The mental health of CYP in the UK. Increasing rates of suicide! Hot topic: The mental health of CYP in the UK. Increasing rates of suicide! Sonya Clarke (Lead for Children’s Nursing QUB) & Dr Karen Galway (Lecturer in Mental Health QUB)

UK wide All age groups Samaritans, 2014 Important point – risk of suicide increases with age, peaking in middle age for both men and women. In terms of youth, the risk increases sharply between ages 19 and 30. However suicides DO OCCUR in younger children and teenagers. Often masked by accidental death verdicts, due to emotive nature and “reasonable doubt” Some theory suggests children are not emotionally mature enough to die by suicide, but this only theory!! Scocroft, E. “Suicide Statistics Report: Including data for 2010-2012″, Samaritans, March 2014.

Risk factors - All age groups Suicide is the leading cause of death among young people aged 20-34 years in the UK and it is considerably higher in men, with nearly four times as many men dying as a result of suicide compared to women. Associated with increased risk of suicide - Drug and alcohol misuse History of trauma or abuse Unemployment Social isolation Poverty Poor social conditions Imprisonment Violence Family breakdown Mental Health Foundation https://www.mentalhealth.org.uk/a-to-z/s/suicide [Accessed 16th June 2016]

Appleby et al. (2016) Suicide is one of the main causes of mortality in young people , and for families its impact is especially traumatic. A previous NCISH report showed that between 2003 and 2013, an average of 428 people aged under 25 died by suicide in England per year. 137 were aged under 20, and 60 were aged under 18 . The UK as a whole has relatively low rates of suicide by children and young people but there are large differences between the UK countries—suicide rates are lower in England and Wales than in Scotland and Northern Ireland . In England, the suicide rate in children and young people is lower than 10 years ago, but this fall occurred in the early 2000s and there has been no fall since around 2006 . Self-harm is more common in young people, the highest rates being in females aged 15 to 19 . Self-harm is strongly associated with increased risk of future suicide and self-harm rates in young people appear to be rising! Suicide by children and young people in England. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). Manchester: University of Manchester, 2016. http://www.bbmh.manchester.ac.uk/cmhs/research/centreforsuicideprevention/nci/reports/cyp_report.pdf

Statistical Update on Suicide, 2104, Department of Health A coroner records a verdict of suicide when they have decided that there is evidence beyond reasonable doubt that the injury was self-inflicted and the deceased intended to take their own life. Statistical Update on Suicide, 2104, Department of Health Subjectivity – more evident when discussing suicide in children and youth – important as a back drop. Most statistics will be under-estimates.

(Youth) Suicide is Subjective In the UK, a coroner is able to give a verdict of suicide for those as young as 10 years. However, rates per 100,000 are provided by the ONS for ages 15 years and over when their suicide bulletin is released. This is due to the known subjectivity between coroners with regards to classifying children’s deaths as suicide, and because the number in those under 15 tends to be low and their inclusion may reduce the overall rates. The subjectivity has lead to official statistics being shaped accordingly. Scrowcroft, “Suicide Statistics Report: Including data for 2010-2012″, Samaritans, March 2014

Risks in Children & YouTH Ten common themes in suicide by children and young people:  family factors such as mental illness  abuse and neglect  bereavement and experience of suicide  bullying  suicide-related internet use  academic pressures, especially related to exams  social isolation or withdrawal  physical health conditions that may have social impact  alcohol and illicit drugs  mental ill health, self-harm and suicidal ideas Appleby et al (2016). Suicide by children and young people in England. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). Manchester: University of Manchester, 2016.

Key Messages Suicide rates sharply in the late teens; numerous factors appear to contribute to this. Many young people who die by suicide have not expressed recent suicidal ideas. An absence of suicidal ideas can not be assumed to show lack of risk. Agencies that work with young people can contribute to suicide prevention by recognising the pattern of cumulative risk and “final straw” stresses that leads to suicide. Improved services for self-harm and access to CAMHS are crucial to addressing suicide and there is a vital role for schools, primary care, social services, and youth justice.

Northern Ireland Context NB: differences between UK graph and NI graph A clear bi-modal distribution, indicating two peaks – at age 25-29 and age 50-55 It is speculated that this could be related to the ‘troubles’ – via a mechanism of intergenerational suicide “contagion” along with factors such as deprivation, but this is based on conjecture, no evidence exists to support this – yet.

Northern Ireland …..focus Northern Ireland continues to have the highest rate of suicide in the UK, per head of population, according to the Office for National Statistics (ONS). The latest available figures show that during 2014 there were 16.5 suicides per 100,000 in Northern Ireland. Scotland had the second highest rate, at 14.5, followed by 10.3 in England and 9.2 in Wales. It is the second consecutive year that Northern Ireland has recorded the UK's highest suicide rate. Troubles legacy However, the overall number of suicides in Northern Ireland decreased in 2014, falling to 268 compared to 303 deaths. This reflected a small decrease in the total number of suicides across the UK as a whole in 2014, where the overall figure fell by 2%. http://www.bbc.co.uk/news/uk-northern-ireland-35491402

Good Friday Agreement was signed in 1998 Feasible conjecture…. In a paper published in 2013, Tomlinson wrote: “Since 1998 the suicide rate in Northern Ireland has almost doubled, following a decade during which the rate declined from a low level of 10 per 100,000 of the population to 8.6.” The overall rate is now 16.25 per 100,000—25.24 per 100,000 men and 7.58 per 100,000 women (2012 figures based on three-year rolling averages). In global terms, this places Northern Ireland in the top quarter of the international table of suicide rates. Tomlinson identified adults whose childhoods had coincided with the worst period of Troubles-related violence (from 1970 to 1977) as the age group that experienced the most rapid rise in suicides in the decade after 1998. It seems obvious that this group, who’d seen the worst of the Troubles, would be affected. But what about the … Ceasefire Babies? Extract from: The Atlantic (Magazine) http://www.theatlantic.com/health/archive/2016/01/conflict-mental-health-northern-ireland-suicide/424683/

So…….. As the newly formed.. ….what are your thoughts & what can we do?