Helping youth at high risk of suicide and

self harm

Dr Paul Denborough

Head Alfred CYMHS

Victoria 2010

• 66 youth suicides (15-24)

• 309 youth deaths

• 521 total suicides

• 2098 national suicides

Why do young people suicide

• Revenge anger and hostility combined with impulsivity

• Isolation-lack of connection

• Hopelessness

• Failure-usually perceived rather than actual

• Loss: real or psychic (i.e. self worth, relationship or goal)

Why do young people self harm

• Allows them to express emotional pain and frustration without hurting

anyone else or completely destroying themselves

• Offers a sense of control when they often have none

• To escape numbness

• Validates emotional pain

• Communicating to others a sense of inner turmoil

• Self punishment

• Can be a suicide attempt

Key points

• Young people should be given optimal care appropriate to their individual

needs and circumstances

• It is not possible to predict whether a particular young person will suicide

• It is possible to validly and reliably categorise those young people into

those at relatively higher or lower probability for suicide in the future

• Therapy can work particularly if significant others and family are included in

the process

Fundamental Elements that Promote Recovery

1. Hope

2. Empowerment

3. Mutual respect

4. Non-judgemental

5. Choice promoting

6. Collaborate

7. Solution focused

8. Strength based

Care teams

• High risk youth often have a number of professionals trying to help them

• Essential for these professionals to form a care team

Elements of a successful care team

• Identification of a co-ordinator

• Respectful interaction amongst participants

• Members expertise is valued

• Time is spent understanding each person’s role and perspective

• Commitment to adopting a solution focused/positive approach

• Input and commitment from all members

What Works in Therapy: the Common Factors

40% client extratherapeutic

15% model techniques

15% placebo hope expectancy

30% relationship

Successful vs. Unsuccessful Therapists

unsuccessful therapists focused on problems,

neglected strengths

successful therapists focused on strengths before

moving to problems

created an environment in which the patient felt he

was perceived as a well functioning person

The Alliance: Research Findings

Quality of alliance more potent predictor of outcome

than orientation, experience or professional discipline

Client perception of the alliance a better predictor of

outcome than therapists

Empowering Client Factors

1. Develop a change focus

- listen for change

- listen for key words that reflect change

- take notice and follow up

2. Listen for heroic stories

- attitude is the key re clients inherent

abilities this does not mean ignore pain or

assume Pollyanna Stance

Give voice to the WHOLE story

confusion AND clarity

suffering AND endurance

pain AND coping

desperation AND desire

3. Validate the clients contribution to change

4. Tap into the clients world

Empowering Alliance

• monitor clients reaction to comments

• stay close to their descriptions of their lives

(monitor and measure the alliance)

• be flexible (some clients will prefer formal over

casual)

• try and travel at clients pace

• validate client

• accept client goals at face value

Form all plans and tasks with the client

• fit the clients theory of change

• change is done with rather than to the client

Empowering Expectancy Factors

1. Believe in the client, in yourself and your work and in

the probability of change

2. Orient therapy toward a hopeful future

3. Highlight the clients sense of personal control

What to do when young person self harming

• Do not panic

• Deal with immediate medical issues

• Never make assumptions i.e. that they want to talk about it or it is attention

seeking

• Listen to what they have to say

• Be honest and non judgemental

• Set boundaries

• See the person not the injuries get help with own reactions

• Hospital stays short but as frequent as required

• Therapeutic alliance is established with a community therapist

• Young person is linked with community supports

• Clinician’s working with high risk young people feel backed up by senior

management and the system