Preventing Suicide in Young People & Children
News and presentations from today’s conference chaired by Ann Rowland, Director of Bereavement Support and Education, Child Bereavement UK.
National Roll Out of Specialist Child and Adolescent Mental Health Services for High Risk Young People with Complex Needs (Community Forensic CAMHS)
Andrew Clarke, Implementation Lead – Forensic CAMHS, National Specialised Commissioning Team (Mental Health), NHS England
Andrew comments: "Lets know how to work with our young people.
Online counselling -Young people can hide behind a computer scrren but still be open and honest
Theres alot we can do for our young peope by wokring together. We can all lern how to recognise signs and changes."
For many years Forensic CAMHS services have only been available to a small number of young people and only in the areas where the services have previously existed.
A review of all young peoples specialised mental health services was carried out in response to the government paper Future in Mind (2015) and the NHS England Five Year Forward View for MH (2016). The review highlighted the disparity in CAMHS services across the country including that of Forensic CAMHS. A Department of Health study in 2013 by Dent et al, also identified the differences in the FCAMHS services that were in place, under CCG commissioning, and recommended the appropriate model for and FCAMHS service from evidence based best practice.
As a result of the evidence above a programme to roll out Forensic CAMHS services across the whole country has been implemented as part of the wider Children and Young People’s MH Transformation Workstream for Health & Justice and Specialised Commissioning, NHS England.
The National FCAMHS Service Specification will be delivered through 13 providers across the country covering regional footprints. The teams are small and highly skilled and knowledgeable in forensic mental health presentation and interventions.
These services are for young people with who have been in contact with the Youth Justice system, have very complex mental health issues, severe neurodevelopmental issues, present a serious concern to parents / carers and professionals and/ or are at risk of harm to themselves or others.
The services are community outreach services designed to support other services with the care of these young people. The clinical model of the service is graded with advice and signposting being the first level and then referral to consultation and assessment and also intervention for the very complex cases.
The Anna Freud Centre has been commissioned by NHS England to evaluate these services over the next 2 years to ensure they are delivering and meeting the needs as required.
Full PowerPoint Presentation
Support after a suicide – postvention is prevention
Karen Harvey, Service Improvement Manager (Education), Samaritans
Karen comments "Someone dies by suicide every 90 minutes
Someone contacts us every 6 seconds
20,000 Samaritan volunteers
Step by step support can be as short or long as needed."
Pre-Event Abstract: Postvention is prevention
By putting in place effective training, support, information and systems to respond to an attempted or suspected suicide, we can enable a community to recover, have access to appropriate support and build resilience, reducing the risk of further suicide.
Evidence shows us that those affected by a death by suicide are less likely to seek support, perceive less support is available, feel more isolated and stigmatised but are also at greater risk of a suicide attempt. It is therefore crucial that we consider, as part of a prevention plan, our responses to such tragedies.
A recent look at the language around suicide bereavement suggests that the term “exposed to suicide” should be used to describe anyone who knows or identifies with someone who dies by suicide and not merely those who witnessed the death. Exposure to suicide (i.e. knowing someone who died by suicide) is far more pervasive than previously considered.
In the first UK-wide study conducted recently to compare the effects of bereavement by suicide to bereavement by other causes in young adults, it was found that those bereaved by suicide were 65% more likely to attempt suicide, compared to those bereaved by sudden natural causes
Samaritans developed a service called Step by Step in 2010, based on research, their experience and expertise in reaching out to those in distress and providing people with a safe space to talk. The aim is to reduce feelings of distress, prevent stigma and isolation and to ensure that everyone knows how to support both themselves and each other.
All those who work with young people have a vital role in responding appropriately to an attempted or suspected suicide to help the process of recovery and improve the long-term outcomes for those impacted and reduce the likelihood of contagion. Through 8 years of supporting schools, colleges and other youth settings, Samaritans have developed a service that is based on timely response to ensure conversations are enabled and everyone has access to appropriate support as well as information about safe language to use. Further information can be found at www.samaritans.org/stepbystep.
Solitude, Social Isolation, Suicidal Ideation, and Self-Harm in Adolescents
Dr Margot Waddell, Consultant Child Psychotherapist
Pre-Event Abstract: Self-destructive states of mind
Weaving longer clinical examples of four young women with poignant vignettes, this paper sets out to bring psychoanalytic insight to a discussion of the troubling areas of self-harm and suicidal impulses and acts among adolescents and children. Thinking about the intense psychic pain felt by this age group, I raise vital questions for practitioners and parents. I ask how can one tune in to the situations that exert so unbearable a force on the young person that the only solution is felt to be attacking, or doing away with, the body and self altogether?
Moments of suicidal and destructive impulses and actions are carefully thought through in this paper using dream material and a wide range of voices from the Tavistock Adolescent Department. Within all these stories, one can find identifications with loss, abandonment and murderousness. Adolescence can bring with it crises of identity: confusion about the self in the present, and the future, as well as traumatic re-evocations of infantile states from the past. Fear and pain are involved in not only the changing body but also in the reworking of family ties and traumas. The recommendation to ‘go home’ if feeling suicidal is far from helpful in many circumstances, as ‘home’ may offer no solace.
With this in mind, tick-box risk assessment can only go so far; in psychodynamic assessment destructive emotions can be emotionally held, not just recognised. Quoting Robin Anderson’s list of factors to be kept in mind, I emphasise the importance of experience and intuition in recognising the subtle clues that indicate how serious the situation actually is. Within a supportive departmental structure, a fruitful relationship can develop between intuitive work and that based on medical research, rules and guidelines to bring us closer to understanding these often unbearable adolescent states of mind.
Future events of interest:
Improving Services & Outcomes for People who Self Harm
Implementing the NICE Quality Standard for Eating Disorders
Mental Health Support for Asylum Seekers and Refugees Providing Emotional First Aid for Refugees: Fourth Annual Conference
Psychological Therapies for Severe Mental Illness: Recovery through Early Interventions
Masterclass: Expert Assessment Skills for the Family Court
23 April 2018