Ann John: A public health approach to suicide prevention in young people during the pandemic

Professor Ann John is Professor of Public Health and Psychiatry, Swansea University Medical School.

Any death in a young person by suicide is deeply tragic and best understood by looking at each individuals’ circumstances. It is however important to remember that suicide is not inevitable, if risk factors at the individual, group and population level are effectively addressed. Suicide prevention requires a broader public health approach, beyond mental health services, that is collaborative across sectors and society – it’s everybody’s business.

Services only work if people seek help and most young people who self-harm do not seek help from services – often it is hidden or they reach out to those closest to them. We need to raise awareness and empower the responses of parents, carers and professionals across sectors (like teachers and youth workers) to a child or young person struggling with suicidal thoughts or self-harming. Although attitudes have changed somewhat, the stigma of self-harm and suicidal thoughts remains. Young people are ashamed to disclose how they feel, and parents and teachers may find it challenging to respond. There is an urgent need for co-produced resources about how to have those conversations that enable help-seeking and which promote coping skills.

Prior to the pandemic young people were increasingly using social media to communicate their distress. This is likely to have increased with more time spent online as other activities are restricted. While there is potential for harm from online behaviour, we need to see this as an opportunity to exploit its benefits. This ranges from crisis support, reduction of social isolation, delivery of therapy, to the ability to actively reach out to populations of excluded.

Cyberbullying too appears to have increased with more time spent at home during school closures. Cybervictimisation is a risk factor for self harm and suicidal behaviours, as is, to a lesser extent, cyberbullying perpetration for suicidal behaviours and thoughts. While school attendance continues to be disrupted, activities aimed at the prevention of harmful behaviours such as bullying and to promote social skills are vital. Prevention of cyberbullying should be prominent in school anti-bullying policies and teaching, taking a whole-school approach including awareness raising/training for staff and pupils, encompassing digital citizenship, online peer support for victims, and tips for acting as an effective electronic bystander.

Responsible media reporting is important as irresponsible reporting can promote suicidal behaviours in young people. Clear guidance exists – avoid sensationalised reporting and descriptions of methods or locations. It’s important not to oversimplify or speculate on pandemic-related reasons for a young person’s death by suicide. Instead reporting can be protective, highlighting sources of help, raising awareness and focussing on stories of how young people have coped during these uncertain times.

The impact of the pandemic and lockdown on delivery of online services has been transformative. We must continue to deliver services based on strong evidence. This should include evidence-based management of self-harm, school-based suicide and self-harm prevention programmes, e.g. SEYLE, and pathways to crisis care. The urgency of response meant that sometimes evidence was sparce for how services needed to adapt. Evaluation is key where the evidence base does not exist, which requires resource-trials to assess the effectiveness of interventions and different modes of service delivery, e.g. telemedicine, observational studies to understand changing patterns of need.

Mental health research is underfunded. The current emphasis on COVID-19 research is likely to widen that inequality. Funders need to explicitly address this. We now need to turn evidence into action, policy and practice to protect young people from further social and emotional harms.