Suicide and child protection
Adolescent Self Harm and Suicide
The transition into adulthood can be tough for most. It is especially hard for teenagers with a complex history of trauma, abuse and neglect. In their annual report for 2010, the NSW Child Death Review team found that young people known to Family and Community Services (FACS) were 4.9 times more likely to commit suicide than young people without a child protection history. Working with young people who self-harm or who are suicidal is extremely challenging but, when done well, can be extremely rewarding.
- On average, suicide risk accounts for 2.5 per cent of Risk of Significant Harm (ROSH) reports. Although suicide is a rare event, it can and does occur, with devastating impacts.
- Since 2009, 34 young people known to FACS have died as a result of suicide.
- Males accounted for 62 per cent of suicide deaths and females 28 per cent.
- Aboriginal young people made up over a quarter (26 per cent) of suicide deaths.
- Most deaths occurred in the 13–17 year age group.
- Most young people died by hanging.
- Suicide is a complex phenomenon that generally results from a combination of individual, social and environmental factors. The young people who died from suicide had a history of risk-taking behaviour, had previously attempted suicide, were living with a mental illness or with a parent who had a mental illness and there had been a previous suicide in the family.
While these risk factors are well known, the circumstances surrounding each death and the reasons why they ended their life varies. FACS reviews of suicide deaths identified three key groups:
- young people with ongoing and serious complex needs who had multiple agency and practitioner involvement
- young people who had some difficulty but not necessarily identified as being at risk
- young people for whom there were no signals or red flags that they required assistance.
- Besides those with complex needs, very few of the young people talked about suicide or their intent to suicide in advance.
- Precipitating events prior to the suicide were common regardless of whether the young person had well known risk factors or not.
Practice issues and missed opportunities arising from reviews of suicide deaths
Several practice issues have emerged from our reviews of suicide deaths including:
- incident-based assessment – a significant amount of information was recorded however a focus on a particular incident overshadowed the cumulative risk of suicide for the young person
- the lack of child-focused assessment – opportunities to engage with children were missed and parents’ account of the situation was the main information used to inform assessments
- case allocation, planning and review – the number of ongoing reports signified the need for a case review but despite this some families ‘limped along’ between crises
- case closure – cases were closed without child protection concerns being fully addressed. This included not checking if referral services were taken up or if the services helped the family to address the identified needs
- cultural considerations – there were limited cultural consultations in cases involving Aboriginal young people and their families.
Key learning from our review work
Our review work identified key lessons and opportunities for improving practice including:
- understanding the lived experience of young people
- the importance of talking to young people and being curious about how they are feeling, how they are coping and the nature and impact of their trauma to understand their vulnerability
- the importance of empathy in building good relationships to understand and engage with young people – this involves placing yourself in their shoes
- empathetic workers do a better job of helping people change
- being empathic assists in recognising young people’s strengths and hopes
- many young people will test a practitioner’s empathy – they test us to see if we will let them down because this is what they have experienced and come to expect from those around them
- young people value practitioners who stick with them
- working with young people and building empathetic relationships involves compromise, flexibility and being pragmatic.
Engage with young people
* Young people need to be placed at the centre of child protection practices.
* To keep young people safe it is vital we connect and invest time working with their family, friends and other people who play a significant role in their lives.
* The relationship between a practitioner and a young person is important but it needs to be reinforced by the child protection system.
* When a child enters our system, we understand and treat them as a victim of child abuse and neglect. However, if they act out during adolescence they are often perceived and treated as a problem – our understanding and focus has shifted.
* Rather than seeing a young person’s ‘risky behaviour’ as a problem, we need to think about the root cause of their behaviour. Are the child protection issues that once caused a young person to be considered a victim of neglect or abuse still evident?
* We need to re-examine the safety of the young person and build a system of safety and support around that young person.
* Understanding and preventing suicide for young people is our ultimate aim.
* To do this it is crucial that practitioners work collaboratively and purposefully.
* Working purposefully involves being clear about how and why we are working with families and young people.
* Working collaboratively involves building connections and sharing information about a young person and their family between different agencies, especially across mental health, education and hospital emergency departments.
* Young people need practitioners to be flexible, work differently and mobilise support from the community.
* If the rules are not keeping a young person safe it may be necessary to break, bend or work outside the rules.
* Building strong and trusting relationships lies at the heart of working with young people at risk of suicide.
* Ask simple questions: ‘Where do you want to meet?’ ‘Where and when do you want to talk?’ Young people need to fit you into their timetable.