Six year-olds have told Dr. Anne Glowinski that they don’t want to live anymore.

It’s her job to figure out what they mean by that, and how to best help them.

Glowinski is a professor of child and adolescent psychiatry at the Washington University School of Medicine, and specializes in treating depression and suicidal behaviors. She is also working on ways to empower front-line providers, such as pediatricians, to deal with the alarming findings from recent research on American youth and suicide.

Researchers reported this month in the Journal of the American Medical Association that the youth suicide rate is the highest it has been in nearly two decades. There’s been a sharp rise among older teen boys and an increase in girls aged 10 to 14. Between 2009 and 2017, rates of depression among kids ages 14 to 17 increased by more than 60%, another study found. The number of children sent to hospital emergency departments for suicide attempts and suicidal ideation doubled over a nine-year period ending in 2016, according to a study published in the Journal of American Medicine-Pediatrics.

Clearly, there is a crisis in mental health among America’s children and teens. And no one is exactly sure what is fueling it.

So, what can be done about it?

Glowinski shared some ideas: All pediatricians should screen patients for depression. And they need to be more comfortable prescribing medication and treatment for children who need it. As the rates of depression have risen, the rate of treatment has not, she said.

Next, doctors should ask about lethal means of suicide in the home. More young people in America die of suicide by guns than homicide by guns. If there is a gun in the home, the risk of suicide increases. This is a public health issue, not a political one. It also makes sense that adding more therapists in schools is likely to save far more lives than arming teachers with guns.

Lastly, when doctors see a depressed or anxious child, they should also screen for parental psychopathology.

“You will do a world of good for the child by treating the parent,” Glowinski said.

Unfortunately, she says, there can be several barriers, both external and internal, standing between a child and treatment. External barriers can include whether there is an available provider nearby, whether the child has health care coverage and a supportive parent who can afford it.

Internal barriers involve the persistent stigma in seeking medical treatment. Too many people are still afraid of using medicines to treat depression, anxiety and other disorders.

“When it comes to depression, it can be a very isolating illness,” she said. Children will manifest symptoms in different ways. Some act out. Others suffer in silence.

Jessie Vance, supervisor of Provident Crisis Services in St. Louis, says alienation, isolation, bullying and feeling unsupported by an adult can all increase suicide risk. Vance says parents shouldn’t be afraid to ask a child about any changes in mood and behavior that they notice.

In the case of a young child, parents can ask questions like:

Have you been having thoughts of going to sleep and not waking up?

Have you been wishing you weren’t here anymore, or wishing that you could disappear?

Vance said that Provident’s crisis hotline has received calls from children as young as 10 years old. The hotline also handles a number of calls from parents worried about their children and not sure what to do.

The idea of young children wanting to kill themselves is shocking to adults, because it goes against our very notion of childhood. But we have to be willing to face the reality of the challenges facing children today.

“It you have major depression, if you are 8 or 38, your risk for having suicide ideation is the same,” Glowinski said.

The National Suicide Prevention Lifeline: 800-273-8255

Jenni Mahoney noticed one of her middle schoolers was having a rough day. She pulled out her stationery and wrote her an encouraging note.

The message she wanted to share was simple: “I see you. You’re doing good things.”

She wanted to cheer up her student with a little handwritten pep talk. The girl didn’t say anything to Mahoney, an eighth grade English language arts teacher in a suburban St. Louis school district. But Mahoney noticed the girl kept the note in the front of her binder for the rest of the year.

That was almost three years ago. Mahoney started writing notes to other students if she saw one of them having a bad day. The small gesture seemed to make a difference. At the start of the next school year, she was thinking about ways to incorporate more praise and positive feedback into her teaching.

Mahoney resolved to write two to three notes for each of her students throughout the year whenever good behavior or effort caught her eye. She has 60 students. Would she really be able to write 180 notes, on top of all the regular teaching, planning and grading?

For the past two years, she’s made it happen by incorporating the practice into a weekly routine. She picks three students from each ELA block, writing nine notes weekly. Additionally, at the end of the school year, all 60 students get an individual note she writes over the course of four days when the students are taking the state-required standardized tests.

“I follow the same format,” she explained. She begins by focusing on specific positive traits she sees in the student and noting the things he or she does well. She tells them she enjoys having them in her class and mentions something specific from their time in her class.

One note might say, “I can tell you are really loyal” or “kind-hearted.” Another might include something the student is working hard to improve. The letters at the end of the eighth grade year also include encouraging words about starting high school in the fall.

It seems like an incredible amount of extra work for a teacher to take on. I asked if it’s been worth it.

“I think the payoff is huge,” she said. It helps develop her relationships with all the students over the year.

“They see that I know them,” she said, “and that I enjoy having them in class.”

This message is especially powerful for students who don’t typically get that kind of recognition or reinforcement at school. Parenting experts say the strategy of praising good behavior is a powerful way to change children’s actions and attitudes. 

But this is middle school. Surely there are some difficult students who are disruptive or rude or slackers. How does she find something praiseworthy for the students who chronically misbehave?

“I always have to think about the positive traits they have,” she explained. She might consider the friends they have. Sometimes, she compliments a great sense of humor or how a student gets along with his or her friends. “It can be hard sometimes, but I always find something.”

She doesn’t say anything to the students when she gives them the notes. She simply leaves them on their desks. Most of the time, they won’t say anything in response to what she’s written. For middle school students, it can be uncomfortable if a teacher approaches them in person. Genuine praise said aloud might be greeted with an eye roll or cause embarrassment in front of their peers.

“This is a quick way to tell them without making it uncomfortable or weird for them,” Mahoney said. Even if they don’t acknowledge it directly, she notices that many students keep the note in their binders. She overhears students ask one another if they’ve gotten a note yet. And a handful of times, students have written her kind letters in return.

Those are the things that motivate her during that marathon week of letter-writing near the end of the year.

“I’ll write 10 at a time, then take a break and do something else,” she said. “My hand hurts for sure, by the end.”

She’s found a way to teach an important lesson without saying a word.

The minute my daughter passed her driver’s test, I entered the ethical quagmire of stalking.

We downloaded the location-based tracking app Life360, both to see if she’s driving safely and to give her the additional security of help arriving quickly in case of an accident.

At that level, it seems as rational as using a baby monitor for an infant in a crib. But the idea of being able to follow her movements also makes me uneasy.

I surely wouldn’t have wanted my own parents to have this technology when I was a teenager. Isn’t part of growing up learning from mistakes and learning how to navigate tough situations?

Before this, I had never used a monitoring device on the kids’ phones, focusing instead on talking to them about the pitfalls of today’s technology.

But driving feels different.

Car accidents are a leading cause of injury and death for teens. It felt almost negligent not to take advantage of a resource that could give us peace of mind and possibly make her a safer driver.

I’m not alone in this decision, however reluctantly I came to it. There are 50 million families who use the Life360 app. Millions more use features like the iPhone’s Find Your Friends feature to keep track of their family members’ whereabouts.

I asked a dozen of my closest mom friends whether they used some kind of tracking app. Only one said no: She expects her kids to stay in touch with her via their phones, and they do a good job with it. She wants communication to be a two-way street between them.

The rest said it gives them peace of mind or a sense of security. After all, sometimes teens don’t or can’t respond to their parents’ texts. Phone batteries die. Practices run late. Plans with friends change at the last minute.

One mother with three teenage daughters with hectic schedules said that tracking them is better than having to nag them all the time via text to see where they are.

It’s true that many teens have more demanding schedules than we did at their age, and we live in a more anxious parenting age with the near-daily news of mass shootings.

Parents say their children also use the app to keep track of them, especially when they are late picking them up from somewhere. One mother tracks when her son leaves work and when he’s on his way home from school. Her daughter keeps track of her mom the same way.

The question becomes where we draw the line.

“I like to know that my college-age kid made it back to his dorm room at night,” one parent said, who continues to track her college-aged son’s whereabouts.

Another said she got a discount on their car insurance by installing a physical tracker on her teen’s car. It monitors speed, hard braking and other driving patterns. It gives the family a weekly driving grade, and their insurance rates are tied to the scores.

But do we feel comfortable knowing that these apps and tech companies are eventually selling all this data to make even more profits off tracking our movements?

Some of our children may call us dictators, or protest that they are living in an “authoritarian state,” as my teenager initially did, but I’m living under the same conditions. This is perhaps a more in-your-face reminder of how much of our privacy we have given away for convenience and security. It’s an uncomfortable reminder that our thoughts, relationships and consumption habits -- expressed through our search histories, social media posts and online purchases -- are tracked, stored and sold, often in ways we don’t even know. Now, we can add our very movements to the list.

At the end of the day, maybe we won’t even need this particular tracking app too much. Our daughter’s younger brother, who she now drives to school, seems to view his new commute as a daily gamble. He sends us a reassuring text upon arrival: “She got us here safely.”

Of course, we had checked our apps, and already knew.