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3 MARCH 2010
NO 1549
Youth suicide
This project was carried out to raise awareness of suicidal behaviour risk indicators among young people with experience of care. While it is important to remember that the sample in this study was small and that the analysis was done retrospectively, it may give some clues about the factors which are implicated in suicidal behaviour, and how to temper these in practice.
Among the social factors, it was interesting to note that withdrawal from work or education was a feature in the lives of these young people. This could represent an early indication that a young person is experiencing instability or problems that require attention. Future research could attempt to gain a better understanding of the link between suicidal behaviour and educational or work experiences. In terms of practice, residential staff and social workers should work proactively to help young people maintain their work or educational placements.
The quality and effect of peer and family relationships is certainly an area to be investigated further in the future. The young people in the sample had superficial or negative peer relationships and severe family disruption. They had also experienced a number of acute life crises. The young people in the study had a number of adverse personal life experiences that would significantly affect any young person, including childhood abuse. When one considers all of the factors that looked-after young people have to contend with, these acute life crises may be significantly more threatening and in every case should trigger additional support systems for the looked-after child.
The examination of the social work history of the young people was enlightening. It was useful to see where the majority of time being looked after was spent. However, one area that could not be fully explored due to gaps in recording was the location of young people at the time of their deaths and with whom, which could potentially be crucial to their state of mind and behaviour. It is important that social work services start to log the type, number, and success of contacts and interventions targeted at young people. Similarly, it would be important for residential staff to record outcomes as accurately as possible. Only by gathering data on what work is being done, with whom, and why, can a better picture be developed about what does and does not work. Interventions were clearly occurring but recording was limited to a brief description rather than what the social worker or young person thought of the contact, or how successful it had been.
In terms of physical and mental health, it was perhaps unsurprising to discover that there were a number of negative indicators. In terms of personality, low self-esteem was a factor in all cases. This is sufficient to expect that work on improving self-esteem should be a priority both in residential placements and in aftercare. Similarly, any type of risky sexual health behaviour could conceivably have subsequent psychological effects and should therefore indicate an area where interventions may be of benefit to the young person.
Perhaps the most sobering data appeared in relation to the history of suicide ideation or attempts. If it were in doubt how seriously this behaviour should be treated, seven of the young people in the study expressed a desire to commit suicide, and 10 had self harmed. There is sufficient evidence here to suggest that suicide and self-harm were significant enough issues in the lives of these young people to be viewed as an important risk indicator. These instances of suicidal behaviour should be compulsorily recordable and should represent points at which specifically targeted interventions or specific procedures should be used. Recording should clearly and concisely state that suicidal behaviour is considered as an issue to be shared with other professionals (e.g. Emergency Standby Services) and a record should be kept of what interventions have been used and how successful they have been. Similarly, case files should have a designated section designed to monitor the progress of attempts made to tackle suicidal behaviour for ease of reference, rather than have details hidden amid other, potentially less serious issues in the file.
Consideration should be given to according suicide and self-harm the same priority level as child protection with procedures in place to try to prevent the escalation of harming behaviour. A register of suicide attempts/self-harm may help to monitor or prevent escalation and would focus social work interventions more clearly on this issue. Intervention should be informed by a risk assessment to assess the likelihood of future episodes of suicidal behaviour and to establish its root causes in each individual.
Conclusion
It is important to consider the limits of the research. It was not
designed to provide detailed information on the issues that were
identified. Several surfaces have merely been scratched that now require
additional work to try to get beneath them to increase our knowledge of
this issue as it relates to this group of vulnerable young people.
Risk indicators such as the ones identified cannot be interpreted as causal factors in relation to suicidal behaviour. Similarly, any aggregation of the risk factors should not be taken to mean that suicide is an inevitable outcome. However, any type of suicidal behaviour should be taken seriously, recorded appropriately and responded to using well-monitored interventions.
CRAIG COWAN
Cowan, C. (2008). Risk factors in cases of unknown deaths of young people with experience of care: An exploratory study. Scottish Journal of Residential Child Care, 7, 1. pp. 39-41.
