Youth Suicide Prevention
Youth suicide generally occurs in the context of the youth's emotional, family and social environment. Prevention and intervention strategies of youth suicide will need to take these factors into account.
Although the utopian concept of a society devoid of stress, family or social problem is unlikely, it does not mean that one should not strive for a better physical and emotional environment for our young people. Better education, employment, self development and leisure opportunities are just a few examples where we can help our youths to reduce their stresses. This decrease in stress and promotion of well-being is primary prevention. The early intervention when a problem arises, e.g. the prompt management of depressive symptoms, is known as secondary prevention. The prevention of complication, e.g. suicide as a result of depression, is known as tertiary prevention. Any effective preventive pro gram should include these levels of prevention.
What Parents Can Do to Prevent Youth Suicide
Parents can do several things to prevent youth suicides. Some of these are general in nature while others are more specific.
Form a Good Relationship with Your Youth
During early childhood development, children generally bond with their parents and they have a good and trusting relationship. They grow up trusting their outside world and see it as a safe place where they can continue to grow and develop. This growth reaches its peak during adolescence. The youth needs to come to terms with rapid physical growth; conflicts between parental and peer values and ideals; emotional and physical intimacy with the opposite sex and the uncertainty about his/her future career. These "developmental tasks" can generate a great deal of pressure but most young people complete them successfully without too much difficulties.
Despite popular belief to the contrary, most teenagers do want a close relationship with their parents even though they may not admit to it openly. The relationship with their parents may have changed in form and content but it is in fact a continuum of their past relationship. Parents have to grow and change in parallel with their teenagers. It is a two way process. If the relationship is there, teenagers generally acknowledge and respect their parents' values and they want their advice and support, especially at times of stress.
A good relationship will open up communication between the youth and his/her parents. This can be a life saving safety valve to the depressed and troubled teenager. Support and early intervention can be effected before the youth contemplate suicide as an option.
Relationship between teenagers and their parents can be improved by:
Providing a stable, safe physical and emotional home environment.
This may seem obvious but unfortunately this is not always the case as exemplified by the problem of homeless youths. With many families breaking up and dispute over the custody and access of children, the teenager may become the "pawn" of the parental battle.
Spending quality time with young people.
"Quality time" is a cliche frequently used in child rearing literature and it is met with a certain degree of cynicism. However, a good relationship between a youth and his/her parents cannot occur unless they spend time together. It is common to hear parents and teenagers talk about their constant arguments about everything. The amount of time spent in conflict is huge. Why not spend some of this time having fun together?
LISTENING to teenagers, not only to what is being said, but also to the covert messages.
Teenagers commonly complain that their parents are keen to give advice but they don't listen to their points of view. Messages sent by teenagers may at times be tangential, contradicting and confusing. Parents will need to "de-code" these scrambled messages to get in touch with their children's feelings. In many instances this may mean an interpretation of their body language. Non-verbal action can "talk" much louder than conversational language.
Being supportive and not intrusive.
There is a fine line between being supportive and being intrusive. It is important for parents to acknowledge the upset and distress shown by their teenage children, but not interrogating and demanding to know the "secrets" of their distress. Teenagers will generally talk to their parents about their problems when they are ready. Respect the fact that they can solve many problems on their own without the support of others. Support is there for them to use but it must not be imposed on them.
Encouraging the appropriate expression of emotions
Many teenagers tend to either hide their emotions or they show them in an explosive manner, thus leading to their parents' comments about their moodiness. Encourage them to show and share their feelings of joy, happiness, excitement in their successes. They can then show and share their sadness, anxiety, distress and disappointment. Both "positive" and "negative" feelings must be contained so that they are not running wild and out of control.
Early Intervention in Stressful Situations
Severe emotional symptoms are frequently found in individuals facing or following significant life events. Youths facing court appearances, family break-up, important examinations or those who have been sexually abused, expelled from school, rejected by love ones are a few examples of common stressful situations to which young people are subjected.
Support from parents and others is particularly important to prevent despair and suicidal ideation. This can be achieved by being in touch with the youth's emotional state. Just because teenagers don't show their feelings readily, it does not mean that they are not concerned about impending major life events or feel distressed after a personal disaster. Have empathy with them. They want to be understood by their parents. Sensitive listening and appropriate advice or debriefing will help.
The successful negotiation and resolution of a stressful situation can be a confidence booster to the youth.
Take Suicidal Threats Seriously
Whether a youth has "genuine" suicidal intent or not, take all suicidal threats seriously. Don't trivialise any suicidal threat. In many instances, the threat is a cry for help - "I am not coping". If this is ignored, the youth may decide to act out his/her threat. It is much safer to be cautious.
Early detection and management of psychiatric illness.
Like suicide, psychiatric illnesses carry with them stigmas and myths. Many major psychiatric disorders, e.g. schizophrenia, bipolar affective illness and anorexia nervosa have their onset in adolescence. Drug induced psychosis is another important condition in this age group. These conditions, which are responsive to treatment, carry with them a higher risk of suicide if they are not managed early and appropriately.
Without describing each psychiatric condition in detail, the following symptoms should be taken seriously by parents:
- Severe and persistent depressive mood
- Severe agitation and panic attacks
- Hallucination - The hearing of "voices" or seeing things in the absence of external stimulus.
- Delusion - a fixed and false belief system that is alien to the person's family and cultural background.
- Grossly elated mood
- The excessive pre-occupation with certain ideas (e.g. cleanliness or body weight) to the point of affecting the person's daily functioning.
The presence of any of these symptoms may indicate the onset of an underlying psychiatric illness. With the support and encouragement of parents, the youth may agree to professional advice. A proper assessment is required to plan ways to help the young person.
Appropriate intervention after a suicide attempt.
All suicide attempts should be taken seriously, particularly if the youth has planned the suicide. Don't dismiss the attempt as an attention seeking behaviour. The seriousness of the attempt is related to the intent of the youth rather than the method of self harm. Proper assessment is required after the attempt and this will generally mean professional intervention.
Apart from the suicidal youth, parents and other family members will also need a great deal of support and their needs must not be forgotten.
Parents can do several things to help their teenager after a suicide attempt:
- Ensure the physical safety of the teenager.
- Be available to support the teenager.
- Be caring but don't be over-protective.
- Close observation but not being intrusive.
- Return to routine as soon as practical.
- Removal of potentially dangerous substance/weapon.
- Discuss issues relating to the attempt only at the initiative of the youth, i.e. no interrogation.
- Seek help and advice. Don't sweep the problems "under the carpet".
Be vigilant of changes in behavior.
Be wary if there is a sudden excessive elevation of the youth's mood in someone who was previously severely depressed. This does not necessarily mean that the youth is getting better. The youth may have in fact finally decided to commit suicide and there is a sense of relief and therefore the improved mood and activity level. The youth may give away his/her precious possessions or ask the parents to go out so that he/she can carry out the suicide act.
A teenager who is grossly agitated is also at risk. The agitation can be caused by drug, depression, anxiety or psychosis. In this instance, the suicide act may be the youth's attempt to relieve the internal distress and agitation. Watch out for the youth who paces the floor and acts like a "cat on a hot tin roof".
Seek advice or help from professionals if in doubt.
It is not easy for parents to come to accept that their teenager is emotionally troubled, not to mention suicide attempt. Parents tend to blame themselves and ask themselves many "if only" and "why" questions. Professional assistance is frequently required for not only the teenager, but also the family. Clinical psychologists, general medical practitioners, psychiatrists, and competent youth counsellors are some professionals who are available for consultation and advice if there is any doubt that a youth is at risk of suicide.
Lethality of attempted suicide is related to the method employed to harm oneself. Any potentially lethal material for suicide should be removed from the home environment especially if there are teenagers who are depressed or stressed.