A sad and tragic fact of our world in 2017 is this: the most common cause of death for young people is suicide (see Australian Bureau of Statistics Leading Causes of Death report, 2015). While this data is somewhat misleading for the simple reason that young people don't die very often (and also important to know that death by suicide is more common in adults than in young people) - it is still distressing and worrying. This is especially true when we know that rates of deliberate self harm and attempted suicide is higher in young people than in any other age group.
For teachers, psychologists, counsellors and youth workers this is unfortunately all too familiar. We frequently work with young people struggling with suicidal thoughts and who self harm - to keep them safe, increase hopefulness and positive mood, decrease the frequency of their self harm and prevent suicide.
There are a range of strategies we can use with young people to do these things, depending on the young person and our relationship with them.
However, in this post, I'm just going to focus on TWO other potentially very important strategies which I believe are worth some extra exploration.
Here's the first:
1. We should do everything we can to help teens be connected with a peer group.
While there are many factors which are associated with an increase in depression, self harm and suicide attempts - there is one clear protective factor which research studies consistently find is associated with well-being in teens: positive interpersonal relationships.
Here's what we know: teens with better relationships with their peers and other adults are less likely to experience depression and self harm and more likely to recover from episodes of depression and stop self harming.
This means almost anything we can do to help teens to feel more connected to their peers is likely to be useful. This might mean:
* Actively intervening when persistent conflict and bullying occurs. Teens often don't have the skills to "handle" persistent peer conflict or bullying themselves. Often we need to help. This might mean:
Role playing conflict resolution conversations with the teen
Helping the teen to do perspective taking/role playing exercises taking two different sides of a situation
Helping the teen to practice assertive statements and body language with us
Starting a process of mediation or restorative justice
Helping the young person to find safe and secure places to be (including off-line mini holidays)
Working with the young person to help them see conflict as common, and with an "end point"
Helping the young person take small steps (possibly including those taken online) to connect with a new peer group where necessary
* Actively working towards teenagers having social contact in general. For many teens there might not be any apparent conflict or bullying - but instead the teen is just withdrawn and isolated.
This is a significant problem.
Teens need friends to maintain good emotional health. As professionals we need to be on the lookout for and working with isolated teens to help them find these connections - because young people are often not capable of doing this themselves.
By the way, young people don't reliably report being isolated or disconnected from their peers. There is such a social cost to admitting this (either to themselves, or to another person) that we have to "dig" pretty hard to find it sometimes. I will often ask young people for the names of friends, and when (or the topic of) was the last conversation they had with them - to get a more accurate measure of the level of social connection in teens.
As professionals we need to then look at the reason for the social isolation (typically these reasons fall into categories of ability - can't do it; motivation - don't want to do it - which could be for reasons of anxiety management or depression). When we know what the reason for the social isolation, we can then chip away at this and work towards improving social connection. It's not easy, but we might be doing things like:
Working with parents/carers to help them encourage/enforce some opportunities
Setting social goals for teens (these might be tiny - eg one "like" on a social networking page, or one "hi" as they walk past another friend)
Practising initiation of conversation, greetings and suggesting activities
Thinking about how young people can manage their anxiety
Incidentally, I talk with parents about the fact that having a job or doing at least one extra curricular should be a non negotiable for all teens. Just like we insist that our teens eat some kind of vegetables and at least look at homework every now and then - we need to be insistent that they spend time working towards finding friends. Of course this is NOT easy for some teens who don't "fit" or who are resistant. But it is something we have to keep talking about, working on, creating opportunities for and often - parents have to make some tiny steps towards this as "no choice" activities. Just like the veggies.
* Connecting teens with other adults. Another way of increasing the quality of interpersonal relationships for young people is to help them be connected to positive adult role models.
As professionals we might be looking at how we help them resolve conflict with parents, spend more time with coaches, GPs, adult neighbours, aunts/uncles or friends of the family.
However we do it, working gradually and persistently at helping teens have better peer and adult relationships is one of the most important steps we can take when young people are down.
Here's a second important strategy:
2. We need to help teens learn strategies to cope when they are feeling agitated, stressed, hopeless and overwhelmed
A long time ago, one of the regular conversations I would have with self harming and suicidal teens was a "safety contract" conversation. Essentially this meant I asked the young person to make a commitment to stay safe and not hurt themselves until the time of the next session.
Unfortunately research shows that safety contracts do not work well (Lewis, 2007).
When young people are feeling agitated, hopeless and overwhelmed - even if they want to stick to a promise - they may be unable to.
What works more effectively is to help young people know, practice and plan for what to do when they feel like hurting themselves.
Sometimes this means having a conversation with teens to help them write down what they will and won't do when they feel really down.
The best tool I've found for this is the Beyond Blue safety planning tool. I've included a link to this at the bottom of this article. This page allows people (young and old) to think about what triggers their hopelessness/desire to hurt themselves and what they will do when this occurs. Teachers, counsellors and any responsible adult - can do this in the room with a teenager with self harm or suicidal thinking in about 15 minutes. We can do it online by just clicking on the link, or have the young person download the (free) app on their phone and use that. It's also a good way to find out more about triggers and protective factors.
Alternatively you can take ask young people these questions (take notes when they answer):
What 3 or 4 situations or times of day do you often feel the worse in?
What short sentences can you say to yourself at those times which help you focus on a positive future or why things aren't as dark as they seem?
What mental or physical activities can you do at those times to keep your mind busy?
Who can you be around at those times which help you be distracted from your hopelessness?
At those times of hopelessness/desire to hurt yourself - what should you NOT do (ie what makes you feel worse?)
At those times of hopelessness/desire to hurt yourself - how can you take things out of your environment so you don't have easy access to ways of hurting yourself?
Who can you call/message/email/ask for help from at those times?
Write down what they say (help them with ideas if necessary) and take a photo of it and send it to their phone.
As well as doing a written safety plan with young people, as professionals we should also be slowly but consistently working on making sure they actually have this range of activities, relationships and supports which they can call on, as well as knowing how they can cope with distress. We need to be sharing with teens about how other young people cope with sad, hopeless and tough times. We need to be asking them what works for them - or what they've seen other people do. We might even share (carefully) what we do.
Again this is not easy because many teens are resistant to this work and these conversations. However, it's such a vital part of keeping teens safe that it shouldnt be entirely up to them as to whether they do it or not.
If you are concerned about a young person, seek help straight away. Talk with a supervisor, call mental health services in your state - if you have no-one to call, feel free to email me directly at firstname.lastname@example.org
And then where you can, work with young people on these two activities:
1) Work hard at improving their social connections and;
2) Help young people identify ways to cope with feeling hopeless and sad - and help them practice these, and build systems to be reminded of them when they need them
All the best in this important work. If you would like know more about how we support professionals who work with kids and teens, click here.
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