Assessing and Responding to Suicide Risk in Children and Young People: Understanding Views and Experiences of Helpline Staff
2. Materials and Methods
2.4. Data Collection
3.1. Starting Conversations about Suicide
3.1.1. Explicitly Asking about Suicide
“…then we would actually ask that question in quite an overt way, saying, “It sounds like you’re really struggling–can I ask, are you having thoughts or feelings…it sounds like you’re having, you know, thoughts of suicide…” and usually that tends to provoke a response of “No, that’s not what I meant” or “Yes, actually, I am” and then that discussion [relating to suicide] opens up.” (S1P1).
“You know, we explicitly ask, you know, on contacts around that because sometimes I think, if it’s not explicitly asked, you don’t give a person a space to say yes or no. And of course that changes, you know. It can be from fleeting thoughts to really intense, overwhelming thoughts.” (S3P2).
3.1.2. Exploring and Understanding
“…like “How long have you been feeling like this. You know, like has something like led to this tonight or how you’re feeling today?” and then like, if they give us like a feeling, we kind of ask questions down like, well, “Why are you feeling like this?” and kind of try and delve deeper into like their story and keep them talking about that…”. (S2P3).
“I would talk about, obviously, historical, because that may come up–you know, is it actually the first time? You know, how long have they been feeling like this, you know, and have they had a historical, em, time of, you know, trying to commit suicide, em, because, again, I think that’s really important to…to get a full picture of actually what their life and journey has been like...” (S3P1).
“I kind of always start with like, “I’m really sorry you’re feeling like that–tell me a bit more, like has something happened recently that’s making you feel like you need to do this?” or trying to get to what’s kind of…what’s the cause of it, really, or if the young person is aware of any causes, because, quite often, they’re not. They’re just like, “Well, I’ve got these feelings, I don’t know why, I don’t know where it’s come from,” and that sort of therapeutic work is about working out with them something that may have triggered it, and [I’m] thinking…finding a trigger helps the young person understand it more…”. (S3P3).
3.2. Identifying and Responding to “Imminent” Suicide Risk
3.2.1. Determining Immediacy of Risk
“I may say, actually, like, “Is there intention of you wanting to take your life?” and em…yeah, I guess it depends where they’ve gone from there. I just…I’m really trying to think about kind of important questions I would actually ask in that situation… Sometimes, I will say like a scale, em, because people may say, “I’m not sure” or, em, and kind of just saying like, “Out of 1 to 10, you know, if 10 is you’re definitely going to do it, where do you feel you’re at right now?” and I think it’s really important to say “right now” because, em, obviously that could change all the time.” (S3P1).
3.2.2. Making Judgement Calls
“It’s something I would definitely negotiate. It isn’t something that–when I say “negotiate”, if there is immediate risk, I would act on it, but I wouldn’t just say… It all depends on the situation [laughing]. If someone gave details, it’s not like, right, I have to do this right now! I would be certainly listening to…to…. I think it’s that, giving them that space to explore it, and if, at the end, it does need to go to the Police, then it would.” (S3P1).
3.3. Responses to Suicide Risk in Relation to Safeguarding
3.3.1. Triggering Safeguarding
“If–there are some callers who have disclosed their information, so…somebody potentially could disclose that during a call, so saying where they are or, you know, giving the location, and that then would be around making a decision about if that person was at immediate risk, and if they are, then we would let them know that we were going to get help for them, and we’d end the call and call the Police so…or call 999…”. (S1P1).
“…being really transparent with the young people, letting them know this is what we’re going to do, because I really care and I’m worried about you, and following up and making sure that they know that we’re still there. So, they still get supported through all that, which is great, and then obviously the follow-up, em, if…in…circumstances where we have contacted the Police to complete a welfare check because we were concerned or an ambulance has been called.” (S3P5).
“Because I think like…when you maybe say to someone, oh yeah, we’ve got an ambulance coming,” and then maybe four Police officers and two paramedics…that’s just so overwhelming for them, like…that is a big issue as well, I think.” (S2P1).
“Police aren’t trained to deal with suicidal people. It feels like quite a blunt instrument that we’ve got really, but we don’t…we don’t really have anything better, I suppose. You know, you can’t…you can’t get an ambulance to go out to deal with suicidal people–it would be the Police. Yeah. So, it’s kind of what we have, but, you know, obviously we realise it isn’t ideal.” (S1P3).
3.3.2. Continued Support When SUs Decline Safeguarding
“…you talk to somebody for whom you don’t have contact details and you have to almost just, at the end of the session, it’s just there and all you can do is go I gave that person my time and my emotional energy and my support at a point when they needed…” (S1P1).
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Starting conversations about suicide||Explicitly asking about suicide||Opportunity to explicitly ask about engagement with self-harm or suicide.|
|Exploring and understanding||Exploring the context and situation of self-harm and suicide.|
|Identifying and responding to “imminent” suicide risk||Determining immediacy of risk||Unpicking how immediacy of risk is determined. Mechanisms to do this might be through caller description of injury, use of language to determine intention or specifically looking for a suicide plan and the timeliness of this plan.|
|Making judgement calls||Frontline staff ultimately have to determine the immediate risk of a caller or client.|
|Responses to suicide risk in relation to safeguarding||Triggering safeguarding||Across all services the safeguarding response was to inform emergency services if the caller or client had shared their details. Critical reflections of calling the police; apprehension.|
|Continued support when SUs decline safeguarding||Frontline staff have to stay calm and continue offering their clinical support to suicidal SU.|
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Williams, A.J.; Kloess, J.A.; Gill, C.; Michail, M. Assessing and Responding to Suicide Risk in Children and Young People: Understanding Views and Experiences of Helpline Staff. Int. J. Environ. Res. Public Health 2022, 19, 10887. https://doi.org/10.3390/ijerph191710887
Williams AJ, Kloess JA, Gill C, Michail M. Assessing and Responding to Suicide Risk in Children and Young People: Understanding Views and Experiences of Helpline Staff. International Journal of Environmental Research and Public Health. 2022; 19(17):10887. https://doi.org/10.3390/ijerph191710887Chicago/Turabian Style
Williams, A. Jess, Juliane A. Kloess, Chloe Gill, and Maria Michail. 2022. "Assessing and Responding to Suicide Risk in Children and Young People: Understanding Views and Experiences of Helpline Staff" International Journal of Environmental Research and Public Health 19, no. 17: 10887. https://doi.org/10.3390/ijerph191710887