Not all suicide attempts are preceded with a warning. However, many occur with at least some outward signal to friends or family members. Being able to Identify and respond to warning signs can help prevent suicide among teens and young adults.
Signs primarily seen in young teenagers and young adults may include some behaviours e.g, rebellion, anger at parents, which are common in most teenagers. Remember it is very easy to misinterpret signs of suicide attempts, so let me make some things clear. Most parents have clear evidence of consistent patterns of behaviour in their children, so use this as a baseline. First of all look for any unexplained changes in their behaviour:
- Decline in quality of schoolwork ( sudden poor grades from previously well performing students)
- Lack of involvement in school or work.
- Skipping school / truancy.
- Drug and alcohol abuse, look for evidence of how children spend their partime job wages
- Prolonged spells of internet use on websites such as You Tube, Facebook, Bebo, My Space, Second life, etc. many of these show suicidal techniques sometimes disguised as "Games"
- Check discreetly what your children look at by moving all computers into the family living area.
- Impulsive or aggressive tendencies.
- Consistent negative attitudes towards the parents.
- Violent or persistent behaviour.
- Disciplinary problems at school or home.
- Parents who argue consistently and produce family conflict
- Attempts to leave home
- Being "Grounded" regulalarly
- Neglect of personal appearance, hygiene
- Frequent physical complaints.( eg stomach ache, headaches fatigue, which are related to emotional distress.
- Breakdown in communication patterns between you and your children, eg do you know their innermost thoughts, can you relate to them, have you the ability to listen to their anxieties ?
- Obsession with death and poems, songs downloaded from the internet with explicit references to death, also drawings of death or suicide acts like "hangman". Try listening to their songs shared between them and their mates. Do this sensitively as signs often are transmitted through downloaded files from USA., where teenagers attempt and often complete suicide.
- Hopelessness , as evidenced by statements such as: " Nothing matters" " I won't be a problem for you anymore" " What's the point of living" "I wish I hadn't been born" " I wish I were dead".
Teenagers who talk about suicide often attempt or commit suicide.Therefore all inferences to suicide and depression should be taken seriously. No one can stop all suicides from happening, but you can make a difference to young peoples lives in your locality and further afield. Psychologists suggest the following techniques and strategies for parents:
1. First of all take your children into your confidence and make time to listen to them. Show unconditional love and acceptance.
2. Establish ground rules and reward positive appropriate behaviours. Any inappropriate behaviours should be openly discussed in a normal tone of voice with the children, avoid shouting and showing aggression. Be unconditional in your actions towards them and show them love, as most children and young people who are parasuicidal always speak of parents who do not love them nor show love towards them.
3. Try to keep lines of communications open at all times and encourage them to talk to you about their mates and close friends, their worries anxieties, likes, dislikes and any signs of bullying by others, even bullying on the internet and by mobile phones.If you see signs of this inform the mobile phone company immediately and restrict the use of the internet to an hour per night, where you as parents can monitor their online activity discreetly. School work could be an exception, but many switch to entertainment channels behind the parents back and go into suicide games and other aversive websites. Close monitoring can prevent this becoming a children's ritual and so break the thinking cycle.
4. Keep a check on who their friends are and what social activities they get involved in and where they are spending their leisure time especially if they are under 18 yrs old. Communication is the keyword here.
5. Do your children show any signs of distress? Look for signs of crying skin rashes on the arms or back due to stress reactions, do they show signs of nervousness for no apparent reason, are their eyes glazed or runny nose and eyes when they have no common cold symptoms.? These are minor signs of drug and solvent abuse and children /youth are conned by older peers into thinking this makes them feel and act "cool".
6. Reflect on their student / teacher relationship, if it seems stressful try to sensitively explore the issue and reassure the child that they are safe and you will support them and take action to redress the problem.
7. Teach them simple problem solving skills especially in terms of sexual jealously and losing a boy/girlfriend. These are constantly in young peoples' minds as they explore their sexuality and gender differences.
8. Try to teach them self assertion skills, these may be available soon or later on in the summer months and I can help you with these. Try the UK based Childline website( see website link on this site) for advice on these and many other websites UK based, for advice on assertive skills in young people and self protection.
9. If children or older adults are depressed, get them to write down a list of all their negative thoughts, starting with the most troublesome one, as many as they can write. Then take each one in turn and challenge it. For example a child writes " Nobody loves me". In an empathetic manner, ask them to show you the hard evidence that no one loves them( normally they cannot !) Then say " Jenny loves you, so there's a start, now, your dad and me also love you and so does …. " Then discuss the evidence of this love you show them. This works really well and the children then realize the futility of their thinking. Simply work along down the list and you will see a difference in their thinking patterns.This is the basis of cognitive behaviour therapy.
10. Get together with your friends and neighbours and form a self help group. I can help you facilitate this if you wish. Meet regularly and discuss emotions feelings threats fears in a supportive environment. Watch this suicide prevention site for details of summer courses in support and self help groups .
The Trust for the study of Adolescence : www.tsa.uk.com ( funded by the Department of Health) has published a wide range of study and training materials some of which is adapted here. I suggest that anyone reading this material if you find it to be of help in suicide prevention please do get in touch with the Trust, Email: info@tsa.uk.com and utilize their materials in your school projects or in your undergraduate study at University.
Dr.John Coleman, J Lyon and R,Pyper have produced the following material which is included in the training packages which also includes CD Roms and cassette material of real life case studies. Lets examine some currently held misperceptions about suicide.
Talking about Suicide and Self harm may be distressing for Adults
Many people say that if you advertise suicide prevention, or even talk about it formally to groups or informally to teenagers, it will trigger off suicides . This is factually untrue as there is not a shred of scientific evidence that talking about or advertising suicide prevention causes it to happen. When talking about responses to suicidal young people or working with people affected by completed suicides its important to remember that people may have painful memories on this subject.They also might have had previous experiences of self harm when they were teenagers. While some people may need time to talk through these past experiences, other s may not wish to talk about the tragedy of a young death and avoid it altogether. You have to accept their wish and respect their privacy. Scientific research informs us that after the immediacy of a young death by lethal means ie ligation, close friends go silent as does the entire community. No one wishes to approach the parents to sympathize because they do no know what to say, this is exceedingly hurtful to the parents and intensifies the deep psychological pain they are undergoing.
ATTENTION SEEKING
We have often hear people say that suicide attempts are often a cry for help or attention seeking. I recommend that you take every mention or indirect reference to suicide seriously. Its not true that people who talk about it don't do it. Many young people in Northern Ireland ,England, Scotland and Wales who have completed suicide have previously spoken about their thoughtsof suicidal intent. We as psychological researchers and scientists have discovered that the reasons for feeling suicidal are a constellation of factors not just a single cause. Every single young suicide is a highly complex phenomena and has to be understood within the wider sociological economic and political structure of society. Adolescence is a time of transition of childhood to adulthood. It involves trying to make sense out of the complex social world with its increasing psychological influences and pressures to conform and comply to established group behaviour patterns and attitudes.Teenagers areexperimenbting with their various identities and trying some on for "fit" to se if they are comfortable with one self concept. Often they are for a short time and then wish to switch to another identity.They are expected to move towards independence and manage their own lives economically as well as psychologically.The influences of school, adults peers and media, as pointed out by the above authors, are in continual conflict and frequently suggest an ideal image of youth culture which is highly unrealistic.Many teenagers feel inadequate and unable to cope with life because of their continual exposure to negative role models. Young people have high expectations and high ideals of adults which do not fit with what they find when they get older. Many are disillusioned by parental behaviour and this makes their children feel alienated disconnected and a burden on their family and peers.They feel as they become an adult thy will never " get it right" they will never become what Rogers calls a "fully functioning person."
RECOGNIZING RISK
All mention of suicidal thoughts should be noticed and the young person listened to carefully. Remember signs are very often not all that obvious.
SIGNS OF RISK:
We may consider that young people are showing extreme distress when the problem is interfering with their everyday behaviour. Look for the following changes in their behaviour:
A. In behaviour
B. In eating patterns
C. In weight
D. In friendship patterns
Suicide is more likely to be a risk if there has been an experience of loss such as
A. A broken relationship at any age
B. A death
C. The loss of contact with an important person
D. The loss of a job or cherished ambition
E. A profound loss of trust- such as sexual abuse.
Other indicators of risk are:
A. Suicide or attempted suicide by friends /relatives
B If the young person has attempted suicide before.
Especially vulnerable groups are:
Young men in prison
Young men living in isolated areas as farmers
Member of ethnic minority groups, especially Africans,
Carribean young men and Asian women
Gay and lesbian young people
Disabled young people.
Other factors which contribute to vulnerability, Identified by the authors are:
Abuse of drugs and alcohol
Poverty
Homelessness
Looked after young people.
Factors which may be common to these high risk groups as perceived by professionals:
Very low self esteem
Feeling Powerless to change the situation
Feeling trapped
Lack of helping resources, or ability to access them
Having a confusion of or problem with various cultures
Being unwilling or afraid to upset family /peers
Lack of knowledge and /life experience
Being or feeling isolated / distanced / cut off from others
No sense of hope in the future
Not belonging to a group.
The Trust for the Study of Adolesence cited above carried out a major study and here are the list of factors which they found to be common with "at risk" young people. These are factors extracted from the groups of youth in the study:
FEAR
Fear of Humiliation
Fear of madness
Fear of punishment
Fear of failing to cope
Fear of ongoing pain
Fear of shame and disgrace
HOPELESSNESS
That there will never be an end to the hopeless feelings
That I will never fit in again
That anyone will accept me
That I will be lonely forever
That there will ever be a cure for these feelings
That anyone will ever understand me.
HELPLESSNESS
I cannot ask for help
There is no one who can help me
I cannot help myself
It is too big for me to do anything about
Its too embarrassing to discuss as I will be judged negatively
I am trapped in a situation and I cannot change it
What has happened to me in the past cannot be undone.
( Trust for the Study of Adolescence 2002)
DELIBERATE SELF HARM
In government figures "self harm" means attempted suicide, and in statistics form hospital departments usually no distinction is made between deliberate self injury without suicidal intent and a suicide attempt.
For the the TSA , self harm usually means deliberate acts of self injury which may or may not involve the wish to die.Then most common occurance is physical mutilation of sorts such as cutting the skin or others ways of inflicting pain. There are a variety of acts which may be followed. The importance of the acts signifies to the cutter and to the outside world that the person is suffering intense psychological pain, relief comes form cutting the wrists usually. Most self harming is not lethal and unlikely to lead to death. Most young people who self cut do not intend to take their own lives. Acts of self cutting are signs of psychological distress which cannot be seen as having a common cause or common cure. The act has special meaning to every individual and this is what must be clearly understood. Its also important not to generalize about young people who self harm It is their way of coping with intense psychological pain.
DESCRIPTIONS OF SELF HARM
Inflicting pain in a way that shows on the body so as can be seen by others
The transformation of psychological torment into a manageable physical
Sensation
A release form a build up of tension
A purification of badness-blood letting
Inflicting pain as a punishment
As a way of subjecting the body to the mind or to spiritual concerns
As a way of repeating an old familiar sensation which, however painful, is a homely feeling
As a way of revisiting the "scene" of the crime
As a way of a release to avoid unacceptable truths / beliefs re: parents abusers, own bad behaviour.
Young people have very different motives for harming themselves
CAUSES OF SELF HARM IN TEENAGERS:
1. Family breakup or disconnection/ relocation
2. Frequent changes of home
3. Sexual /psychological abuse
4. Loss event, bereavement, broken romance/relationship
5. Lack of parental emotional warmth and physical contact
6. Hospitalization and surgery before age 15
7. Working in a medical setting ie nursing, residential care.
8. Being an achiever in sorts/ music
How does it happen?
The cycle of self harm begins by self disgust and then tension builds up.
A trigger event increases distress. This leads to increasing distress followed by self harming action which leads to relief form the tension is experienced resulting in guilt or shame a the self harm which riggers the cycle all over again.
STRATEGIES FOR HELPING:
RELAXATION
VENTILATING EMOTIONS
TALKING THERAPY
PHYSICAL EXERCISE
DISTRACTIONS
PHYSICAL CONTACT
REDUCING ISOLATION
SETTING ACHIEVEABLE TARGETS
SETTING UP A CONTACT CIRCLE.