My name is Michelle, and I am making my way through my second year at Mount Royal University with a major in Child and Youth Care Counsellor. I am completing my practicum in a group home setting where the youth, aged 12-15, that are living there are easy to get along with, and do not engage in at-risk behaviours. Although there have so far been no concerns regarding self-harm, drug use, or suicidal actions, the youth frequently say things such as “I’d rather die than…,” or, “that makes me want to kill myself.”
I have found that the staff does not cue the youth on these comments. This could be because staff are trying to diminish these behaviours through extinction and because these youth are not deemed “at risk” for suicide, and there is no threat associated with the statements. Personally, I do not think these are appropriate statements to make as a way of expressing frustration, or as a way to be funny, but due to the other staff’s lack of response I am thinking I might be looking too deep into it.
In school we are taught to always take any statement of suicide very seriously, which often results in hospital visits and evaluations. At the same time we do not want to give into negative attention seeking, or exhaust any available resources.
My question to all of you is, to what extent do we acknowledge and engage in these statements, and what are you opinions of youth saying things like this?
Thank you for your time, I look forward to your responses,
This is a great question that often comes up in my own work. I believe that we create meaning through our interactions with others. That is to say, should a youth say "that makes me want to kill myself", the responses of others – whether that is not responding or exploring further, co-creates the meaning of this statement. I would also suggest that behaviours – including communications – are an expression of needs, and how others respond to expressions of needs influences how we see ourselves – as (not) worthy of having our needs met (or understood) by others.
If child and youth care workers intentionally ignore the comment, identify the comment as 'attention seeking', or choose not to explore further because the youth has not displayed any other indicators they may be 'at risk' for suicide, what meaning is created in the interaction about the statement "that makes me want to kill myself"? What meaning does the youth walk away with about him/herself? About death? About living?
Alternatively, if a child and youth care worker turns toward the youth, identifies this statement as worthy of following up, checks out the youth's intentions behind this statement, what meaning is created in the interaction about suicide? About the youth? About the worker? About the helping relationship?
While the youth's comment may not necessarily be an expression of suicidal thoughts or intentions on dying, it may be an expression of a need to be understood, to express frustration or powerlessness in a situation, or to draw a child and youth worker into a conversation. How will we know if we don't explore further?
Effective responding does not mean that we will be sitting in emergency with every youth, but by exploring the youth's meaning of this statement and needs behind it, we are communicating that they are listened to, worthy of being heard, understood and having their needs met.
Thus the statement actually may afford opportunities to build or strengthen the youth-youth worker relationship – so, I'm not sure why we would turn that opportunity down?
I would ask the other staff what their reasons are for responding (or not) in the way they do. Also, check out these reflections in the September 2014 issue of CYC-Online which highlight four characteristics of relational care that are important to those who are struggling with harming or ending their lives.
It is very important as CYC workers that we have a relationship with our youth, because when the youth is distressed you, as an adult in her life, are able to see if the youth is going through a tough time or there is a serious problem that the youth is struggling with. Going back to suicidal threats are not to be taken lightly. Report the matter and make an arrangement with the clinical team to see that youth gets the help that she needs.
It is important to always respond to expressions and thoughts of suicide. Responding does not have to be complicated and with even very minimal training, one can learn to approach the subject very sensitively. Many people who have thoughts of suicide are not actively considering suicide and does not need medical intervention, so every conversation about suicide should not result in a visit to an emergency room. Ignoring it is however not the way to go. One will have to decide whether to respond immediately or wait and follow up later, but there should always be a follow up.
I particularly like to work of Shea on the CASE approach (Chronological Assessment of Suicide Events) which provides very practical interviewing skills for dealing with suicide.
Check out the link below.