Background Suicide is amongst the leading causes of death in young people globally and a health priority worldwide. For children and young people (CYP) attempting or considering suicide there is no agreed treatment model. Development of treatment models should be informed by the views and experiences of CYP using services. Methods Meta‐ethnography was used to systematically identify and synthesise studies reporting the views of CYP who used mental health services following suicidal behaviour. Relevant studies were quality appraised. First order (participants) and second order (original author) data were translated to identify common and disconfirming themes and concepts. Translated findings were synthesised and led to a new hypothesis supported by additional ‘linguistic analysis’ of texts to construct a novel third order line‐of‐argument. Results Four studies conducted since 2006 in three countries involving 44 young people aged 11–24 years were synthesised. Translation revealed that suicidal CYP do not know where or how to access help, they cannot access help directly and when seen by mental health practitioners they do not feel listened to. Line‐of‐argument synthesis identified a silence around suicidality within the conversations CYP have with mental health practitioners and within academic research reporting. Use of the term ‘self‐harm’ to encompass suicidal behaviours potentially contributes to this silence by avoiding the word ‘suicide’. Conclusions Children and young people who are suicidal need to have easy access to mental health services. When using services, they want to feel listened to and have suicidal feelings acknowledged. This involves professionals referring explicitly to suicide not just self‐harm.
IntroductionSuicide is one of the leading causes of death among children and young people globally and a major public health issue. Government policies determine how much recognised health issues are prioritised and set the context for investment, development and delivery of services. A review of policies concerning children and young people who are suicidal could shed light on the extent that this public health issue is prioritised and highlight examples of best practice in this area. There has never been a review to explore how policy worldwide addresses the specific needs of this vulnerable population. This review will map the key policy documents and identify their relevance to the review question: how does policy address the treatment and care of children and young people who experience suicidality? (international, national (UK) and local (Scotland)).MethodologyEmploying scoping review methodological guidance a systematic and transparent approach will be taken. Preliminary searches will facilitate the identification of MeSh terms, subject headings, individual database and platform nuances. A full search strategy will be created to search five databases: CINAHL, PsychInfo, Medline, Web of Science and Cochrane. Government and other key agency websites (eg, WHO, Unicef) will be searched to identify policy documents. The reference lists of identified documents will be checked. A second reviewer will independently screen and cross validate eligible studies for final inclusion. A data extraction template will then be used to extract key information. We will report our findings using narrative synthesis and tabulate findings, by agreed key components.Ethics and disseminationEthical approval is not required to conduct a scoping review. We will disseminate the findings through a peer-reviewed publication and conference presentation.
ObjectiveTo map key policy documents worldwide and establish how they address the treatment and care needs of children and young people (CYP) who are suicidal.DesignWe conducted a scoping review to systematically identify relevant key policy documents following a pre-established published protocol.Data sourcesFour databases (CINAHL; Medline; PsycINFO; The Cochrane Database of Systematic reviews) and the websites of key government, statutory and non-statutory agencies were searched. Google and Google Scholar were used to identify other policy documents and relevant grey literature. Leading experts were consulted by email.Eligibility criteria for selected studiesPolicies, policy guidance, strategies, codes of conduct, national service frameworks, national practice guidance, white and green papers, and reviews of policy—concerned with indicated suicide prevention approaches for children up to 18 years old. Limited by English language and published after 2000.Data extraction and synthesisData were extracted using a predetermined template. Second reviewers independently extracted 25%. Documents were categorised as international guidance, national policy and national guidance, and presented in a table providing a brief description of the policy, alongside how it specifically addresses suicidal CYP. Findings were further expressed using narrative synthesis.Results35 policy documents were included in the review. Although many recognise CYP as being a high-risk or priority population, most do not explicitly address suicidal CYP. In general, national guidance documents were found to convey that suicidal children should be assessed by a child and adolescent mental health practitioner but offer no clear recommendations beyond this.ConclusionThe lack of specific reference within policy documents to the treatment and care of needs of children who are suicidal highlights a potential gap in policy that could lead to the needs of suicidal children being overlooked, and varying interpretations of appropriate responses and service provision.
Suicide among children and young people (CYP) is a leading cause of death. In the UK children identified as suicidal are referred to Child and Adolescent Mental Health Services (CAMHS) for assessment and treatment. However, the number of children referred for suicidality, and their care journey is unknown. This retrospective cohort study conducted in two distinct CAMHS teams, in Scotland, UK, aimed to quantify the numbers of children referred for suicidality, describing this population and the outcomes of these referrals. All CAMHS referrals (n = 1159) over a 6-month period (Jan-June 2019) were screened to identify those referred primarily for suicidality. Data extracted included: age, gender, source of referral, reason for referral including underlying issues, whether offered an assessment, and referral outcome. Area based deprivation scores were attached to each referral. Associations between the referred CYP's characteristics (including source of referral and underlying issues) and referral outcomes were explored using Chi Square, Fishers Exact test, and one-way ANOVA. Referrals for 284 children were identified as being for suicidality across the two sites (Site A n = 104; Site B n = 180). These represented 25% of all referrals to these CAMHS over a six-month period. One third of these concerned children under 12. The underlying issues, referrals sources, and demographic indicators were similar in both sites. In site A 31% were offered an assessment, whilst in Site B which had a dedicated team for suicidal CYP, 82% were offered an assessment. Similarly, more children in Site B were offered treatment (47.8%), than Site A (7.7%). Referrals from A&E were prioritized in both areas, and those who had attempted suicide offered an assessment more often. Older children were more likely to be offered treatment, although they were more likely to present with a history of self-harming behavior and/or previous suicide attempt. There are high numbers of children being referred to CAMHS for suicidality, and many are young children (<12). There is variation within and between services in terms of assessment, referral outcomes and care pathways for these children. Having a dedicated team to respond to referrals for suicidality appears to support access to assessment and treatment.
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