MIND MOVES:I HAD the pleasure of speaking to the staff of a secondary school in south Dublin recently as they prepared to open their doors to more than 500 pupils. Together we covered a broad range of mental health issues that arise in school settings. Inevitably, the issue of self-harm and suicide was raised. A question asked of me by one teacher struck me as particularly pertinent: "Is there a danger that talking about suicide with young people might put ideas in their heads?"
With persistent reports coming at us from all sides about young people and suicide, I felt his question echoed a fundamental anxiety felt by teachers, parents and everyone engaged in the care of young people. The answer is not straightforward and it is beyond the scope of this column to be able to consider it adequately. But here are some things that we know and don’t know about this issue.
The evidence is that 20 per cent of young people aged 12-20 have had thoughts about suicide sometime in the past 12 months, but they often find it a difficult subject to raise. What this means is that we cannot assume that young people will bring up the subject themselves, no matter how much it is troubling them or how much they may want to.
For those young people who do seek help, when asked sensitively the majority will disclose honestly how they feel and experience some measure of relief having done so. Some research carried out with young people who have accessed mental health services indicates that, not alone is it okay to ask young people sensitively and directly whether they have thoughts of harming themselves, but that it is actually best practice to do so.
Having suicidal thoughts and feelings is one thing; acting on them is quite another matter.
A number of risk factors have been identified, but the following three questions are particularly worth asking: Has the young person been thinking this way persistently for some time? Have they been engaging in behaviour that is clearly harmful? Has their distress had the effect of isolating them from their family and close friends?
A yes to any of the above is reason to be concerned, and to encourage and facilitate that young person in making contact with a GP or some professional counsellor.
What is clear is that when young people do come to us in distress, we need to talk to them very openly, not only about what is going on for them generally, but specifically on the matter of suicidal thoughts and self-harm behaviour.
What we are much less clear on is the impact of talking about suicide to those young people whose distress is hidden, who do not directly seek anyone’s support or advice. We don’t yet have the evidence available to answer the teacher’s question in respect of this group of young people, particularly when it comes to general group-based discussions about the issue.
It is likely that suicide will be discussed at some point, given the frequency with which young people’s lives are touched by this issue. But when we do speak about it, we need to consider that what we say has the potential to inflame hidden wounds among some young people. Ideally, any conversation about suicide and self-harm needs to be part of a much larger conversation about the reality of distress in all our lives and the capacity in all of us to engage with pain and grow through it.
If the subject of suicide arises outside of such a conversation, we need to be aware that there is the possibility that it may leave some young people feeling even more vulnerable and alone. Paradoxically, this may increase their distress or lead them to consider self-harm or suicide as valid ways to deal with the pain they are carrying that they feel unable to share.
It is therefore vital that any discussion on suicide or self-harm needs to be accompanied by clearly identified ways to access support for those who are feeling vulnerable. A trusted adult in that setting should be identified for anyone who feels they would like to speak privately about the issues raised by the discussion. In addition, details need to be provided for a number of alternative options for speaking to people or agencies outside the school.
This does not fully answer the question of how to address this issue in a way that is likely to help rather than to hurt. That is a question for which there are no simple answers and one that deserves thoughtful debate and consideration. But always, within such a debate, we should ensure that the views of young people are listened to and that their needs and wishes are respected.
- Tony Bates is founding director of Headstrong – The National Centre for Youth Mental Health. www.headstrong.ie
