Suicidal behaviour is increasingly common in closed juvenile care. As a result, social workers are more likely to control young people, for example by placing them in solitary confinement. That is counterproductive, according to PhD research by Psychologist Shireen Kaijadoe. "What suicidal young people need is connection."
The juvenile court may decide to place young people aged between 12 and 18 in a closed juvenile institution if they pose a danger to themselves or their surroundings. In this kind of institution, control measures such as isolation, restraint (holding or tying someone down), checking urine for drug use, and locking doors are allowed.
During her PhD, Kaijadoe investigated how closed institutions deal with suicidal adolescents and which approaches are effective in this context. "The deployment of experience professionals is particularly effective," she says. "People who have been suicidal themselves recognise the thoughts, and listen carefully to these young people, without judging them. This creates a sense of closeness."
Isolation
That sense of closeness cannot always be provided in closed youth care institutions. Kaijadoe: "Risk management is often at the forefront, because the primary goal is the young people’s safety. In the case of self-harming and suicidal behaviour, social workers often respond with protective and safeguarding measures, such as separation. When someone makes a suicide attempt, the reflex is to intervene in a controlling way, for fear that the person will make another attempt."
One control measure involves placing someone in an isolation cell, where they have no contact with the outside world. This quickly creates a negative spiral, says Kaijadoe. "Young people fear solitary confinement, and it actually leads to an increase in suicidal feelings. Placement in isolation makes them feel that they are a burden to others, and that they are not worth caring for. As a result, they decide not to talk about their feelings with professionals, who, in turn, do not know what is going on and therefore cannot properly assess the risk of suicide. This shifts care to ongoing crisis management, with a focus on incidents, and the underlying suffering disappears from the picture.
And that while the best antidote to suicidality is connection, she continues. "What works is: creating a connection, building a bond of trust, and increasing a sense of autonomy. But carers are afraid of the risks, especially if they have previously witnessed a suicide. That kind of event has a lot of impact on them personally, and on their actions as professionals. Therefore it is important to support them well in their difficult work."
Experience professionals
As part of her research, Kaijadoe spoke to young people and staff from closed youth care institutions. In the process, she worked closely with experience professionals: young adults trained as healthcare professionals who had also undergone training to harness their own experiences of suicidality. Together with them, she developed an intervention to provide weekly counselling for a year to a young person who, at that time, had been in an isolated ward for 15 months. Treatment had completely stalled, the girl in question made daily suicide attempts, and spent a lot of time in isolation. Support from experience professionals helped. "Low-threshold conversations with someone who knows what you are going through can help tremendously," Kaijadoe says. "They help break the taboo. Experience professionals simply talk to young people about their suicidal thoughts, without judging them. They help them with simple everyday things and get to know them by having a walk together, listening to music, or playing football."
Healthcare professionals also benefit from the help of experience professionals in youth care, Kaijadoe observed. Young people’s suicidality decreased and as a result, teams also dared to give young people more autonomy. Through contact with the experience professionals, healthcare professionals learn how to handle things better themselves. "But unfortunately, this collaboration is still in its infancy," the researcher acknowledges. "Plus, the workload needs to be reduced to make room for peer consultation and staff training. And it is important to make space in organisations to talk about the vulnerabilities and fears involved in working with suicidal young people."
Products from this research include a weekly calendar on suicidality and a short film, see: www.stilgevecht.nl
Are you thinking about suicide? Contact 113 Suicide Prevention 24/7 for free and anonymously on 0800-0113 or chat at 113.nl.
