What are they thinking?

Understanding youth mental health for 21st Century Parents


Parents Support

Understanding youth mental health



Youth Mental Health Awareness and Suicide Prevention

Ireland has the fourth highest teen suicide rate in the EU/OECD

Well-being of Young People 2017 - UNICEF

Youth Suicide Prevention Ireland has been working for over 10 years to provide free education and training services to schools and colleges around Ireland. According to the World Health Organisation's 2016 report suicide is the 2nd highest cause of death amongst young people across the World. Sadly Ireland is not spared from this problem which affects almost every community in the country.

In the European Union during 2015, according to Eurostat, there were approximately 56,000 reported deaths by suicide making it one of the leading causes of death. Males accounted for 43,000 of those deaths or 76%.

According to research by UNICEF published in 2017 Ireland has the fourth highest teen suicide rate in the EU/OECD region. The organisation's latest report card on well-being of young people found that Ireland's suicide rate amongst adolescents aged 15 to 19 was 10.3 per 100,000 population and ranks well above the national country average of 6.1 per 100,000.

Parents are so important to the development of personality, social skills and self-worth in a young person. In ideal world they would always be the first people a teenager turns to when they are in distress but for any number of reasons this is not what normally happens.

In this guide we will try and give adults, and particularly parents, an overview of youth mental health with an emphasis on suicide awareness and prevention, the issues that young people have to deal with and the warning signs that they are not coping with the issues facing them.


An overview of youth self-harm and suicide

Suicide and self-harm in the youth of Ireland is receiving an increasing amount of coverage over the last number of years, and with good reason. Unfortunately, Ireland is one of the most severely affected countries in the EU in this regard. While there is some recent cause for very cautious optimism, there is much work yet to be done.

While depression and self-harm is far more common in females than males, completed suicide remains far more common in males. In the past, one of the explanations given was that while females were more open about describing their feelings, males tended to “bottle them up”, and often resorted to drugs or alcohol to deal with their emotional distress. However, recent work done by the HSE has shown that drug and alcohol misuse is at least as prevalent in teenage females as males, suggesting that we have to look elsewhere for reasons.

While the suicide rate is a very important indicator, by no means does it tell the whole story. The rates of depression in young people are extremely important, because the level of impairment which depression causes can be marked, preventing young people from reaching their potential, and affecting them emotionally, academically and socially. The issue of self-harm has certainly generated much discussion over recent years, with some research suggesting that children as young as seven years old can engage in such activity. While this is very much the exception, it nonetheless backs up the impression that self-harm in young people is happening at a younger age, and appears to be more widespread. There are many reasons why people engage in self-harm, and it would be wrong to assume that everybody who engages in self-harm is suicidal, and equally it would be incorrect to assume that everybody who engages in self-harm is depressed. Nonetheless, it does represent a worrying act because of its associations.

The most common forms of serious self-harm are cutting (particularly to the arms, but less frequently to the legs, abdomen and torso) or poisoning (particularly with over-the-counter medications), and choking/hanging (which is more common in completed suicides).


What should I be watching for?

Parents are in the unique position to observe teens individually or in groups, to sense the emotions seething under the surface, and to monitor subtle changes in behaviour, and to realise that the teen in reality might be a hurting human being.

It is possible for parents, through no fault of their own, to misinterpret a warning sign of suicide or to not even be aware of it. This can be said of the most caring of persons. We were not born with intuitive knowledge. Along with everyone else, we must be trained to discern the messages and signals that our teens are sending out.

Someone might ask, "Won't I appear foolish if I misread the signal and get involved in a non-suicidal situation?" That is possible; but if we need to appear foolish to possibly save a life, then it is better than to suffer self-recrimination for doing nothing. The risk of a teen dying is more serious than the possible risk of being embarrassed for asking the "wrong" question. If a parent does raise the question of suicide needlessly, the only reaction possible is a positive one - "This parent cares."


General Warning Signs of mental health issues

If someone is seriously depressed and/or thinking of attempting suicide there are often warning signs that family and friends can pick up on. Noticing and acting upon these warning signs could save a life. Most people who are dealing with mental health issues, or considering suicide, are willing to talk about their problems if someone shows they care. Don’t be afraid of discussing these subjects with someone you think may be in crisis. Talking about emotive issues or even suicide won’t ‘plant the idea’ in someone’s head. This is a myth. If you are wrong, you’re at least showing a friend you care. If you are right, you could save their life.

Sometimes stress or a traumatic event like bereavement can trigger depression or even suicidal thoughts in a vulnerable person. For this reason it’s important to ask teenagers who are going through a tough time how they are coping and if they need some support. Having someone to talk with can make all the difference.

Warning signs can include but are not limited to:

  • Withdrawing from family and friends.
  • Having difficulty concentrating and thinking clearly.
  • Sleeping too much or too little.
  • Feeling tired most of the time.
  • Gaining or losing a significant amount of weight.
  • Talking about feeling hopeless or guilty.
  • Talking about suicide or death.
  • Self-destructive behaviour like drinking too much or abusing drugs.
  • Losing interest in favourite things or activities.
  • Giving away prized possessions.
  • Mood swings.

Additional warning signs that a teen may be in crisis:

  • Change in eating and sleeping habits
  • Withdrawal from friends, family, and regular activities
  • Violent or rebellious behaviour, running away
  • Drug and alcohol use
  • Unusual neglect of personal appearance
  • Persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork
  • Frequent complaints about physical symptoms, often related to emotions, such as stomach-aches, headaches, fatigue, etc.
  • Not tolerating praise or rewards

IMPORTANT NOTE

If someone mentions suicide, take it seriously. If they have expressed an immediate plan, or have access to prescription medication or other potentially deadly means, do not leave them alone. Get help immediately.


Frequently Asked Questions

1. Why do people die by suicide?

People who die by suicide are often having intense feelings of helplessness and hopelessness and may not see any other way out of their emotional pain. It is important to remember that most people who attempt suicide do not really want to die. They simply want to end the pain they are experiencing.

2. Is it true that people attempt suicide as a cry for help?

The suicide attempt is quite often a conscious or unconscious method for getting others to recognise just how badly the individual is feeling. Yes, suicide attempts are very often cries for help

3. If someone in a family has completed suicide, are other members of the family tempted to try suicide when they have problems?

If someone in a family has completed suicide, other family members may be tempted because suicidal behaviour has been "modelled' for them. However, suicide behaviours are not inherited in families.

4. Do people ever attempt suicide to "get attention" or to get others to feel sorry for them?

Anyone who attempts suicide in order to get attention desperately needs it. It is tragic when someone feels they need to bargain with their life in order to have their problems taken seriously. Any suicide attempt needs to be taken seriously.

5. If a person attempts suicide and fails, what is the likelihood of them trying again?

One of the important warning signs for suicide is a prior attempt. Anyone who attempts suicide once is more likely to try suicide again than those who have never attempted. However, many people who receive licensed professional medical and behavioural health care following a suicide attempt may never become suicidal again.

6. Is it true that people who attempt to kill themselves really don't want to die?

Many people who attempt suicide are ambivalent about life. They want to live and die at the same time. But, as noted in number 1, it is not that the person really wants to die, but rather that death may seem like the only way to end the emotional pain the suicidal person may be feeling. It is the pain they want to end usually, not the life.

7. Will a person who is deeply depressed always become suicidal?

While it is true that suicidal feelings often develop in a person who is deeply depressed, the fact that one is depressed does not mean that a person will become suicidal.

8. Does anyone ever impulsively try suicide and then become sorry for making such an attempt?

A person at a particular moment may find the emotional pain being experienced absolutely intolerable. At a given moment, a suicide attempt might impulsively be made which, in retrospect, might be regretted.

9. Does taking drugs or alcohol increase one's chances of becoming suicidal?

Taking drugs or alcohol in excess can exaggerate painful feelings to a point where the feelings become intolerable. In such a state, a person might attempt suicide who otherwise would not go that far.

10. Is a person who attempts suicide mentally ill?

All suicidal individuals are not necessarily mentally ill, though many people who attempt or complete suicide may have symptoms of mental illness, the most common being some form of depression. It is important to note that most depression is of a temporary nature and is treatable.

11. Is it true that gay teenagers are at higher risk for suicide than teenagers in general?

Studies in the US indicate that gay, lesbian and bisexual youth account for some 30% of all youth suicides, yet constitute only about 10% of the total youth population. Thus, it is clear that such youth are at much higher risk for suicide than the youth population as a whole.

12. How can one help a person who is suicidal?

A person who feels that life is too painful is often feeling very worthless, perhaps unloved, perhaps isolated Showing such individuals some real caring, by listening to them, accepting their feelings without judgment, by staying close, and getting others to be supportive, can really help. Giving time and really listening to someone in crisis is critical. It may be important to refer the person to a professional medical or mental health worker at some point.

13. How does talking about suicide help to prevent it?

Talking about suicide diffuses some of the intensity of suicidal feelings. It helps the person get connected to the help that may be needed. It creates a climate of caring and helps to break through the loneliness and isolation a person may be experiencing. By asking someone in crisis if they are suicidal, we give that person permission to talk about possible suicidal feelings, about which they may otherwise feel they cannot, or should not, talk about.

14. Is suicide or attempted suicide against the law?

At one time suicide or attempted suicide was against the law. In Ireland it has only been within the last 20 years that suicide has ceased to be a crime.

15. What effects does a suicide have on the individual's remaining family and friends?

The survivors of a suicide are left with complex and often confusing feelings of rage, guilt, despair, grief, loss, shame, etc. Recovery from the loss of a loved one by suicide is a very difficult form of grief to resolve, and may never be completely resolved. It has been estimated that every suicide, on average, has a direct, profound emotional impact on 8 to 12 other people. With some 30,000 suicides each year in the EU, there are consequently a huge number of emotionally impacted "suicide survivors".

16. Why do some people keep secret the fact of a suicide in the family?

Some people keep the fact of suicide in the family a secret out of fear of being blamed or socially ostracized. Fortunately today, much of the historical stigma of suicide is lifting and people are dealing with suicidal death more directly and honestly.

17. What are the most common methods used by teenagers to attempt or complete suicides?

Lethal methods for attempting suicide by teenagers include guns, hanging, carbon monoxide, jumping, and drug overdoses. Auto accidents account for many deaths, but it is often difficult to determine whether the death is suicide or an accident.

18. Do more men or women make attempts on their lives?

Although about three times as many women attempt suicide than do men, about four times as many men complete suicide than do women. This is due to the fact that men use more lethal methods, such as guns or hanging, while women are more likely to attempt suicide by using pills.

19. Does everybody think about suicide at least once in their lifetime?

At some point in their lives, most people have at least fleeting thoughts of suicide, especially in times of personal crisis but it does not mean a person will die by suicide.



The role of the listener

For parents the role of listener can be a bit unnerving. As parents we are much more used to talking, to taking charge of our teens and being the source of information. In terms of assisting a teen who wants to express themselves to us we need to become more passive.

The funny thing is that listening seems to be so challenging when actually it can be quickly and easily learnt by using the techniques of Active Listening. Active Listening is widely used by helplines such as the Samaritans as it allows a consistent approach, established empathy but, importantly, also allows the listener to keep distance between themselves and the person who wants to talk.

General guidance

It is actually ok to ask teens about their mental state. We need to know where their thoughts are going even though it may seem challenging.

So how do you ask a teen about their thinking?

  • DO be yourself. Let the person know you care, that he/she is not alone. The right words are often unimportant. If you are concerned, your voice and manner will show it.
  • DO Listen. Let the person unload despair, ventilate anger. No matter how negative the conversation seems, the fact that it exists is a positive sign.
  • DO be sympathetic, non-judgmental, patient, calm, accepting. Your family member is doing the right thing by talking about his/her feelings.
  • DO offer hope. Reassure them that help is available and that these dark, possibly suicidal feelings, are temporary. Let the person know that his or her life is important to you.
  • If the person says things like, “I’m so depressed, I can’t go on,” ask the question: “Are you having thoughts of suicide?” You are not putting ideas in their head; you are showing that you are concerned, that you take them seriously, and that it’s OK for them to share their pain with you.
  • DON’T argue with them. Avoid saying things like: "You have so much to live for," "Your suicide will hurt your family," or “Look on the bright side.”
  • DON’T act shocked, lecture on the value of life, or say that thinking these thoughts is wrong.
  • DON’T promise confidentiality. Refuse to be sworn to secrecy. A life could be at stake and you may need to speak to a health professional in order to keep your teen safe. If you promise to keep your discussions secret, you may have to break your word.
  • DON’T offer ways to fix their problems, or give advice, or make them feel like they have to justify their feelings. It is not about how bad the problem is, but how badly it’s hurting your friend or loved one.
  • DON’T blame yourself. You can’t “fix” someone’s depression, only support them, seek professional assistance and offer love.


Fighting stigma

One of the most positive influences we can have is by fighting stigma. There is still a huge amount of stigma attached to suicide, and this can be further instilled by religious or moral teachings.

Some teens have given us feedback that when they wanted to visit a friend who had attempted suicide they were actively discouraged by some parents from doing so; although the same parents had been encouraging their teens to visit a young teen from their school who had been diagnosed with leukaemia. The teens couldn’t see how the situations differed but they were being given different advice.

None of us are perfect, and we all have prejudices, but it is so important that we allow our teens to develop their own attitudes to issues which challenge them, their friends and peers. This is particularly the case with suicide, where we often still see the young person who has lost their way and tried to end their suffering treated as a perpetrator rather than a victim.



HELP AND ASSISTANCE

If you are concerned about yourself, friends or family get immediate support and information 24/7 FreeText HELP to 50015

Texting 50015 is free of charge from any network and you can text this number even if you have no credit. This service is fully confidential and YSPI has no information on mobile numbers that use the FreeText service. The FreeText service is provided and supported by NeonSMS, Little Island, Cork.

For information on:

  • Emergency Contacts
  • National Helplines
  • Local Support Groups
  • Directions to your nearest GP or out of hours clinic
  • Directions to your nearest safe place or refuge

If you need help or support please visit our website ineedhelp.ie for information and contact numbers.

Visit ineedhelp.ie


IMMEDIATE ASSISTANCE
In case of an emergency

  • contact your GP or out of hours service.
  • take the person to your local hospital or A&E department
  • seek crisis counselling through the IACP

Always call 999 if someone is seriously ill or injured, and their life is at risk.
Gardaí / Ambulance / Fire call 999 or 112