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Wednesday, October 29, 2014

Haiku on Close/ Believe/ Tell/ Nothing

Close

I'm scratching my head
Point close to the confusion
In my struggling brain

Close your mind gently
Settle it down next to mine
Then switch off the light

Children brought up close
One travels Spain, one Japan
Third in Korea

Believe

Peer out the window
Winter sun warming the view
I believe it's cold

Mango flowers burst
Holding their bright heads up high
They believe in bees

Peace full garden lunch
Honeyeater squawks offence
Does not believe us

Tell

Please tell me the truth
Does this suit make me look fat?
Do not answer that...

You're a tell tale tit
Your tongue is likely to split
And become dog food

Wrinkles tell my age
Also speak of brilliant life
Rich experience

Nothing

I know the whole truth
I am nothing without you
Just an empty shell

Nothing at all moved
Except one tall blade of grass
Storm is on its way

The still of the night
Nothing moves in the darkness
Except you, breathing

Monday, October 27, 2014

National Suicide Prevention Strategies: A Comparison (FREE PDF DOWNLOAD)

This seminal work examines national suicide prevention strategies that had been in place for 10 years or more. The key question (examined by comparing annual rates of suicide for each country for years before compared with years after) was "Did the strategy reduce rates of suicide?" It appears that national strategies can and do work, and we then attempt to answer the questions as to how this may occur.
"Suicide is a behaviour, sometimes planned over time, but often impulsive. It can sometimes be predicted, but often is quite unpredictable. There are many life patterns that may lead to suicide. These may include the bright young person from a caring family who seems to be happy and successful but at a moment in time has some ‘bruise’ to their sense of self and decides and acts within minutes; the person whose life has always seemed to be in chaos, where the struggle against exclusion frequently gets to be too much, and the attempt to find relief and solace in medication was misjudged; the middle‐aged woman with severe depression, not yet responding to treatment and support where a chronic sense of hopelessness and nihilism leads to the carefully made decision; the person with a psychotic illness who appears to be improving, is released from an inpatient unit and goes home to find their life is unchanged, and the spectre of long term illness has added more burden; the elderly man who has lost a spouse, his work and a sense of meaning, and feels that life is over.
Along the pathway to suicide, there are many risks that can increase the likelihood of suicide, or bring the likelihood forward. Risks may be biological (as in the gene which controls serotonin synthesis, and therefore depression); or risks may come from family or social interaction (for example from violence or abuse); or risks may be related to societal factors (such as chronic unemployment or social exclusion); or cultural (for instance at least in the first and second generations, Greek migrants may have a very low risk compared to those who migrate from the Baltic States). One very common risk is the abuse of alcohol – we know that more than 80% of suicides have alcohol in their blood stream, while nearly 25% have levels of alcohol that normally cause drunkenness (Smith, Branas and Miller, 1999). On the other hand, there are protective factors that may support someone with even the most intrusive of suicidal thoughts, or mitigate some of the other risks. As an example we know that connectedness to other people is highly protective against suicide in the context of suicidal thinking.Any national strategy purporting to be comprehensive has to manage this complexity. The full picture from biological risk and protection to societal risk and protection must be fully understood and integrated, and strategies put in place at all relevant levels, and for all appropriate contexts."
(Text taken from the introduction to this work)




Martin, G. & Page, A., 2009. National Suicide Prevention Strategies: a Comparison. The University of Queensland. ISBN 978-0-9808207-9-9. Commissioned review, DOHA, Canberra. Downloadable in pdf format from http://www.suicidepreventionstudies.org/index.html Alternate source: http://www.livingisforeveryone.com.au/Library.aspx?PageID=60&ItemID=1443    

Seeking Solutions to Self-injury: A Guide for Family Doctors

OK, we realise you are busy.
OK, we know you have far more important things to do.
But if you manage self-injury in a positive solution-focused way, your patient will thrive, your consultation will be brief and successful, they may not have to return for further care, and you may have saved a life.
How to manage self-injury, self-harm and suicidality in your practice. Real Solutions and practical strategies for Self Injury. A brief guide for family doctors, written in straight forward language.


http://www.familyconcernpublishing.com.au/products-page/

Seeking Solutions to Self-injury: A Guide for Emergency Staff

OK, we realise you are busy.
OK, we know you have far more important things to do.
But if you manage self-injury in a positive solution-focused way, your patient will thrive, and not need to return to your emergency department.
How to manage self-injury, self-harm and suicidality in your department. Real Solutions and practical strategies for Self Injury. A brief guide for emergency staff, written in straight forward language.


http://www.familyconcernpublishing.com.au/products-page/

Seeking Solutions to Self-injury: A Guide for School Staff

How to manage self-injury, self-harm and suicidality in your school. Real Solutions and practical strategies for Self Injury. A brief guide for school staff, written in straight forward language.


http://www.familyconcernpublishing.com.au/products-page/

Seeking Solutions to Self-injury: A Guide for Families

Real Solutions and practical strategies for Self Injury. A brief guide for families, written in straight forward language.

http://www.familyconcernpublishing.com.au/products-page/

Seeking Solutions to Self Injury; A Guide for Young People

Real Solutions and practical strategies for Self Injury. A brief guide for Young People, written in straight forward language. 

Thursday, October 23, 2014

Child Suicide in Australia; however does this happen?

Child deaths from suicide (9-14 years) appear to be a hidden problem, which may well be increasing in Australia. A ‘Trends and Issues’ Paper (No 19, Commission for Children and Young People and Child Guardian (CCYPCG), January 2014), reported on a total 169 suicide deaths of children and young people registered in Queensland between 1 July 2004 and 30 June 2013 (9 yrs) and drawn from the Queensland Child Death Register (2004–13). Unfortunately, the CCYPCG ceased operation on 30 June 2014, and its functions moved elsewhere (http://www.ccypcg.qld.gov.au) as part of the implementation of far-reaching recommendations from the Queensland Child Protection Commission of Inquiry (Carmody Review). (http://www.childprotectioninquiry.qld.gov.au/__data/assets/pdf_file/0017/202625/QCPCI-FINAL-REPORT-web-version.pdf) As a result, the Trends and Issues’ Paper No 19, is complex to find on government sites, but is available for download elsewhere. (http://www.iasp.info/pdf/web_resources/child_deaths_prevalence_of_youth_suicide_in_queensland.pdf)

Of the 169 suicides, 124 (73.4%) were aged 15–17 years (average 13.8 suicides per year). However, 44 suicides (26.0%) were of children aged 10–14 years (average 4.9 suicides per year), and one was a child aged 9 years (2011). For the most recent year (2012-13), for young people aged 15–17 years (10 deaths), suicide was the second-leading external cause of death (5.5 per 100,000). However, suicide was the leading external cause of death for children aged 10–14 years (12 deaths, 4.1 per 100,000 children), and the rate was the highest since 2004. Of these 22 suicides, 15 (68%) were male and 7 female. Only 6 suicides (27%) were from an indigenous background (17.1 per 100,000), but this rate was 5.5 times higher than the non-Indigenous (3.1 per 100,000). Only 1 of the 22 was from a remote background, with 7 from regional Queensland, and the rest (14) from metropolitan backgrounds. Eleven were from low to very low socioeconomic backgrounds, with 5 from moderate, and 6 from high or very high. Eleven (50%) were known to the child protection system, (7.1 per 100,000) a rate 3.9 times more than expected. There were 18 hangings, 1 gunshot, 1 jumping from height and 1 in front of a train, and 1 poisoning. The number of hangings seems surprising, and challenges our thinking; our expectation might have been that children would take medication in an extreme moment of frustration or emotional pain. But to organise a hanging perhaps suggests the more deliberate nature of these deaths.

Do the Queensland rates differ from the national rate or from other states and territories?
It is complicated. Queensland figures are from 1st July to the following end of June, while ABS figures are specific to a given year. The latest report from the Australian Bureau of Statistics (http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2012~Main%20Features~Age~10010) is from beginning 2008 to the end of 2012 (5 years), for ages 5-14 years, with a total of 57 suicides from all states and territories, 14 from Queensland. The equivalent number for the same 5 years in the CCYPCG report could be up to 26 deaths, so there may be a disparity.

For New South Wales (http://www.ombo.nsw.gov.au/__data/assets/pdf_file/0005/12389/CDRT_Annual_Report_2012_web.pdf), nine children under 15 are reported as suicides, whereas the ABS report suggests 12.

Northern Territory
A thorough report from the Northern Territory demonstrates marked increases in child and youth suicide, but covers the period 2006-1010, and does not overlap the ABS period reporting (http://www.childrenscommissioner.nt.gov.au/pdfs/other_reports/nt_youth_suicide_public_release_final_with_ISBN.pdf).

After an extensive online search, I cannot find parallel figures for Victoria, Western Australia, Tasmania or the ACT. If anyone can point me in the right direction, I would be very grateful.

The National Children’s Commissioner, Ms Megan Mitchell, has recently completed a national consultation on how children and young people under 18 years can be better protected from intentional self-harm and suicidal behaviour.(https://www.humanrights.gov.au/about/commissioners/ms-megan-mitchell-national-childrens-commissioner) Findings are scheduled be reported in her 2014 Statutory Report to Parliament. One can only hope that she has access to exact figures from all states and territories to compare with ABS data.

One real issue for child suicide is perhaps not the numbers, as much as the human tragedy. The Queensland Commissioner, in noting that half the children were known to the child protection system, suggested these children often “live in circumstances characterised by substance misuse, mental health problems, lack of attachment to significant others, behavioural and disciplinary issues or a history of abuse or violence”. This harks back to many comprehensive reports on how a child can get to the point of suicide. In one of the earliest, David Shaffer (1974) found the most common precipitants were conflict or a ‘disciplinary crisis’ with parents, teachers or police, fights with peers or friends. Annette Beautrais (2001) reports somewhat more complexity, while Dervic and colleagues (2008) note that precipitants may be less easy to identify and child suicide seems to have a brief stress-suicide interval.
If this latter point is true, then more or better services may not solve the problem; we may not get to see the child in time to assist change. We need to focus our prevention efforts more broadly on assisting parents to understand the consequences of trauma, and make changes. We also must assist schools to improve their efforts toward adopting more social and emotional learning programs aimed at helping children toward better mental health, with strategies like mindfulness to work through conflict and trauma.

References
Beautrais, A.L. (2001) Child and young adolescent suicide in New Zealand.
Australian and New Zealand Journal of Psychiatry 35(5): 647-53.
Dervic, K., Brent, D.A. and Oquendo, M.A. (2008) Completed Suicide in Childhood. Psychiatric Clinics of North America 31(2): 271-91.
Shaffer, D. (1974) Suicide in Childhood and Early Adolescence. Journal of Child Psychology and Psychiatry 15(4): 275-91.

Tuesday, October 21, 2014