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SUFFER THE LITTLE CHILDREN

Suicidal Behavior in Children

Such information is important for emergency physicians and other personnel who will likely encounter prepubescent children at risk for suicidal behavior. Increasing numbers of children now present to the ED with mental health issues. In addition, the rate of ED visits for attempted suicide for children younger than 14 years is comparable to the rate of visits for individuals aged 50 years and older. ED personnel are increasingly charged with determining the most appropriate disposition options for these children, sometimes without the assistance of specialty mental health services. 

 

Previous Suicide Attempts:

Once a child has made a suicide attempt, the risk that he or she will eventually complete suicide increases signif cantly. Prepubertal children who have attempted suicide previously may be up to six times more likely to attempt suicide in adolescence, as such behavior ‘‘may begin with relatively low intent and lethality and increase in crescendo-like fashion with age.‘‘44 Rosenthal and Rosenthal examined 16 suicidal preschoolers (2.5 to 5 years old) who were referred to a child psychiatry outpatient clinic after attempting to seriously injure themselves.39 Three children had made a single previous suicide attempt, and 13 had made multiple attempts.

 

Warning Signs of Youth Suicide:

1.  Suicide notes.  These are a very real sign of danger and should be taken seriously.

 

2.  Threats. Threats may be direct (“I want to die.” “I am going to kill myself”) or, unfortunately, indirect (“The world would be better without me,” “Nobody will miss me anyway”). In adolescence, indirect clues could be offered through joking or through references in school assignments, particularly creative writing or art pieces.  Young children and those who view the world in more concrete terms may not be able to express their feelings in words, but may provide indirect clues in the form of acting-out, violent behavior, often accompanied by suicidal/homicidal threats.

 

3.  Previous attempts. Often the best predictor of future behavior is past behavior, which can indicate a coping style.

 

4. Depression (helplessness/hopelessness). When symptoms of depression include pervasive thoughts of helplessness and hopelessness, a child or adolescent is conceivably at greater risk for suicide.

 

5. Masked depression. Risk-taking behaviors can include acts of aggression, gunplay, and alcohol/substance abuse.

 

6. Final arrangements. This behavior may take many forms. In adolescents, it might be giving away prized possessions such as jewelry, clothing, journals or pictures.

 

7. Efforts to hurt oneself.  Self-mutilating behaviors occur among children as young as elementary school age.  Common self-destructive behaviors include running into traffic, jumping from heights, and scratching/ cutting/marking the body.

 

8. Inability to concentrate or think rationally.  Such problems may be reflected in children’s classroom behavior, homework habits, academic performance, household chores, even conversation.

 

9. Changes in physical habits and appearance.  Changes include inability to sleep or sleeping all the time, sudden weight gain or loss, disinterest in appearance, hygiene, etc.

 

10. Sudden changes in personality, friends, behaviors. Parents, teachers and peers are often the best observers of sudden changes in suicidal students.  Changes can include withdrawing from normal relationships, increased absenteeism in school, loss of involvement in regular interests or activities, and social withdrawal and isolation.

 

11. Death and suicidal themes. These might appear in classroom drawings, work samples, journals or homework.

 

12. Plan/method/access. A suicidal child or adolescent may show an increased focus on guns and other weapons, increased access to guns, pills, etc., and/or may talk about or allude to a suicide plan. The greater the planning, the greater the potential.

 

This isn't the answer, if you tried every- thing and everything has failed, try Jesus.  He has the answer to your problems.

Suicide is one of the leading causes of death in children younger than 12 years and is the fourth leading cause of death in 12 year olds.    Increasing numbers of young children now present to the emergency department (ED) with mental health issues, and ED personnel must determine the most appropriate disposition options for these children, sometimes without the assistance of specialty mental health services. Much of the present body of literature describing suicidality fails to separate children from adolescents for analysis and discussion. This article reviews relevant literature pertaining to suicidal thoughts and behaviors in young children and discusses problems with available data, as well as epidemiology, risk factors, typical motivations, methods, assessment, and disposition for these patients. Suicidal children younger than 12 years are often clinically different from suicidal 12 years are often clinically different from suicidal adolescents and adults and may require unique

Safety Planning:
For these reasons, no-suicide contracts shood not be used. The more helpful alternative is safety planning.  A safety plan, created in collaboration with the client, provides steps the client can take to stay safe. These steps center on client’s doing the following: -
 

     1.   Keeping their home environment safe (for example, removing firearms).

 

     2.   Recognizing warning signs that a suicidal crisis may be approaching.

 

     3.   Coming up with ways to cope personally with suicidal thoughts, without calling on other people or resources.

 

     4.   If that doesn’t work, identifying friends, family, and other people to contact for help or distraction.

 

     5.   And if that doesn’t work, identifying mental health agencies and other places (such as a hospital emergency room) that the client can call or visit. - 

 

See the following resources about safety planning:

http://www.suicidepreventionlifeline.org/Learn/Safety

 

http://www.psychologytoday.com/blog/promoting-hope-preventing-suicide/201209/safety-planning-suicide-prevention-in-the-emergency-de

 

This site contains a blank safety planning form that you can fill out with clients:  - 

http://www.sprc.org/sites/sprc.org/files/SafetyPlanTemplate.pdf

Read more at: The Use of No-Suicide Contracts | Speaking of Suicide

assessment and disposition strategies in the ED.  A child who has ideation without a clear plan, or has made an attempt of low lethality, can sometimes be discharged home, provided that a supportive, responsible care-giver is willing moniter the child and take him or her to outpatient mental health appointments.  If the home environment is detrimental, or the child has used a method of high potential lethality, inpatient treatment is the most appropriate course of action.  Mental health specialty services, when available, should be used to help determine the most appropriate disposition.

From both a child safety and an emergency department (ED) perspective, suicidal behavior in young children is a concern. This phenomenon is more frequent among children younger than 12 years than previously realized. It was once assumed that young children were not capable of either contemplating or performing suicidal acts; however, a growing body of research has shown that young children do plan, attempt, and successfully commit suicide. This article addresses several issues, including problems with defining and determining the rates of childhood suicide, relevant risk factors, methods of suicidal behavior, and strategies for assessing suicidality in this population. We also suggest strategies for disposition for this special population group.

Suicide pact:

A suicide pact is an agreed plan between two or more individuals to commit suicide. The plan may be to die together, or separately and closely timed. Suicide pacts are important concepts in the study of suicide, and have occurred throughout history, as well as in fiction.

 

Suicide pacts are generally distinct from mass suicide. The latter refers to incidents in which a larger number of people kill themselves together for the same ideological reason, often within a religious, political, military or paramilitary context. Suicide pacts, on the other hand, usually involve small groups of people (such as married or romantic partners, family members, or friends) whose motivations are typically non-ideological.  A suicide pact negotiated over the internet, often between complete strangers, is an Internet suicide.

Suicide prevention contract:

There are Pros & Cons:

A suicide prevention contract is a contract that contains an agreement not to commit suicide. It is often used by medical professionals dealing with depressive clients.  Typically, the client will be asked to agree to talk with the professional prior to carrying  out any decision to commit suicide. Suicide prevention contracts have been described as a "widely used but overvalued clinical and risk-management technique."  Indeed, it has been argued that such contracts "may in fact increase danger by providing psychiatrists with a false sense of security, thus decreasing their clinical vigilance."  It has also been argued that such contracts can anger or inhibit the client and introduce coercion into therapy.

      *  In the managed care era, mental health professionals increasingly rely upon suicide prevention contracts in the management of patients at suicide risk. Although asking a patient if he or she is suicidal and obtaining a written or oral contract against suicide can be useful, these measures by themselves are insufficient. "No harm" contracts cannot take the place of formal suicide risk assessments. Obtaining a suicide prevention contract from the patient tends to be an event whereas suicide risk assessment is a process. The suicide prevention contract is not a legal document that will exculpate the clinician from malpractice liability if the patient commits suicide. The contract against self-harm is only as good as the underlying soundness of the therapeutic alliance. The risks and benefits of suicide prevention contracts must be clearly understood.

 

     *  The suicide-prevention contract is a widely used but overvalued clinical and risk-management technique. The scant information on this topic in the psychiatric and mental health literature is reviewed, along with the literature on collateral subjects including suicide prediction, medicolegal aspects of treating suicidal patients, the therapeutic alliance, and countertransference with suicidal patients. A group of 112 psychiatrists and psychologists was surveyed about their use of suicide-prevention contracts; the majority of them had never received any formal training on the topic. A combination of factors—the unpredictability of suicide, the many different antecedents to completed suicides, the complex psychological reactions of clinicians (including fear of litigation), the incongruity between clinical and legal usages of the contract concept, and the hazards that come of collapsing a complex treatment process into a few words—limit the applicability of suicide-prevention contracts. We reason that the use of these contracts is based upon subjective belief rather than on objective data or formal training. We recommend an alternative approach to suicide risk management rooted in the well-known and well-defined principles of Informed consent.

 

     *  No-suicide contracts, in their various forms, can deepen commitment to a positive action, strengthen the therapeutic alliance, facilitate communication, lower anxiety, aid assessment, and document precautions. Conversely, they can anger or inhibit the client, introduce coercion into therapy, be used disingenuously, and induce false security in the clinician. Research on no-suicide contracts (frequency surveys, assessments of behavior after contracting, and opinions of users) has limitations common to naturalistic studies, and is now ready for more rigorous methods. Mental health professions should be trained to deal with suicidal individuals, including how to use no-suicide contracts. Good contracts are specific, individualized, collaborative, positive, context-sensitive, and copied. However, they are not a thorough assessment, a guarantee against legal liability, nor a substitute for a caring, sensitive therapeutic interaction. No-suicide contracts are no substitute for sound clinical judgment.

Suicide prevention experts discourage the use of no-suicide contracts. With a no-suicide contract, the client signs an agreement promising not to do anything to harm or kill himself or herself within a specified period of time. The contract may also “require” the client to take some specified action if they want to act on suicidal thoughts, usually going to an emergency room or calling 911. - See more at:                                                                                                                                 http://www.speakingofsuicide.com/2013/05/15/no-suicide-contracts/#sthash.gUznfPlx.dpuf

Suicide prevention experts discourage 

No-Suicide Contracts:

The no-suicide contract has quite a few disadvantages that can harm the therapy and the client: - 

 

     1.   There is no evidence that no-suicide contracts actually work. In fact, there is quite a bit of evidence that they do not work. One study found that of people who attempted suicide in a psychiatric hospital, 65% had signed a no-suicide contract. A survey of psychiatrists found that  of those who used no-suicide contracts, 40% had a patient die by suicide or make a serious attempt even after signing such a contract.   

 

      2.   Many clients feel mistrustful of therapists if asked to sign a no-suicide contract. Some clients perceive these contracts to be a way to protect the therapist, not the client.  

 

      3.   If a client promises not to attempt suicide, what happens when the client actually does attempt suicide? Some clients may withhold such information, out of fear that the therapist will be angry at the client for having broken their promise. Yet, to most effectively help, the therapist needs to know that the client attempted suicide. The client needs to feel free to share such information without fear of rebuke. 

 

     4.   No-suicide contracts do not actually protect a therapist from a malpractice judgment, should a lawsuit occur.  +If suicide really could be prevented with a simple contract or agreement, then suicidal people would never need our help. A person stricken with intense suicidal thoughts would, by virtue of the no-suicide contract, call on their strengths, resources, and self-control to manage their impulses and stay safe on their own. The task of therapy is to help build those assets, not to presume that they already exist. - 

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