Paul Denborough - Alfred Health - Managing youth at high risk of suicide and self harm
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Paul Denborough - Alfred Health - Managing youth at high risk of suicide and self harm



Paul Denborough delivered the presentation at the 2014 Young People at Risk Forum. ...

Paul Denborough delivered the presentation at the 2014 Young People at Risk Forum.

The 2014 Young People at Risk Forum reviewed the challenges and solutions surrounding intervention programs around topics such as suicide prevention, substance abuse, mental health, education, employment and housing. Additionally, the forum focused on culturally competent care and care within Aboriginal communities.

For more information about the event, please visit:



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Paul Denborough - Alfred Health - Managing youth at high risk of suicide and self harm Paul Denborough - Alfred Health - Managing youth at high risk of suicide and self harm Presentation Transcript

  • Helping youth at high risk of suicide and self harm Dr Paul Denborough Head Alfred CYMHS
  • Victoria 2010 • 66 youth suicides (15-24) • 309 youth deaths • 521 total suicides • 2098 national suicides
  • Why do young people suicide • Revenge anger and hostility combined with impulsivity • Isolation-lack of connection • Hopelessness • Failure-usually perceived rather than actual • Loss: real or psychic (i.e. self worth, relationship or goal)
  • Why do young people self harm • Allows them to express emotional pain and frustration without hurting anyone else or completely destroying themselves • Offers a sense of control when they often have none • To escape numbness • Validates emotional pain • Communicating to others a sense of inner turmoil • Self punishment • Can be a suicide attempt
  • Key points • Young people should be given optimal care appropriate to their individual needs and circumstances • It is not possible to predict whether a particular young person will suicide • It is possible to validly and reliably categorise those young people into those at relatively higher or lower probability for suicide in the future • Therapy can work particularly if significant others and family are included in the process
  • Fundamental Elements that Promote Recovery 1. Hope 2. Empowerment 3. Mutual respect 4. Non-judgemental 5. Choice promoting 6. Collaborate 7. Solution focused 8. Strength based
  • Care teams • High risk youth often have a number of professionals trying to help them • Essential for these professionals to form a care team
  • Elements of a successful care team • Identification of a co-ordinator • Respectful interaction amongst participants • Members expertise is valued • Time is spent understanding each person’s role and perspective • Commitment to adopting a solution focused/positive approach • Input and commitment from all members
  • What Works in Therapy: the Common Factors 40% client extra therapeutic 15% model techniques 15% placebo hope expectancy 30% relationship
  • Successful vs. Unsuccessful Therapists unsuccessful therapists focused on problems, neglected strengths successful therapists focused on strengths before moving to problems created an environment in which the patient felt he was perceived as a well functioning person
  • The Alliance: Research Findings Quality of alliance more potent predictor of outcome than orientation, experience or professional discipline Client perception of the alliance a better predictor of outcome than therapists
  • Empowering Client Factors 1. Develop a change focus - listen for change - listen for key words that reflect change - take notice and follow up 2. Listen for heroic stories - attitude is the key re clients inherent abilities this does not mean ignore pain or assume Pollyanna Stance
  • Give voice to the WHOLE story confusion AND clarity suffering AND endurance pain AND coping desperation AND desire 3. Validate the clients contribution to change 4. Tap into the clients world
  • Empowering Alliance • monitor clients reaction to comments • stay close to their descriptions of their lives (monitor and measure the alliance) • be flexible (some clients will prefer formal over casual) • try and travel at clients pace • validate client • accept client goals at face value
  • Form all plans and tasks with the client • fit the clients theory of change • change is done with rather than to the client
  • Empowering Expectancy Factors 1. Believe in the client, in yourself and your work and in the probability of change 2. Orient therapy toward a hopeful future 3. Highlight the clients sense of personal control
  • What to do when young person self harming • Do not panic • Deal with immediate medical issues • Never make assumptions i.e. that they want to talk about it or it is attention seeking • Listen to what they have to say • Be honest and non judgemental • Set boundaries • See the person not the injuries get help with own reactions
  • • Hospital stays short but as frequent as required • Therapeutic alliance is established with a community therapist • Young person is linked with community supports • Clinician’s working with high risk young people feel backed up by senior management and the system