If you work with young people one of the toughest situations you may find yourself in is when a young person starts talking about suicide. This can cause you to panic and wonder how to respond. The first school I worked in as a counsellor was off the back of a young person coming in one day and saying that this is what they were thinking of doing and it just so happened that I had been into that school the day before talking about what I could offer, and so my business card was at the top of the pile and I received a call.
This blog post today may seem like tough reading but if you work with young people it will become more and more likely that this is a conversation that will come up sooner than you think.
- One in Four (26%) young people in the UK experience suicidal thoughts
- ChildLine (UK) has revealed that it held 34,517 counselling sessions in 2013/14 with children who talked about suicide – a 116 percent increase since 2010/11.
- Among teenagers, rates of depression and anxiety have increased by 70% in the past 25 years, particularly since the mid 1980’s.
- The number of children and young people who have presented to A&E with a psychiatric condition have more than doubled since 2009. (8,358 in 10/11; 17,278 in 13/14)
- 55% of children who have been bullied later developed depression as adults
- 45% of children and young people under the age of 18 detained under s.136 were taken to police custody in 2012/13
As we have discussed a lot over this last week, the most important response to a young person is to simply listen. It can be so easy to leap into action and try to protect and fix and plan and bring in professionals immediately. First and foremost, if a young person has told you think then be proud that you have obviously put in a lot of effort up to this point to have built a strong enough relationship, based on trust, for the young person to have shared this with you in the first place.
Of course the language that they use may not be so that they actually say the words “I want to kill myself”. Thats why constant active listening is so important. As you develop your listening skills you need to listen for language that reflects feelings of hopelessness or despair and these should be noticed and explored. For instance, it is so important to ask a young person for explore further what they mean when they say such things as “I can’t go on anymore.” “I want to end it all.” “I wish I were dead.” “This is hopeless, I don’t see any way out of this situation.”
When I have spoken to youth workers and support staff before around this issue their natural instinct is to try to help the young person to find things or reasons in their life that give reason not to feel this way. This is a natural response; to challenge why they might be feeling this and to help them to counter negative beliefs about their life with an alternative view.
This can be because of the belief that if you were to ask about suicidal intent you could encourage a suicide or drive the conversation more in a negative direction. This, however, is simply not true. In fact your concern for the young person is likely to lower their anxiety and reduce the likelihood of suicide happening.
How do you go about doing this? What possible way could you ask a young person this sort of question?
In the case of suicide, subtlety is counterproductive. I would ask one of three questions:
- Ask directly if the client has thoughts of suicide. “Have you thought of committing suicide?”
- “Are you thinking of killing yourself?”
- “I wonder if you can tell me how you have thought about killing yourself?”
In my experience these questions come as a shock to a young person. They are simply not expecting you to challenge, in such a direct way, what they have shared.
In most cases this will lead to a confident “No”. That they are not actually thinking of following this through and through questioning, what they are actually expressing is how hopeless a situation that they feel that they are in. That they feel that they have reached a dead end and they cannot find the words to effetely say how they feel.
When this happens it is a brilliant way to open up dialogue around issues of hopelessness and having this out in the open can be enough. For many young people even saying this out loud is enough to have released the build up of pressure.
Some ways to open this conversation up may be:
- Say “I’m concerned about you”
- Say “I know you are having a bad time at the moment”
- Let the child or young person set the agenda for discussion on their own terms;
- Be patient and sympathetic; children and young people may not be able to articulate how they feel;
- Help the child or young person discuss his or her options, offering solutions and alternatives;
- Enable them to talk both about what led them to feel like this, and what they might look forward to in the future;
If they still will not communicate with you about how they feel, suggest they might talk in confidence to another person – a trusted family member, another trusted adult, such as a teacher, or a friend. You might say: “If you can’t or don’t want to talk to me, who you think you might talk to? What about ChildLine, for instance?”
Even in cases when a client answers by saying “No”, continued exploration and discussion of what the client has said or presented that may be related to suicidal ideation is warranted. For example; have there been previous attempts? “When?” “How often?” “What happened?” “What was going on in your life at the time?” Remember that is is the young person who has brought up the subject, this doesn’t happen with things they don’t want to talk about. This will give you a picture of previous experience and a basis of what to do going forward.
But what should you do when the answer isn’t a NO it’s a YES or at least it’s ambiguous?
If a young person suggests that they are actually having suicidal thoughts, but have not yet put them into action, you should always take them seriously, ensuring that they understand that you care about them, and that they feel properly heard. The worker should explore with the young person what makes them feel so hopeless, and why they feel that death is preferable.
It is essential that you ascertain that the young person is not at immediate risk, and then make it clear that you want to listen, and will explore with them the negative and the positive aspects of their lives, focusing on the positives, exploring options and, where possible, finding solutions and discovering what support networks are available to them. For example, a young person who is in despair because of bullying may ask that a call is made to the school; or a young person whose life is being damaged by parental drug or alcohol abuse may wish to be referred to a relevant support group, or to Children’s Social Care.
These referrals would be made with the consent of the young person, and full information offered to the young person, sometimes by means of a conference call with the agency or team involved.
If a child or young person has made a suicide plan but you believe that they are not in immediate danger, you should ask if the young person has the means to put the plan into action, for instance, have they obtained enough tablets for an overdose or has a knife. If so, you should attempt to persuade the young person to separate themselves from the means of taking their own lives, for instance, by asking to take control the pills or relinquish the knife or other weapon.
Again you should then make it clear that you want to listen to the young person’s thoughts and feelings, trying to connect with the part of the young person that wants to live, while acknowledging the part that wants to die.
The crucial task you have in these cases is to assure the young person that they are being heard and taken seriously. The young person may have chosen you as their last resort, believing that no one else in their lives cares whether they live or die. In this case if is you role to assure them that they care.
If the young person does not relinquish their plan or if you believe that the young persons life is in immediate danger , the worker may need to contact the emergency services and immediately follow your child protection policy that should include checking to see if an attempt has been made and contacting the relevant support based upon your policy document: It is essential that YOU DO NOT DO NOTHING and that you remain calm and keep listening.
In all of these situations it is vitally important that you work within and know your child protection policy, be speaking with your child protection officer and seek support for yourself through supervision.
I am sure, though, that this may bring up questions of “what if…” and “when this happens…” or “what do I do when…”. So please feel free to ask questions below. I want this blog to be about dialogue, a back a forward between us on these subjects.
But remember. If all you do is listen to a young person today then you would have done more than most adults in their life have done.