The kids who don’t know they are too young to die

He was a teenage boy threatening to kill himself. He didn’t want to live any more, he said, and everyone would be sorry when he was gone. She was a teenage girl, his friend, desperate to talk him out of it. Her best effort belied her naivete: “You’ll be sorry if you do it!” (A week later, he tried and failed to kill himself).

“Neither of them understood that death was final,” says suicide researcher Dr Kate Blackmore. To such overwhelmed young people, suicide seems just one of many possible responses to life’s problems: “Suicide is just (another) act; it’s not something they separate from cutting yourself or taking drugs or driving a car too fast … They don’t really understand what death is.”

Australia has among the highest rates of male youth suicide in the world, with about 500 deaths in the 15 to 24 age group each year – a rate that has tripled since the 1950s. In contrast, the rate for young women has not changed since the 1960s.

Blackmore, a research fellow at Wollongong University’s department of public health, is part of the national effort to stem the tide. As part of the National Youth Suicide Prevention Strategy, her task has been to work out how to best educate young people, as well as professionals, in ways to minimise youth suicide. Her approach incorporated some revolutionary material – the views of the kids themselves.

Talking to focus groups of 30 city, semi-rural and rural teenagers in NSW, Blackmore found they did not want suicide prevention education for themselves. They wanted to be taught coping skills so they could better deal with crises in their own lives and help friends survive their problems. Forget the ambulance at the bottom of the cliff, they seemed to be saying – teach us how to keep from falling off it.

Most of the young people interviewed were from groups at high risk of suicide. They had emotionally or materially deprived or abusive backgrounds and many were unemployed or school dropouts. Several had attempted suicide.

Blackmore says she was floored by their insight: “Probably the most humbling part of the experience was the gradual dawning on me of how much wisdom actually resides with these young people and how appalling it is that they haven’t been listened to in the past.”
Their debates mirrored academic discourse about the issue, including arguments about whether the topic should even be raised with young people for fear of giving them ideas they may not otherwise develop.

“Most of the kids we interviewed said: ‘Don’t use the word suicide with younger kids’,” Blackmore says. “A lot of them had younger brothers and sisters still at home that they were very worried about. They said if they talked to them, they used language that they understood, and that didn’t scare them, like: ‘You must be feeling really, really bad’.

“Most felt that (classroom discussion about suicide) was not an issue for kids in the older levels of high school. But several said: ‘If you’re really depressed, if you have lost your job or your relationship has broken down, and someone says to you that suicide is what people do when they are really desperate, it can give you the idea’.”
But the teenagers did believe youth suicide prevention education for adults was a good idea. They wanted grown-ups to know what they needed. Top of the list, even with the toughest kids, was the need for a sympathetic adult who could truly listen.

Said one: “Parents just have to be able to, like, sit there and listen. Don’t get mad with what the kid says, or anything like that … I’ve been through it. I got kicked out of home and everything. It’s just … it’s scary.” Another talked about the need for understanding friends: “You just want them to talk to. Just make sure that someone can understand you, so then you won’t go any further.”

They also wanted help to see things more clearly: “I was 14. Sitting at the bus stop, waiting to go home, cutting my arms up with bits of broken glass because . . . just because of some of the things that happened, you know. I got abused when I was 11 and I didn’t tell no-one for years, because I thought it was me . . . Someone needs to be there to say something, you know? (To say) ‘It isn’t your fault’.”

Asked what else they wanted from a friend, parent or other adult in a crisis, the young people listed understanding and sympathy (free of blaming or judgmental attitudes) and information about where to go for help. They wanted professionals to be adequately trained, to have a uniform approach and to offer continuity of care.

Many were scornful of professionals with whom they had come in contact, particularly psychiatrists and school counsellors. They mistrusted school counsellors, Blackmore says, because they saw them as people who could get them transferred away from their friends to another school.

They saw continuity of care as central. Some had been shunted from one counsellor to another as a result of developing suicidal tendencies, after having sought help. Said one: “Why should a counsellor, because they feel uncomfortable all of a sudden, say: ‘Oh, I don’t know what to do with you no more. I’m scared of you now’? And then you’re dumped, like that . . .

“(You’ve) put your trust in them. You’re saying: ‘Help me; I don’t know what to do’. And they’re saying: ‘Well, I don’t know what to do with you either’. I’m not blaming them, but I am saying that can’t help the situation.”
They were also highly critical of hospital casualty staff. “Some casualty nurses see suicides as a waste of time,” says Blackmore, “You’re holding up this bed for someone who has had a heart attack or a severed limb, you self-indulgent little wanker!”‘

Blackmore knows one young woman who was slapped by her treating nurse. Another, an unstable schizophrenic who frequently overdosed when she had a psychotic episode, found herself in the hands of a sadistic nurse who gave her a gastric lavage three times in one visit to punish her for her frequent trips to casualty. One young woman told of being left on the floor until regaining consciousness after an overdose; another, of being called a “useless little slut”.

“It reinforces the kids’ idea that they are garbage and that no one cares what they do,” Blackmore says. She believes there is an urgent need for education about suicide in undergraduate courses for doctors and nurses.

But she is wary of some suicide prevention courses aimed at teachers and students. Programs that talk to kids about suicide in class are no longer seen as appropriate, she says, and she is concerned by some teacher training programs. “It’s important that teachers are conscious of risk factors,” she says. “Teachers probably know kids almost as well as parents; they spend every day with the same kids. If you have a kid whose performance suddenly drops off, who suddenly withdraws, or who does something about death in art or writing, it’s important to recognise that (as a warning sign).

“But to expect the teacher to take responsibility for anything more than that is dangerous. They must be told to refer on to someone who is trained to deal with a very depressed child.”

The young people interviewed, like Blackmore, were staunchly opposed to suicide education programs based on fear, which present horrific details about violent means of suicide and the potential physical consequences of failed attempts (such as warnings that a young person who survives hanging might be left with a paralysed face). Such stories might be scary, they said, but they were no help to a person in despair.

Blackmore says: “They also thought it was inappropriate to say that suicide is the morally wrong thing to do, because that just loads up kids with more guilt, potentially making someone who is borderline feel even worse about themselves.”

What they did want for themselves was easily accessible, easily understandable, practical advice on what to do in a crisis. And they had great ideas about how to distribute it. “We posed the question: ‘You have just hit Wollongong, you’re unemployed, you have nowhere to go, and you would like to get some information. What do you need?” Their answer: graffiti the name and phone number of a refuge on the wall of the local cop shop.

Says Blackmore, “These focus groups were very funny at times, but they also came up with some very sound ideas.”

* If you need someone to talk to about your troubles or are worried about a friend or relative, contact Lifeline, tel: 13 1114, or Suicide Helpline, tel: 1300 651 251.

Young people are at a higher risk of suicide if they:

* Live in rural or remote areas

* Are unemployed

* Have a profound mental illness

* Are Aboriginal or Torres Strait Islander

* Lack a trusted adult in whom they can confide

* Are struggling with their sexual identity

* Have suffered a recent loss or a shaming experience that is significant to them, even if it does not appear so to others

* Have previously attempted suicide

* Were victims of physical or emotional abuse as children

Signs that a young person may be suicidal:

* A sudden change in behavior, as when an extrovert becomes very quiet

* Obvious depression

* Excessive ongoing anger

* Loss of interest in things that used to give pleasure

* High-risk behavior, such as excessive drinking, dangerous driving or drug-taking

* Isolation from others, including a lack of friends, or a withdrawal from networks and activities at work or at school

* A preoccupation with giving away belongings and setting their affairs in order (a phase in which they can appear very calm) — Sources: Kate Blackmore and Lynn Bender, manager of Lifeline and Suicide Helpline.

First published in The Age.