Suicide in Young People – Policy and Prevention

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Risk factors for suicide in young people include bereavement, bullying, academic pressures, abuse, physical illness, social isolation, alcohol, illicit drug use, and mental ill health

Suicide is a significant cause of death worldwide, accounting for almost one million deaths every year1, and is a leading cause of mortality in young people, particularly in the later teenage years.2

As with adult populations, more teenage males complete suicide, while more females experience suicidal ideation and attempts.3 Although the rate of suicide is declining (or has at least stabilised) in many developed countries, possibly due to restriction of means and greater treatment provision4, there is little data available from developing countries.3 Additionally, our understanding of the epidemiology of suicide is reliant on accurate reporting (e.g. by coroners).5

A recent national enquiry6 identified a number of risk factors for suicide in young people, including bereavement, bullying, academic pressures, abuse, physical illness, social isolation, alcohol, illicit drug use, and mental ill health. Many had previously self-harmed or expressed suicidal ideation7, but many young people are not known to services.8

In addition to loss of life, suicide has significant implications for the young person’s social network. It is a devastating trauma to the surviving family, particularly if there were no warning signs, and has major psychosocial consequences.9 GPs10 and other healthcare providers11 may also struggle with a patient’s suicide.

The rest of this article will briefly describe current provision and policy, and outline areas to be targeted for prevention.

How do we currently help young people?

Mental health provision for young people is roughly divided into four tiers, dependent on severity of illness.

Tier 1 providers (often GPs, nurses, teachers, social workers and youth justice workers) can identify and manage common mental health problems, and also contribute to mental health promotion.

Tier 2 staff include professionals with mental health training such as psychologists, counsellors and paediatricians, and can identify and manage more severe or complex cases.

Tier 3 provision incorporates child and adolescent psychiatrists, community psychiatric nurses, psychotherapists and clinical psychologists, and services are typically based in the community (e.g. an outpatient service).

Tier 4 services are highly specialist services such as day units and inpatient units, reserved for young people requiring intensive care from experienced providers such as a child and adolescent psychiatrist.

Tiered provision of mental health services for children & adolescents. Source: http://www.icptoolkit.org/child_and_adolescent_pathways/about_icps/camh_service_tiers.aspx

In addition to formalized healthcare provision by primary care and CAMHS services, numerous third-sector organisations contribute to mental health support. These include charities such as Papyrus12, who work nationally to try to prevent suicide in young people by running campaigns, delivering awareness training and offering confidential support.

the young people most in need of mental health support are the ones with least access

However, these interventions are all reliant on the young person seeking help, and typically the young people most in need of mental health support are the ones with least access (for example, reflecting the psychosocial and cultural context of health, some ethnic minority groups have additional risk factors for mental illness but experience poorer access to and quality of services).13,14

What more can be done, and how can we do it?

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Not all young people at risk have access to appropriate mental health care services

Prevention of suicide depends on a multitude of factors, including those at the individual level and those at societal level. All young people at risk (for example, those with a history of mental illness or self-harm) should have access to appropriate primary or secondary services, yet we know that this is currently not the case15, which is perhaps in part due to pressures on mental health services.16 However, we know that many young people end their lives without outwardly displaying any ‘warning signs’, so simply targeting those known to be at risk is not enough.

In addition to improved mental health services, there is a crucial role for schools, primary care, youth justice and social workers. These Tier 1 professionals should be appropriately trained and encouraged to promote wellbeing and awareness of mental illness, in addition to identifying it and making links with other services. Initiatives such as Connecting With People17 already exist, and could be expanded. This could make a difference to individual children, but also (assuming a large number of young people are supported) improve general public mental health.18,19

A ‘one size fits all’ approach to prevention and management is inappropriate when we consider that there are numerous at-risk populations (and that these populations do not necessarily have similar risk factors). Young people with a physical health problem are more likely to also have a mental illness such as depression, so case-finding and treating may help to reduce these young people’s risk.20,21 The Joint Commissioning Panel for Mental Health14 outlined guidelines for service commissioners for people from black and minority ethnic communities. These recommendations include collecting more data specifically assessing the needs of these communities, allowing for the modification of existing services to better reflect these needs, and trying to prevent the development of mental ill health by reducing social adversity and educating to mitigate stigma.

Similarly, we know that native and indigenous populations (for example, Maori populations in New Zealand3) are more at risk, so on a global scale it is vital to explore the potential reasons for this in order to implement appropriate prevention and management strategies.

Young people with a physical health problem are more likely to also have a mental illness such as depression

In the long term, research should focus on comparing the characteristics of those young people who complete suicide to those that do not, in order to try to identify risk factors arising as children progress through adolescence, and points at which intervention could be made. Globally, it is important to consider cultural, historical and socioeconomic domains and their role in the development of mental illness (and their contribution to risk), and encourage the creation of specific mental health policies focused on young people.3


Anna Taylor is a final-year medical student at the University of Bristol, has a BSc in Global Health, and will take up an academic foundation post in the North West in August 2017. She tweets under the handle @Anna_K_Taylor.


References

  1. Sinyor M, Tse R, Pirkis J. Global trends in suicide epidemiology. Curr Opin Psychiatry. 2017 Jan;30(1):1-6
  2. Office for National Statistics (ONS) Suicide in the United Kingdom, 2014 Registrations. Statistical Bulletin 2016:1-33
  3. McLoughlin AB, Gould MS, Malone KM. Global trends in teenage suicide. Q J Med. 2015; 108:765–780
  4. Bursztein C, Apter A. Adolescent suicide. Curr Opin Psychiatry. 2009; 22:1–6.
  5. Hawton K, James A. Suicide and deliberate self-harm in young people. Brit Med J. 2005; 330:891–94
  6. Suicide by children and young people in England. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). Manchester: University of Manchester, 2016
  7. Rowe SL, French RS, Henderson C, et al. Help-seeking behaviour and adolescent self-harm: a systematic review. Australian and New Zealand Journal of Psychiatry. 2014;48:1083-95.
  8. Windfuhr K, While D, Hunt IM, et al. Suicide in juveniles and adolescents in the United Kingdom. Journal of Child Psychology and Psychiatry. 2008;49:1155-75.
  9. Lindqvist P, Johansson L, Karlsson U. In the aftermath of teenage suicide: A qualitative study of the psychosocial consequences for the surviving family members. BMC Psychiatry. 2008, 8:26
  10. Foggin E, McDonnell S, Cordingly L, et al. GPs’ experiences of dealing with parents bereaved by suicide: a qualitative study. BJGP. 2016 [Epub ahead of print]
  11. Fairman N, Montross Thomas LP, Whitmore S, et al. What Did I Miss? A Qualitative Assessment of the Impact of Patient Suicide on Hospice Clinical Staff. Journal of Palliative Medicine. 2014. 17;7:832-836
  12. Papyrus. https://www.papyrus-uk.org/
  13. King’s Fund. Access to health care and minority ethnic groups. 2006. [online] Available from: https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/access-to-health-care-minority-ethnic-groups-briefing-kings-fund-february-2006.pdf [Accessed 21st February 2017]
  14. Joint Commissioning Panel for Mental Health. Guidance for commissioners of mental health services for people from black and minority ethnic communities. 2014. [online] Available from: http://www.jcpmh.info/wp-content/uploads/jcpmh-bme-guide.pdf [Accessed 21st February 2017]
  15. Carr MJ, Ashcroft DM, Kontopantelis E, et al. Clinical management following self-harm in a UK-wide primary care cohort. Journal of Affective Disorders. 2016. 197;182–188
  16. King’s Fund. Mental health under pressure. 2015. [online] Available from: https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/mental-health-under-pressure-nov15_0.pdf [Accessed 21st February 2017]
  17. Connecting with People. http://www.connectingwithpeople.org
  18. NHS England. Future in mind. Promoting, protecting and improving our children and young people’s mental health and wellbeing. 2015. [online] Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdf [Accessed 21st February 2017]
  19. Cole-King A, Lepping P. Suicide mitigation: time for a more realistic approach. Br J Gen Pract. 2010 Jan 1; 60(570): e1–e3.
  20. Williams JW Jr, Mulrow CD, Kroenke K, et al. Case-finding for depression in primary care: a randomized trial. Am J Med. 1999 Jan;106(1):36-43
  21. King’s Fund. Bringing together physical and mental health: a new frontier for integrated care. 2016. [online] Available from: https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Bringing-together-Kings-Fund-March-2016_1.pdf [Accessed 21st February 2017]

2 Responses to “Suicide in Young People – Policy and Prevention

  • Dr Knut Schroeder
    8 months ago

    Excellent article and a great summary of important issues around suicide prevention in young people. One point I particularly agree with is training of Tier 1 professionals, enabling them to spot the warning signs of mental health problems and providing support. There’s so much they can do without having to have an in-depth knowledge of mental illness – there are so many simple and straightforward steps to provide that little bit of extra support to young people which can make such a difference.

    • McrGlobalHealth
      7 months ago

      Hi Dr Schroeder,

      Thank you for commenting on our student blog. We are currently running a mental health feature and if you are interested in writing a short blog for us, please email us at admin@mcrglobalhealth.com. We would love to hear more from you.

      Thanks,

      Manchester Global Health Society

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