Preventing suicide in children and young people: What can GPs do?

Dr Maria Michail and Dr Faraz Mughal provide some practical tips that GPs should bear in mind when consulting with a young person at risk of suicide.

Primary care is often the first and the last healthcare contact for those who die by suicide (Photo: iStock.com/aldomurillo)
Primary care is often the first and the last healthcare contact for those who die by suicide (Photo: iStock.com/aldomurillo)

Suicide is a global public health concern and costs the lives of approximately 1m people per annum.1 It is the second leading cause of mortality in young people worldwide.1

In the UK, suicide accounts for 14% of deaths in 10-19 year olds and 21% of deaths in 20-34 year olds.2 Almost 50% of young people who die by suicide have a history of previous self-harm, making self-harm the strongest risk factor for suicide.2

The primary care setting is often the first and the last healthcare contact for those who die by suicide; 60-80%, including young adults, have visited their GP in the 12-month period before suicide. When it comes to mental health problems, young people are more likely to seek professional help from a GP than any other healthcare professional.3

The role of primary care

In light of this, what role do GPs have in supporting vulnerable young people and mitigating the risk of suicide?

The National Suicide Prevention Strategy in England highlights the role of primary care in suicide prevention emphasising the need of specific GP education and training in awareness of suicidality and safety planning.

The high rates of pre-suicide contact documented would also suggest that GPs are well-placed to identify early, assess, and mitigate the risk of suicide in vulnerable young people.

However, the reality is very different. Our research and those of others shows that GPs face particular challenges in the assessment and management of suicide risk in young people.4,5

Difficulties in accessing secondary mental health services, lack of communication with mental health providers, as well as time-limited consultations are significant barriers to the effective management of suicidal young people in primary care. In addition, a lack of GP confidence and skills in assessing and managing suicidal risk, as well as difficulties in communicating with vulnerable young people have been highlighted by GPs as significant challenges.

Practical advice

In response to these challenges, the RCGP has recently launched an online educational resource Suicide in Children and Young People: Tips for GPs.

This brief, practical, and user-friendly resource provides GPs with a snapshot of the most well-documented risk factors for suicide in children and young people including previous suicide attempts, diagnosis of mental illness (e.g. depression), substance use, as well as family discord, bereavement, and history of mental illness in family.

It draws attention to young people with complex needs who are more likely to experience multiple vulnerabilities including those who identify as LGBTQ, looked after children and those who have been victims of bullying.

In this resource, we provide GPs with suggestions about how to assess and mitigate suicide risk in a consultation keeping in mind the competing demands of general practice and acknowledging that more detailed mental health assessment may need to take place over a number of consultations and with input from other sources (e.g. family, school, specialist services).

Tips to bear in mind

These are some top tips all GPs should bear in mind when consulting with a young person at risk of suicide:

1. Communicate effectively
Allowing young people to express their feelings and their concerns, listening intently, and responding with empathy and compassion is important in establishing therapeutic alliance and a trusting continuing relationship.

2. Ask about suicidal ideation directly
It is important to emphasise that there is no evidence to suggest that talking about suicide or self-harm increases risk. On the contrary, open communication and direct questioning about suicidal ideation could facilitate disclosure and provide young people with the platform to express their feelings and thoughts.

3. ‘What could keep young people safe’
Agreeing in partnership with the young person a brief safety plan including coping strategies, restricting access to means, identifying social support (e.g. family, friends) as well as ensuring follow-up by booking the next appointment directly with the young person could reduce suicide risk and support young people and their families.

GPs have a key role

Preventing suicide is everybody’s business. A recent survey of 302 GPs reported that 61% are seeing more young people self-harming than five years ago.6 GPs have an important role to play in suicide prevention and must remain front and central in assessing young people’s needs, managing and coordinating care, and receiving adequate support to deliver these services.

  • Dr Maria Michail is senior research fellow at the Institute for Mental Health, School of Psychology, University of Birmingham.
  • Dr Faraz Mughal is a GP and NIHR in-practice fellow, Primary Care & Health Sciences, Keele University and RCGP clinical fellow in mental health

Acknowledgements
Dr Mughal is supported by an NIHR In-Practice Fellowship. The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

References

  1. World Health Organization. Preventing suicide: a global imperative. Geneva, 2014.
  2. Suicide by children and young people. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). Manchester: University of Manchester, 2017.
  3. Rickwood DJ, Deane FP, Wilson CJ. When and how do young people seek professional help for mental health problems? Med J Aust 2007; 187 (7 Suppl):S35–9.
  4. Fox F, Stallard P, Cooney G. GPs role identifying young people who self-harm: a mixed methods study. Fam Pract 2015; 32:415–19
  5. Michail, M. and Tait, L. 2016: Exploring general practitioners’ views and experiences on suicide risk assessment and management of young. people in primary care: a qualitative study in the UK. BMJ Open 6 (1).
  6. Stem4, 2016. 'A Time Bomb Waiting to Explode' A Survey of GPs’ Concerns about Mental Health Services for Children and Young People.

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