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Abstract
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Estimates in 2019 put suicide as the fourth leading cause of death in adolescents aged 15-19 years. Additionally, a high number of children aged 6-12 years, mostly in high-income countries, experience suicidal ideation and self-harm behaviours. This shows the urgent need for quality mental health care tailored for young people. For World Suicide Prevention Day on September 10, the theme is creating hope through action. We need to ensure we are taking the right action for young people and considering new approaches to individual risk management.
Challenges in helping young people with suicidal behaviours include under-recognition, stigma, and long waiting lists for youth mental health services. At the point-of-care, effectiveness of services is paramount. Training on suicide and self-harm prevention is typically insufficient, and support is often siloed, with referral pathways from the clinic lacking clarity or coordination. Identifying adolescents at risk of suicide is difficult; objective assessent tools for predicting risk are largely unreliable, and in a clinical assessment, young people might deny thoughts around suicide for reasons such as fear of judgement and loss of privacy. Moreover, the formulaic and reductionist nature of assessment tools does not lend itself to responsive conversations.
A recent framework for suicide prevention calls for a greater emphasis on therapeutic alliance--the relationship between a psychotherapist and patient. Applying this framework to young people, a clinician should view their patient, however young, as an equal, and gain a detailed understanding of their needs through a genuine conversation. A young person is more likely to be honest about intimate factors that matter most to them, such as social pressures, bullying, isolation, or home life, when their clinician has fostered trust. Building this rapport is particularly important, given that safeguarding overrides confidentiality if the clinician perceives serious risk, of which the young person would be informed. When underlying factors are identified, a collaborative care plan should be formulated that offers the young person autonomy in decisions. This approach can be standardised into domains (historic, future, modifiable, and protective factors) and a defined care pathway. Following initial assessment, practical resources and planning must be provided, and the care plan revisited regularly.
Culturally informed care that considers patient demographics (eg, background, first language, welfare requirements, schooling, disability, and gender identity) is essential. Previous trauma and other mental health conditions are key to determining a patient's overall mental state and might require multisectoral approaches and increased patient contact with clinicians. Comprehensive assessments at presentation can give a full picture of risk factors and guide safety planning in the long term.
In March, 2022, the American Academy of Pediatrics published a Blueprint for Youth Suicide Prevention, which emphasised improved referral and continuity of care for young patients, with detailed resources for building connections beyond the clinic. In suicide prevention, care networks and social connectedness are key, and investing time and resources into school, community, and youth employment partnerships can provide opportunities for health professionals, who have little contact time in the clinic, to have a broader role in active prevention...
Language: en |