Seeds of despair

    Child suicide may be rare but when it does occur its impact is
    felt throughout the adult world. Frances Rickford explores the
    possible causes for such a desperate measure.

    Nine-year-old Oteas Tedder was found dead by her mother, hanged
    in her bedroom. Jevan Richardson, aged 10, was found by his father
    hanging by a nylon stocking from a shower rail. Daniel Overfield,
    aged 12, hanged himself from his bunk bed by his dressing gown cord
    and was found by his mother. Thirteen-year-old Kayleigh Davies
    hanged herself from a cupboard in her bedroom after being sent home
    from school. Amy Burgess, aged 16, threw herself from the top of a
    multi-storey car park on the day her mock GCSEs were due to
    start.

    When children kill themselves, it’s a big story and deeply
    disturbing to adults. How could we have created a world so painful
    that a child cannot bear to continue living in it? We search
    frantically for simple explanations – it was exam pressure,
    bullying, getting into trouble at school, or a family row.

    Suicide among children is, thankfully, rare. According to
    official figures, in 1999 suicide or self-inflicted injury was
    mentioned in the coroner’s report in a total of 25 deaths of
    children under the age of 15,1 but it is widely
    acknowledged that the true rate may be much higher.

    Coroners are likely to want to spare the family from the extra
    pain of a suicide verdict, so opt for open verdicts, misadventure
    or even accidental death. Suicide verdicts recorded for children
    are double checked for validity on a monthly basis by civil
    servants.

    Some may interpret this caution as squeamishness. But there may
    also be genuine questions over the state of mind of children who
    kill themselves – and whether they fully understood what they were
    doing.

    In a fact sheet for parents and teachers on suicide in young
    people, the Royal College of Psychiatrists says child suicide is
    rare because children under the age of 14 lack the ability to plan
    or carry out complex tasks on their own, and don’t understand the
    permanence of death.2 “When children kill themselves it
    is usually by accident, sometimes because a game has gone
    tragically wrong”.

    But ChildLine recently reported that it is receiving a growing
    number of calls from children and young people where the main
    problem recorded by the counsellor is a suicide attempt or serious
    intention.3 Between 1990 and 1991 and 1998 and 1999 the
    number of suicidal calls more than doubled, from 346 to 701. Most
    were from young people aged 15 or 16, but there were calls from
    children as young as six who had already taken an overdose or
    conveyed a serious intention to kill themselves.

    Suicide among teenagers over 15 is much more common, and has a
    dramatic gender bias. It was registered as the underlying cause of
    death for 105 young people aged between 15 and 19 in 1999 – 78 per
    cent of them young men. Among men aged between 15 and 25, the
    suicide rate has more than doubled over the past 30 years from
    seven per 100,000 in 1971 to 16.4 in 1997, while for young women in
    the same age group it has barely increased – from 3.3 to four per
    100,000.

    Interestingly, the ratio is reversed for children calling
    ChildLine about suicide. Four times as many suicidal girls as boys
    have called the charity, which could indicate that it is girls’
    ability to ask for help and talk through their feelings which is
    saving their lives. The Royal College of Psychiatrists notes that
    boys are less likely than girls to show their distress before
    making a suicide attempt, and in about one in five cases a young
    person who tries to kill themselves will have shown no previous
    sign of distress.

    Much more commonly, in three out of five suicide attempts the
    young person has been showing signs of emotional or behavioural
    difficulties for months before, and has not been able to find help.
    Another fifth will have had serious problems for a long time and
    will already be in contact with professional services. It is this
    group which is most at risk of trying to kill themselves again.

    As with adults, research suggests that young people who have
    made previous attempts to harm or kill themselves are most likely
    to do it again. Behaviour sometimes written off as
    attention-seeking should be taken seriously and, according to the
    Royal College of Psychiatrists, should trigger a specialist mental
    health assessment.

    Steve Lewis is a community psychiatric nurse, working for the
    multi-disciplinary child and adolescent mental health service in
    Warrington, Cheshire. He and his colleague Jeanette Makin visit and
    carry out risk assessments on all under-16s admitted to local
    hospitals as a result of suicide attempts or self-harm. The team
    used to have a social worker, but since the last postholder left,
    the job has remained unfilled.

    He reports that the team has found that looked-after children
    who take a big overdose are particularly likely to have a history
    of self-harm which has never been picked up. Lewis also reports
    that those young people who come closest to succeeding with a
    suicide attempt are most likely to have serious family-related
    problems.

    The average age of children referred to the team for suicide
    attempts is 14 to 15. The pattern of referrals reflects times of
    stress for children, with peaks at the start of the school term and
    exam periods. He estimates that in slightly more than half of all
    cases, children have taken overdoses of Paracetamol, often using
    alcohol and other medicines as well. In one recent case a boy went
    to stay with a friend who was epileptic and took a large overdose
    of his friend’s anticonvulsant drugs, with cider.

    “At the time the child takes the overdose there is a strong
    motivation to end things, but they usually regret it and seek help.
    Those who don’t tell anyone, perhaps leaving a note, are the most
    worrying. Most we discharge from the ward on the day with a package
    of services. The paediatric ward is not the right place for these
    young people, and the staff are not equipped to cope. But
    in-patient resources are scarce.

    “We’re more likely to involve social services in the case where
    we need to look for a hospital bed because the risk is high –
    perhaps one or two children in every 10.”

    Media coverage of child suicide has tended to focus on bullying
    as the cause, and ChildLine too has found that children calling
    about bullying are more likely than others to mention suicide.

    Tim Field has co-authored a book about children whose death or
    suicide has been associated with bullying.4 He believes
    there is a clear pattern to bullying-related suicide in
    children.

    “Bullying causes psychiatric injury over time, leading to
    reactive depression which can cause a person’s objectivity to
    waver. Typically, the child gets bullied for a long time and
    finally says something, but instead of the situation being resolved
    they may find themselves in greater danger. The school goes into
    denial and the parents, if they take it up, get labelled as
    troublemakers.”

    But Peter Wilson, director of the children’s mental health
    charity Young Minds, believes the causes of suicide among children
    and young people are more complex. “Some kids do live a nightmare,
    but lots of children who are bullied don’t kill themselves. About
    one in 20 teenagers has a significant clinical depression and in
    children under 12 it’s about 2 per cent. But not all children who
    are depressed try to kill themselves.

    “We’re not going to eradicate suicide. But children and young
    people do need well-trained people to talk to. Also a lot depends
    on how well modulated parents and carers can be, staying with and
    bothering about their teenage children when they become secretive,
    hostile and difficult. So there should be opportunities for them to
    talk through things as well.

    “Suicide among younger children is a disturbing problem which we
    don’t really understand much about. What it does show is that
    children have extreme states of mind, and we should be providing
    services which respond to that fact.”

    1 Office of National Statistics,
    Mortality Statistics: Cause, England and Wales 1999,
    (Table 3), Stationery Office 2000.


    www.statistics.gov.uk/downloads/theme_health/DH2_26book_v1.pdf

    2 Royal College of Psychiatrists, Mental
    Health and Growing Up: Suicide and Attempted Suicide
    , Fact
    sheet 29 for parents and teachers. RCP, 1999

    3 Brigid McConville, Saving Young Lives:
    Calls to ChildLine About Suicide
    . ChildLine 2001

    4 Neil Marr and Tim Field, Bullycide:
    Death at Playtime
    , Success Unlimited 2001. From Success
    Unlimited, PO Box 67, Didcot, Oxfordshire OX11 9YS.
    www.successunlimited.co.uk/books

    Suicide indicators

    Calls to ChildLine have led the organisation to put forward the
    following as likely indicators for high suicide risk among young
    people.

    – Talking about methods of suicide

    -n Dwelling on insoluble problems

    – Giving away possessions

    – Hints that “I won’t be around”, or “I won’t cause you any more
    trouble”

    – Change in eating or sleeping habits

    – Withdrawal from friends, family and usual interests

    – Violent or rebellious behaviour, or running away

    – Drinking to excess or misusing drugs

    – Feelings of boredom, restlessness, self-hatred

    – Failing to take care of personal appearance

    – Complaints about headaches, stomach pains, tiredness, or other
    physical symptoms

    – Becoming over-cheerful after a time of depression

    – Unresolved feelings of guilt following the loss of an
    important person or pet (including pop or sports idols)

    Source: ChildLine 2001

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