The Role of Help and Hope in Prevention and Early Intervention with Suicidal Adolescents: Implications for Mental Health Counselors

Beginning of article

The role of help and hope as protective factors in prevention and early intervention with suicidal adolescents is examined Hope is a forward-looking attitude serving as a buffer against suicide. Help reflects the belief and reality that there is a place to turn for support or assistance; it serves as a dynamic force against suicide. Help and hope can be powerful and mutually reinforcing components of any attempt to reach adolescents contemplating suicide. Implications for mental health counselors are presented, with an emphasis on the interrelatedness of help and hope.

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In 2004, 4,599 adolescents in the United States between the ages of 10 and 24 committed suicide (Centers for Disease Control and Prevention, 2007)--an 8 percent increase from the previous year and the largest yearly increase since 1990. In the United States, suicide is the third leading cause of death among adolescents (National Center for Injury Prevention and Control, 2007). In Europe, suicide is also a leading cause of death among adolescents, and among those 15-24 years old the rate is higher than in the United States: For 1950 through 2002, the European rate for that group was 13/100,000 and the U.S. rate 9.9/100,000 (World Health Organization, 2007). Suicide attempts among adolescents are also high and significant in numerous countries (e.g., Britain, 13.2%, South Brazil, 9.0%, Slovenia, 10.4%, and China, 9.0%; Ali & Maharajh, 2005).

Researchers have identified behavioral signs that may indicate an adolescent is considering suicide; typical signs are changes in sleeping or eating patterns, dysthymia or onset of depression, drug or alcohol abuse, suicidal ideation, a previous suicide attempt, social isolation, withdrawal, or marked changes in the established behaviors of the adolescent (Berman & Carroll, 1984; Borges, Benjet, Medina-Mora, Orozco, & Nock, 2008; Fombonne, 1998). However, a literature analysis demonstrated that a suicidal adolescent may only be differentiated from a depressed, schizophrenic, or acting-out adolescent after the final act of suicide (Berman & Carroll; Groholt, Ekeberg, & Haldorsen, 2000). Therefore, mental health counselors are often left to use clinical judgment and assess suicide risk case by case. They cannot rely solely on tools such as checklists for assessment purposes (Berman & Carroll; Maris, Berman, Maltsberger, & Yufit, 1992).

Although each case must be handled with extreme care, adolescents who have previously attempted suicide do have some commonalities. In 1964, Kobler and Stotland (p. 1) stated that

   our conception views suicidal attempts and ... suicidal intent as
   efforts, however misdirected, to solve problems of living, as
   frantic pleas for help and hope from other people; help in solving
   the problems, and hope that they can be solved.

Thirty years before Martin Seligman introduced the concept of positive psychology, emphasizing positive attitudes as protective factors (Seligman, Steen, Park, & Peterson, 2005), Kobler and Stotland provided us with a model of suicide prevention that emphasized the positive attitudes of help and hope. This paper will examine the role of help and hope as interrelated protective factors against adolescent suicide and the resulting implications for mental health counselors.

THE ROLE OF HELP

Help means having somewhere to turn for support or assistance. In a survey of adolescents and their parents, Stivers (1988) found that adolescents considering suicide are communicating their pleas for help, though often parents do not take notice. Without the parents' attention, the adolescent senses no place to turn for help, and therefore the act of life-threatening behavior becomes a more attractive option. Further, cultural expectations may shape the likelihood that an adolescent will seek formal mental health services (Goldston et al., 2008). However, Kobler and Stotland (1964) contend that hope can be built or restored with the belief that help is available and the subsequent delivery of that help. Many successful preventions and interventions communicate that help is available and that help-seeking behavior is appropriate, efficacious, and will be responded to. While further research is necessary, a systematic review, controlled evaluation, and meta-analysis demonstrate a positive role for preventions and interventions including gatekeepers, screening, acute chain-of-care, problem-solving therapy (Mann et al., 2005), school-based prevention programs (Kalafat, 2003), and crisis intervention brought directly to those in need (Roberts & Everly, 2006).

Potentially suicidal adolescents need to be reached with the message that help is available and that help-seeking is a desirable response to a serious issue. A Boston City Hospital program facilitated adolescent help-seeking by making students aware that hospital resources were available for anyone suffering from suicidal ideation (Deykin, Hsieh, Joshi, & McNamarra, 1986). The program realized a two-fold increase in emergency room admissions for adolescents having suicidal ideation without suicide attempts. The program was viewed positively because it increased help-seeking behavior while providing a clinical source to deal with any increased anxiety on the part of the adolescent. Thus, adolescents were reached with the message that help was available and help was subsequently delivered. Increasing positive attitudes toward help-seeking significantly increases actual …