Mental health takes care and nurturing just like so many aspects of health and wellbeing.  When I have concerns about a patient’s mood, something we always talk about is safety.  Even impulsive actions in response to mood can have devastating outcomes and is unfortunately not uncommon.  In fact, suicide is the second leading cause of death in ages 11-14 and the third leading cause of death for ages 15-24.  One study showed that 12.3% of teenagers 12-17 had serious thoughts of suicide in the preceding year.  Some risk factors for suicide include mental illness, alcohol and substance use and intoxication, access to firearms, a history of trauma or abuse, prolonged stress, and a recent tragedy.  Of course we want to support your family before there is a crisis, but 988 is a number to know for 24/7 support.  Additionally the UVA emergency department can provide psychiatric evaluations when there are immediate safety concerns.