for kids who don’t present an imminent risk but who do need immediate services. Families can call the PIRC crisis line at 513-636-4124 and request a same-day or next-day appointment for an assessment, crisis therapy or a provider referral. We may meet with them one to three times in person or via telemedicine and then set them up with long-term services. It’s a great resource, especially when there are long wait times.

Inspire: How can you tell if someone is serious about committing suicide? Lee: That differentiation is best left up to a mental health provider. If someone expresses suicidal thoughts to you, refer them to our crisis line or have them contact their primary care physician. In the meantime, consider these safety issues:

  • Does this person have access to any means to hurt themselves, such as weapons or medications?
  • Has this person attempted suicide in the past?
  • Is this person impulsive?

If you suspect the person is in immediate danger, call 911 or bring them to the Emergency Department.

Inspire: Sometimes when one teenager commits suicide, you hear of other kids following suit. Is suicide contagious? Lee: That’s a debated subject, but it’s very tough to study because it doesn’t happen that often. But I do think that people should not be afraid to discuss suicide. Talking about it will not make people suicidal. Many kids and teens have suicidal thoughts and never act on them. It’s better for it to be a topic of discussion so that there’s an opportunity for appropriate interventions and connections with resources, if needed.

Inspire: Is it typical for kids to have suicidal thoughts? Lee: I think it’s typical for kids to feel overwhelmed, depressed and sad at times. But anytime someone talks about ending their life, you should take it seriously and have them follow up with a mental health provider for a more thorough assessment to determine how prevalent those thoughts are and how much of a risk there is so we can make an individualized plan for treatment.

Inspire: Are there any other misconceptions about suicide you’d like to dispel? Lee: Having suicidal thoughts is probably more prevalent than people think, but thoughts don’t necessarily translate into action. The more we can talk about it, the better—even at well-child visits where there’s no sign of mental health problems. It only takes a couple of seconds to ask the question and make sure. I’d rather ask and find out the child has no issues than not ask and miss a potential safety concern.

Inspire: What are we doing to make mental healthcare more accessible? Lee: In addition to using telemedicine, we have an ECHO training series for pediatricians in the community to educate them about mental health and available resources. The idea is to boost their confidence in helping the kids they see in their own practices. We have psychologists embedded in primary care physicians’ offices to offer preventive care and introduce mental health concepts to families. HealthVine provides care management to connect their patients to resources. We also have the Zero Suicide Committee that is working to standardize system-wide processes for safer suicide care. This is a national initiative for which we have our own hospital committee working to implement it here.

Inspire: We’re doing all this for patients, but how are we supporting our employees who have been under a great deal of stress, especially since the pandemic started? Lee: We have our Peer2Peer program for frontline caregivers, which provides them with a confidential outlet where they can be vulnerable, ask for help and learn about available resources. Anyone who’s interested in that type of support can send an email to We also have a program with the Lindner Center of HOPE where members of the Medical Staff can connect directly with an adult-trained psychologist or psychiatrist within 24-48 hours. Of course, we also have our Employee Assistance Program where any employee can get up to eight free visits with a licensed professional counselor in the community.

Inspire: What do you recommend if you are concerned about someone committing suicide? Lee: The first step would be to refer them to mental health services by calling our crisis line or the adult crisis line at UC Health. They could also get referrals through their primary care physician. Unless you have extensive training in the field, you should not feel responsible for solving complex mental health problems. Don’t be afraid to reach out for help for yourself or a loved one.

In general, there is still a stigma associated with mental health problems, so the more we can normalize it and understand that everyone goes through struggles and challenges, the better. It’s okay, it’s acceptable and there are many resources the hospital provides on many levels to meet your needs.

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