1. Suicide by children and young people: what does current research tell us?
@NCISH_UK

2. National Confidential Inquiry into Suicide and Safety in Mental Health
Suicide by children and young people
Findings from the UK’s first national investigative study
Cathryn Rodway

3. Suicide rates worldwide
Source: WHO Global Health Estimates (

4. …BUT recent data shows a rise
UK suicide rates
Suicide was falling….
…BUT recent data shows a rise
Source: ONS

5. Suicide rates in the UK in 15-19 year olds (2000-2018)
Source: ONS

6. New standard of proof

7. Rising self-harm rates
Self-harm rose by 68% in girls aged between 2011 & 2014
Referral to specialist MH care 23% less likely in deprived areas
Young people who self-harmed 9x more likely to die unnaturally
Catharine Morgan et al. BMJ 2017;359:bmj.j4351
©2017 by British Medical Journal Publishing Group

8. Rising self-harm rates
Reasons for non-suicidal self-harm among men and boys (A) and women and girls (B) aged 16–74 years
McManus S, Gunnell D, Cooper C, Bebbington PE, Howard LM, Brugha T, Jenkins R, Hassiotis A, Weich S, Appleby L. Prevalence of non-suicidal self-harm and service contact in England, 2000–14: repeated cross-sectional surveys of the general population. The Lancet Psychiatry Jun 4.

9. Self-harm and suicide 1 in 50 of people 50-fold in year
Source: Manchester Self-Harm Project (MaSH)
1 in 50 of people
seen in A&E
after self-harm have
died within a year
Risk of suicide
increased up to
50-fold in year
after self-harm

10. Report coverage 595 suicides (UK, under 20)
January 2014 – December 2016
595 suicides (UK, under 20)
544 (91%) reports available
mainly coroner inquests
personal testimony of family, friends
social media
relevant professionals – school, youth justice, health & social care
other sources where available
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
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11. Researchers examine reports & extract information
Data collection
All potential cases nationally
(suicide & undetermined from ONS, GRO, NISRA)
Coroners
reports
Criminal justice
reports
Official reports/
records received
Child death
investigations,
reviews
NHS Serious
Incident reports
Researchers examine reports & extract information
Relevant antecedents
recorded
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12. Suicide in people aged <20
Number of suicides increases steadily with age, esp. in mid-late teens
Most deaths in year olds (74%)
Mainly males (71%)
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13. Main causes of death
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14. Common themes 10 common themes
Family factors such as mental illness (23%)
Abuse & neglect (11%)
Bereavement (25%) & experience of suicide (9%)
Bullying (19%)
Suicide-related internet use (24%)
Academic pressures, especially related to exams (63%)
Social isolation or withdrawal (21%)
Physical health conditions (30%)
Alcohol & illicit drugs (42%)
Self-harm (49%) & suicidal ideas (59%), mental ill-health (40%)
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15. Gender differences Witnessing domestic violence 4% 12% Abuse 6% 16%
Bereavement 21% 33%
Bullying 14% 29%
Academic pressures 27% 44%
Physical health conditions 27% 38%
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
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16. Gender differences Diagnosis of mental illness 35% 52%
Self-harm 41% 69%
Excessive alcohol use 22% 21%
Illicit drug use 39% 28%
Workplace problems 18% 10%
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17. Suicide and the internet
Suicide-related internet use
24%
Searched the internet for information on suicide methods
13%
Communicated suicidal ideas or intent online
10%
Victims of online bullying 5%
Visited websites that may have encouraged suicide 3%
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18. LGBT groups 6% LGBT or uncertain of sexuality
Most experiencing conflict over their sexuality
Over a quarter bullied
LGBT groups (n=32)
Abuse
5 (16%)
Bullying
9 (28%)
Suicide-related internet use
14 (44%)
Previous self-harm
20 (63%)
Suicidal ideas or intent
24 (75%)
Any diagnosis of mental illness
16 (50%)
Depressive illness
7 (22%)
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19. 8% had been ‘looked after children’
45% housing problems/change of accommodation (v. 15%)
71% previous self-harm, suicidal ideas
Majority in recent service contact – but not with mental health services
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20. ¼ bereaved Young people who are bereaved 9% bereaved by suicide
Bereaved (n=134)
Non-bereaved (n=410)
Family history:
Mental illness
34 (25%)
46 (11%)
Physical illness
27 (20%)
19 (5%)
Substance misuse
21 (16%)
23 (6%)
Abuse
20 (15%)
30 (7%)
Bullying
36 (27%)
66 (16%)
Suicide-related internet use
45 (34%)
83 (20%)
Excessive alcohol use
43 (32%)
74 (18%)
Previous self-harm
88 (66%)
179 (44%)
Suicidal ideas
101 (75%)
223 (54%)
Any diagnosis of mental illness
70 (52%)
147 (36%)
Service contact
104 (78%)
225 (55%)
¼ bereaved
9% bereaved by suicide
For many bereavement added to existing problems
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
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21. Academic pressures 51% 63% 28% In education Academic pressures
Exam-related
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22. Indications of risk 49% previously self-harmed
High rates of excessive alcohol (30%) & illicit drug use (43%) in those who had self-harmed
59% expressed thoughts of suicide
28% in the week prior to death
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23. Mental illness diagnosis
Affective disorder most common diagnosis, especially depression
6% anxiety disorder
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24. Service contact 40% no service contact
Mainly mental health service contact
Under half in current (<3 month) contact
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25. What about older age groups?
January 2014 – December 2015 (E&W, yo’s)
606 suicides
20% sample
106 (85%) reports
Many factors reflected life experience at different ages
<20 year olds
20-24 year olds
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26. Pattern of cumulative risk
Adversity & risk
behaviours in
adolescence
Recent
stressful event
Traumatic
experiences in
early life
Prevention measures
Support for
young children
& their families
Access to CAMHS,
incl. self-harm &
substance misuse
services
Crisis support,
promoting mental
health in education
Suicide prevention contributed to by recognising this pattern
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27. Multi-agency approach Emotional Self-harm Safer prescribing health
Support for
Student
Primary
care
Education
families
support
Work-
place
Social
care
Multi-agency
approach
Anti-
Bereavement
Youth
justice
Third
sector
bullying
support MH
services
Self-harm
services
Substance
Prompt
Psycho-social
assessment
misuse
access
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28. What approach to suicide prevention?
Improving online safety
Beyond social media
Reducing the accessibility of information on suicide methods
Increase online vigilance
Encourage online safety
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
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29. What approach to suicide prevention?
Action for groups with specific needs
Support for young people and their families who are bereaved, esp. by suicide
Housing support and mental health care for looked after children
Mental health support and anti-bullying measures for LGBT groups
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30. Society-wide factors Debt Demand for MH care Economic adversity
Appearance
Austerity
The environment
Job insecurity
Fears about opportunity
Cost of housing
Perceived injustice
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31. National Confidential Inquiry into Suicide and Safety in Mental Health
@NCISH_UK

32. Suicide by children and young people
National Confidential Inquiry into Suicide and Safety in Mental Health
Suicide by children and young people
Cumulative Risk
Jane Graney

33. Suicide by Children and Young People
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
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34. Common themes 10 common themes
Family factors such as mental illness (23%)
Abuse & neglect (11%)
Bereavement (25%) & experience of suicide (9%)
Bullying (19%)
Suicide-related internet use (24%)
Academic pressures, especially related to exams (63%)
Social isolation or withdrawal (21%)
Physical health (30%)
Alcohol & illicit drugs (42%)
Self-harm (49%) & suicidal ideas (59%), mental ill-health (40%)
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

35. Pattern of cumulative risk
Adversity & risk
behaviours in
adolescence
Recent
stressful event
Traumatic
experiences in
early life
Prevention measures
Support for
young children
& their families
Access to CAMHS,
incl. self-harm &
substance misuse
services
Crisis support,
promoting mental
health in education
Suicide prevention contributed to by recognising this pattern
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

36. Early life experiences
Can make young people vulnerable
Common factors
Mental illness
Physical health
Substance misuse
Domestic violence
Abuse
Looked after children
Bullying
Physical illness
Approach to prevention
Improving early life experiences through working with families, supporting vulnerable children
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
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37. Getting older Adolescence Common factors
As they get older other concerns may arise
Common factors
Unemployment
Financial problems
Leaving home
Excessive alcohol use
Illicit drug use
Diagnosis of mental illness
Preventive measures
Availability of CAMHS including services for self-harm and substance misuse
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
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38. Final straw Trigger Event
Final straw-Recent event occurring in the 3 months prior to death
Event
Relationship breakup
Exam result
Family argument
Change in accommodation
Approach to prevention
Support for young people in crisis, healthy workplaces and campuses
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
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39. Fears about opportunity Cost of housing Perceived injustice
Society-wide factors
Debt
Demand for MH care
Economic adversity
Appearance
Austerity
The environment
Job insecurity
Fears about opportunity
Cost of housing
Perceived injustice
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
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40. Approach to prevention
Mental health services
Substance misuse services
Services for self-harm
Youth justice
Probation services
Police service
young person
Mental health services
Social care
Education
Family support services
Youth justice
Education
Healthy campus initiatives
Anti-bullying measures
Digital awareness
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
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41. Self-harm and other harming behaviour
National Confidential Inquiry into Suicide and Safety in Mental Health
8 October 2019
Self-harm and other harming behaviour
Dr Ali Baird

42. % Population reporting self-harm
Source: NatCen, 2019

43. Self-harm attendance in
primary care
Self-harm rose by 68% in girls aged between 2011 & 2014
Young people who self-harmed 9x more likely to die unnaturally
Non-fatal self-harm is strong risk factor for subsequent suicide
Catharine Morgan et al. BMJ 2017;359:bmj.j4351
©2017 by British Medical Journal Publishing Group

44. Suicide by Children and Young People
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45. 52% previously self-harmed
Indications of risk
52% previously self-harmed
7% self-harmed in the week before death. 5 required medical intervention in A&E
High rates of excessive alcohol (33%) & illicit drug use (42%) in those who had self-harmed
58% expressed thoughts of suicide
27% in the week prior to death
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46. Approaches to prevention
Self-harm
Good psychosocial assessment after
self-harm
Access to psychological therapies - follow-up
with CBT/DBT
Mental health & alcohol/drug services working
together
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47. “Although there are many antecedents of suicide in young people, self-harm is a crucial indicator of risk and should be taken seriously, even when the physical harm is minor.”
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
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48. For discussion What is our understanding of self-harm?
What is a good conversation to have about self-harm?
How can we help young people to build resilience?
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49. Suicide-related internet and social media use
National Confidential Inquiry into Suicide and Safety in Mental Health
8th October 2019
Suicide-related internet and social media use
Nicola Richards

50. Media use
12-15 year olds
70%
16-24 year olds
95%

51. Media coverage of suicide and social media

52. Suicide by Children and Young People
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53. Suicide and the internet
Suicide-related internet use
24%
Searched the internet for information on suicide methods
13%
Communicated suicidal ideas or intent online
10%
Victims of online bullying 5%
Visited websites that may have encouraged suicide 3%
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
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54. Internet and social media use
Social support
Online community (e.g. LGBT)
Help-seeking
Mental health resources
New technology
Access to information on methods
Online bullying
Comparisons to unrealistic portrayals
Normalisation of suicide-related behaviour
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55. Approaches to prevention
Encourage online safety by:
Removal of online information about suicide methods
Increase online vigilance for people being bullied or expressing distress
Teach safe internet use
© National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved.
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