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Backed Into a Corner : Youth Suicide

Stats, risks, triggers, assessment and management

Peta-anne Burns

on 25 November 2013

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Transcript of Backed Into a Corner : Youth Suicide

Suicide is a death which occurs intentionally as a result of a person knowingly, and willingly placing him/herself in perilous circumstances. Suicide contains three main aspects: will, knowledge and intention.
A previous suicide attempt
Current plan
Mental illness and substance use disorders
Physical Illness
Family history (suicide, substance, other mental illnesses)
Abuse history
Poor self-esteem and social functioning
Geographical isolation
Social disconnectedness
Sexuality concerns
Childhood bereavement
Family disturbances
Financial concerns
Loss of significant relationship through rejection
Recent discharge from psychiatric hospital
Further information and training



Asist: Applied Suicide Intervention Skills Training

Youth Mental First Aid Training

Australian Institute for Suicide Research and Prevention (AISRAP), Griffith University. Offers Masters and PhD courses in suicidology.
Adolescents are the highest risk for suicide

If they talk about it they won’t do it

Suicides occur without warning

If they survive an attempt – they will never try again

Can’t stop someone if they are intent

Large / sudden improvements means less risk
Myths About Suicide
Backed into a Corner:
Youth Suicide
risk factors
management strategies

Suicidal ideation refers to thoughts that life isn't worth living. These can range from fleeting thoughts, developed plans for killing oneself, to complete preoccupation with self-destruction.
Each instance of youth suicide is a unique combination influenced by physical, psychological and environmental risk factors and triggers.
Assessing for Risk
Ask them directly.
ABS: Australian Bureau of Statistics
QCDR: Queensland Child Death Registrar

Threatening to hurt him/herself or suicide
Looking for ways to suicide e.g. seeking access to pills, weapons, or other means
Deliberately hurting him/herself i.e. by scratching, cutting, or burning
Talking or writing about death, dying or suicide
Hopelessness, saying they have no reason to live, no purpose in life
Rage, anger, seeking revenge
Acting recklessly or engaging in risky activities, seemingly without thinking
Feeling trapped, like there’s no way out
Increasing alcohol or drug use
Withdrawing from friends, family or society
Anxiety, agitation, changes in sleep or appetite
Dramatic changes in mood
Giving away possessions or saying goodbye to family/friends.
No reason for living, no sense of purpose in life
22%-38% of adolescents have thought about suicide at some point in their lives.

12%-26% have had such thoughts within the previous year
Have you ever thought about killing yourself?
Have you ever done anything on purpose to hurt or attempt to kill yourself?
How are you planning to do it?

Relationship ending
Loss of status or respect
Debilitating illness or accident
Death or suicide of a loved one
Anniversary of a significant event
Suicide of someone famous or a peer
Argument at home
Abused or bullied
Media report on suicide or suicide methods.

Facts about Queensland children and young people who completed suicide aged 10 to 17 years for the period from 2004 to 2007:

63% had significant behavioural problems

60% had previously stated or implied their intent

43% had mental health problems

42% were contagion or imitative and

28% were Aboriginal or Torres Strait Islander, most aged between 10 and 14 years.
Youth Suicide,
a difficult topic.
Tell the young person that you care, and want to help
Express empathy
Explain that there is help available
Tell them that thoughts of suicide are common, and do not need to be acted on.
Discuss ways to address the specific problems they are experiencing.
Do not use threats or guilt to prevent suicide.
Never keep a person’s plans for suicide a secret
Where possible, involve the young person in deciding who will be told and what they will be told.
Acknowledgment of Country
Complete rather than "commit" or "successful";
Attempt rather than "unsuccessful"
Risk Factors - Who Is Vulnerable?
But Why?
The only way to escape an intolerable situation - emotional, financial or physical pain.

Outcome of reckless behaviour, accidental or intentional risks are taken.

For some it is about choice, to choose the manner of their own death.

An altrustic or heroic act - to relieve others of a burden.

An attempt to send a particular message through symbolistic location or method or gain a certain outcome, such as notoriety, revenge or to leave a specific legacy.
When a child or young person states that they are feeling suicidal it means they believe there is something seriously wrong in their lives, and it is vital that this statement is not ignored.
Risk Factors/
Warning Signs
Expressed Intent
Trigger or
Tipping Point
Suicide Attempt
or Completion
The Commission’s review of the circumstances of deaths suggests that a number of children and young people had been communicating their suicidal intent in the weeks, months or years prior to their suicides. Some children were as young as 9 years of age when they first indicated they were suicidal.
Other research has estimated that approximately 80% of young people who complete suicide communicated their suicidal thoughts and feelings and their intent to kill themselves to someone before their death. However it is often difficult to tell what some signs may mean, or indications may be so subtle that they go unrecognised.
Orygen Youth Health Research Centre 2009.
Commission for Children and Young People and Child Guardian, 2011

Three features in particular are characteristic of the state of mind of suicidal young people:

: Most people have mixed feelings about suicide. They want an end to the pain they are in, not necessarily something as final as death.

: Suicide is an impulsive act that is transient and lasts for a few minutes or hours. It is usually triggered by a negative event.

: When people are suicidal, their thinking, feelings and actions are constricted.
They constantly think about suicide and are unable to perceive other ways out of the problem.

Medium risk
The young person has suicidal thoughts and plans, but has no plans to attempt suicide immediately.

Action needed
• Offer emotional support, work through the person’s suicidal feelings and focus on positive strengths. In addition, continue with the steps below.

• Use the ambivalence. Focus on the ambivalence felt by the suicidal person so that gradually the wish to live is strengthened.

• Explore alternatives to suicide, even though they may not be ideal solutions, in the hope that the person will consider at least one of them.

• Make a contract. Extract a promise from the suicidal person that he or she will not attempt suicide
- without contacting the health care staff;
- for a specific period.

• Refer the person to a psychiatrist, counsellor or doctor, and make an appointment as soon as possible.

• Contact the family, friends and colleagues, and enlist their support.

Low risk
The young person has had some suicidal thoughts, such as “I can’t go on”, “I wish I were dead”, but has not made any plans.

Action needed
• Offer emotional support.

• Work through the suicidal feelings. The more openly a person talks of loss, isolation and worthlessness, the less his or her emotional turmoil becomes.

• Focus on the person’s positive strengths by getting him or her to talk of how earlier problems have been resolved without resorting to suicide.

• Refer the person to a mental health professional if needed.

• Meet at regular intervals and maintain ongoing contact.
All these questions must be asked with care, concern and compassion

High risk
The young person has a definite plan, has the means to do it, and plans to do it immediately.

Action needed
• Stay with the person, enlisting those close to them - family, friends . Never leave the person alone.

• Gently talk to the person and either remove the means of suicide or have the support person do it if the plan is to go somewhere else and attempt.

• Contact a mental health professional or doctor immediately and arrange for an ambulance and hospitalization.
Have you got the (pills, rope, gun etc)?
When are you planning to do it?
Have you made plans to kill yourself?
Path to Suicide
You can determine level of risk, but you will never be able to determine impulsivity.
If in doubt, containment is always the best option.
Look after yourself!
or Intent
Intent, method & time
Commission for Children, Young People and Child Guardian, 2011
Orygen Youth Health, Youth Mental Health First Aid Edition 2, 2009
Full transcript