“Some guidance and somewhere safe”: Caregiver and clinician perspectives on service provision for families of young people experiencing serious suicide ideation and attempt

Abstract

Background: Previous research has recommended the involvement of caregivers in the treatment of young people with depressive illness, but the best form and type of involvement remains largely unknown. This qualitative study aimed to explore clinician and caregiver perspectives on service provision for family members of young people (15-25 years) attending a specialist clinic for moderate-severe mood disorder.Methods: Eight caregivers, and eight specialist clinicians were interviewed via a semi-structured interview. Thematic analysis was used to interpret qualitative findings.Results: Thematic analysis revealed four key themes related to caregivers initial needs, crisis needs, discharge needs and broad challenges. Recurrent subthemes included the need for both information and support, especially at times of heightened suicide risk, or preceding a suicide attempt. Caregivers sought greater information, specific to their young person, and more support and guidance in their role managing the safety of the young person in their care.Conclusions: Results highlight that addressing the unmet support and information needs of caregivers may be of benefit to all (both the caregivers and the young person in their care). The lived experience of caregivers in this study indicates the significant stressors placed on them (especially when the young person they are supporting is at high risk of suicide), and the need to develop efficient and cost-effective ways to enhance their perceived competence and skills. Implications are discussed for practitioners working with young people experiencing ongoing suicidal ideation. Key Points1 Caregivers of young people experiencing depression and suicidality have specific needs that appear differ across the stages of a young person's therapeutic engagement.2 Whereas clinicians may consider that they include caregivers and utilise their skills in suicide safety planning, caregivers reflected that they rarely felt they knew what was happening or how best to help in crisis situations. 3 Attending to the information and support needs of caregivers through negotiating issues related to disclosure, confidentiality and consent, may help caregivers and the broader family system more effectively.

Parents’ Experience and Psychoeducation Needs When Supporting a Young Person Who Self-Harms

“…This finding is consistent with other research on the meaning of self-harm for parents [36]. It also underlines carers' need for accurate and user-friendly psychoeducation on suicide and self-harm, including the use of consistent terminology [31,[40][41][42][43].…”

“…Reflecting findings of previous studies [28], parents noted a significant gap: such resources often do not exist, they are difficult to find or receive, or they do not meet their needs. Importantly, participants also noted that parents' psychoeducational needs evolve over time, which suggests the need to provide appropriate and diverse informational support [29][30][31].…”

Severe and complex youth depression: Clinical and historical features of young people attending a tertiary mood disorders clinic

“…Davey and McGorry (2019) conceptualized severe and complex depression as being often nonresponsive to first‐line treatments (e.g., CBT, fluoxetine), and challenging to manage in solo‐practise settings, requiring a multidisciplinary team approach offering expertise across psychiatric, social, family, educational, and vocational domains. Whilst approaches used by YMC include psychotherapeutic case management with embedded psychiatry review, integration of psychosocial recovery interventions including evidence‐based group therapy and reengagement with education (Cotton et al, 2011), and support and engagement with caregivers (Rice et al, 2018a; Dempsey et al, 2019), scope remains for treatment innovation.…”

“…The Youth Mood Clinic (YMC) at Orygen (Centre for Youth Mental Health, The University of Melbourne, Australia) provides time‐limited outpatient treatment according to intake criteria for severity, risk and complexity (Rice et al, 2017). YMC provides psychiatry review, multidisciplinary psychotherapeutic care, engagement of caregivers and crisis planning to support symptom management and functional gain (Rice et al, 2018a; Dempsey et al, 2019). In doing so, YMC is unique within Australia, though other international academic tertiary care centres seek to provide comparative comprehensive care for youth MDD (e.g., Brent et al, 2015; Osuch et al, 2019; Verduyn, 2011).…”

Taking Youth Suicide Prevention to the Schools: Pilot Evaluation of School-Based Clinician Outcomes and Perspectives of a Multi-Modal Program Including Post-Training Online Consultations for Management of Ongoing Suicide Risk

“…The face-to-face training explored six modules to assist social workers in responding therapeutically to young people with suicide risk. Workshop content was drawn from IPTS [28,33], recent research of suicidality in young people [34][35][36], and evidence-based models of suicide safety planning [37]. The workshop also incorporated elements targeting assessment and response to suicide risk undertaken by Pisani and colleagues [9], such as the Assessment and Management of Suicide Risk (AMSR) model [38], and the Chronological Assessment of Suicide Events (CASE; [39]).…”