Mental health: 9-8-8 set to become national crisis hotline
An easy-to-remember three-digit number aims to transform the nation’s approach to crisis care by providing mental healthcare emergency service.
Claire Hardwick, USA TODAY
Editor’s note: This article discusses suicide and suicidal ideation. If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org.
Neal and Samara Tricarico first noticed their son Anthony was different when he was about 3.
The Southern California couple discovered that Anthony, then a toddler, had pulled a chunk of his own hair out while they were away. Alarmed, they sought help from professionals. Anthony was diagnosed with anxiety at 4. At 7, he was diagnosed with “high-functioning autism spectrum disorder,” his dad says.
These diagnoses brought relief. And for a while, Anthony seemed to thrive.
He became a stellar student, earning a 4.6 GPA, and often set the curve in his advanced placement classes. Mental health professionals warned he might have problems socializing, but, luckily, that didn’t seem to be the case. At 16, Anthony had plenty of friends and enjoyed hosting parties and poker nights. He threw himself into health and fitness, participating in Spartan Races and marathons.
However, Anthony’s mental health took a nosedive during the pandemic. He confided in his best friend that he felt suicidal. That friend told his mom, who told Neal and Samara. They got Anthony help but knew he was still struggling.
“He just poured himself into physical wellbeing,” Neal says. “But we saw the pain. We saw the anguish. We saw the suffering.”
One night, Anthony said he was going for a walk. Shortly after, his parents heard the sirens.
Youth suicide has been on the rise in recent years. For kids with autism, it’s even more common. According to a 2023 study from the University of Pittsburgh, autistic children and teens have about a 5% higher rate of suicidal ideation and are twice as likely to attempt suicide than their non-autistic peers. For kids who are autistic and highly intelligent − a group called “twice exceptional” − the risk in even higher. A 2023 study from the University of Iowa found kids with autism and high IQs were nearly six times more likely to have suicidal thoughts than non-autistic kids.
Despite this, experts say barely any research is being done on this overlap. What’s worse, they add, is hardly anyone outside the autistic community even seems to be talking about it.
The result has left kids like Anthony to suffer in silence, with their parents, teachers and, in some cases, even their therapists unequipped to help them.
“It’s very difficult for us to understand where autism starts and ends, and where being a high schooler, a teenager starts and ends,” Neal says. “That was our biggest challenge in all this. There was no training or tools around that.”
The kids who suffer in silence
Dr. Mayank Gupta, a psychiatrist and the medical director of Southwood Psychiatric Hospital in Pittsburgh, started seeing a pattern among his patients around 2015.
He says many of the teens who ended up in his practice following a suicide attempt, despite very few apparent risk factors, had similar quirks. Many had food sensitivities. Many avoided certain types of clothes. Many hated loud noises.
Many were also brilliant but struggled socially.
“When I look at their profiles, I see they are honor-roll students,” Gupta says. “They come from very good families. But they don’t have friends.”
It wasn’t long before Gupta realized many of these kids had undiagnosed or misdiagnosed autism − an oversight that compounded their mental health issues.
“This is a big issue — untackled, unresearched and it’s not being implemented,” he says.
Her kid’s suicide shocked the community: Now, she’s raising awareness.
There are a number of reasons why Gupta believes autistic kids are more at risk for suicide. For starters, he says, many of them think in black-and-white terms: Some don’t pick up easily on emotional nuance and tend to see things as entirely one way or the other. As a result, these individuals may struggle to find hope amid hardship. As Gupta puts it: “When they give up, they really do it.”
On top of that, many also have trouble socializing, which makes forming friendships and building support networks − key bulwarks against depression − difficult. They may also face bullying.
Some kids may try to mimic the social skills of their peers, sometimes to great success, but this effort, called masking, often becomes exhausting for them.
Samara believes this is what happened with with her son Anthony.
“It’s almost like he overcompensated in the social department because he learned how it operated,” she says. “Really, underneath that, they are feeling completely isolated and alone and different.”
In many cases, Gupta says, it’s the kids whose autism goes unnoticed who suffer the most.
Gupta estimates that the suicidal kids at his hospital have an autism rate about five times higher than that of the general population.
“This has been completely missed,” he says. “I think a lot of folks have been misdiagnosed. There’s a whole, huge burden of people who are actually undiagnosed, or suffering in silence.”
Samia McCall, a lawyer in Boise, Idaho, believes her 14-year-old daughter Maisa was one of them.
‘She hated being called gifted’
Samia remembers her daughter Maisa as a “wise, old soul.”
She loved looking at stars at night. She loved to climb trees. She built a pulley system with a bucket so she could bring a book and snacks up into a tree with her in the backyard. She liked solitude. She hated injustice. She loved animals.
She was also extremely bright. She read books rapidly. She could pick up instruments for the first time and play them well days later. She was in the gifted program at her school.
She also didn’t fit in.
“It’s not that she didn’t have friends necessarily, but she struggled socially,” Samia says. “She felt uncomfortable. She was targeted a little bit for being different or weird. And that is hard for a child.”
Maisa’s first suicide attempt, at 13, came as a shock − and it sent Samia down a research rabbit hole to understand what was going on with her daughter. Now, she believes she’s found the answer.
According to UCLA Health, about 80% of girls on the spectrum have autism that’s still undiagnosed by the time they’re 18. Samia believes Maisa was one of these girls. When she brought this idea to the mental health professionals treating Maisa, she faced pushback. She believes that, due to lack of research and information, they didn’t understand all the nuances of autism and how they applied to her daughter.
“They would say things to us like, ‘Oh, well, she makes eye contact,’ or ‘She has friends,’ ” Samia says. “We have since talked to people outside of our area that have confirmed our suspicions, that it was pretty clear that she fits the criteria.”
Samia says Maisa had sensory issues that made navigating school difficult. The loud noise of the bell bothered her. So did kids bumping into her in the hallway. Samia believes Maisa also had alexithymia, a condition that often comes with autism and makes recognizing emotions challenging. Kids with alexithymia may not know they’re angry until they’re furious. They may not know they’re depressed until they’re in crisis.
“They don’t know emotions until it’s a hundred,” Samia says. “And then, with the black-and-white thinking, what will happen is, when those kids are at a hundred, all of a sudden death seems like a good idea.”
One reason why kids with autism and high intelligence struggle in particular, Gupta says, is because they have a hard time navigating how academics come so easily but day-to-day social interactions feel so difficult. Why can they recall minute details from a history textbook but struggle at making friends? Why can they write brilliant essays but fumble at expressing their emotions?
Calling these kids “gifted,” Samia says, does them a disservice by minimizing their struggles.
“My daughter Maisa was in a gifted program, and she hated the term,” Samia says. “She hated being called gifted. And it took me a while to figure out why. And I think you’d be hard pressed to find a child who is gifted, who doesn’t have another area where they need support.”
Another common misconception, Samia says, is that life is easier when you’re smarter; however, this isn’t necessarily the case.
“I can’t tell you how many times I’ve had other parents say to me … ‘Oh, you’re so lucky. Your kids are so smart,’ ” Samia says. “And I think to myself, ‘Well, I kind of wish they were less smart, because I think that my daughter might still be alive if she were a little less smart.’ Her intelligence kind of enabled her to see a lot of the world for what it was, and that was hard for her.”
Instead of addressing or looking into the possibility that Maisa might have autism, Samia says mental health professionals insisted her daughter’s problems stemmed mainly from depression. Samia says she tried to speak up about what she believes her daughter was really going through. No one listened.
More: His teen tried a suicide chemical he got online and then sought help, but it was too late
Maisa’s mental health reached a crisis during a time when Samia believes she was experiencing autistic burnout.
Treatment for autistic burnout can be quite different from treatment for depression. For someone with depression, it can be helpful to do activities, like getting out of bed and spending time with friends, even if doing so feels challenging.
For someone with autistic burnout, however, the advice is the opposite: It’s better to remove stimuli, calm down and let the burnout pass to avoid a meltdown.
Had Maisa, her family and doctors known this, Samia says, things may have turned out differently.
His son died by suicide. He wants every parent to know what he found on his kid’s phone.
Maisa died by suicide at 14 in November 2023. Since then, Samia says she fills her days working on Maisa’s Space, a blog dedicated to her daughter and mental health awareness.
“I don’t fit into all the places where I used to go. I look the same on the outside, mostly. I’m sure I look a lot more tired and older. But I’m completely different,” Samia says. “A part of me died when Maisa died. And I’m just sitting here, in the ruins of my life, trying to build something new. But it’s never going to be the same for any of us, for me or my husband or my two boys.”
The conversation we need to have
It’s never going to be the same for Anthony’s family either.
When paramedics found Anthony, a first responder resuscitated him. His heartbeat came back, and he was sent to the hospital in a coma.
Anthony spent nine weeks at a children’s hospital where hundreds gathered regularly to pray for his recovery. At first, he made tremendous progress. But then, he got worse. He died in May 2024.
Throughout Anthony’s time in the hospital, a reminder notification flashed on his phone at 8 every morning: “Volunteer for suicide prevention.”
Neal and Samara say Anthony had an entrepreneurial spirit and often put his black-and-white thinking to good use: When he had his mind set on something, he wasn’t going to stop until he accomplished it. He had plans for his senior year to make T-shirts to raise awareness for suicide prevention.
Anthony felt it was important not to couch discussions about suicide in soft language or gentle euphemisms, his parents say. He wanted it talked about openly, honestly and frankly. He believed doing so could save lives.
His parents are trying to remember that as they share his story. They believe it’s what Anthony would have wanted. They’ve started the Endurant Movement − a campaign dedicated to mental health awareness and autism and suicide research − in their son’s memory.
“He was adamant that it needed to be ‘suicide prevention,’ that we needed to talk about suicide. We needed to get the conversation going,” Samara says. “We needed to say those scary words and get it out there, because there is so much stigma associated with it.”
The conversation about suicide and autism is just getting started. When it does, Gupta says, the next question will be if people will listen.
Suicide Lifeline: If you or someone you know may be struggling with suicidal thoughts, you can call the U.S. National Suicide Prevention Lifeline at 988 any time, day or night, or chat online.
Crisis Text Line provides free, 24/7, confidential support via text message to people in crisis when they text “HOME” to 741741.
