Adolescence

As young people move from childhood to adulthood, they enter the period of human development defined as adolescence. This period, between the ages 10 to 19, sees a young person transition from being part of a family group, towards closer affiliation with a peer group, and then on to independence as an adult (Geldard et al., 2019). The World Health Organisation (WHO; 2022c) recognises this unique stage of development as an important time for laying the foundations of good health. Adolescents experience rapid physical, cognitive and psychosocial growth that affects how they feel, think, make decisions, and interact with the world around them (WHO, 2022c). Despite many commonalities amongst young people, individual experiences of adolescence can be vastly different. Adolescents face biological, cognitive, psychological, social and spiritual challenges that can lead to mental health problems if not managed adaptively (Geldard et al., 2019). These challenges include changing relationships with parents, peer pressure, increased academic expectations, emerging personal and sexual identity, and moral decision making (Geldard et al., 2019). These encounters are influenced by childhood experiences or environmental stresses or hazards that result in some young people not being emotionally equipped to navigate them without professional support (Ivey et al., 2017; Weare, 2015). Where social support is lacking and adolescents have an accumulation of adverse childhood experiences, they are more at risk of developing a variety of mental health concerns (Rigby & Slee, 1999).

Suicidal Ideation

Suicidal ideation refers to having thoughts about suicidal acts and can involve a range of degrees of intent and detail regarding those thoughts (Be You, 2021). Suicidal ideation often emerges in adolescence and is prevalent among this age group, particularly among females (McKinnon et al., 2016). The Department of Health and Aged Care (2000) estimated that over 785,000 men and over 1,130, 000 women experience suicidal ideation at some point in their life. They also state that studies of suicidal ideation usually rely on self-report in interviews or questionnaires. Acts of suicide and suicide attempts are increasingly identified as options by young people with poor coping strategies (Geldard et al., 2019). Given that suicide ideation strongly relates to suicide attempts and suicide, identifying potentially modifiable risk factors and strengthening protective factors are essential for preventing deaths (McKinnon et al., 2016). Whether a young person thinks of suicide as an option, and/or chooses it, is dependent on their personal coping resources (Be You, 2021). Geldard et al. (2019) suggest that individuals who consider or attempt suicide often exhibit some of the following characteristics both at home, school and within the wider community:

• They may over-invest themselves in few, very intense interpersonal relationships.
• They tend to express problematic feelings through behaviour rather than verbal communication.
• They may perceive an inability to control their environment.
• They express high levels of hopelessness and the belief that circumstances will not improve.
• They tend to overreact or may be hypersensitive to certain situations.

Evidence of Symptoms

The prevalence of adolescent suicidal ideation and behaviours varies across countries, yet a consistent set of risk factors of suicidal behaviours is evident across all regions and most countries (McKinnon et al., 2016). Adolescents with a history of childhood abuse or other adverse life experiences demonstrate significantly more risk factors for suicide or suicide ideation; for example, depression, substance abuse and disruptive behaviour (Geldard et al., 2019).  Literature indicates further possible risk factors for suicidal thoughts or behaviours include severe anxiety and inability to experience pleasure, alcohol, relationship loss, serious interpersonal conflict or weak family and peer relationships and exposure to bullying or harassment (Ivey et al., 2017; McKinnon et al., 2016). Risk factors impact a young person’s ability to cope with life’s challenges and increase the probability that problems will occur, while a warning sign such as statements of hopelessness or social withdrawal, may indicate that a problem has already begun (Be You, 2021). These warnings signs may be apparent at school when a young person’s behaviour or performance changes, for example, truancy, negative conduct, a decline in academic or other areas of achievement.  At home they may become disconnected, seem hopeless and helpless, or excessively angry and irritable (Be You, 2021). It becomes imperative for those working with young people to maintain a watchful eye for suicide potential and provide immediate crisis support or client referral when required (Ivey et al., 2017).

Identifying suicidal ideation in young people can be complex and often relies on self-reporting or peer submissions (Rigby & Slee, 1999). A survey by McKinnon et al. (2016) used standardised school-based sampling and a set of core questionnaire modules that addressed leading causes of mental illness and mortality worldwide, including alcohol and drug use, mental health, violence and unintentional injury and sexual behaviours. Such questionnaires would be a useful method for helping to identify prevalence of risk factors within a school population. Rigby and Slee (1999) investigated relationships among suicidal ideation, involvement in bully–victim problems at school, and perceived social support with samples of adolescent students in South Australia. Results were obtained from self-reports and peer nomination procedures and identified bullies and victims’ involvement in bully-victim problems at school. The results indicated that involvement in these problems at school, especially for students with relatively little social support, was significantly related to degree of suicidal ideation. It can be surmised that when a young person feels excluded, harassed, or disconnected and does not have the support of an understanding adult, feelings of hopelessness and impending thoughts of suicide are more likely.

Impact on the Individual and Interactions

Not only does suicidal ideation increase an adolescent’s risk of suicide attempts and of death by suicide, but it is also an important indicator of an array of significant mental health needs, sexual risk behaviour, substance use, and delinquent behaviour (Thompson et al., 2012). As previously stated, adverse life experiences are important in understanding suicidal ideation in high-risk youth. Suicidal ideation is a maladaptive coping strategy that interferes with a young person’s education, work, and relationships (Geldard et al., 2019). There is a heightened risk of abnormal psychosocial and psychopathological functioning for young people who experience suicidal ideation in adolescence (WHO, 2022).

Suggested Interventions

Setting up a quiet room with regular talk-therapy sessions for young people experiencing suicidal ideation is a recommended support strategy. Be You (2021) recommends this process for either individual or small groups within the school setting. This would include the availability of a quiet, reflection room set up by the school Counsellor for students who are at risk of suicide attempt or experiencing suicide ideation. Open during school hours, it would be a place for young people to go to receive support and have some quiet time to reflect. A safe, supervised location where young people’s emotions and needs can be expressed, responded to, and monitored (Be You, 2021). While many adults may seek out talk-therapy when they are experiencing challenges or crises, young people often need encouragement to develop this as a coping strategy (Geldard et al., 2019). The establishment of productive counsellor and adolescent communication entails the counsellor being present by using attentive listening skills, open questioning, and empathetic understanding of the young persons’ needs. The effectiveness of talk therapy as an intervention is such that many successful and happy people use talk-therapy as a regular part of their self-care routine well into their adult lives (Kendall, 2011). Whilst Kendall (2011) urges that additional professional support is recommended in cases of severe suicidal tendencies, talking through suicidal ideation and the accompanying feeling of hopelessness allows young people to look at situations objectively and create greater sense of awareness and understanding.

When advocating for the social-emotional wellbeing of adolescents, Weare (2015) recognises that the effects of regular talk therapy within a support room with a trusted counsellor can be long lasting, and the benefits include:

• Increased self-awareness, understanding and self-compassion
• Increased understanding and empathy towards others
• Learn how to process and manage emotions
• Develop coping strategies for challenging situations
• Identify the causes of symptoms and distress
• Increasing a support network in a non-judgemental environment
• Helps teens identify their goals and existing strengths as well as areas for growth

Young people will come to see talk-therapy as a positive approach to taking control back in their lives and to develop self-accountability (Kendall, 2011; Weare, 2015).