There are ten years since, to children and their families, we opened the Child Protection Center of Zagreb, specialised for work with traumatised children. The Center was the first in Croatia to offer the multidisciplinary approach in the protection of abused and traumatised children after the model implemented in developed countries.
Today, on 10 September is World Suicide Prevention Day, on the initiative of the International Association for Suicide Prevention and the World Health Organization.
To many people, death is a taboo theme, something they do not like to talk or think about, something they hope will never hit them, their loved ones, family or friends, even though they know it is impossible to avoid it. If we just have to think about mortality, many will imagine peaceful death in a daunting age, without pain and suffering. However, when death is linked to aggression, or suicide, they are subjected to various unpleasant emotions.
Especially difficult is to deal with when those that commit suicide are children and young people, in front of who could be an entire life. It is only natural that people have a need to avoid a flood of unpleasant emotions that may entail with reflection on the suicides of young people. However, the suicides of children and youth are taking place and it is important that we are aware of it, and some of the information that is being testified is in the text below.
In the US population, more than 30 children aged under 12 years die annually from suicide and studies show that this figure is systematically increasing with age(Bridge et al., 2015). Children under 11 or 12 years of age do not have the cognitive maturity to understand what suicide actually means, that death is irreversible and that they can change thei mind later, that they can not witness their own funeral and the like. Their suicides are therefore often less thoughtful and more impulsive than suicide in adolescents.
Adolescents, except impulsive suicides, often commit suicide after prolonged depression, after careful planning and one or more unsuccessful attempts. For young people from 12 to 18 years suicide is the second leading cause of death in the United States (CDC WISQARS, 2016), rather than more common cancers, heart disease, AIDS, congenital malformations, shock, pneumonia, influenza, and chronic lung diseases together.
According to the Croatian Institute for Public Health, in Croatia on an annual basis between 5 and 6 of 100,000 young people aged 15-19 years loses their lives by suicide. In 2016, 36 adolescents and young adults in ages 15 to 24 lost their lives by suicide in Croatia (HZJZ, 2016).
Much more often than suicides ending in death, we are confronted with suicide attempts by children and young people. It is estimated that at each suicide committed by young people, there are at least three attempted suicides (Maple et al., 2010).
As adults and responsible members of society, especially mental health professionals, it is important to know at least the basic facts and ways of preventive action to help children and young people at risk. Let’s start by breaking up a few of the most common myths:
“If I talk to a child about suicide, it can trigger him to kill himself!”
As neither of us adults would not be forced to kill ourselves by one’s question, the same goes for children and youth. By placing direct questions about suicide to child we suspect that he/her could kill themselves, we send a message that we see, hear and that we are willing to be with him/her when and if s/he share suicidal thoughts. Talking about suicide with children and youth and otherwise is important because it gives them the opportunity to be informed by the adults they trust, to share their thoughts and emotions and to understand that there are no forbidden topics – this increases the probability of being entrusted if they themselves are in trouble, or someone close to them.
“Children just say they will kill themselves, there is no need to pay attention to that!”
Although it is possible that the suicidal thought is pronounced without real intention, it is always good to take it seriously and encourage the child to tell more about it. Each suicide mark is important to take extreme seriousness and, if necessary, seek professional help.
“If we show to children details of suicide in the media, it will distract them from the idea!”
On the contrary – in the young can occur so called Werther effect, which means that the coverage of other suicide in a spectacular way that romanticize suicide can provoke more suicides of young people in the community. A suicide is good to talk about, but do not exploit the unfortunate fate of the child and his family in order to create sensationalist story that will encourage other young people to want to become “popular” n a similar way.
“It was not a suicide attempt, s/he only attracts attention!”
Attempts of suicide in which children and young survive are an opportunity to provide them obviously much needed help. Trivializing their problems as attempts of “attention seeking” will certainly not contribute to their recovery. The attention they certainly should be given, will help.
“If they want to kill themselves, they will do that, there is no help!”
There is always help, hope and opportunity for advancement. Persistent support of primary family, community, peers and mental health professionals can help children and young people who want to kill themselves.
“Every child who is self-harming will commit suicide!”
Although among children who commit suicide there are more children who were self-harming themselves than those who did not, this doesn’t mean that every child who is self-harming will commit suicide. There are completely other psychological mechanisms in the background of one and the other problem. It is important to help children who are self-harming and engage them in treatment whit experts and thus show them that we take them seriously.
Symbols that precede suicide attempt
Adults may often notice on children and young people the signs that precede suicide attempt or suicide and recognize them as cries for help. Most people do not really want to die, but seek a way out of the situation, that seems desperate for them at that moment. Children and young people can retreat into themselves, lose interest in activities that were previously making them happy, forgive themselves for loved ones, become preoccupied with the theme of death, search for articles about suicides on the internet, be depressed, write suicide notes, say sentences such as: “It would be better not to exist, to have never been born”.
In case of any sudden changes that give rise to suspicion that something unusual happens to a child, whether they indicate to suicide or not, it is good to talk openly and without hesitation to a child, and, if necessary, to include professional help. Although children and young people in such cases often resist visiting a psychologist or psychiatrist, adults have a responsibility to provide professional help for them, the same as they would take them to the doctor if they would have some physical illness such as pneumonia, regardless of their opposition. Clear boundaries with the gentle approach of parents give the child the knowledge that s/he is taken seriously, that the close one love them and that they will fight to help – and this is often crucial.
If a suicide of a child or young person occurs, what we should not do (but society unfortunately sometimes just do it) is to point fingers at parents of deceased child or young person, and look for culprits in them. People usually do this to keep two fundamental beliefs about the world to help them cope with risks and challenges in their daily lives: a belief in a just world and in their personal invulnerability. If we really accept that no one is to blame for some situations in life, that a variety of troubles and accidents can happen to us, no matter what we do or do not do, we feel quite helpless and unprotected.
However, there is no greater sorrow in life than when a parent loses a child, especially in these circumstances when a child just decided to take his/her life. Rather than condemn, it is important that we help the family as a community and that we get out a clear message for the future, that we learn something for other children and young people who can be found in the same predicament in the future.
If you suspect a suicide of a child and a young person in Croatia, call 0800 0800, Brave Phone, adult line every working day from 9 am to 8 pm, free and anonymous. In a crisis situation, if you suspect someone is really trying to take his/her life or if s/he is going to harm themselves or others in any way , call the police and emergency assistance.