Suicide Awareness and Trauma-Informed Mental Health Approaches for Children

Purpose

The purpose of this module is to review two important aspects of psychiatric disabilities for children and adolescents. Although not explicitly indicated the connection between trauma and suicidality is explored.

Retrieved from: TOT 3: Suicide Awareness and Trauma-Informed Mental Health Approaches for Children (2019)

Begin here - Justice Serai writes about her experience with her four-year old who became suicidal in this blog. https://themighty.com/2015/07/i-never-knew-a-4-year-old-could-be-suicidal/

The Centers for Disease Control identify suicide as one of a number of things identified as self-directed violence (SDV). SDV includes fatal suicide, suicide attempts and something the CDC is referring to as Undetermined SDV such as self-mutilation (CDC, 2011). According to the CDC suicide is tracked well but other forms of SDV are not well documented at this point. Currently there is an effort to define and gather more information on non-suicidal forms of SDV. Although the overall numbers of children who engage in SDV is lower than the adult population the numbers are still alarming.

What is Suicide?

According to the CDC, Suicide is defined as “a death caused by self-directed injurious behavior with any intent to die as a result of the behavior.”
A Suicide attempt is “a non-fatal self-directed and potentially injurious behavior with any intent to die as a result of the behavior. A suicide attempt may or may not result in injury.” (CDC 2017).

In 2015 Suicide was the third leading cause of death for children ages 10 – 14, and the second leading cause of death for ages 15 – 24. There are a number of risk factors associated with suicide. The CDC has categorized them into four levels to account for the varied reasons people identify for choosing to end their lives.

Individual Level – This includes a history of depression and other psychiatric disabilities, feelings of hopelessness, substance abuse, certain health conditions and disabilities, previous attempts and violence. There has been an important association of suicide to bullying although the CDC cautions people from stating the bullying “causes” suicide. If you would like more information on this relationship read through the CDC pamphlet: The Relationship Between Bullying and Suicide: What We Know and What it Means for Schools. https://www.cdc.gov/violenceprevention/pdf/bullying-suicide-translation-final-a.pdf

If the link doesn’t work, copy and paste it into your browser.

Relationship Level: This includes relationship characterized by high conflict or violence, poor social support, neglect or isolation, history of family suicide, and financial stress.

Community Level: This include marginalization or inadequate community connection, barriers to health and mental health care.

Societal Level: Availability of lethal means to suicide, unsafe portrayals of suicide, stigma associated with help-seeking behaviors. View this video and article on adolescent cluster suicides. Note that there are greater numbers of childhood suicide in communities plagued by violence and poverty but I have experienced two suicide clusters with adolescents in my career and both were in areas of wealth like in the Atlantic article.

Suicide clusters – Atlantic

https://www.theatlantic.com/magazine/archive/2015/12/the-silicon-valley-suicides/413140/

The bottom line is that anyone, including children, who are contemplating suicide are feeling pain and hopelessness – it doesn’t matter the reason. This TED Talk by Mark Henick will give you an excellent understanding of what is going through the mind of a teen in that moment when he/she is considering suicide. Warning this is hard to listen to, especially if you have had any experience with suicide or suicidality. You don’t need to listen to this TED talk to complete the module. https://www.youtube.com/watch?v=D1QoyTmeAYw

Read the article by Tischler, Reiss and Rhodes on suicide behavior in children (in the Readings and Resources file). The article provides a nice overview of the risk factors identified above, as well as some suggestions for screening children you think might be suicidal. This was written specifically for emergency department personnel but the suggestions for screening children are helpful to school staff as well. Also, if a child is thought to be suicidal then it is extremely important that someone accompany the child and the family to the emergency department as people with psychiatric disabilities are not always well treated in these departments - for a number of reasons. ** IMPORTANT to note – This article was published in 2007 but the rates for adolescents have risen significantly, especially for girls ages 10-14 where the rates tripled. The reasons are speculative, focusing on the economic downturn and the rise of heroin and painkillers use and earlier puberty (National Centers for Health Promotion, 2016).

Retrieved from: TOT 3: Suicide Awareness and Trauma-Informed Mental Health Approaches for Children (2019)

Group Discussion Post:

Watch this TED talk by Jenny Buscher on How Can We Prevent Childhood Suicide. When you are done watching, post your thoughts about what you have learned about suicide and children and what role, if any, would OT have in suicide prevention in schools. Once you have shared your thoughts, read and comment on other people’s comments.Final note on working with a child who is feeling fearful, hopeless, helpless and/or is acting “seemingly” irrational. When I was working in pediatric and adolescent inpatient I learned the value of asking these three questions, in this order, and then really listening to the answers. Jenny addresses the first one in the TED talk you just watched but all three questions – together, are a powerful way to open the door to self-determination and a to increase the person’s sense of self-control when they are experiencing a moment of feeling very out of control. What happened? Or what happened to you – (instead of what’s wrong with you?), What can I do to help you?, What can you do to help yourself? Much of the previous information above comes from this CDC publication. You can download it CDC Preventing Suicide: A Technical Package of Policy, Programs and Practices https://www.cdc.gov/violenceprevention/pdf/suicide-technicalpackage.pdf

As OT’s it is our responsibility to ask the right questions and show up. We are bred to want to help people, but our perspective on helping others is so much more complex than what their neurological state behind suicide is. OT’s look at the person as a whole and consider other obstacles that might be leading to their decision to end their own life. Our role and job is to make sure we sit and take in everything that they have to say. Kids get their opinions pushed to the side so frequently and are usually told what is best for them, but they are not dumb. Kids are very intuitive, and they see and hear everything. While they may not fully understand the context of what is happening around them, they are able to make decisions about their own bodies and know what is good for them. I think Jenny Buscher’s point that what Suzie decided to do in order to get the help that she needs was in fact very adaptive. It was a new perspective on what the other adults in the situation were missing. The other adults immediately stigmatized her and placed a label on her due to her previous behaviors. Yes, that is a typical response and adults must be cautious and aware, but nowhere in the line of questioning did they seek Suzie’s perspective. Kids want to be understood. As a teenager, how many times did you think or scream at your mom that she just doesn’t understand. Well, similar things are happening to children with suicidal thought and attempts. It’s hard to understand if you don’t understand, or aren’t willing to understand, and many adults are not willing to understand. Parent’s rarely listen to their kids and the kids see that. The speech Jenny Buscher gave was inspiring and provoked a new perspective for me to take with me. I want to be better at listening when kids speak to me and not just brush off their opinions. When I babysit, I try to listen and be agreeable, but there is a limit between fun and practicality. Kids will push the limits, but not listening and losing a child to suicide is not worth the risk for me. I want to strive to be better and hopefully accept Jenny’s question by being someone that can help prevent childhood suicide rates.

Office for Victims of Crime Training and Technical Assistance Center (VAT)

The courses can be found on the Victim Assistance Center (VAT) at

https://www.ovcttac.gov/views/TrainingMaterials/dspOnline_VATOnline.cfm

The 2 courses you will take are: VAT Online – Specific Considerations: Children and Youth; VAT Online – Core Competencies and Skills: Trauma- Informed Care

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