National Confidential Inquiry into Suicide and Safety in Mental Health Suicide in children and young people Cathryn Rodway

Suicide rates worldwide 3rd leading cause of death in 15-19 year olds globally (15th overall) approx. 67,000 deaths in 2015

Leading causes of death England & Wales 13% 10-19 year olds: suicide & injury/poisoning of undetermined intent 21% 20-34 year olds: suicide & injury/poisoning of undetermined intent 9% 35-49 year olds: cirrhosis & other liver diseases 13% 50-65 year olds: ischaemic heart diseases

Media coverage of young suicide

Research: Self-harm Self-harm rose by 68% in girls aged 13-16 between 2011 & 2014 Referral to specialist MH care 23% less likely in deprived areas Young people who self-harmed 9x more likely to die unnaturally Non-fatal self-harm is strong risk factor for subsequent suicide

% of population aged 11-19 reporting self-harm Source: NHS Digital, 2018

Annual Report 2018 Annual update of key figures on suicide (2006-2016) Messages on safer care Some analysis by age-group, incl. <25s

Age-specific suicide rates, UK 10-19 year-olds have lowest suicide rate But suicide rates are increasing, esp. females UK_SUICIDE (2006-2016) © National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide rates in England in 15-19 year olds (2006-2016) © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Recent history of self-harm (2006-2016) 39% patients aged <25 had recent history of self-harm Over half of females aged <25 had self-harmed © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Report coverage 595 suicides (UK, under 20) January 2014 – December 2016 595 suicides (UK, under 20) 544 (91%) reports available witness statements/personal testimony of family, friends social media relevant professionals – school, youth justice, health & social care services © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Researchers examine reports & extract information Data collection All potential cases nationally (suicide & undetermined from ONS, GRO, NISRA) Coroners reports Criminal justice reports Official reports/ records received Child death investigations, reviews NHS Serious Incident reports Researchers examine reports & extract information Relevant antecedents recorded © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide in people aged <20 Number of suicides increases steadily with age, esp. in mid-late teens Mainly males (71%) Hanging the most common method © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Common themes 10 common themes Family factors such as mental illness Abuse & neglect Bereavement & experience of suicide Bullying Suicide-related internet use Academic pressures, especially related to exams Social isolation or withdrawal Physical health Alcohol & illicit drugs Self-harm & suicidal ideas, mental ill-health © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Common themes 23% 11% 19% evidence of disruption to family environment a history of abuse and/or neglect 19% a victim of bullying © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Common themes 27% 30% 42% reported exam-related pressures a physical health condition recorded 42% excessive alcohol use or illicit drug use © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Gender differences Abuse 6% 16% Bereaved 21% 33% Bullying 14% 29% © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder. Abuse 6% 16% Bereaved 21% 33% Bullying 14% 29% Academic pressures 45% 61% Excessive alcohol use 22% 21% Illicit drug use 39% 28% Diagnosis of mental illness 35% 52%

Important sub-groups

¼ bereaved Young people who are bereaved 9% bereaved by suicide Bereaved (n=134) Non-bereaved (n=410) Family history: Mental illness 34 (25%) 46 (11%) Physical illness 27 (20%) 19 (5%) Substance misuse 21 (16%) 23 (6%) Abuse 20 (15%) 30 (7%) Bullying 36 (27%) 66 (16%) Suicide-related internet use 45 (34%) 83 (20%) Excessive alcohol use 43 (32%) 74 (18%) Previous self-harm 88 (66%) 179 (44%) Suicidal ideas 101 (75%) 223 (54%) Any diagnosis of mental illness 70 (52%) 147 (36%) Service contact 104 (78%) 225 (55%) ¼ bereaved 9% bereaved by suicide For many bereavement added to existing problems © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

8% had been ‘looked after children’ 45% housing problems/change of accommodation (v. 15%) 71% previous self-harm, suicidal ideas Majority in recent service contact – but not with mental health services © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

LGBT groups 6% LGBT or uncertain of sexuality Most experiencing conflict over their sexuality Over a quarter bullied LGBT groups (n=32) Abuse 5 (16%) Bullying 9 (28%) Suicide-related internet use 14 (44%) Previous self-harm 20 (63%) Suicidal ideas 23 (72%) Any diagnosis of mental illness 16 (50%) Depressive illness 7 (22%) © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide-related internet use 24% under 20s searching for information on suicide methods (13%) 21 (4%) died by a method they were known to have searched on communicating suicidal ideation/intent online (10%) online bullying (5%) visiting websites that may have encouraged suicide (3%) © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide-related internet use 10-19 year olds 20-24 year olds Suicide related internet use 26% 13% Searched the internet for information on suicide method 8% Visited websites that may have encouraged suicide 4% Uncommon Communicated suicidal ideas or intent online 10% 6% Victims of online bullying 7% © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

49% previously self-harmed Indications of risk 49% previously self-harmed High rates of excessive alcohol (30%) & illicit drug use (43%) in those who had self-harmed 59% expressed thoughts of suicide 28% in the week prior to death © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Mental illness diagnosis Affective disorder most common diagnosis, especially depression 6% anxiety disorder © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Service contact 40% no service contact Under half in current (<3 month) contact Mainly mental health service contact © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Pattern of cumulative risk Adversity & risk behaviours in adolescence Recent stressful event Traumatic experiences in early life Prevention measures Support for young children & their families Access to CAMHS, incl. self-harm & substance misuse services Crisis support, promoting mental health in education Suicide prevention contributed to by recognising this pattern © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

What the findings tell us Specific actions Support for young people who are bereaved, esp. by suicide Housing support and mental health care for looked after children Mental health support for LGBT groups © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

What the findings tell us Improved online safety Public awareness of availability of online information on suicide method Increase online vigilance Encourage online safety © National Confidential Inquiry into Suicide and Safety in Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

What the findings tell us Shared role Self-harm Promoting mental health in education Availability of support at times of risk, e.g. exam months Shared role for frontline services Good psychosocial assessment after self-harm Access to psychological therapies - follow-up with CBT/DBT Mental health & alcohol/ drug services working together

What have we learnt? Innovative & meaningful methods of reaching young people are needed to tackle the shortfall who are referred into services Develop services & systems in an innovative way to support coping strategies in young people? Assessment after self-harm needs to give sufficient weight to suicide risk More integrated care involving schools, health & social care providers & voluntary sector needed to enhance safety Development of youth services with a later & more flexible transition point into adult services

Want to know more?

National Confidential Inquiry into Suicide and Safety in Mental Health www.manchester.ac.uk/ncish @NCISH_UK