Issues relating to suicide and prevention has hit the media today (19 January 2015) as Deputy Prime Minister Nick Clegg hosts a Health Conference, bringing together leading clinicians, policy makers and campaign groups to discuss the future of mental health services in England. His agenda is for hospitals to end suicides, and his attention, rightly so, is on anyone of any age attempting suicide.
But my attention falls with vulnerable children and young people. After all, I've counselled children and young people for 15 years. While I also counsel adults, my energy regarding suicide goes out to young people and children. Visiting schools and speaking with parents, some of them clients, I'm often asked how to support children and young people when a parent or other key relative attempts or dies by suicide, and how to prevent young people and children from attempting suicide. While the government’s attention is now on hospitals (and yes, government needs to focus some where specific) what about support for front line people who are with young people every day: teachers and parents or other carers?
What ever the statistics on young people and young people – and the Samaritans has a useful report on how to understand the many complex statistics surrounding suicide [ref]Samaritans Suicide Statistics Report 2014[/ref] – the best way to minimize the risk of suicide is to know the myths and risk factors and to recognize the warning signs of suicide.
Take these signs seriously.
Know how to respond to them.
By taking a few moments to read this article, YOU could save someone's life.
The following statements are false, followed by a truthful statement.
People who talk about suicide won't really do it.
Almost everyone who commits or attempts suicide has given some clue or warning. We need to take suicide threats seriously. Statements like "you'll be sorry when I'm dead," "I can't see any way out," — no matter how casually or jokingly said may indicate serious suicidal feelings. The feelings may, or maynot, turn into an attempt.
Anyone who tries to kill him/herself must be crazy.
Most suicidal people are not psychotic or insane. They are upset, grief-stricken, depressed or despairing. Extreme distress and emotional pain are not necessarily signs of mental illness.
If a person is determined to kill him/herself, nothing is going to stop them.
Even the most severely depressed person has mixed feelings about death, wavering until the very last moment between wanting to live and wanting to die. Most suicidal people do not want death; they want the pain to stop. The impulse to end it all, however overpowering, does not last forever.
People who commit suicide are people who were unwilling to seek help.
Studies of suicide victims have shown that more than half had sought medical help in the six months prior to their deaths.
Talking about suicide may give someone the idea.
You don't give a suicidal person morbid ideas by talking about suicide. The opposite is true—bringing up the subject of suicide and discussing it openly is one of the most helpful things you can do.
Risk factors for suicide
The teenage years can be emotionally turbulent and stressful in themselves. Teenagers face pressures to succeed and fit in. They may struggle with self-esteem issues, self-doubt, and feelings of alienation. For some, this leads to suicide. Depression is also a major risk factor for teen suicide.
Some possible risk factors for teenage suicide include a combination of the following:
has a mental illness
been a victim of violence, bullying or sexual abuse
recently experienced or is going through a traumatic event
going through a major life change
is being judged or shamed
has no sense of their own identity
friends or family don't support their sexuality or identity.
has a serious physical illness
lacks a support network, no connection with family, friends or community
has an intimidating, unsettling social or school environment
bereaved of a friend or relative to suicide
feeling lack of control in their life
has attempted suicide before
Suicide warnings among teenagers
We're told someone who is going to attempt suicide gives warning signs but they're often missed. If we know a friend or relative who is living out some of these risk factors described above, what are the warning signs?
It's usually a combination of some of the following signs, but any one of these could be an indication that the young person needs extra support with something going on in their lives. Offering support sooner rather than later may even help prevent a suicide attempt.
Be aware of any of the following in a young person or child:
Change in eating and sleeping habits
Withdrawal from friends, family, and regular activities
Violent or rebellious behaviour, running away
Drug and alcohol use
Unusual neglect of personal appearance
Persistent boredom, difficulty concentrating, or a decline in their ususal quality of school work
Frequent complaints about physical symptoms, often related to emotions, such as stomach aches, headaches, fatigue, etc.
Not tolerating praise or rewards
What to do to prevent a suicide attempt
Having observed one or more of the behaviours listed above in a friend or relative whose experienced falls within in the risk factors, what do we do? As the last myth above clarifies: talk with the young person and take that person seriously.
Don't be afraid to approach a friend or relative who you think isn't coping. Just showing that you care will be a positive step towards supporting them. You don't have to be able to solve their problems but if you feel you can, offer support and encourage them to talk about how they're feeling. Actively listen to what they are saying, even if it really difficult for you to hear their pain, let them say what they need to say. Ask direct questions and don't be afraid of frank discussions. Don't attempt to argue him or her out of committing suicide. Rather, let the person know that you care and are listening. Avoid statements like: "You have so much to live for." Even if you think that, they don't feel it at that moment.
Know that many people do want a chance to talk but worry they may be a burden to those around them.
Look after yourself, too
Supporting a friend or relative in distress can be distressing in itself. If you're helping someone who feels suicidal, make sure you take care of yourself as well. If you need to talk about how you are feeling, or you need further support to help the suicidal person and don't have someone you feel safe speaking with, contact:
On a visit to Canada, my older brother and I were walking through my favourite park. On shaded tarmac, we doddled along. Suddenly my brother stopped and put an arm out to stop me. "Look," he whispered, as he gazed down. There in front of us was a thin, small snake, about 8 inches long. It's what I knew as a "gardener" snake, yellow line down it's back. We watched it curl itself one way, then the other as it made it's way, heading in the same direction as us. My shadow caught it, and the snake froze. My brother moved closer. The snake tightened into a coil. It was a tiny,, thin, maybe eight inches long, thing. We must have been towering giants. My brother leaned over, still watching a few feet from above. Suddenly the head sprang up from it's coil and the snake hissed with wide open mouth. I actually jumped. This tiny skinny snake had scared me for a moment. It held it's position, stretched and hissing.
My brother and I backed off. Not that we were scared, now. I don't think my brother had even been shocked. He's a cool, laid back soul. We didn't want the snake to feel threatened. With my shadow no longer over the snake, and my brother and me a couple more feet away, the snake eased itself down and swayed, coiling one way, then the other; one way, then the other; moving until it was lost to us in the grass.
The image of that tiny snake pulling itself up to its fully, few inch, height and baring it's mouth at us towering beings, remains vivid. This happened years ago.
A tiny being, not cowering against strong, huge beings, but straightening up and holding position. Ready to attack in a situation where it had no chance of fighting us off. (It's not a poisonous snake). What a strength. What a power.
Working with children who appear timid and definitely emotionally scarred, I have often experienced their mighty strength rear up at me. Sometimes they frighten me for that instant moment — like the tiny gardner snake — sometimes they inspire joy: their development and ability to overcoming pain, difficulties or hurts is inspiring.
This is one of the many reasons I love counselling children. This unexpected strength rears up frequently when the outterly timid feels safe to express their inner power.
British Sign Language was only recognised as an official language in its own right in this country, 11 years ago: 18 March 2003. May it continue to be welcomed and used in all walks of life.
British Sign Language is a vibrant language in its own right with its own grammar, vocabulary, structure and syntax.. British Sign Language is not simply about replacing a spoken word with a hand gesture. Like other languages (e.g. French and English), there cannot be an exact word for word translation.
Sign language has been around for a long time this changed suddenly in 1889. Back in the 18 century Thomas Braidwood brought sign language into the educational system in the United Kingdom. Sign Language remained in schools for a good fifty years until the fateful Second International Congress of Education of the Deaf was held in Milan. There the 1889 Royal Commission of the Blind and Deaf & Dumb was issued. This commission decreed the end of sign language in schools in preference to the Oral Method, a method that punished those who dare use sign language and promoted the difficult, often impossible task, of teaching children who were born deaf, had never heard, to speak. One of the consequences was that more than 70% of UK Deaf children left school with a reading age of 7 and with few qualifications and social skills.
The British Deaf and Dumb Association (BDDA) was formed in 1890 by Francis Maginn to fight the Oral Method and to protect the rights of the Deaf people. In 1971, the "Dumb" was dropped to create the British Deaf Association which continues to exist today. What a long time it has taken in this country for British Sign Language to once again accepted and recognized: from 1890 to 2003!
Apparently, with the combination of Deaf and hearing people who use BSL, this language is now more common than Welsh and Gaelic!
The British Deaf Association has deemed 16th – 23rd March 2014 as Sign Language Week. In previous years they had a one day event to mark the recongition of British Sign Language as an official language — now 11 years ago — on 18th March 2003. To find out more about what's happening that week, check out the BDA listing http://www.bda.org.uk/Events
Learn 11 BSL signs
Signature, a national charity and the UK’s leading awarding body in deaf communication qualifications, is marking the 11th anniversary of British Sign Lanuage day by calling for school teachers to take fifteen minutes out of their day to teach students 11 basic BSL signs. The charity has created a short video demonstrating 11 key words and phrases and has freely distributed it to schools across the UK. You can visit Signature’s website to stream Signature’s 11 BSL phrases http://www.signature.org.uk/eleven-signs
Shocking or just another manipulative and misleading act of some media?
It now comes to light that a photo of Mark Duggan was cropped to create a 'ganster' image of this father of six. The photo was taken when he was grieving. As the full image shows, he was at the grave site of his daughter who was still born.
Mark Duggan is the 29-year-old Tottenham (London, England) resident, who was shot and killed by police in Tottenham, North London, England, on 4 August 2011. The inquest jury found that Duggan's killing was "lawful". Duggan was unarmed when he was shot dead by police.
Deeply personal moments of grief are frequently shown in newspapers, magazines and on television. Now, grief has been hidden and twisted to proliferate a particular view of a family man: that he was a gangster too.
Three major organizations who work on the issue of bereavement have come together and identified six crucial steps to address bereavement as a major public policy issue.
The National Bereavement Alliance has a vision that all people have awareness of and access to support and services throughout their bereavement experience. Working with the National Council for Palliative Care and the Dying Matters Coalition, its members have now published these six steps in an easy to read document. To download a copy, go to:http://www.ncpc.org.uk/sites/default/files/LifeAfterDeath.pdf
The well referenced 12 page document is a combination of personal experiences/case studies, many statistics and the steps that could be taken to make bereavement a less isolating, difficult experience. Alison Penny, Project Coordinator for the National Bereavement Alliance and Coordinator of the Childhood Bereavement Networkhas yet again researched and written a paper that says a lot in simple words. She did this with support from National Bereavement Alliance members, Simon Chapman, Director of Policy and Parliamentary Affairs and Joe Levenson, Director of Communications, NCPC and Dying Matters
I was drawn to an article about infant and child awareness month. A quote announced that there was a long tradition of October and November being a time when different faith and culture groups remember their dead. The article only mentioned three such days:
All-Saints Day (Christian)
Day of the Little Angels (Día de los Angelitos) and Day of the Dead (Dios de los Muertos)
Jizo Remembrance Ceremonies (Zen)
As I work in a bereavement service, I'm wondering about other annual death rituals and would welcome hearing about them. If you know of an annual festival or ritual or celebration to remember those who have died, please do let me know.
By the way, I discovered the Awareness month was last month, October, and it was in the United States. But the article by Rev. Sue Wintz, an American board certified health care chaplain, is still worth a read. It's basic but informative about the implications for those who know and care for bereaved parents.
The experiences of death and bereavement are often intimately connected to spirituality and religion. As counsellors, how do we work with these deeply personal beliefs of our young clients, when they may be so foreign to our own? How do we meet them where they are, even when the link to bereavement isn't always clear?
The desire to present a service as welcoming is often equated with being seen to be ‘multicultural’, and results in either the display of no religious imagery or the inclusion of images and symbols from a variety of religions, along with ‘understanding a bit about those beliefs’. But I’ve never heard the word ‘spirituality’ mentioned, even though it is an important aspect of life for many people. Spirituality, to me, is not always tangible but rather a deep experience of connecting with something – a divine being or an energy, or a power that is greater than all of us. For some, it is found in religion, for others it may be in a unique and special experience. I will show here some of the variations on spirituality that I have come across during my 12 years’ bereavement counselling with children and young people in multicultural inner-city areas, using composites of the many children I have worked with, in order to bring the work to life.
As with toys in the therapy room, religious symbols and images may be the catalyst that encourages children and young people to question their faith or discuss God-related issues, even when they have no family religion.
Recently, I was based in a church in an area where many of the children and young people were Muslim. To arrive at the therapy room, the child and I had to walk through the nave, passing pews, pulpit and a cross. It wasn’t a Catholic church, so there was no Jesus ﬁgure nailed to the cross, but it was indeed large enough to have held an adult ﬁgure. Behind it, a magniﬁcent stained glass window often created a many-coloured glow around the cross.
The ﬁrst day I walked with Aahil to the therapy room, he slowed his pace, stared at the dark benches, the prominent pulpit and the wooden cross, and spoke in hushed words. Initially, his comments were factual questions. This is a church? That is where people go on a Sunday? This is where people pray? I responded directly to his questions, and I also reﬂected his quietness. I acknowledged this space was very different from his mosque and gave openings for him to comment or ask questions. We hadn’t reached the therapy room, but counselling had begun.
His parents had visited the therapy room, walking this route, and so were aware of what their son would be seeing. I’d openly wondered if they would be uncomfortable with Aahil seeing these Christian symbols. They were of a liberal attitude that all places of worship were valuable – ‘but Aahil is a Muslim!’ I reassured them that although the counselling service was in a church, the counselling was not Christian based. I answered their questions, and I asked one of my own. I was aware that some Muslim families allow images of family members, paintings or photos, and some do not. How was it in their family? Would it be acceptable for Aahil to see photos in the therapy room and – if he wanted – to create images (paint, drawing, clay) of how he imagined his twin brother, Aaban, might have looked. Aaban had been stillborn. The family had photos in their home, but none of Aaban. They did not mind Aahil creating images of Aaban ‘if it would help Aahil through his sadness’.
Aahil's focus was on the Christian symbols outside the therapy room, and these were the doorway into his exploration of his own faith, and his coming to an understanding of the death of his twin brother.
As Aahil and I walked to and from the therapy room each week, his questions became more probing about 'these people’s’ beliefs about heaven and hell, and death rituals, and God, and good and evil. In talking about these ‘others’, Aahil began to open up about his own thoughts and feelings about his faith, his confusion about Aaban ‘needing to die’, ‘why him not me?’ and Aaban’s funeral, which no one spoke about.
In the therapy room, there were photos of funerals and related ‘death images’, including a Muslim temple and one of children gathered around a grave. Aahil never took note of these or other pictures. His focus was on the Christian symbols outside the therapy room, and these were the doorway into his exploration of his own faith, and his coming to an understanding of the death of his twin brother.
Not all of my clients were Muslim. There were those with no religion (but often a lot of faith) and there were Christians of different types, as well as Sikhs, Roma and others.
Sometimes we have to be creative to make something relevant. At The Candle Project in south London, I have seen what they call ‘the Crem’. From my view of it, the crematorium could just as well be used for a church chapel. It’s made from a Sylvanian Family school. The windows are covered with imitation stained glass. Pews are doll house benches and chairs. The doll house cofﬁn was found in a shop, at Halloween, full of goo. Having a spider web illustration on the lid and being transparent, it needed painting, and then a good wash to clean out the goo. Now it ﬁts nicely into the crematorium. There is also has a rough wooden cofﬁn to ﬁt a Barbie doll.
My own therapy room was ﬁtted with soft carpet and contained a wide range of resources, including friendly, scary and angry puppets, wet and dry sandboxes, a range of mini characters and the dollhouse with a cofﬁn to ﬁt the dollhouse characters. Yet there was something one of my clients needed that could not be found within this room.
Poppy, a bright articulate nine-year-old, attended a church school, and told me that she went to church every Sunday. But she had been ‘too young’ to attend her mum’s funeral when she was two years old. Now, her Dad had cancer and she was obsessed with his dying and her being ‘left alone’.
In the therapy room, she was drawn to the paint and the sandbox. She produced massive, red and black poster-size painted sheets of ‘The Devil’. She feared her dad would not go to heaven because ‘he did not go to church every week’. In the sandbox, Poppy spent the remaining time burying plastic Playmobil characters. She didn’t appear to discriminate who she buried. She would grab handfuls from the basket, pile them in a corner of the box, and bury them one after another. There were no tombstones – she had never visited her mother’s grave. While she dug holes for the grey-haired character, or the handyman dressed in overalls, or the boy on a skate board, or the girl holding a teddy, she would talk about ‘the nice service’ and ‘how lovely the priest’s words were’. When she placed the Playmobil character into a hole, and gathered sand, which she watched intently as it trickled through her ﬁngers, she would ask me questions about what would happen at a funeral. I knew from discussions with her father, that he would not discuss this with her. He was ﬁne with me doing so, but he didn’t see why she needed ‘to talk about all this death stuff’. I learned from Poppy that she had never been to a funeral and her limited knowledge was from TV soaps. I learned that she was ‘rather scared’ about attending her father’s funeral ‘some day’.
I reﬂected on what Poppy needed. I could play out a funeral for her, as I had with other children (I knew the basics of a Catholic funeral). My tentative suggestions were met with a clear negative response. Following more thought, discussions with my supervisor, and a difﬁcult discussion with her father, I suggested the following (with her father’s permission): would Poppy be interested in meeting a friendly nun in the neighbouring parish church who would tell her about what happens at a funeral and try to answer any questions Poppy might have? She was.
Taking the therapy outside
So Poppy and I visited the nun in her church. The three of us sat in a pew facing the pulpit and the nun answered the many questions that Poppy had that day. Then the nun walked her through a funeral.
'Everyone would be sitting here… and here,’ she said, pointing to the many pews on the right and left sides. She walked slowly to the front of the church with us following, me a few steps behind, and added, ‘Music from the organ would be playing. You might be able to choose one of the hymns for your dad.’
Reaching the front of the church, the nun turned, looked at Poppy kindly and said in a hushed tone, ‘You would be sitting in a pew at the front with your auntie.’ (I had ascertained who would accompany Poppy.) Poppy glanced at the pews, then up at the pulpit and cross, and back to the nun, who continued speaking as we walked through the motions. ‘The doors would open. Men dressed in black would carry the cofﬁn on their shoulders to the front of the church and place it here.’ And so the nun went on explaining what the priest might say, the order of the service, and all the details of a Catholic funeral. I stood a few feet back, supporting Poppy with my presence but not interfering.
When the nun had ﬁnished, she served us a cup of tea in ﬁne china and answered Poppy’s remaining questions of the day. We said our goodbyes and returned to the counselling service. We had a few minutes to sit quietly together and we talked about how she felt now and how she had felt these last weeks. Then her father arrived to take Poppy home, as arranged.
Was that counselling? Or was that a ﬁeld trip? In following sessions, Poppy was much more settled, less anxious. She thought about what hymns she might like played at her father’s funeral and wondered which ones he might like. (He refused to talk about this with her or me.)
Some weeks later, Poppy gathered in her hands the toy cofﬁn. She brought together ‘the family’ and in silence placed an adult-size Playmobil female into the cofﬁn, and buried this in the sand. We stood together for many moments in silence.
As a member of the Religious Society of Friends (Quakers), I am comfortable talking about other religions and faiths. As silence is common in our worship, I do not feel a need to disturb the silence that a child or young person brings into the therapy. My beliefs as a Quaker ﬁt well with my person-centred approach to counselling. We believe that ‘there is God in everyone’ and that we are all equal (in an unequal world). My deeply spiritual experiences happen during silent Quaker worship and among natural settings. In the therapy room, there are bowls of pine cones, rocks, shells and conkers. I am aware that others are affected by other experiences and spaces, and if I could create them within the therapy room, I would.
Gaurav, a 10-year-old Sikh boy, now living with his uncle following the accidental death of his mother, came warily to the school therapy room the ﬁrst time. He stood at the doorway looking around. When he saw the toy plastic silver swords, he ran directly to them. Unlike many children, he didn’t swish one around and challenge me to a duel. He held it reverently. ‘It’s the wrong size,’ he said. I dipped my head in acknowledgement and asked, ‘What size should it be?’
As Gaurav laid the sword on a pillow, he said, ‘You can’t hold this, you are not a Khalsa.’ He stood straighter and in a way I’d never seen him stand, and looked me directly in the eyes. I nodded and agreed, ‘I am not a Khalsa. I have not been initiated into the Sikh faith.’
I knew from discussions with his uncle, and from reading, that a Khalsa was a baptised or initiated Sikh who was required to wear the ﬁve ‘kakars’, the symbols of their faith: the kes, uncut hair; kanga, a wooden comb worn in the hair; kara, a metal bangle or bracelet worn on the wrist; kachera, loose, long underwear, about knee-length; and kirpan, the sheathed sword worn on a belt or strap. As I was remembering all this, Gaurav showed me a distance of about eight centimetres. So, he was meaning one that is worn, not a ceremonial kirpan, which may be the length of a standard sword. ‘You know about Sikh religion?’ he asked in a whisper. Perhaps not many white women did. ‘Some of it,’ I said.
Gaurav returned the sword to the toy shelf and sat down on the pillow. ‘What do you know?’ he demanded.
I sat on the ﬂoor and he threw a pillow at me, which I deftly caught and sat on. ‘I know the ﬁve Ks,’ I said.
‘Name them, he demanded,’ and so I did. This began many discussions. He knew little of his own faith. His mother ‘wasn’t a good Sikh’, his uncle had told me. Gaurav was learning but struggling. His ‘brother’ (cousin) was being brought up as a Sikh and so knew a lot more. This brother teased Gaurav in the playground in front of other children. Gaurav was bullied by classmates about being Sikh. Gaurav felt overwhelmed in the large family. He had been an only child. Furthermore, he was the only Sikh in his year group. Over the months, I met frequently with his uncle and we discussed these and other issues, including his own grief over the death of his sister, Gaurav’s mother. These chats led to Gaurav’s uncle helping his son make his own memory box of his aunt. Gaurav already had one. I came to know a lot more about Sikhism.
However, Bo was an often-yawning, seven-year-old Romani boy, who entered my school counselling room soon after morning registration. Since ending the travelling life and moving into a house about a year ago, he had become silent. He would not talk. His school work deteriorated. Many class lessons were spent looking out of the window.
Bo spoke again: “Dark storm clouds. Throw spears of lightning.” Lightning brightened the room for a moment and a great crash of thunder quickly followed. Bo continued to lie still, then whispered: “Thunder, clashing drums.”
He took to play instantly, mostly in the sand, or on the ﬂoor with horses and polished pebbles. Sometimes he gestured for me to play a hide-and-seek game with an object in the sand. The sessions were full of activity, but silent of words.
Often, Bo would ﬁnish his session with his head and torso on a bulky pillow, legs sprawled out on the carpet. He liked me to lie at a 90-degree angle to him with our heads nearly touching, but not quite. On the days our heads did bump, he would giggle, then settle into silence. We would look towards the ceiling. The sessions were quiet, with no speaking, but this silence felt hushed and reverent. After many of these endings, Bo broke the silence. In a rough, hoarse voice, he said, as he gestured with his hands, ‘Big ﬂuffy clouds. Where horses dance.’ Smiling, these were the only words he spoke. On frowning days he was, again, silent – until one day when rain pelted on the curtained windows and the dark clouds that blotted out the sky made our room feel like a cave. We both had our heads on the shared pillow. Bo spoke again. ‘Dark storm clouds. Throw spears of lightning.’ Lightning brightened the room for a moment and a great crash of thunder quickly followed. Bo continued to lie still, then whispered, ‘Thunder, clashing drums.’
Were these spiritual moments? Gaurav’s talking about his religion and faith with me, and Bo’s restfulness on the pillow and comments about clouds? I do not know. But Bo was always calmer leaving the therapy room, and more attentive for the rest of the day in his classroom. Gaurav now played cooperatively with other boys during break. The teasing stopped, and he and his cousin-brother were friendlier to each other.
The opportunities for opening the doors to children’s faith, religion and spirituality are many, both in and outside the therapy room. Religious symbols and images may be keys to those doors, but, as children have shown me, it may not be their own religious symbols. What is a toy to others may be a symbol to them. And sometimes we need to step outside the therapy room. Sometimes, again, the symbols are not available, as with ‘the Crem’, and creativity is needed. But as always, in the end, it is about the relationship between counsellor and child or young person, and our openness and conﬁdence to understand them, learn a bit about their faith and religion, and to seize or create the spiritual moment for stories to be told and shared.
Originally published in BACP Children & Young People, September 2012.