Suicide and Self-Harm Special Edition

Juliette Kennedy


I am a Consultant Child and Adolescent Psychiatrist working clinically in a North Yorkshire CAMHS team. I am Associate Director of Medical Education in the trust I work in, also Training Program director for CAMHS higher training in Yorkshire.

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Welcome to this important issue of The Bridge that focuses on suicide and self-harm.

The National Confidential Enquiry into Suicide and Safety in Mental Health Annual Report (2018)  highlighted that suicide in the under 20’s is rising generally and that the number of suicides rises towards late teens (p.38).

Common antecedents reported included family problems, bullying, physical health conditions, self-harm, exam stresses, and relationship problems (p.38). 25% had experienced bereavement (9% of which was by suicide) (p.38). 23% had engaged in suicide-related internet use (p.38). Excessive use of drugs and alcohol was common (42%) (p.39). Of those who completed suicide, 60% had been in contact with services for children or young people at some time and in 41% of cases, this had been a contact within the last 3 months (p.40). Thus, in some of these cases Children’s and Young People’s services may have an opportunity to intervene. Ongoing research seeks to establish what we can do that might be effective in preventing suicide, and what risk factors might it be helpful for us to understand, when undertaking risk formulations and when developing risk management plans.

The RCPSYCH and Health Education England (HEE) published “the Self-Harm and Suicide Prevention (SHSP) Competence Framework” in October 2018. One of these is for Children and Young People’s services. This framework considers what skills, knowledge, and behaviours, professionals working with children and young people need to have to be able to effectively manage risk. It is acknowledged in this report that the evidence suggests our ability to predict risk outcomes accurately is limited (p.14). Therefore, it suggests the emphasis should be on developing a collaborative, person-centred, assessment of risk, alongside an understanding of the young person’s needs and strengths (p.14) and “to attempt to engage young people (and their carers) in a personally meaningful conversation that helps them consider their difficulties and the context of these and the resources that are available to keep them safe” (p.14).

A competent workforce needs to work to the evidence base. There is much research still needed to understand what this evidence base is and what therefore might help a suicidal young person.
This edition of the Bridge follows the JCPP October Special Issue 2019 – on Suicide and Self-harm: Pathways for Minimizing Suicide & Premature Deaths and Maximizing Hope and Wellbeing.

10 research highlights are summarised here, to add to the current evidence base:

Predisposing factors such as childhood maltreatment (Zelazny, J. et al.), and relative stress (Miller et al.) are explored.

Protective factors are highlighted such as school and social connectedness (King et al.) and the importance of strengthening positive social bonds (Wyman et al.)

Response to treatment is considered; Adrian et al. explore who might respond best to DBT and Mehlum et al. report that DBT may improve feelings of hopelessness. The efficacy of family focussed CBT is considered (Esposito-Smythers et al.),

Community interventions such as long-term youth suicide prevention programs (Godoy Garraza et al.) are considered. Barzilay et al. look at perceived interpersonal difficulties with parents as a primary mediator of suicidal ideation and suggest that interventions with high parental involvement may be most effective.

Important negatives are also reported; Russell et al. report their finding that inflammation does not mediate an adverse childhood experience – self-harm risk association.

This edition is also available in PDF form, please do download it from the ACAMH website and share it with colleagues.

Articles from this edition

Childhood maltreatment increases suicide risk despite strong neuropsychological functioning

Individual changes in stress-level predict non-suicidal self-injury

Social connectedness is a protective factor against short-term suicide attempts (post discharge) in school children

Social cohesion and integration in schools reduces suicidal behaviour rate

DBT is effective for youth with high levels of emotion dysregulation

DBT-A reduces self-harming behaviours by improving feelings of hopelessness

Family-focused CBT is not superior to enhanced treatment-as-usual in reducing suicide attempts

Long-term youth suicide prevention programs can have sustained effects

Low parental belongingness increases suicidal ideation risk

Inflammation does not mediate an adverse childhood experience– self-harm risk association

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