Child mental health is becoming an area of ever-increasing concern and research, including within the area of child sexual abuse, depression, anxiety, suicidality, and bullying that lead to suicide. Recently, within the past two months, I had opportunities to visit a large metropolitan hospital in Atlanta at which mental health care is provided on an inpatient and outpatient basis for people of all ages. I primarily made observations in the children’s mental health unit in which children from ages 4-12 were hospitalized as inpatients.
Since making my observations, I have done much research in the area of medicine and counseling related to depression, anxiety, suicidality, and bullying that ultimately ends in the suicide of the victim. I have also consulted with many professionals in these areas, including pediatricians, psychiatrists, psychologists, and licensed professional counselors. Further, I have communicated with school teachers, school administrators, school mental health professionals, school system administrators, and religious about these issues. This blog article will share some of what I discovered related to these critically important issues in mental health care.
At the hospital in Atlanta at which I made my observations regarding inpatient child mental healthcare, the most significant part about it that was very noticeable was that most of the children were boys. On one particular day, there were 16 children housed in the unit, and 12 of them were boys, with the majority of the boys being African-American. Of the girls present, the majority of them were Caucasian. It was also my understanding that the majority of the boys were hospitalized due to suicidality (and/or other mental health concerns related to it, such as depression, anxiety, and/or sexual and/or physical abuse or neglect).
To me as an untrained observer, I found this to be very significant because my personal expectation was to observe there to be a greater number of girls than boys present in the unit. Because there were significantly fewer girls than boys present in the unit over a period of several days, it became important to me to understand the reasons for it. I got to thinking about several possibilities to explain this reality.
Perhaps girls are more open about their feelings and experiences, and/or a depressed or otherwise upset mood in girls may be more visible to others. Perhaps boys are keeping their feelings too much to themselves due to the societal and cultural expectations for them to “be a man,” and thus, not to show their feelings. Possibly, adults were unable to recognize signs of suicidality or depression in boys compared to girls.
Further, it may be possible that adults did not view boys’ depression or suicidality to be as serious as that of girls until a crisis point was reached. Culturally, it is also significant that most of the children housed in the unit were African-American boys. Specifically related to cultural or ethnic differences, I do not yet have particular potential explanations for this. Additionally, perhaps there are other general explanations and reasons that I have not thought of for there being significantly more boys in the unit than girls.
As I stated previously, since the time of my observations of the children’s mental health unit in the metro Atlanta hospital, I have researched several issues relating to child mental health, and I have consulted with many professionals in the field. In a study completed by Cynthia R. Pfeffer (2001, p. 1057), she stated that during prospective follow-up into adulthood of children at risk for suicide showed that a “history of sexual abuse (RR: 5.71, 95%; CI: 1.9-16.7) imparted the greatest risk” for it. Reading this was saddening and disheartening for me because it appears that most suicide attempters and commiters have internalized their pain and suffering, are taking it out on themselves, and appear not to be able to successfully cope. They were hurt, have lost hope and trust, and are now hurting themselves, possibly in efforts to make the painful memories disappear. For them, suicide seems to be the only answer for removing and escaping the emotional pain.
In a study by Stanley, Brown, Brent, Wells, Poling, Curry, Kennard, Wagner, Cwik, Klomek, Goldstein, Vitiello, Barnett, Daniel, and Hughes (2009, p. 1005), the researchers reported that individuals who attempted incomplete suicide are at the greatest risk for repeat attempts and/or actually committing suicide within the first six months following the incomplete attempt (as this study particularly relates to adolescents, aged 13-19 years old). This is extremely important to understand because those who are untrained in this area do not understand the seriousness or severity of it, or are, perhaps, in denial that the situation is serious or severe. Regarding children, I believe this particularly applies to those in education, including teachers, administrators, and other staff because they are not equipped with the knowledge and understanding about the manner in which to best support students who have been suicidal.
And sometimes, those adults in education who are bullies toward children truly have absolutely no understanding or compassion toward students who made an incomplete attempt at suicide because they simply do not seem to care. In fact, those type of adults may even do more damage to the child through their insensitivity and failure to understand the situation by being even more punitive or retaliatory toward the student because the issue is one with which they, themselves, are unable to successfully cope. It remains easier for such adult bullies of students in education to bully, blame, and revictimize the student victim.
Also unhelpful are the student peer bullies with whom the suicide attempt survivor must cope. Student peer bullies of the victim seem to bully the survivor even more because they are aware of the emotional vulnerability of the survivor, and they capitalize on that because it makes them feel good. Therefore, in a school environment in which bullying goes unchecked, unresolved, and not corrected, suicide attempt survivors are at an even greater risk for a future successful suicide attempt because they experience bullying from adults and peers.
Additionally, O’Connor, Gaynes, Burda, Soh, and Whitlock (2012, p. 15) reported in their study that “psychotherapy did not reduce the risk for suicide attempts in adolescents in contrast to adults.” They (O’Connor, Gaynes, Burda, Soh, and Whitlock, 2012, p. 11) further reported that “psychotherapy did not reduce suicide attempts in adolescents at 6 to 18 months” into a suicide prevention treatment program. They (O’Connor, Gaynes, Burda, Soh, and Whitlock, 2012, p. 11) also stated that “psychotherapy had no beneficial effect on suicide ideation beyond usual care” in adolescents. These findings are shocking, disturbing, and disheartening, particularly when there may be the extant societal belief that counseling and psychotheraphy benefit individuals with emotional disturbances and/or self-destructive ideations. If psychotherapy is not beneficial to adolescents who have attempted suicide and/or who have suicidal ideation, what benefit is psychotherapy to children who have had similar experiences and/or beliefs?
A professional friend of mine who is a psychiatrist provided me with an article written by a women who is a sexual abuse survivor, and who was hospitalized on three occasions throughout her life due to depression and suicidality related to her traumatic experiences. The article, “How ‘Person-Centered’ Care Helped Guide me Toward Recovery from Mental Illness,” by Ashley R. Clayton (2013), was extremely helpful to me in better-understanding what is going through someone’s mind when they are hospitalized for a mental health crisis. The article was further assistive to me because, as a graduate student in counseling who is working on my second master’s degree, it was important for me to perceive and understand the great value of Person-Centered Therapy in counseling suicide and sexual abuse survivors.
Because so much hope and trust has been lost in survivors of sexual abuse and suicide, it is obviously critically important for others, including mental health professionals, to be as sensitive and supportive as possible of them. The author shared that she experienced the greatest improvement through the person-centered approach and caring relationship that a particular nurse developed with her. This is something important for me to remember and put into practice in my own counseling of trauma survivors.
Further regarding children’s mental health in relation to surviving trauma and suicide attempts, as well as those areas in relation to children’s school attendance, I spoke with two pediatricians regarding the issues. Both pediatricians took the issues seriously, however, they did not desire to take responsibility for children who were suicidal because they stated they were not trained or highly-experienced in those areas. Both pediatricians also desired for parents to work with the expectations of schools, even though such expectations, stresses, and pressures may be too overwhelming for some children. Regarding the experience of child sexual abuse, both pediatricians believed that counseling was needed for child survivors, however they both believed that medication to manage the child survivors’ moods were necessary as long as they believed the child was “functioning.”
For me, the perspectives of both pediatricians – both of whom are Caucasian women with many years of experience in pediatrics – were discouraging in many areas. First, both doctors appeared to be very quick in the desire to refer suicidal patients to other medical professionals. While that has advantages and disadvantages, it places those at risk in the position of believing that their doctors are unable to properly care for or understand them. Both also believed that child survivors of sexual abuse need not be medicated if they were “functioning.” I believe that it is one thing to survive, and quite another thing to thrive. Merely “functioning” is not fully living or thriving, to me. And also, both pediatricians appeared to also be too quick to go along with schools’ expectations for students, including maintaining the same academic and/or disciplinary standards for students who are trauma survivors. As an individual who is an experienced teacher, I know that students have different learning styles; placing everyone in the same category is detrimental to those who have suffered trauma.
Both a psychologist and a licensed professional counselor (LPC) with whom I consulted about difficult, damaging, challenging, and/or overly stressful and overwhelming school experiences of child trauma survivors both believed that people in education are or may be unable and/or unwilling to change in a manner that is more supportive, understanding, and compassionate toward them. The psychologist believed there is not likely any school that would be able to meet the needs of a child who is a trauma survivor. And, both the psychologist and the LPC believed that schools are part of the problem in not successfully supporting and understanding trauma survivors and their needs. Those who are in education – perhaps including school counselors and school psychologists – may be unequipped in schools at being able to fully or successfully support children who are trauma survivors; this can and does have devastating effects on such children.
Of all those in the medical and mental health fields, I believe those who are most fully trained and equipped to successfully both treat and understand trauma survivors – in particular, those who have experienced sexual trauma, depression, anxiety, and suicide attempts – are psychiatrists. Psychiatrists are in the best position to provide urgent and necessary medical and mental health care to suicide attempters, including hospitalization, evaluations, medical care, and medications.
I assume that the psychiatrists are those who most often see patients who are suicide attempters; and they see them at their lowest points, emotionally. Therefore, psychiatrists who truly have what is best for their patients in mind seem to help suicide attempters and trauma survivors become stabilized and recover as quickly as possible. Psychiatrists are in a wonderful position with their patients to be supportive, understanding, and compassionate; and to inform and educate society, in general, about the medical issues and needs experienced by suicide attempters and other trauma survivors.
In communicating with several people who are education professionals regarding survivors of sexual trauma, suicide attempts, and bullying (both by peers and adults in school), I have largely encountered biases against the survivors, as well as an incredible absence of sensitivity toward them. Such refusals of understanding, sensitivity, and compassion toward survivors by the majority of education professionals with whom I communicated can possibly be attributed to a lack of or refusal toward being educated and informed about the needs of the survivors. Such outright insensitivity by the education professionals – the majority of those who were insensitive toward survivors were administrators – could also be attributed to a denial about the seriousness or severity, or fear due to stigmas or the unknown, regarding the issues related to survivors.
In some situations of communicating with administrators, upper administrators, and school psychologists of schools and school systems related to student survivors of sexual trauma, anxiety, depression, suicide attempts, and bullying, I also encountered not only insensitivity and a lack of understanding toward the survivors, but also inconsistencies in their behaviors toward them. In most school and/or school system administrative personnel and school psychologists with whom I communicated, I encountered adult bullying by them toward the child survivors that was sadistic. In such education professionals, it appeared that their incredible harshness toward the survivors was something that they wanted to occur, regardless of the outcome or effects that may or may not have resulted in actual suicide.
In other situations in communicating with education professionals about such survivors, however, I encountered empathy, compassion, understanding, and sensitivity toward them. Such supportive actions were those exhibited by other particular school system administrative personnel and/or educators and counselors. Such desparities in the treatment of survivors by various school personnel reflects that education professionals must be on the same page in order to consistently understand and support, as well as be compassionate and sensitive toward survivors. This appears to be direly and desperately needed in education in order that students who are trauma and suicide attempt survivors receive the greatest possible support and understanding in their educational environments.
Therefore, it was personally extremely shocking and disturbing to me in a life-changing manner that some of the very leaders of schools and school systems not only do not support said survivors, but are actually bullying and sadistic toward them. In these situations, I believe it would take not less than a miracle to convince such individuals to even consider a different and more positive and understanding perspective toward said survivors.
In regard to particular religious leaders with whom I have communicated about issues related to survivors of child sexual abuse, anxiety, depression, suicide attempts, and bullying, I have – thus far – experienced their compassion, kindness, and prayers toward survivors. I have also learned, however, to carefully choose which religious to approach; not all religious are as understanding and supportive as others. And, I am further aware that there are those religious who would take such information and use it against the victims and/or survivors in order to revictimize them. Presently, however, that is not what I have experienced in my recent and present communications with particular religious about these issues related to survivors; and I am thankful for and relieved about that.
I believe that society has come a long way in supporting and understanding the experiences and needs of trauma survivors, including those who have experienced sexual abuse, depression, anxiety, trauma, bullying, and suicide attempts, however there is still much more progress to be made. Those who best-recover from traumatic experiences are those who have positive, stable support in their lives. Stressful and overwhelming situations are serious set-backs that only cause them to regress, and to continue not to hope or trust.
It is so critically important for sexual abuse survivors and suicide attempt survivors to have the consistent and unconditional support of those around them, including family members, community members, those who are in education, and others. Without such support, compassion, and understanding – and, in fact, if the survivor experiences the opposite of those – he or she could make a future suicide attempt that is successful. Such tragedies are avoidable and preventable if everyone practiced more patient, respect, appreciation, and compassion toward each other, particularly trauma survivors who have attempted suicide.
Clayton, A.R. (2013). “How ‘Person-Centered’ care helped guide me toward recovery from mental illness.” Health Affairs, 32 (3), pp. 622-626.
O’Connor, E., Gaynes, B.N., Burda, B.U., Soh, C., & Whitlock, E.P. (2012). “Screening for and treatment of suicide risk relevant to primary care.” Annals of Internal Medicine, pp. 1-22; pp. W-1 – W-5.
Pfeffer, C.R. (2001). “Diagnosis of childhood and adolescent suicidal behavior: Unmet needs for suicide prevention.” Society of Biological Psychiatry, 49, pp. 1055-1061.
Stanley, B., Brown, G., Brent, D.A., Wells, K., Poling, K., Curry, J., Kennard, B.D., Wagner, A., Cwik, M.F., Klomek, A.B., Goldstein, T., Vitiello, B., Barnett, S., Daniel, S., & Hughes, J. (2009). “Cognitive-Behavioral Therapy for suicide prevention (CBT-SP): Treatment model feasibility, and acceptability.” Journal of the American Academy of Child and Adolescent Psychiatry, 48 (10), pp. 1005-1013.