Great post on Teens Who Self-Harm by Marie Hartwell-Walker, Ed.D. over at Psych Central.

In the blog Marie Hartwell-Walker encourages that “Self-harmers need to be understood, not scolded. They need to unlearn the idea that their feelings are “wrong” and learn that it’s okay to feel them. Most important, they need to learn new ways to manage stress and emotions that they find overwhelming.”

Also we just linked up with Dr. Mary Kay Nixon and her team of the Interdisciplinary National Self-Injury in Youth Network Canada (INSYNC). Lots of great info for youth, families and professionals.

For some interesting and powerful reading on self-harm I recommend the books Cut by Patricia Mccormick and Skin Game: A Memoir by Caroline Kettlewell

Carol Marquis has written a touching and highly personal story about her brother Donnie and his tragic suicide at age 27 years. While Carol’s personal journey led her to feel life more deeply, my professional journey is more focused on what we can do to prevent others, who like Donnie are living with a mental disorder (in his case bipolar illness), from death by suicide.

We know that unfortunately suicide is a mode of death for people who suffer from and live with mental illnesses, much like a heart attack is a mode of death for those who suffer from and live with heart disease. Thus, it is no surprise that in Canada, the highest rates of suicide are found in people who live with a major mental illness – in particular: major depression; bipolar disorder; schizophrenia. Study after study has demonstrated that these mental disorders are the greatest risk factors for suicide. Study after study has demonstrated that there are effective interventions for individuals living with mental illness that can decrease this risk for suicide.

Some of these interventions are: the continued application of effective treatments (medications and psychological interventions); easy access to emergency/crisis mental health care; unique programs that address a variety of factors that can lead to or trigger a suicide act. We know that the majority of individuals who die by suicide visit a health provider prior to the event.

The difficult questions we need to ask are as follows. Why is it that with so much knowledge about what can be helpful that so many people living with mental illness still die by suicide? Why is it that with so much knowledge about what we can do we still invest in programs and activities for which there is little or no evidence of effectiveness? Why is it that we do not widely distribute and ensure that evidence based standards of care for suicide prevention are available in every location where health care is provided? Why is it that we spend little or no time in educating the large legion of health providers to identify and intervene when their patients are or could be suicidal?

Are there many other areas in medicine where we know what to do to make things better and we still persist in doing things that we either know do not work or do not know if they work? If not, what is it about the field of mental health that encourages us to act this way?

~ Dr. Stan Kutcher

The American Journal of Nursing (AJN) recognized the best nursing and healthcare publications of 2008 with an announcement today of its Book of the Year Award recipients. Winners in 15 separate categories appear in the journal’s January issue. Many of the winning publications address a variety of controversial consumer health topics and nursing industry issues that span medical-surgical nursing, psychiatric-mental health nursing, maternal and child health, and other areas.

Two of the top three consumer health books awarded by the AJN were about mental health issues:

Helping Teens Who Cut: Understanding and Ending Self-Injury, by Michael Hollander, which brings to light the serious and potentially devastating issue of self injury which affects the quality of life of teens and their parents. The author suggests interventions for families to use.

What Works for Bipolar Kids: Help and Hope for Parents, by Mani Pavuluri, takes an optimistic, evidence-based “how to” approach to help parents and children manage a bipolar child’s behavior, understand medications and therapies and reduce family stress.

One of the goals of this blog is to provide evidence-based information about adolescent mental health. Scientific evidence helps us confirm truths and debunk myths.

A recent BBC article looked at some Christmas myths debunked by the British Medical Journal. One of the myths the BMJ busted is the belief that suicides are more common during the holiday season and winter months.

“The combined stresses of family dysfunction, exacerbations in loneliness, and more depression over the cold dark winter months are commonly thought to increase the number of suicides,” said Dr Vreeman.

But, although the holidays may be difficult for some, there is no good evidence to suggest a peak in suicides.

Also people are not more likely to commit suicide in the dark winter months - around the world suicides peak in warmer months, the researchers said.

Some of the other myths debunked in the article were: there’s no cure for a hangover, eating late does not make you gain weight, and sugar doesn’t make you hyperactive.

~ D. Venn

There’s a lot of misinformation out there about youth suicide. Suicide rates in young people nationally have decreased by about 20% from the mid 1990’s to 2004. Nova Scotia is a good case study. It is difficult to determine trends in youth suicide in Nova Scotia because of the small numbers involved, but total suicide rates as well as total suicide attempts in this province have decreased substantially between 1995 and 2004.

Suicide in Canada, 1950 to 1992

Suicide in Canada, 1979-2003

Why this has occurred is not clear.

One explanation is that effective treatment of depression in young people may be an important factor. Studies have demonstrated a strong relationship between increased use of antidepressant medications and decreased suicide rates in youth. Evidence shows that both medications and psychological therapies decrease rates of suicide attempts in depressed youth. Recent research reports in both Canada and the USA indicate that when anti- depressant medication treatment in young people has decreased, suicide rates have increased. Treatment of depression in young people may effectively reduce suicide rates.

Association between suicide rate and SSRI use in youth 5-14 years old (Gibbons, et al. Am J Psychiatry 163:11, November 2006)

Suicide behaviour is complex. Not all self-harm behaviours are suicide attempts. Self-harm behaviour in young people may not be related to suicide, but rather to deficient problem solving strategies, difficulties with emotional control or impulsivity. It is only recently that we have understood the need to differentiate the two in how we collect data. Treatment for young people who demonstrate self-harm behaviours may be different than treatments for youth who attempt suicide.

Self-harm behaviours reflect many mental disturbances and may be an important vehicle by which young people can access emergency care. Thus, increases in self-harm emergency visits may not reflect an increase in suicide as has been erroneously suggested, but may reflect other phenomenon such as: greater parental awareness of the importance of immediately addressing these behaviors; difficulty in access to specialty mental health services; inadequate delivery of child and adolescent mental health care in primary care; inadequacies in the capability to provide early identification and interventions for youth at risk for mental disorders; or others.

Suicide in young people is a complex problem that requires thoughtful, evidence-driven approaches to appropriately address. It is also an emotional issue raising substantial concern amongst parents, youth, care providers, policy makers and the public alike. There are some interventions that we know work to decrease suicide rates in young people.

One of the most important is improving the early identification and effective treatment of depression in youth. This includes enhancing the competencies of primary health care providers (doctors, nurses, social workers, psychologists, etc) in the diagnosis and treatment of adolescent depression. Training programs for school personnel including “gatekeeper” programs for teachers and linkages between schools and health providers to facilitate identification, rapid assessment and effective treatment may also decrease youth suicide. Restriction of access to lethal means (such as bridge barriers) is helpful as is reasonable and informed media reporting.

Youth suicide is an important public health problem. We must work together to better understand it and to apply what we know works. We need to avoid inciting public anxiety through media reports that are not based on a solid understanding of the issue and we need to support the further development of easily accessible and effective mental health care – not just in hospitals but in schools and community settings. We need to do the right thing – not just do something!

~ Dr. Stan Kutcher