Bender got into the field — in addition to psychiatry, he trained in psychodynamic therapy, a form of in-depth talk therapy — in part because he was the teenager whom friends confided in, and he never forgot how life can feel out of control when you are an adolescent. He wanted a career that allowed him to help children as much as possible by prescribing meds and providing therapy.
Bender, who still has a boyish face at 35, wears his hair neatly combed and prefers plaid shirts (he never wears a doctor’s coat). He’s a horror-movie fan: His office décor includes a poster from “Halloween” and small figurines like Pennywise, Wolf Man and Stripe from “Gremlins.” With his patients (who don’t see him in his office), Bender plays the role of curious, open-minded confidant. By the time he gets to them, some children are, as he put it to me, “so done” — frustrated by school, parents, on-and-off-again friendships, romantic relationships, their lack of control over much of anything, life. “They are mad, so mad,” he says. One threw apple juice in his face; two girls threatened to kill him after they said they found his address on the internet. “I tell kids, please hate me if you need to,” he says. “I prefer you hate me instead of your parents.”
His goal is to understand how it feels to be them, not to tell them what they need to do. “When you can’t make sense of your despair, I can make sense,” says Bender, who has won several teaching and clinical-care awards. “Not ‘expert’ sense, but a realistic sense of what may be going on. I can help them feel contained and engage them. Or not react in the same way as their family. I’m not going to understand everything while they are here. But we can find a closer gray about what the real story is. And, hopefully, help parents do so, too.”
As he talked, more children were waiting at the hospital’s Psychiatric Emergency Services, six floors below. The PES (pronounced Pez) is the first stop when children and adolescents come to Western Psych’s emergency department after passing through security and handing over their phones and bags. To fill out forms, they have to use soft, bendable plastic pens, so they can’t harm themselves or others. (For the same reason, the bathrooms’ metal toilets have nondetachable seats.) TVs play cartoons, cooking shows, Hallmark movies. The only available phone is attached to the wall. Patients often spend hours in one of two pediatric waiting areas, sometimes wearing hospital gowns after having been transferred from another medical center. They sit in the blue-and-orange plastic chairs around a table with board games or in leather chairs that fold out to become single beds. Some patients stay overnight — or several nights — when Bender’s unit cannot accommodate them.
Psychiatrists at PES interview children and their parents (or other caregivers) separately, to figure out if the patients needs to be admitted or if a referral for outpatient care, which can include crisis services, will be enough. Most teenagers who experience suicidal thoughts don’t need to be hospitalized and most don’t kill themselves (about 2,800 did in 2021). Psychiatrists have to weigh the possible protective factor of admitting a child against the reality of limited beds and the fact that hospitalization can make anxiety worse, which can drive adolescents away from mental health care altogether.
Medical professionals use the word “suicidality” to refer to a range of thoughts and actions, from passive death wishes, like the desire to go to bed and not wake up, to more active thoughts and, at the most extreme, suicide attempts and death. Though we know a lot about some causes of suicidality — mood disorders, child abuse, substance use — experts don’t understand why the numbers have been rising, on the whole, over the last decade. Some blame social media, which can both deprive children of sleep — the lack of which is associated with increased suicidal thoughts — and increase loneliness and feelings of being left out (even as it offers helpful communities for children, especially those who feel marginalized). Since 2020, the pandemic has likely been another factor.
Systemic conditions can also fuel anxiety, anger, dread and, in turn, suicidal thoughts and actions among particular groups — Black children facing trauma and persistent racism, for example, or trans children forced to use the wrong bathroom for them at school and made to feel ostracized, unseen and alone. Rates of suicidality in both populations have increased in recent years. “Ignore the social and family context at your peril,” says Brent, who has tracked the rise in adolescent suicide for years.