Adolescent Self Harm and Suicide
The loss of an individual life by suicide can have wide-reaching impacts on family, friends and the community. In 2012, there were 2,535 deaths from suicide in Australia, which equates to an average of 6.9 people every day. While the largest numbers of deaths by suicide are by older adults, suicide is the leading cause of death for young people aged 15–24 years. Young people who have experienced abuse or neglect are more likely to consider, and die, by suicide because they are exposed to many suicidal risk factors and they may lack access to factors that protect or prevent them from taking their own life.
- Suicide in Australia is most common among men aged 85+ and for women aged 80–84. However, suicide accounts for a small proportion of deaths in these age groups.
- In contrast, suicide accounts for a larger proportion of deaths in young people. In 2012, suicide accounted for 25.8 per cent of male deaths aged 15–19 and 25 per cent of female deaths aged 20–24.
- Suicide is more common among young males than females. Since the 1990s, the ratio of male to female suicides has varied from 4:1 to 3:1.
- Since peaking in 1997, there has been a steady decrease in suicide rates among adolescent males aged 15–19 and 20–24.
- Suicide rates for females have also decreased since 1997. A slight increase in 2012 is most probably attributable to a decline in the rates of prescribing antidepressants for young people.
- Available data indicate that Aboriginal and Torres Strait Islander young people are twice as likely to die by suicide.
- For men aged 25–29 years, the Indigenous suicide rate is approximately four times the non-Indigenous rate.
- For women aged 25–29 years, the Indigenous suicide rate is 3.4 times the non- Indigenous rate.
- Youth suicide occurs across all socio-economic groups.
Methods of suicide
- The most common method of suicide for males and females is hanging.
- The second most common method is poisoning by prescribed drugs.
- There has been a decline in firearm suicide.
Common myths about suicide
- Most suicide occurs without warning. There are almost always warning signs.
- People who attempt suicide are just selfish or weak. It takes a lot of effort to attempt or complete a suicide and is often motivated by a belief that others would be better off without them.
- People who talk about suicide are just seeking attention. People who attempt suicide are in profound distress. This should not be ignored or minimised.
- Talking about suicide will give someone the idea or make the situation worse. Your concern is likely to lower their anxiety and reduce the likelihood of suicide.
Thomas Joiner’s theory of suicide
- Thomas Joiner (2005) proposed that for a person to suicide they must perceive they are a burden to others (perceived burdensomeness), they must be disconnected from others and have a low sense of belonging (thwarted belongingness) and must be desensitised to or not fear pain.
- These three factors together with knowledge of ways to die enable a person to complete a suicide.
What are the risk factors?
Risk factors play a critical role in understanding who is at heightened risk of suicide. Major risk factors include:
- prior suicide attempts
- substance abuse
- mood disorders
- access to lethal means
- social or geographical isolation
- family discord, violence or abuse.
What are the warning signs?
Warning signs indicate an immediate risk of suicide. Some common warning signs for suicide include:
- feelings of hopelessness
- withdrawing from friends, family and society
- seeking a means to kill oneself
- increasing alcohol or drug use
- dramatic mood changes
- uncharacteristic or impaired judgement or behaviour.
What are the tipping points?
Young people facing a suicidal crisis may not appear obviously distressed. Often the final trigger does not look too serious on its own but, when considered against a backdrop of other problems, can be the tipping point. Some common tipping points include:
- physical illness or accident
- death or suicide of a friend or someone famous
- the end of a relationship
- being abused
- being bullied
- media report on suicide or suicide methods.
What creates an imminent risk?
Imminent risk of suicide occurs when a series of factors are aligned or occur simultaneously.
The factors that create imminent risk are when a young person:
- expresses an intent to die
- has a plan in mind
- has access to lethal means
- is impulsive, aggressive or displays anti-social behaviour
- is exposed to an event such as another suicide or a report of suicide method that temporarily creates a loss of prohibition or a sense of permission about suicide.
- Risk factors, warning signs and tipping points should not be viewed in isolation.
- It is important to talk to young people, step back, listen and respectfully engage with them to get an understanding of what life is like for the young person.
The factors that make it less likely that individuals will attempt or die by suicide are:
- being connected to a family, peer group or community
- having at least one person to relate to and bond with
- good physical and mental health supported by effective clinical care
- having problem solving and conflict resolution skills to assist with managing difficult situations
- spirituality and beliefs that discourage suicide
- restricted access to lethal means of suicide.
- Resistance to suicide is not permanent and it is important to work with young people to maintain these protective factors.
What is contagion suicide?
- A contagion suicide is when a suicide within a school, community or geographic area increases the likelihood that others will attempt or complete a suicide.
- A suicide cluster is an excessive number of suicides occurring during the same time period or in the same geographic location.
- The perception within a community that there is a cluster of suicides may itself promote more suicides. It is therefore important to be careful how we talk about a potential cluster of suicides in the community.
Following a suicide, those at most risk include young people who:
- have attempted suicide in the past
- were close friends or family members of the person who died
- witnessed the death
- are already dealing with stressful life events
- had contact with the person shortly before they died
- had argued or fought with the person before they died
- have experienced other losses or suicides in the past
- are isolated and who may have been in the same school as the person who died.
Components of the mental health system in NSW
Within the public sector a number of supports are available to help young people who attempt suicide:
- NSW Mental Health line 1800 011 511
- Headspace www.headspace.org.au
- Child and Adolescent Health teams (CAMHS) in all local health districts
- some local health districts have adolescent assertive outreach teams
- hospital emergency departments
- psychiatric emergency centres
- child and adolescent mental health acute inpatient units
- paediatric inpatient units
- adult acute inpatient units
- CAMHS longer stay high-severity inpatient units.
Within the private system there are clinical psychologists, child and adolescent psychiatrists, the youth inpatient unit at St Vincent’s Hospital and private psychiatric hospitals.
Online supports include:
- eheadspace www.eheadspace.org.au/
- Youth beyondblue www.youthbeyondblue.com/
- ReachOut au.reachout.com/
Using ISBAR to talk with mental health professionals
ISBAR is a framework that health professionals use to communicate and transfer patient information from one professional to another. Components include:
- Information – who you are, your role, where you are and why you are communicating
- Situation – what is happening at the moment
- Background – what are the circumstances that led up to this situation
- Assessment – what do you understand the problem to be
- Recommendation – what do you think can be done to correct this situation.
When talking about suicidal risk among young people, it may be useful for child protection practitioners to use the framework to guide their communications with mental health professionals.
To learn more about suicide, read the presentation of keynote speaker Dr Philip Hazell ‘An overview of self harm and suicide’.