Suicidality in children

10 September 2019  Features

            Suicide prevention is in the public eye this week with World Suicide Prevention Day on 10 September and the national R U OK? Day on 12 September.

Mental Health Professionals’ Network (MHPN) supports interdisciplinary practitioners to share knowledge through online webinars and in-person networks.

In February this year, we worked with a panel of interdisciplinary experts to present the webinar 'Suicide ideation in primary school-aged children'. This MHPN webinar attracted the highest number of viewers so far in 2019.

Community Psychologist Dr Lyn O’Grady, who is also the Manager of Strategic Projects at the Australian Psychological Society (APS), was part of the webinar panel and shared her extensive experience in parenting education; and child and adolescent mental health and wellbeing.

MHPN also caught up with Dr O’Grady in person on World Suicide Prevention Day 2019. Watch the interview.

‘The theme for World Suicide Prevention Day this year is shining a light on suicide prevention which is perfect for this issue. I think we’ve begun this process already with the webinar. The level of interest would suggest that it’s an area that people want to know more about’, says Dr O’Grady.

‘I remember looking through the many questions that came through at the registration and during the webinar and reflected on how sometimes when faced with an area of concern like the risk of suicide that we can forget some of the things we know that work when working with children and families’, she says.

MHPN is pleased to announce that it will be organising a webinar on suicide risk assessment as part of the 2020 webinar program. Dr O’Grady will participate in the development and delivery of this webinar.

Risk assessment
‘Assessing risk of suicide is a very difficult thing to do if we are trying to predict whether a child is going to act upon their suicidal thoughts. If we are thinking about this as a way of expressing distress and assessing the current needs of the child, we are better able to work out what to do next’, explains Dr O’Grady.

She says practitioners need to respond differently to a child ‘who is very distressed and saying they are planning to die, and obviously need to respond differently to a child who is talking about suicide more generally and doesn’t have a plan to act on those thoughts’.

‘We need to explore this with the child and to try to get a sense of the meaning of the talk about suicide in order to determine what they need. In any event, we should be looking at developing a safety plan which is based on what the child and parent are telling us and helping them to know what to do if the needs change later on’.

Dr O’Grady says suicidality in children in itself is not a reason for child protection to be involved.

‘However, we know that children can express suicidal thoughts or behaviours because of child abuse. So we need to be aware of this and in our listening to children about what is happening be aware of the possibility that a child protection report might be necessary if we form the belief that this is appropriate’, she says.

Read Dr Lyn O’Grady's article about suicide and young children from the June 2019 edition of InPsych.

Protective factors
We don’t have a lot of research that helps us to understand protective factors in general but also specifically in relation to suicide, says Dr O’Grady. ‘We know much more about risk factors – and for suicide risk we know that there are over 200’.

She says it’s important when understanding the meaning around suicidality is to certainly hear what’s going wrong but also to be ready to help to identify what is protective for the client.

‘This can often relate to relationships with family members and friends, interests and things that give our lives meaning, considerations like beliefs and values. In many ways, talking with people about suicide can place us in a space of being very real with clients, to explore what matters and what it is about life that is important’.

Watch the webinar 'Suicide ideation in primary school-aged children'and visit the MHPN webinar library for more webinars on a wide range of mental health topics.

Engaging family members
‘It’s important that parents know if their child is having thoughts of suicide or behaving in unsafe ways. It’s important too that they have support to help them to support the child in helpful ways', says Dr O’Grady.

‘Helping parents to understand the importance of taking the risk of suicide seriously is important. This can take some time and it can be incredibly distressing for parents to hear this’.

She says parents may respond to the news of their child’s suicidality in a number of ways, such as becoming angry or being dismissive. ‘Being ready to acknowledge their feelings can be helpful and working with them to problem solve what to do next can be helpful’, she says.

Dr O’Grady believes practitioners need to understand the child is trying to communicate something – probably distress.

She explains that it’s important for practitioners to make sure that there’s been ‘a proper assessment to understand what’s going on with the child’, she says.

‘We also need to think about our responses to a child who is repeatedly talking about suicide. We know that children like to say things that get a reaction from adults so we need to think about how we respond – is this a time when they get our attention, for example? If so, how can we give them attention in other ways?’

Dr O’Grady says it may be a way the child has for communicating their distress. ‘If so, we can help him or her to find new ways to express their feelings if we are sure that is the purpose of their talk of suicide’, she says.

‘It’s a very unhelpful thing to think about talk of suicide as just being attention-seeking. This risks dismissing the child’s needs and can actually place them at greater risk’.

We need to be able to help parents to understand what is happening for the child and to assess the needs of the child at the time, says Dr O’Grady.

‘This will involve safety planning and maybe a referral for further assessment and treatment. If the child has been able to tell us what is concerning them most, we should be working with the child to problem solve how to resolve this’.

‘For children, this can make a huge difference to how they are feeling and the thoughts of suicide can reduce if they see that people are taking them seriously and changes are happening’, according to Dr O’Grady.

Interventions
We are still in the very early stages of understanding what specific therapeutic interventions are suitable in relation to suicidality for people of all ages, says Dr O’Grady.

‘We know that some of the factors related to children’s suicide risk are the day to day stressors such as family conflict and change or issues they’re facing at school, including bullying so I think for children the focus should be on listening to what is happening that is leading to the child feeling distressed’.

When we can understand what the concerns are then the interventions can be directed to resolving those concerns, she says.

‘A safety plan needs to be part of this. Interventions with parents can also be important, especially related to communication within the family’.

She says there may also be a need for a mental health assessment to check if there’s any underlying problems that may require treatment. For example, specific learning problems, ADHD, Autism Spectrum Disorder, depression or anxiety).

Dr Lyn O’Grady will present a poster at the 30th International Congress on Suicide Prevention in Northern Ireland from 17-21 September.

She has a book coming out soon – ‘Keeping our kids alive. Parenting a suicidal young person’ - which draws on her experiences working with parents; children; KidsMatter; and her recent study in Suicidology.

Do you want to join a suicidality and suicide prevention network?

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