MHM Magazine

16 | MENTALHEALTHMATTERS | Issue 3 | 2021 MHM N o matter how many years of experience in practice, when a teenage client turns around and says they “kind of attempted suicide the other day”, it’s hard not to feel panicked. After my 15-year- old client casually announced her recent suicide attempt in this manner, she then mentioned feeling relieved I didn’t “freak out” like most adults do at the very mention of suicide. Little did she know, internally I was definitely ‘freaking out’. I realised in that moment that if I’d reacted with the distress I was feeling, not only would I have been unable to assist effectively, but my client would have been reluctant to bring up the topic of her suicidal behaviour with me again. Teenagers hold many assumptions of how their parents or teachers will react to such distressing information (often correctly), which results in them avoiding these conversations all together. The thing is, we can’t help if we don’t know what they’re going through. So it’s important we identify helpful ways of reacting, that encourages them to open up and share so we can go on to help them cope and not act on their suicidal ideations. So, if ‘freaking out’ isn’t an option – what are more helpful ways to respond when your teenage client presents with risk for suicide? First and foremost, assess the level of risk , as your suicide safety plan will be determined by the severity of risk. If you’re unsure how to assess suicide risk, you can find plenty of screening tools online. When assessing risk, it’s important to distinguish between thinking about suicide or death versus intention to act upon such thoughts and whether they have already come up with a plan. If medium to high risk, you’ll have to: • Inform their parent/guardian and explain what they need to know to try prevent a suicide from occurring (e.g. removing all harmful objects, not leaving the individual alone and seeking professional help). • Consider hospitalisation. The difficulty with knowing what to do in these situations is that it always depends on the individual case. What’s in one person’s best interests can be the opposite for another. So it’s essential you work together with the client to identify what’s in their best interest, regarding their safety plan. This often entails having to inform a family member, especially if your client is still a teenager. The general approach I take, when it comes to dealing with low to medium suicide risk is as follows: 1. Psycho-educate – Explain what mental health is and how illnesses such as depression affect the way someone thinks, feels and behaves. It’s important they understand the following: a. Their intense suicidal thoughts, feelings and urges are not permanent, yet taking their own life is . b. Many of their thoughts (e.g. people would be better off without me) are not true, they are symptoms of depression. Suicide beckons when people no longer feel they can By Alexa Scher Clinical Psychologist Johannesburg ascher.psych@gmail.com TEEN SUICIDE AND SUICIDE SAFETY PLANS