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

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

3. 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

4. Media coverage of young suicide

5. Research: Self-harm
Self-harm rose by 68% in girls aged 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

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

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

8. Age-specific suicide rates, UK
10-19 year-olds have lowest suicide rate
But suicide rates are increasing, esp. females
UK_SUICIDE ( )
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9. Suicide rates in England in
15-19 year olds ( )
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10. Recent history of self-harm
( )
39% patients aged <25 had recent history of self-harm
Over half of females aged <25 had self-harmed
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11. 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.

12. 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
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13. 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
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14. 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
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15. Common themes 23% 11% 19% evidence of disruption to family environment
a history of abuse and/or neglect
19%
a victim of bullying
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16. 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.

17. Gender differences Abuse 6% 16% Bereaved 21% 33% Bullying 14% 29%
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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%

18. Important sub-groups

19. 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
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20. 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
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21. 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%)
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22. 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.

23. 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.

24. 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
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25. Mental illness diagnosis
Affective disorder most common diagnosis, especially depression
6% anxiety disorder
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26. Service contact 40% no service contact
Under half in current (<3 month) contact
Mainly mental health service contact
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27. 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
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28. 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
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29. 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.
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30. 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

31. 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

32. Want to know more?

33. National Confidential Inquiry into Suicide and Safety in Mental Health
@NCISH_UK