Fife Children’s Services Partnership recognise that the children, young people and families of Fife have experiences, needs and aspirations that are many and varied. This recognition is underpinned by the importance of valuing diversity and challenging of discrimination. Within this context it is recognised that some groups of young people experience additional vulnerabilities and challenges which may increase risk of suicide as a result. It remains crucial to understand any identified vulnerabilities within the wider context of the young person’s circumstances using a Time Space and Compassion approach and GIRFEC. 

This section outlines some of the contributory factors which may increase the risk of suicide, however it is not exhaustive. The assessment carried out during a discussion with the individual will be central to identifying, understanding, and responding to potential risks.

Care Experienced Children and Young People

Young people looked after away from home are particularly vulnerable to an increased risk of self-harm and suicide. They are much more likely to have had adverse/traumatic early experiences and can experience high levels of stress during adolescence. They are also likely to have far fewer protective factors and positive support networks than their peers. Looked After Children experience “significantly poorer mental health than the most disadvantaged children outside the care system” [10]

There is evidence to suggest that children in care and care leavers are more at risk both of hurting themselves and completing suicide, than those who are not care experienced. It is important to investigate and act upon any evidential links between adverse childhood experiences, suicide and these groups[11].

The roots of adolescent suicide can often be found in the early trauma experienced by young people[12]. These risks continue into adulthood and may well be implicated in much self-harm and many suicides later in life. Traumatic experiences prior to and in care have an adverse impact well into adult life[13]. Many care experienced young people are likely to have several of the risk factors associated with suicide. This can create difficulties in maintaining a balance between responding to transient, though intense distress which may be manageable, and under reacting to more subtle but serious difficulties where young people may need professional help and protection. Careful assessment and intervention are required as a result.

In recognition of this increased risk for children and young people who are care experienced, the following Care Inspectorate resource is recommended: Suicide Prevention for looked after children and young people. A further resource may also be useful: Understanding suicide and self-harm amongst children in care and care leavers.

Supporting Care Experienced Children and Young People

The key principles of Time, Space, Compassion remain the main components to any conversation or planned approach with any care experienced young person who is communicating signs of suicidal crisis. Many of the supports and interventions that will address the risk of suicide are key tasks for social workers, residential care workers and foster carers. Using their existing skills and working confidently, caringly, and competently with young people helps address their underlying distress and difficulties. Training and support specific to the practitioners who support children in these contexts are critical and Fife offers a tiered approach of training to meet this need, as well as access to more specific training for Fife Council Foster Carers.

Important Points

  • Young people can form genuine and secure attachments to adults caring for them which provide opportunities to resolve some of the underlying chaos and distress that impacted their earlier lives.
  • Supporting positive peer relationships, both within their care setting and at school or work, combats the social isolation often associated with self-harm and suicidal behaviour.
  • Success at school is a protective factor and so helping young people to attend regularly and achieve their full potential both academically and socially is essential.
  • Supporting young people to manage and improve their relationships with their families is a key role for carers and workers.
  • Relationships with the other young people with whom they share their living space can be very powerful. Adults can encourage the reciprocal responsibility of relationships among young people. This is particularly important as we know that young people contemplating suicide are most likely to confide their intentions to a peer. Creating a positive culture where distress is talked about and understood by everyone can prevent some of the dangers of contagion within residential settings.
  • A sense of connectedness and belonging is protective against both self-harm and completed suicide. Children in care and care leavers often experience a massive amount of turbulence in their living arrangements. When change and transitions, whether planned or unplanned, disrupt important and comforting relationships this can greatly increase the risk that young people will hurt themselves.

Pathway for Children and Young People who are Looked After in Fife

Fife is committed to delivering The Promise ensuring that children, young people and their families can access the support they need, where and when they need it. Considering the likelihood of increased complexity of presentation of children who are in care and at risk of self-harm or suicide, the use of existing planning and review processes continue to be important. This supports the shared analysis of any presenting risk factors and how this can be integrated alongside other known assessment information. This may include Looked after Children (LAC) core groups, LAC reviews or the use of multi-agency risk management processes.

In Fife, CAMHS support is offered through an enhanced pathway, reducing the need of any waiting time for planned mental health assessment and support. For those children and young people who are Looked After and Accommodated within foster or residential care placements, the child’s social worker should consider as a second step, making a referral to the Springfield Project (for children in local authority placements) The Beeches (children in purchased placements within Fife) or The Willow Project (children in Kinship care) service for a therapeutic service.

The stability of the young person’s placement is of upmost importance, and it may often be appropriate for CAMHS professionals to offer external consultancy to those directly caring for the young person, even or especially if that young person feels unable to accept individual therapeutic support. Targeted CAMHS provision has greater flexibility in overcoming such barriers to support young people and can use a range of geographical locations across Fife.

For Fife young people resident out with Fife, at present, carers are required to access CAMHS support via their local GP service or according to local CAMHS pathway arrangements. A lack of continuity in terms of mental health support for vulnerable young people who move frequently between placements can be a barrier and working arrangements across health board boundaries can require clarification.

Carer Support

The impact of supporting a young person who is experiencing suicidal crisis in residential or foster care can be traumatic to both staff and other children and young people. All staff and carers require adequate support and training to remain resilient in the face of such difficult circumstances and enable them to continue to support the young person and the other young people living in the same environment.

Care Leavers

Any young person who ceases to be looked after on or after their 16th birthday will be classified as a Care Leaver. All looked after children can become ‘care leavers’, including young people who were classified as ‘looked after at home’ and in formal kinship care. The Children and Young People (Scotland) Act (2014) extend eligibility to aftercare services to care leavers aged 26. Section 58 of the Act also outlines corporate parenting responsibilities this group of young adults.

The Scottish Care Leavers Covenant supports corporate parents to deliver changes in action and practice to bring improvement and consistency to the care of these young people. It offers clear guidance on how to meet the needs of young people who are often disadvantaged because of their care experiences.

The Covenant outlines a range of actions and practice changes across key policy themes, which need to be delivered consistently by all relevant corporate parents across Scotland, at national and local level. One of the policy themes is “Health and Wellbeing” and it states a range of actions, one of which is that corporate parents will ensure that care leavers are given priority access to specialist services (including self-harm services) and improved access to adult mental health services. It also specifies that each local authority and health board has a named contact with specific responsibility for care leavers’ health and for promoting and coordinating actions to reduce health inequalities, these being made explicit within Corporate Parenting Plans.

Support for ‘care leavers’ is provided by the Children and Family Social Work Service depending on the age they move on from their care arrangement. There are barriers to young care experienced adults in accessing the mental health support they require, including geographical accessibility and stigma. There is a further transition point between CAMHS and Adult Services that requires navigation. Pathways to access more flexible mental health advice, assessment and intervention continues to be developed. This includes a post of a Senior Mental Health Nurse who is located within the Young People’s Team and can be contacted for further advice and guidance. There is also a Senior Nurse for Transitions who is located within CAMHS to support transitions to Adult Mental Health Services.

Social Media

Social media platforms are now a part of everyday life. This can provide many opportunities including: learning more about, or connecting with, others in relation to areas of shared interest; staying connected with family and friends; developing communication or technical skills; or campaigning for social good. However, like many things, social media also carries risks, such as: pressure to overshare personal information online; sending or receiving inappropriate content; cyberbullying; or developing an unrealistic sense of reality[14], all of which, could have a detrimental impact on health and wellbeing. Online platforms can also provide young people with opportunities to access harmful content disguised as support, including online forums; message boards; and groups that have been set up for people experiencing similar feelings in relation to issues such as eating disorders, self-harm or suicide[15].

LGBTQI+

LGBTQI+ people are much more likely to have experienced[16]:

  •  bullying and name calling at school
  •  hostility or rejection by family
  • danger of violence in public places
  •  rejection by some religions
  •  harassment
  • casual homophobic/biphobic/transphobic comments

Research by LGBT Youth Scotland in 2022 [17] found that 50% of LGBQ young people who responded to their survey had experienced suicidal thoughts or behaviours.  Research commissioned by Just Like Us, an LGBT+ young people’s charity in the UK, carried out a pupil survey exploring the wellbeing and experiences of young LGBT+ people aged 11 to 18. A total of 2,934 pupils from 375 schools and colleges across the UK were surveyed, 1,140 of whom identified as LGBT+ (39%).  The research found that LGBT+ young people were twice as likely to contemplate suicide than their non-LGBT+ peers[18].

Refer to the practitioner wakelet for further information. 

 Young Carers

Children and young people who care for someone are known as young carers. They can be as young as three or as old as 25. They may be caring for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support. Older young carers are also known as young adult carers[19]. For many young carers their exposure to the stress of their caring role, family illness/disability or substance use issues, coupled with other risk factors can compromise their ability to remain resilient[20] which in turn, could have a detrimental impact on their mental health.

Refer to the practitioner wakelet for information on toolkits to support young carers in relation to their mental health and wellbeing.

Speech, Language and Communication Needs

Many children with social, emotional and mental health needs have unidentified speech, language and communication needs (SLCN) (RCSLT, 2020), with one study identified that 81% of children with emotional and behavioural disorders having significant unidentified language deficits. Around 60% of youth offenders have an unidentified SLCN. Difficulties with speech, language and communication impacts on all areas of a young person’s life including academic attainment, mental health, long-term outcomes, making and maintaining positive relationships with family and peers.

Difficulties with speech, language and communication can often be attributed to a young person having poor motivation or attitude through behaviours or the young person may have superficial skills which mask underlying difficulties. These difficulties can prevent them from being able to access mental health supports which typically require good language and reasoning capabilities.

Please refer to Promoting social, emotional and mental health leaflet for further information. E-learning modules to support understanding of children and young people with social, emotional and mental health needs and speech, language and communication needs are available: Mind Your Words – RCSLT CPD.

Neurodivergence[21]

Neurodivergent people are more likely to experience mental health issues with research showing that autistic children are 28 times more likely to think about or attempt suicide than neurotypical peers. Factors known to increase the risk of suicide in the general population are more common in those with neurodevelopmental conditions. These factors include social isolation, low mood and self-esteem, rumination, and difficulty identifying, regulating and expressing feelings and emotions. Often neurodivergent young people face language, processing and communication challenges which should be considered when using the Time Space Compassion approach. It is important to adapt language to avoid confusion. Use well-defined (short and to the point) questions to probe the specific circumstances and check understanding.

Some neurodivergent young people may discuss plans and intent in what appears to be a ‘matter of fact’ way and interpret questions literally. It may be helpful to ask specific questions with timeframes such as “How many times have you thought of suicide today?”, “Do you think these thoughts will be less or more over the next week?” or “What do you do when you have these thoughts?”

Neurodivergent people process information differently and adapting communication means can help e.g., writing things down, drawing things or allowing the young person to do the same. If a young person says they do not understand, rephrasing the question using specific key words and pausing between points to provide additional processing time may help. Using visual aids and tools (such as an emotion and feelings wheel) to support the young person recognise and label their own feelings and emotions, and describe the situations where they occur, could be beneficial.

Unaccompanied Asylum Seekers

All unaccompanied young people arriving in Fife through the National Transfer Scheme will be supported within the legal frameworks and guidelines of Section 25, Children of Scotland Act 1995. As a result, they will have an allocated social worker and access to the Interpreting Service if required.

Young people who have fled their country of origin and made the long journey to the UK are at risk of increased mental health problems. They are often completely isolated from everyone and everything they know, separated from their families and living alone in a country where they don’t speak the language or understand the culture. Some of these young people may have suffered extreme torture or other significant trauma. Instances of Post-Traumatic Stress Disorder (PTSD) are significantly higher for these young people than in the average population. There are also elevated rates of depression and anxiety.

Whilst it is difficult for us to comprehend what these children have been through, for some of them the impact of abuse, trauma and torture on their behaviour is not always obvious. These young people often present as very resilient.

Refer to the practitioner wakelet for further information