Nurses and other health professionals can play a key role in preventing young people taking their own lives by identifying risks and factors that may be the “final straw”, says the first in-depth national study of child suicides.
The report, by the University of Manchester’s National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH), highlights the need for improved access to child and adolescent health services.
“Self-harm is strongly associated with increased future risk of suicide”
But it also makes it clear that primary care, social services, youth justice and schools have a role in suicide prevention.
Researchers studied reports from a range of investigations and inquiries into the deaths of 130 young people aged under 20, who committed suicide between January 2014 and April 2015. It is the first time there has been a national study of suicide in children and young people in England on such a large scale.
The findings show 41% had been in contact with mental health services, while 30% were involved with the police or youth justice and 18% had contact with social services.
More than a fifth – 22% – had been in contact with one or more agencies in the week before their death, including 16 young people who had been in touch with mental health services. However, 43% had no known contact with any services.
The study also highlighted the link between self-harm and suicide, as more than half – 54% – of young suicide victims had a history of self-harm.
“Nurses working in mental health and those working with children can give vital support”
Meanwhile, 10% had an episode of self-harm in week prior to death and in three cases were treated at A&E.
The report identified a complex range of underlying factors and “final straw” events that can bring children and young people to crisis point.
The research found 28% of the young people who died had been bereaved and in 13% there had been a suicide by a family member or friend.
Over a third – 36% – had a physical health conditions, such as acne and asthma, and 29% were facing exams or exam results when they died.
“Suicide is a leading cause of death in young people,” said Professor Louis Appleby, director of NCISH. “We found the risk rose sharply from mid- to late teens and the reasons appear to be complex.
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“There are often family problems, such as drug misuse or domestic violence, and more recent stresses, such as bullying or bereavement, leading to a ‘final straw’ factor, such as an exam or relationship breakdown,” he said.
The report said services working with young people, especially in health, social care and education can help prevent suicide by “recognising the cumulative pattern of risks” and such “final straw” stresses.
In particular, the report authors highlighted the need for improve support around self-harm.
“Self-harm is strongly associated with increased future risk of suicide and is one of the main warning signs,” said Professor Nav Kapur, NCISH head of suicide research.
“It is crucial that there is improved help for self-harm and access to mental health care,” he said. “However, with the variety of factors we found with this study, it is clear that schools, primary care, social services and youth justice all have a role to play.”
The Royal College of Nursing agreed that early intervention was vital.
“This report paints a picture of young people with a variety of problems, who find themselves unable to get the support they need,” said Ian Hulatt, professional lead for mental health at the RCN.
“Issues like bullying or bereavement can make young people feel trapped with some tragically feeling that their only escape is to take their own lives,” he noted.
“Nurses working in mental health and those working with children can give vital support and identify those at risk, and it is heartbreaking that young people have not known where to go or struggled to get help,” said Mr Hulatt.
“Early intervention is absolutely crucial, which is why there needs to be a far greater focus on young people’s mental health throughout the school system, and a real recognition in the health service of the devastating impact when these needs are not met,” he added.