September 10th marked the third WHO, World Suicide Prevention Day with the theme ‘Changing the Narrative on Suicide’. With 720,000 people dying each year, the call to action was ‘start the conversation’ with the global responsibility ‘to challenge harmful myths, reduce stigma, and foster open, compassionate conversations about suicide. It is about shifting from silence and misunderstanding to openness, empathy, and support, creating environments where people feel able to speak up and seek help.’ (WHO)
In Australia suicide is the leading cause of death in 10 to 17-year-olds and while breaking the silence is crucial it is also important for practitioners to be better informed in supporting families where a young person expresses a desire to die.
What is Helpful?
Authors Simes et al (2025) note that despite years of research our knowledge about how best to support young people who express or act on suicidal thoughts and their families remains inadequate. They undertook a qualitative study comparing the experience of young people, their parents and therapists of a systemically informed youth suicide intervention that included individual and conjoint family therapy. Family relationship factors have been identified as both risk and protective factors for suicidality and recovery providing theoretical support for systemically informed intervention. Family members have also been identified as central in facilitating engagement in therapy and providing support.
The Study
Semi-structured interviews were conducted with seven psychotherapy triads comprising the young person, parents and therapist. Each of the young people had attended ED with a suicide crisis and made at least one attempt.
Four domains were identified. The first was the youth -parent relationship where all participants identified fracture and disconnection as key issues. However, while therapists and the young person saw this as contributing to distress and suicidality, parents were more likely to attribute relationship difficulties to mental health issues and suicidality.
The second domain referred to individual therapy for both parents and young people where the value of a strong therapeutic alliance and separate support was highlighted. It was also clear that both working with the same practitioner ‘seemed to lay the groundwork for more productive individual and conjoint therapy’. Separate treatment appeared to be important throughout and not just as a preparation for conjoint work.
The third domain referred to joint work focussed on relational repair which was identified ‘as both the most uncomfortable and anxiety-provoking aspects of treatment and as potentially the most transformative’. While all the young people expressed reluctance about these sessions, they also found them helpful with some describing them as very important in improving their relationship with their parents and creating a sense of being loved and valued. Parents similarly found these sessions stressful and helpful.
The final domain referred to service delivery where previous siloed and individualised treatments for the young person worsening disconnection which ‘did not resolve their suicidality, foster understanding with their parents, or help communication and support (thus maintaining isolation and family disconnection).’ The authors suggest that ‘systemic and relationally focused intervention with individuals and families ‘may be under-utilized in suicide intervention’.
In Conclusion
This is a useful study which emphasises the value of looking beyond the individual to the social and relational world of the young person expressing a frightening symptom. Harnessing the support of those who care for them and addressing family matters that have created fracture produces positive outcomes for all.
Di Simes, Ian Shochet, Kate Murray & Isobel G. Sands (2025) Adolescent, caregivers, and therapists’ experiences of youth and family suicide intervention: A qualitative study, Psychotherapy Research, 35:8, 1396-1414, DOI: 10.1080/10503307.2024.2415991
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