Suicide in children is a rare event, but one that appears to be becoming more common. Because of this, any talk, comments, mention of wanting to die, behaviours related to death or dying, or threats of suicide need to be taken seriously. Children who are highly disadvantaged, are in care, or come from difficult or traumatic backgrounds are most at risk. Given the risk for this population all children involved with Oranga Tamariki – Ministry for Children. need to be screened for possible suicidal ideation regardless of whether they have talked about it or not. If a child has indicated that they have thought about suicide or they no longer want to be alive then they need to be assessed further to determine their degree of risk. Mental health may need to be involved in this but the social worker can also play an important role.

Assessing suicide risk in children is challenging. A child’s language skills, understanding of the questions you may ask, understanding of time frames and relationships between events, and understanding of death all contribute to the challenge of getting accurate information. Because of this, high levels of distress and suicidal thoughts may be expressed in behaviour (e.g., games of people being hurt, acting as if they are hurting themselves, playing on the road when they didn’t before, or drawing things related to death) rather than by what they say. Because of this, getting information from other sources such as whānau/caregivers is important to help get an accurate picture. When talking to whanau/caregivers, it is also important to consider if the whanau member/caregiver may be minimising risk due to difficulties in acknowledging their child could feel suicidal and feeling such as shame, anger and frustration. Due to this, it is important to get information from a range of sources as the more information available about what the child is thinking or planning the easier it is to get appropriate agencies involved (e.g., Mental Health) and put an appropriate plan in place to support them.

Guidelines for asking children about suicide
Whilst it might be hard or uncomfortable asking children about suicide, there are several things that you can do that will help you get a more accurate picture of the child’s risk:

• Use direct language about suicidal thoughts, behaviours or wanting to hurt themselves.
• Ask about suicide in several different ways to make sure the child understands what you are asking (e.g., wanting to hurt themselves, not wanting to be alive, not wanting to wake-up).
• Be aware of the emotional impact on the child when asking about suicide (e.g., the child may feel embarrassed or ashamed and may deny it, or they may report wanting to die when upset but not when they have calmed down).
• Be aware that children’s understanding can fluctuate when they are upset. Children who are upset when being assessed may struggle to concentrate or understand questions that they normally would if they were not upset.
• It is important to find out both what they did (or intended to do) and what they thought this would achieve. Children vary in their level of understanding how likely suicidal behaviour will harm them (e.g., thinking that taking two paracetamol thinking this would kill them).
• It is important to get an understanding of what they wanted to gain from their actions e.g. wanting to be noticed, needing support, feeling angry, or trying to escape from a situation which they have difficulty coping with.

Suggested questions (adapted from Jacobsen et al. 1994)

Asking about Suicidal Ideation and Behaviour

• Did you ever feel so upset that you wished you were not alive or that you were dead/wanted to die? Or did you ever not want to wake up when you went to sleep?
• Did you ever do something that you knew was so dangerous that you could get hurt or killed?
• Did you ever hurt yourself or try to hurt yourself?
• Did you ever try to kill yourself?
• What did you do to try and kill yourself?
• What did you think would happen when you did this?

Assessment of Suicidal Intent

• Did you tell anyone that you wanted to die or were thinking about killing yourself? What did they say or do?
• Did you do anything to get ready to kill yourself?
• Was anyone near you or with you when you tried to kill yourself?
• After you tried to kill yourself, did you still want to die, or did you want to live?

Use of prompts may be helpful

• Do you think about killing yourself more than once or twice a day?
• Have you tried to kill yourself since [last reported attempt]?
• What did you think would happen when you tried to [insert method here]?
• What do you think would happen if you died; what would that be like?

Assess their perceived strengths

• What are the good things about you? What are you good at?
• Who do you care about and who cares about you?
• Who can you talk to when you are feeling upset?
• What would you like to do when you are older?
• Is there anything that you are looking forward to?

If the child indicates that they do feel suicidal

• Validate their feelings.
• Show concern that they are thinking this way.
• Don’t judge or rush to try to solve the problem for them.
• Spend time listening to them.
• Give the hope for the future.
• Get help is appropriate.

If you have a child who has told you that they feel suicidal or are thinking about suicide, please consult your clinical advisor or help@twb.org.nz, and please refer to the following Te Oranga Tonutanga (TWB) resources:
1. Guidelines for providing a safe home for someone at risk of suicide
2. Identifying suicide risk
3. Suicide Risk Assessment Prompt Questions

If you would like more help with asking about suicide or are unsure about suicide risk, please contact your Te Oranga Tonutanga clinical advisor or help@twb.org.nz.

Places to get help

• Call your local mental health crisis team if you would like the person to be assessed.
  The contact details for your local team can be found at Crisis / emergency mental health district teams • Crisis / emergency mental health district teams • Healthpoint
• Lifeline 0800 543 354
• Suicide crisis line 0508 828 865
• Youthline 0800 376 633 or text 234
• Free text or call 1737- anytime 24/7

We acknowledge the assistance of Associate Professor Annette Beautrais in developing this material.