Abstract:
This thesis explores treatment issues faced by clinicians working with suicidal children, adolescents and their families. I conducted two studies in an outpatient Child and Adolescent Mental Health Service (CAMHS). Study 1 involved a clinical file audit of 100 children and adolescents who attended the service from 1998 - 2000. Study 2 was a prospective study of 66 adolescents who were referred to the service in 2002 with significant suicide ideation or deliberate self-harm (DSH). The relationship between suicide ideation and DSH was explored by combining data from Study 1 and Study 2. Study 2 also involved interviewing adolescents, parents and clinicians about key elements of successful treatment. Study 1 found almost universally high loadings of biopsychsocial risk factors for suicide behaviour among children, adolescents and their families presenting to the clinic. Suicidal children and adolescents had higher rates of childhood sexual abuse, previous episodes of DSH, maternal substance abuse and family offending. Study 2 demonstrated that treatment protocols can facilitate a shift in clinician behaviour towards more aggressive outreach of non-participating families and can improve health outcomes for suicidal adolescents. A non-significant trend towards reduced repetition of DSH was also observed. This project also improved perceived support and connection to their work among participating clinicians. Children and adolescents who used cutting as a method of DSH were a heterogeneous group that included males and females, of all ethnic and socioeconomic backgrounds. Those engaging in cutting were more likely to have a previous history of suicide ideation and had a greater number of previous episodes of DSH There was considerable crossover in the methods of DSH used by children and adolescents, with high rates of previous DSH and suicide ideation. Suicidal adolescents and their parents believe that successful treatment requires a friendly, kind, professional therapist who is a good listener and is not judgemental. Adolescents reported that therapy works when you can talk about your big worries. DSH is not always the main concern of adolescents although it is often the primary focus of their parents. Clinicians cited successful engagement and collaboration as the most critical aspect of treatment with suicidal adolescents. The significant clinical impkcations of these findings are explored including the need to pay greater attention to suicide risk in all clients presenting to CAMHS, the need to engage in meaningful conversations about suicide ideation while also paying attention to other psychosocial stressors, strengthening consideration of resiliency factors and moving towards a more flexible model of service delivery in CAMHS.