Using a therapeutic approach to suicide risk assessment with young people.

Please take care of yourself; If you need to leave this presentation please be assured that all presentation materials will be made available to you. Self Care

All deaths from intentional self-harm in young persons aged 10 years and over, and deaths where intent was undetermined in those aged 15 years and over. ONS 2017 Definition

Completed suicide or died by suicide. Terminology

In 2017 there were 6,213 suicides in the UK and Republic of Ireland. In the UK men remain three times as likely to take their own lives than women, and in the Republic of Ireland four times more likely. The highest suicide rate in the UK was for men aged 45-49. There has been a significant decrease in male suicide in the UK, and the male suicide rate is the lowest in over 30 years. Samaritans 2019 The overall picture

177 young people aged 15 – 19 died by suicide in 2017 121 young men 56 young women ONS 2017 Data for Young People

The National Confidential Inquiry https://www. hqip. org

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 Ten common themes in suicide by children and young people up to the age of 20

52% of young people under 20 who died by suicide had experienced self harm 26% of young people under 20 who died by suicide had suicide related internet use 25% of young people under 20 who died by suicide had suffered a bereavement 9% of young people under 20 who died by suicide where or had been looked after children 6% of young people under 20 who died by suicide identified as LGBT

Suicide in young people is rarely caused by one thing; it usually follows a combination of previous vulnerability and recent events. The stresses we have identified before suicide are common in young people; most come through them without serious harm. Conclusions Health and social care, and other agencies that work with young people, as well as families and young people themselves, can contribute to suicide prevention through greater awareness of the range of factors that may add to risk and of the “final straw” stresses that can lead to suicide.

Theories of Suicide Robert Burton 1621– Anatomy of Melancholy Dr. Karl Menninger 1936 - Purposive Accidents as an expression of self destructive tendencies. Edwin Shneidman 1986 - The Suicidal Mind Thomas Joiner 2005 – The Interpersonal theory of Suicide

The interpersonal theory of suicide Thomas Joiner “Suicide is a process, not an act”

Task Using examples from your own practice with young people; What experiences might lead to a young person feeling they don’t belong? What might lead a young person to feel that they are a burden?

Acquired Capacity “surmount the most powerful instinct in nature” The third component of Joiners theory is the acquired capacity to, in Voltaire's words, “surmount the most powerful instinct in nature”

Dispelling myths ……. It is ok to talk about suicide – there is lots of really good evidence that talking to clients about suicide does not increase suicidal thoughts, in fact it reduces the likelihood of suicide. Suicide is not an impulsive act, it is a process. The best risk assessment tool is you. No one has all the answers, the work is in the therapy.

Risk assessment as part of the therapeutic relationship “Skilled assessment assures youth that clinicians are genuinely concerned about their well-being, supportive of their autonomy, and willing to engage in open and empathic dialogue about sensitive topics” (Jeremy w. Pettit and Victor Buitron 2018)

“The assessment of children and adolescents for risk of suicide and self-injury can therefore serve a two-fold function; firstly to prevent early death and disability, whilst promoting life and resilience, and secondly to intervene as early as possible in a potentially disturbing trajectory towards adult suicidality.“ (Australian Psychological Society, February 2016)

David Jobes Working with suicidal clients using the Collaborative Assessment and Management of Suicidality “A strong therapeutic alliance where counsellor and client work closely together to develop an understanding of the clients suicidal phenomenology” “Through collaborative assessment and deconstruction of the Clients suicidality, key problems and goals emerge”

Safety planning Safety planning can help to reframe a young persons image of the world around them. Working with a young person to figure out what sooths them when they feel sad or hopeless. Who they can call if they feel that they can no longer cope with how they are feeling. Making sure that they know that there are services for people who feel the way that they do, because they are not the only person who feels like this.

Hope

Orcombe Point Project Devon

Barriers 1100 plants National Trust donated @£0.50p each

Risk Assessment Tool

Questions ?

Contact Tricia Leonard Dip Couns, Post Grad Dip Supervision, MA C&YP Couns BACP Accredited Counsellor and Supervisor tricialeonard2000@yahoo.co.uk

References Barnardo's Action for Children, The Way Forward: (2014) A Report For Care Leavers,, Barkingside, Essex. Betteridge, C and Taylor, F, Assessing suicidal risk in children and adolescents: Adopting a developmental lens, InPsych 2016, Vol 38: February Issue 1. Cooper, M. (2013), school-based counselling in UK secondary schools: a review and critical evaluation, University of Strathclyde Dazzi, T.Gribble, R., Wessely, S., Fear, N., Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Cambridge University Press 2014, Cambridge, UK. Joiner, T (2007) Why People Die by Suicide, Harvard University Press, Harvard, USA. Pettit et al.,  Assessment and Management of Suicide Risk in Children and Adolescents .  Cognitive and behavioural Practice, 2018, Elsevier, Australia. Reeves, A Chair of BACP;  BACP, BPC and UKCP response to the children and young people's mental health green paper.  Therapy Today, March 2018 Reeves, A., Mintz, R. (2001) The experience of practitioners who work with suicidal clients: an exploratory study. Counselling and Psychotherapy Research Journal 2: 37–42. Suicide by children and young people. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). Manchester: University of Manchester, 2017. Shairi Turner, Chief Medical Officer, Suicide Prevention Resource Crisis Text Line: Psychology Today, 11th June 2018. Wand, T (2011) Investigating the Evidence for the Effectiveness of Risk Assessment in Mental Health Care, Issues in Mental Health Nursing, 33:1.