Suicide mitigation: a compassionate approach to suicide prevention

Cole-King, Alys; Green, Gill; Gask, Linda; Hines, Kevin; Platt, Stephen

doi:10.1192/apt.bp.110.008763

Cited by 47 publications

(38 citation statements)

References 12 publications

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“…Dealing with negative emotions, thoughts and impulsivity can be an integral part of psychosocial interventions (such as Problem Solving Therapy and Cognitive Behavioural Therapy) for which there is evidence of reducing distress in those who self-harm (Townsend et al, 2001). Removing the access to the means for self-harmful behaviour is possible and is also recommended, especially for people reporting suicide ideation (Cole-King et al, 2013). …”

Section: Discussionmentioning

confidence: 99%

Uncovering key patterns in self-harm in adolescents: Sequence analysis using the Card Sort Task for Self-harm (CaTS)

Townsend

Wadman

Sayal

et al. 2016

Journal of Affective Disorders

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BackgroundSelf-harm is a significant clinical issue in adolescence. There is little research on the interplay of key factors in the months, weeks, days and hours leading to self-harm. We developed the Card Sort Task for Self-harm (CaTS) to investigate the pattern of thoughts, feelings, events and behaviours leading to self-harm.MethodsForty-five young people (aged 13–21 years) with recent repeated self-harm completed the CaTS to describe their first ever/most recent self-harm episode. Lag sequential analysis determined significant transitions in factors leading to self-harm (presented in state transition diagrams).ResultsA significant sequential structure to the card sequences produced was observed demonstrating similarities and important differences in antecedents to first and most recent self-harm. Life-events were distal in the self-harm pathway and more heterogeneous. Of significant clinical concern was that the wish to die and hopelessness emerged as important antecedents in the most recent episode. First ever self-harm was associated with feeling better afterward, but this disappeared for the most recent episode.LimitationsLarger sample sizes are necessary to examine longer chains of sequences and differences in genders, age and type of self-harm. The sample was self-selected with 53% having experience of living in care.ConclusionsThe CaTs offers a systematic approach to understanding the dynamic interplay of factors that lead to self-harm in young people. It offers a method to target key points for intervention in the self-harm pathway. Crucially the factors most proximal to self-harm (negative emotions, impulsivity and access to means) are modifiable with existing clinical interventions.

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Section: Discussionmentioning

confidence: 99%

Uncovering key patterns in self-harm in adolescents: Sequence analysis using the Card Sort Task for Self-harm (CaTS)

Townsend

Wadman

Sayal

et al. 2016

Journal of Affective Disorders

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“…14 Working with people who self-harm provides medical trainees with experience in talking to young people in distress, and allows the trainee to develop a compassionate and non-judgemental approach. The characteristics of an assessment by healthcare professionals can affect suicide risk identifi cation and response, 15 with a compassionate approach by far the most useful and potentially life saving, as patients are more likely to disclose their suicidal thoughts. Many hospitals use various risk assessment tools, often recorded electronically.…”

Section: Box 2 Junior Doctor Experience: 'It Was Difficult'mentioning

confidence: 99%

Mental health in young adults and adolescents – supporting general physicians to provide holistic care

Jurewicz

2015

Clinical Medicine

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In the era of an ageing population, young adults on medical wards are quite rare, as only 12% of young adults report a long-term illness or disability. However, mental health problems remain prevalent in the younger population. In a recent report, mental health and obesity were listed as the most common problems in young adults. Teams set up specifi cally for the needs of younger adults, such as early intervention in psychosis services are shown to work better than traditional care and have also proven to be cost effective. On the medical wards, younger patients may elicit strong emotions in staff, who often feel protective and may identify strongly with the young patient's suffering. In order to provide holistic care for young adults, general physicians need to recognise common presentations of mental illness in young adults such as depression, deliberate self-harm, eating disorders and substance misuse. Apart from treating illness, health promotion is particularly important for young adults.

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“…In some high-risk groups (such as young offenders), other psychological factors such as anxiety and self-esteem are also important aspects to consider 9. Excellent guidance on assessing suicidal risk and intent associated with self-harm can be found in the refreshing ‘suicide mitigation’ approach developed by Cole-King et al 8. During assessment of subsequent risk of fatal and non-fatal repetition, the method of self-harm used is important to consider since robust longitudinal data indicate that cutting is a significant risk factor for completed suicide in children and adolescents 7.…”

Section: How Should Young People Who Self-harm Be Assessed?mentioning

confidence: 99%

“…Dealing with clients compassionately in a competent manner through active, non-judgmental listening should be the bedrock of all clinical practice for self-harm,8 especially with young people. Given the negative attitudes that persist in clinical practice it is crucial that all frontline staff receive self-harm and suicide awareness training—even briefly.…”

Section: Recommendations For Clinical Practice and Service Provisionmentioning

confidence: 99%

Self-harm in young people

Townsend

2014

Evid Based Mental Health

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Self-harm is a common problem among young people with many presenting to clinical services via general hospitals, but many more do not come to the attention of clinical services at all. Self-harm is strongly associated with completed suicide so it is extremely important that patients are assessed and treated for this problem effectively. Despite the scale of the problem in young people, there is a very limited evidence base on what interventions may help them to recover from self-harm. The evidence is discussed here and some recommendations are made about how to engage clinically with young people who self-harm from assessment to therapeutic intervention. WHAT IS SELF-HARM AND WHAT IS THE SCALE OF THE PROBLEM IN YOUNG PEOPLE?Self-harm (self-poisoning or self-injury regardless of the motivation or intent associated with the act) is common in young people.1 Here, 'young people' refers to anyone from age 11 up to the age of 25 years, since psychologists and neuroscientists now suggest this as the most appropriate cut-off for late-adolescence. Hospital-based data demonstrate that self-harm is most common in 15-24-year-olds, with females presenting more frequently than males.2 However, hospital-based statistics are likely to be the 'tip of the iceberg', with many more episodes occurring in the community that do not come to medical attention; community-based studies estimate that around 10% of young people have self-harmed. Self-harm is often repeated; in young people presenting to hospital for self-harm around half will have a history of prior harm and 18% will repeat the behaviour within a year (and present to hospital) again. Self-harm is strongly linked to completed suicide with 40-60% of those who die by suicide having self-harmed in the past, making it the strongest predictor of eventual suicide. 4 In one consecutive case series study, 80% of young people who died by suicide had self-harmed in the preceding year. 5As Owens et al 4 put it, 'suicide risk among self-harm patients is hundreds of times higher than the general population'. Suicide is the second commonest cause of death in young people globally. 6 Importantly, and of significant clinical relevance, is the recent research demonstrating that self-cutting in young people who self-harm is a significant risk factor for completed suicide as is being male, having previously self-harmed and having received psychiatric treatment.7 Given these associations, it is vitally important that young people seen by a clinician (in any setting) for self-harm are taken seriously and are cared for competently and compassionately.

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Suicide mitigation: a compassionate approach to suicide prevention

Cited by 47 publications

References 12 publications

Uncovering key patterns in self-harm in adolescents: Sequence analysis using the Card Sort Task for Self-harm (CaTS)

Uncovering key patterns in self-harm in adolescents: Sequence analysis using the Card Sort Task for Self-harm (CaTS)

Mental health in young adults and adolescents – supporting general physicians to provide holistic care

Self-harm in young people

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