Two important ways to support teens at risk of self harm
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The most common cause of death for young people is suicide (see Australian Bureau of Statistics Leading Causes of Death report, 2018). While this data is somewhat misleading for the simple reason that young people don't die very often - (and it's also important to know 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.
So what can parents do to keep teenagers safe?
Before I even start this article - let me emphasise this important point - it is not possible for parents to prevent their child or teen from hurting themselves if they are determined to do so. There may be many parents reading this post who have children who have hurt themselves and as well as those parents who have their children die by suicide - and I want to be really clear: this is NEVER a parent or carer's fault. This is a tragedy which happens to families - not one caused by them.
However, there are strategies parents can use to support teens who are struggling with self harm or depression.
These strategies include getting professional help when you are concerned about your young person, continuing to communicate with young people as much as possible, focusing on helping teens to get healthy amounts of sleep (shown to be significantly associated with positive mental health) and to exercise, reducing access to means by which young people hurt themselves (medication/cutting implements, ropes etc) and many other steps we can take.
However, in this post, I want to focus particularly on TWO other potentially very important strategies which I believe are worth some extra discussion.
Here's the first:
Doing 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.
As parents, 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. Don't let the teen "handle" it by themselves. Get the school counsellor to help, discuss what they might say and work really hard to helping them find safe places to be at school and at least one or two friends they can be with during the day. Forgive my mixed metaphors but red flags are waved loud and clear for me as a therapist when I am working with a young person who spends all break times alone.
* Actively working towards teenagers having social contact. 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. 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 - as parents we have to make some tiny steps towards this as "no choice" activities. Just like the veggies.
* Connecting teens with other adults. When young people are not willing or able to talk with us as parents, despite our best and persistent efforts then one of our new jobs becomes finding other adults for the teen to talk to. That might be school counsellors, coaches, pastoral support workers, youth workers, GPs, 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:
Helping 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. Parents/carers sometimes do a form of this by telling the teen they "must not" hurt themselves and tell them about what it would do to the family if they did this, and try to make them promise to not hurt themselves.
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. Email or message this link now to a teen you are concerned about and ask them if they would be willing to do this with you.
Alternatively you can take the teen out for a walk/drive/soft drink and ask them these questions (take notes on your phone/paper when they answer):
In which 3 or 4 situations or times of day do you often feel (or think you would feel) the worse?
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 parents 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 we personally 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.
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.
Remember:
If you are concerned about a young person, seek help straight away.
And then put some time into these two activities: 1) work at improving their social connections and 2) help them practice and know how to cope with feeling hopeless and sad.
https://www.beyondblue.org.au/get-support/beyondnow-suicide-safety-planning/create-beyondnow-safety-plan
Best wishes
Kirrilie
