Suicide is the third-leading cause of death among 15-to-24-year olds, and youth suicide remains a challenging public health problem that is strongly linked with psychiatric disorders and other mental health issues.
Research shows that there are effective education, prevention, and treatment intervention strategies to address this problem. However, there are also barriers that prevent young people from receiving the kind of help that can make a difference.
Some Evidence for Effective Approaches
While it’s a challenge to gather evidence for strategies that address suicide prevention, research indicates that certain approaches lead to increased awareness of risk factors, more referrals to treatment for those at risk, and reduced suicidal thoughts. In some instances, the studies have been large enough to look at reduction in suicide attempts. But we can’t say we have data on treatments and interventions that are actually shown to reduce suicides in youth.
Targeting the Suicide Risk
One thing we’ve learned about psychotherapy and treatment that targets acutely suicidal young people is that it’s important to target the suicide risk directly. While it’s helpful to treat the primary risk factors—the depressive or bipolar disorder, substance abuse issue, or anxiety problem—our evidence suggests that to have an impact, we need to address the suicide risk itself.
We look at each youth’s constellation of risk factors—and there is very clear evidence on risk factors—and then target these risks, but also seek to understand why a particular youth is considering suicide or having suicidal impulses, when many with the same risk factors are not.
Evidence tells us that aspects of cognitive-behavioral therapy and dialectic-behavioral therapy that focus specifically on the patient’s self-harmful and suicidal thoughts and behaviors can be effective. As an example, cognitive-behavioral approaches may include addressing hopelessness through creating a Hope Box, which is a literal or figurative collection of things or ideas that have meaning to the young person, and that they consider important for their future; and targeting relapse prevention by identifying a patient’s “downward spiral” or behavior/thought pattern that preceded past suicide attempts, and intervening before it results in another attempt.
These treatments also include working with a therapist to create a “safety plan” that includes
- personal triggers for self-harmful and suicidal thoughts
- coping strategies
- means removal
- reasons for living
- emergency contact names and numbers.
Barriers to Effective Treatment
While evidence supports the use of these interventions, there are significant barriers to treatment for the youth who need it.
A basic barrier is lack of recognition of the problem or risk, either by the teen, their family, or those who interact with them regularly. Teens may be
- unaware that their problems are treatable
- concerned about the stigma
- put off by the idea of needing help.
The people around them also may not recognize a young person’s problem as a treatable mental disorder. Some of our more universal strategies—awareness campaigns, school workshops, parent events that educate about warning signs—can help get at these barriers.
Even once a problem is recognized, good help—meaning proven treatment or intervention strategies—is not always available for young people. Well-trained clinicians may not be available in the community, and families don’t always recognize whether their provider has the right skills to address the youth’s particular problems.
Educating consumers is one way to go, but we find that in this and all areas of healthcare, it’s difficult to be a vulnerable or struggling patient and be highly assertive about your treatment. An essential component of an effective solution will be to build a more competent and caring clinical workforce, ensuring that clinicians are trained in how to conduct a suicide risk formulation, implement best practice treatments, and conduct ongoing risk assessment.
Financial resources can be another hurdle. In the United States, personal funds often buy better care. Access to quality mental health care depends upon the type of insurance coverage. Often there is a direct correlation between out-of-pocket costs for plan coverage and limits placed on treatment options. Many battles remain to get adequate coverage for everyone.
While barriers exist for everyone, they’re especially challenging for those with severely limited financial resources. Our public mental health system has been facing reduced funding, and although there are excellent providers in this system, they are not in every community. Waiting lists can be long, to the point where an acutely suicidal teen discharged from a psychiatric hospital can’t get an appointment with a clinician within as week, as would be recommended. Unfortunately, the patient simply might not be perceived as being most in need for an appointment in the public mental health system.
The Audience’s Turn:
- What barriers have you met in trying to get psychiatric help for a teenager? How did you overcome or work around them?
- What have your schools or community done to prevent youth suicide? In what ways do you think this is effective, or not?
Dr. King’s upcoming post addresses public policy challenges and priorities related to youth suicide prevention.