DAN MOSS: Hi everybody and welcome to our webinar on Understanding and responding to childhood suicidal ideation. My name is Dan Moss. I'm replacing Amanda today as facilitator of this webinar today. And welcome to our presenters for today, Arianne Coad, Lyn O’Grady and David Newman. It's great to have you with us.

Our role at Emerging Minds is to create practitioners by drawing on the knowledge and skills of both practitioners and parents who are supporting children experiencing distress, despair and suicidal ideation.

This webinar is part of a suite of practitioner resources to support those working with children and families where a child is experiencing distress or despair. They are available under the subject search 'self-harm and suicide'. We’ve just released our latest course, Understanding and Responding to Childhood Suicidal Ideation. You’ll also find a selection of podcasts.

I'd like to recognise the lands that belong to the Aboriginal and Torres Strait Islander people as Traditional Owners, where we work, play and walk this country. We acknowledge and respect their traditional connections to their land and waters, culture, spirituality, family, and community for the wellbeing of all Aboriginal and Torres Strait Islander children and their families.

I'd also like to acknowledge that today's conversations might be quite hard for some people to hear, and they might even bring up some thoughts or feelings for you. If you have any concerns about how you are travelling throughout today, please give yourself a break and reach out to those in your support network. Or else you can contact one of the services in the links that we are going to provide through the Resources tab.

In terms of the GoToWebinar dashboard, just to let you know there is a resource list, as I mentioned, in the Resources tab on the GoToWebinar dashboard. Importantly, you can ask any question you like on the Question box.

Thank you so much to the hundreds of people, really, who have provided feedback to us already, and questions. We will do our best to answer those questions today, acknowledging that we aren't going to be able to get through all of them. We hope this is all the beginning of a long conversation around this topic.

Today's webinar is the second webinar we have convened together, and we will aim to: explore the experiences of childhood distress and despair that can lead to suicidal ideation. Reflect on the ethical considerations when responding. Apply collaborative and curious approaches to support connection and understanding with children and their families. Recognise and highlight children's responses to reveal their ideas, values and skills in managing challenges in ways which find children's values, skills, in the ways they've managed challenges in their lives.

We will start by discussing a case scenario followed by some questions participants have asked us. Just to let you know, that case scenario can be found in the Resources tab, so for those of you playing along at home, please find that case scenario and have a read of it, as our panellists discussed that scenario throughout the next hour.

We welcome you to ask any questions as they come up through todays webinar. Now I would like to invite our panellists to introduce themselves. I have a short, introductory question for the three of you. David, thanks so much for joining us. Tell us a bit about what you are most drawn to in your work with children and young people and families around suicidal ideation?

DAVID NEWMAN: Hi, I'm here in Gadigal country, also known as Sydney. This theme means quite a lot to me. I suppose the first thing I would say is, I'm not sure if we could get a more profound realm or theme that we can speak with people about. When we are thinking about life and death, it's really big. I don't know if anybody here has read Albert Camus' quote, "There is but one serious philosophical topic, and that topic is suicide."

Maybe he is overstating it, but I think there is something to that.

The other thing that really catches my attention, especially when working with young folks around suicidal ideation, is just how hard people are fighting. You know? I find that very moving. People are fighting very hard to find reasons to be here.

So, I think it's just such an uncertain manoeuvre to speak with someone about it. Like, it is such - it's often a very tender and uncertain thing to do for young folks and children, to speak about this. It's very complicated territory.

Another thing I'd like to say yes, I'd really like to interrupt the sort of 'us and them' about suicide. I'm in the picture as well. When we speak about this, when we talk about it here, I've got friends who have died by suicide, people I've known in my work who have died by suicide, I have a lot of people I've spoken with who have really grappled with wanting to die. My mother died by suicide and when I was a child.

They are all there. I'm implicated in this. In a sense, they are there in a way that kind of helps me some company in the incredible complexities and ethical complexities of this work.

Finally, the last thing I would like to say, Dan, in terms of what draws me to this work is the social justice of it. I'm interested in looking at the context around when people are tempted with dying or not existing. So often there are terrible context of marginalisation, poverty, etc. I have a colleague and friend from Vancouver called Vicky Reynolds, who speaks about how hate kills. Maybe we need to think about that some more. The extent to which people don't have reasons or can't find reasons to live, because they are at the receiving end of horrid experiences in our culture.

There you go, there's a little opening. 

DAN MOSS: Thanks David. Arianne, welcome. What stands out to you when supporting children who are experiencing distress and despair? 

ARIANNE COAD: I am a mum of six kids between the ages of nine and 22. I have children who are neurodiverse and I have a transgender child. We've lived through a lot of stress and challenges as a family. And I have lived experience of kids, my own kids, who have struggled with self-harm, suicidal ideation. And I've seen sort of first hand how powerful it can be when you work with practitioners as allies towards helping your kids. 

And I can see what can happen when a practitioner is a barrier to that. But I also benefited because my kids are such a wide variety of ages. That early intervention, when children are young, can save a world of heartache later. So I'm really passionate about stepping in when children first have these thoughts when they are younger, to give them the tools that they need so that this doesn't snowball into something much more dangerous and more difficult to deal with as they get older. 

So yeah, I think I really benefited - one of my children is alive because of practitioners who really helped us keep her alive. I'll always be grateful for that. So if I can contribute something to the conversation, I'd really like to be able to. 

DAN MOSS: Thanks Arianne. Lyn, welcome. What have been the most impactful or meaningful moments in your work with children or families who are navigating suicidal ideation? 

DR LYN O'GRADY: It's great to be here in and see so much interest in this topic. I guess I was thinking about various times when you are working with children and families, and you go through stages when you first find out what's happening with them. We will talk about that in terms of the case study today. And different times when you feel perhaps that you are spinning a bit, you are not sure, you might be quite concerned. 

And you kind of get to a point, oftentimes, when things start to improve. You see the hope of kicking in and using some things we are talking about. That's something we're working on making a difference. And ideally you get to the point - I love when people turn up to the appointment and we never know what's going to happen. This is in my private practice work these days. And checking in, how are things going on since last time? And they can say, and so much better. The suicidal thoughts are not coming. Then you can start to do some really rich work around, so what happened? What has changed? How do we learn from that? How do we understand what's happened? And make it a really rich learning opportunity. The hope then. 

From then, what do we need to do? Maybe you don't need to come back, maybe we can stretch out the appointments. So it's this relief, raw feeling that comes from that. But also the hope that it builds, it reminds me and gives me hope in working with other children and families, then saying to them, I've been here before with people, and I believe that the things that we are all doing, working together, everybody trying to understand and do all the things we're going to talk about today - it's going to work for us. 

It's creating that hope and feeling that hope in myself I think is really important, and they are the moments that keep me continuing to be able to do this work, I guess. So it's very special, when it gets to that point. And oftentimes it does. 

DAN MOSS: Thank you, looking forward to hearing more from you as the our progresses. 

As mentioned, today's scenario has been shaped from collective experiences both from practitioners but also from people such as Arianne, with lived experience of working with and supporting children through distress and despair and suicidal ideation. 

We we're going to talk for the next 45 minutes, really, around this particular case study. As mentioned, this case study is in the Resources tab on GoToWebinar. But I will begin to read a bit about what we will discuss. 

"I am a mental health worker at the Northern NSW Health Service, based in the hospital. I have been working with Semmy for the past two months, following her separation from her husband and subsequent experience of depression. 

"I have put together some details from my and Semmy’s conversations over the last two months that I’m pretty sure are important to consider. I am seeking reflections and ideas from the panel on how other practitioners might proceed with a family I’m currently supporting. 

"During our sessions, Semmy has often expressed concern about her 10-year-old son, Max. Recently, she shared that Max has been saying he wants to end his life. His school has also raised concerns, reporting that his behaviour is becoming increasingly disruptive. He frequently gets into fights during recess and lunch and has been sent to the principal’s office several times. 

"In a follow-up meeting with Semmy and Max, I learned that he is upset about not making the school soccer team. I heard him refer to himself as a loser and believes his father hates him and his father never wants to see him. Semmy shares that things have been even more difficult since their family dog passed away last month as he was Max’s best friend. 

"Although she has tried to speak with Max about how he's feeling, Semmy says it's been hard to find the time since returning to full-time work. Additionally, Max now divides his time between Semmy's home and his father's, which has disrupted his usual family routines. Semmy describes him as withdrawn and easily irritable. He often refuses to shower or change his clothes for days at a time and she has become increasingly concerned about his low mood and 'give up' attitude and some behaviour, like throwing stones at the neighbour’s bird aviary." 

I'm going to invite our panellists to provide me with some insights into how we might progress with the work, with Semmy and Max. Lyn, I think we might start with you, if we can. 

Thinking about Max's situation, and we have heard a little bit about the context of some of his hardships, I'm wondering if you can describe in your experience, what can lead children to begin to experience suicidal ideation? 

DR LYN O'GRADY: Thanks, Dan. This is a big topic, and one that is fairly difficult, I think, for us to get our heads around. Often something that adults find hard to understand or to believe, perhaps, when children talk about wanting to die. 

It's something that challenges our ways of seeing childhood and lots of ways, or makes us question whether or not they really understand what they are saying. Sometimes people ask whether or not it is something, do they know what suicide means? Do they understand death? 

And I guess the general approach is to, not to focus on that too much. Children often do understand death. In any event, if they are talking about wanting to die, it is telling us something that we need to listen to. 

And we know that even young children can think about dying. We know that, from kids helpline data, about 10 years ago now Kids Helpline, the Your Town people put together some research. They found that suicide was a big topic, even in younger children. 

They broke up the data between under 14s and older, 15 and 17-year-olds in the groups that they come up with. They found that 25% of suicide related contacts at this time, in 2001 and 2015, were children 14 years and younger. 

Children had been ringing the helpline for a long time in relation to suicide. The thing that bothered me, at that time, and has driven some of my interest in the work, was that the younger group of children were more likely to not get help from adults. 

They also asked questions around who helps you when you reach out for support, and that under 14 age group were getting less help then the older group. Adults around them were not taking it very seriously, so then these children were calling Kids Helpline to get some help from that. 

Some of the things they investigated was whether the young children were not more serious about it, but when we asked whether they had a plan to die or had made some kind of attempt to really hurt themselves with a view to dying, they had. 

82% of that age group, of 136 kids, had actually made a suicide plan. 54% had made an attempt of some sort. They are children, so their attempts could be a whole lot of different things, that may be aren't as likely to be lethal. But they are still in the thinking, and this is under 14-year-olds. 

We know from that research that it's really important. So then, who are these children, what is going on for them? There is very little research, it is difficult to do research directly with children. A lot of research often happens through adults, so the questionnaires or research happens with parents or teachers or other people working with children. 

There is little research that looks at the children directly. But if we think about the protective factors framework models that help us understand children's mental health and suicide prevention, we know the family is really important to children. We know that local community and neighbourhood is really important for children. 

They are the factors we would be looking at in terms of potential risks. David has a ready mention some of these, in terms of people that are going through some really difficult times. 

We know that conflict at home, changes at home, family separation could be one factor. It is unlikely to be just one factor - as with all suicides we understand it is multiple factors coming together. There may be bullying happening at school, perception that they are not doing well at school, it could be a perception or a belief. It could be a belief that they are in trouble. 

They could not feel like they fit in, not feeling like they belong or fit in. It could be bullying. We hear about cyber bullying, which is very closely connected. Physical and cyber bullying don't happen separately, often. We kind of need to understand that as well. 

It can have a relationship aspect, the hate aspect that David mentioned as well. We know that LGBTIQ community more broadly is more at risk in terms of suicide risk, there is not research yet. We might want to think about what makes things more difficult for them, and that there are many aspects to that. 

We see that in the case study. We think about the case study, we've got Max going through a lot of changes and his family, quite rapid changes in the last few months. The dog died - often pets are very protective for children, and adults as well, but for children particularly. That was described in the case study as well, that that was his friend. 

His feeling like his dad hates him, he missed out on the soccer team. Again, if we look at that socio-ecological model, there are a lot of risk factors and change that is happening at that level. We are not really sure how Max is feeling about all that, and feeling about himself. But there are some pretty good indications that he is struggling with a lot of changes that have happened. 

That would fit with the theories around what the problems could be. It is sort of making good sense to think about it in that way. 

DAN MOSS: Thanks, Lyn. Arianne, you talked a little bit about your own perspective as being a mother to 6 children. Given your experience, what stands out to you about this case study? 

ARIANNE COAD: I think it's very clear that there are 2 stories going on here. There is Max's story, and also Semmy's story. She is facing her own changes and challenges, she has gone back to work full-time, she has just gone through a separation, she has had a change in living arrangements. 

And I think that is quite a load to carry. And she is also noticing that her child is carrying his own load, and she has all of her worries around her child. She is noticing whether he showers or not. 

Really, they are both... They both need attention. I think we can tend to look at Max and think that he is the most danger here, or the most risk, if he is having suicidal thoughts. But in reality she is also struggling. 

Semmy is the person in the best position to be able to help Max. She is the one who was with him 24/7. She is the one who is noticing things like personal hygiene, whether he eats or not, what kind of mood he is in. That he is experiencing low mood for a long period of time. If we only address one person, it can get missed. 

I think it's important to affirm and validate in the situation the fact that this mum is carrying a load, that she is noticing. She is doing a great job. There is a lot of pressure on mothers in particular to put their children first in everything. 

And I think that can be a really big pressure to have to live up to being on top of everything. And she is carrying this load, but she is still noticing, reaching out, and is going to get him help, which I think is really amazing. 

Also the fact that it's a huge energy output. From my own experience, it's a lot to carry your own load, to carry your family's load, and then to see one of your children really struggling. It takes a lot of energy to fight those thoughts of "It's my fault, I failed." I imagine she could be thinking it's her fault, it's because of her separation, it's because she has to go back to work. She could feel like a complete failure. 

I think a practitioner in this position has a real opportunity to encourage her and affirm her and to support her, as well. Because it does, it takes a lot of energy to do that. 

It's tiring work being an advocate for somebody else, when you are fighting your own battles. And if we can help both of them, everybody wins, right? 

DAN MOSS: What do you think that both Semmy and Max might be hoping for when they are sitting there, speaking to the worker? 

ARIANNE COAD: I think she is reaching out to help. Think she probably doesn't know what to do or where to start, she wants to take it seriously. I think being listened to and having somebody validate your experience, and not just dismiss it. 

When Lyn was talking about how children don't get heard by the adults in their life, that's why they are phoning helplines. I think the same thing is true for parents. 

You don't want to be dismissed, you don't want to be treated like you are being a hypochondriac or worrying too much. You want somebody to listen, and to affirm, and to be nonjudgemental. 

I think something that was really helpful in my experience was also, when we did sit with practitioners who really reinforced the connection that I had with my child. For a practitioner to sit and say, "I can see you care about Max, because you are looking out for him." 

Reinforcing that bond, and connecting that bond. Validating her experience. I think something that a practitioner can do that a parent can't do - we all know that kids listen to their teachers better than their parents. I can ask my kids to tidy up their rooms 400 times, and they will ignore me. If the teachers asks them to bring a pencil to school tomorrow or else, they do it. 

I think that's because there is a different relationship. And I think it's really powerful that a practitioner can ask questions, difficult questions, and tread on difficult ground with a child in a way that a parent can't. 

I think it would be difficult for her to ask questions. "Max, how do you feel about how things with changed with me and dad? What is upsetting you?" A kid will always try to protect their parent and not be an extra burden. I think the practitioner can ask those questions and tread on that ground in a different way. 

And kids believe things that other trusted adults say to them. This could be an incredible allyship, where the parent and the practitioner can work together to try and really get to the bottom of what is happening for Max. 

Especially if there are patterns of conflict. I think quite often in families you get your little hamster wheel going of, "Why haven't you had a shower? You need to shower. If you smell bad people won't want to play with you." That becomes a pattern. 

When an outside voice comes in with a different perspective, that conflict pattern is gone, and you can dig a little bit deeper. There is a lot of great opportunity in there. 

No judgement, I think. Who doesn't want to speak when you know you are being heard without judgement? I think that's what they would probably be looking for. A safe place to be heard, to be validated, to be helped, and to not be judged. To know what comes next. 

DAN MOSS: Thanks. David, thinking specifically about working with Max, how would you gain a clearer understanding of some of Max's experiences? 

DAVID NEWMAN: What I will say will be incomplete, because conversations are dynamic. We hear something, we respond, someone responds, et cetera. This is just like a possibility of some of the things we might be doing. 

Given what I just said, I think we want to take our cues from Max. How is he sitting, what is he saying, what is the tone of his voice, what is he looking at, what is he pulling at? We would respond to those things. We take our cues from Max. 

I would say, I really try and bring a kind of sense of collaboration to this work. There is so much that could be said about how we support collaborative practice. 

One thing is, we would be wanting to ask questions, rather than make statements. We would be very interested in what matters to Max, what his position is on things, rather than what matters to us, and our position on things. 

Another way we can do collaboration is... And this is a little bit of a complicated point, but we can decline to be the expert. We can understand that Max has expertise in his own life. And part of what we might be orienting the work around is Max's expertise in his life. 

What he knows keeps him safe. He would have something to say about that. What he knows about why he might have given up, or why he is tempted to not exist. He would have something to say about that. 

Rather than ask being the experts, we would want to understand Max as the expert. 

The other thing that can be tricky especially with handling this is that it sets up the isolation. Generally, if people are really tussling with wanting to die or suicidal experience, isolation just makes the whole thing worse. So how can we interrupt isolation in this practice, in this work? Well, there is many things we can do. Semmy may well be in the waiting room. What might ask Max what it would be like if Semmy joins us. Semmy might be able to speak on behalf of Max, and get Max to comment on the extent to which Semmy has got it right or not, in terms of his experience. 

Another thing I've done a lot in work, especially when I've worked with young folks any psychiatric unit, is either collected a lot of know-how. So when I hear people say, "The way I stay alive is that I know I want to be a good older brother to my younger sibling," I write down the stories, collect them, with the person's permission. And I have the stories to share in one-on-one context, context as well. 

That's one way to interrupt isolation. Because often we are inviting young people and children to do - it's difficult to do this - is individual disclosure, which is very difficult. It's quite a pressure. If we can interrupt that by introducing other people's stories, if Max is interested, he can join the conversation that is already started, rather than having to start the conversation. 

So I might have plenty of documents, and one of them is about suicidal thoughts. It's a way of interrupting isolation. 

DAN MOSS: 
Might that help Max to talk a bit more confidently about his experience? 

DAVID NEWMAN: I think confidence is quite a high bar. That is able to feel joined with others as he talks is the intention, really. He might feel a bit more like this is a collective experience rather than an individual experience. That would be the intention of sharing some of these documents and know-how that I've collected. 

DAN MOSS: Yeah, great. And how would you respond, David, for example, if Max is finding it a bit tough to engage with you or not saying much about how he feels or his experiences? He might, for example, feel like he's there because his mum wants to him to be there. How do you go about working with children and young people under those circumstances? 

DAVID NEWMAN: Yeah, look, these are just possibilities. These are some principles I use. Some of these are drawn from narrative therapy. 

Some people will be familiar with them. One that I can be very useful is to assist Max to find a safe place to stand. Sometimes the narrative therapy is like a river bank where you are standing in a safe place and the trauma of the river is something you are looking in, you are not drowning in. So a safe place to stand here might be that we ask Max a bit about his dog actually. 

What was the name of the dog? If the dog would bark some appreciation of you, what might it say? What might the dog say? If you could see yourself through the dog's eyes, what might the dog be barking? This might be a tender topic. We would always negotiate it and it might not be easy for Max to speak about it, but that would be one option. 

One other way to get a safe place to stand is maybe talk about soccer. He was disappointed he didn't get into the soccer team. "Tell us a story about soccer. Who is your favourite player? What leagues do you support?" We could get onto some of Max's interests. 

Things that are important to Max that stand outside the territory of the turmoil. That's one way we can get onto a safe place to stand. 

Another is... These are big points, but to potentially speak directly with Max. Narrative therapy has developed quite a lot of methodologies around speaking metaphorically with children. So some of you may have heard of the tree of life or the team of life. So to speak about your identity through the metaphor of a tree or a team. The team may well be a great thing for Max to speak about. We could ask him, "Do you think football or soccer is the correct term?" 

The other thing, I might say, to get onto things to assist with Max thinking is to use his language. So the word 'suicide' has a certain history. It arrived from a certain place. But it has become... All of this realm, where people are contemplating dying has been reduced to that word. And I think that really does a disservice to the incredible complexity that can happen when people are really tempting with or contemplating dying. 

When I work with young folks, and sometimes with older people, they will say 'die thoughts', lay out thoughts, they will say, 'just wanted to die.' So we asked Max, what is the best word for it? Is it just 'sadness'? Futility? Is it, what's the point? So we use his words and we externalise it. We understand where he is in relation to the sadness, sorrow, or way-out thoughts. And we ask about that relationship. 

Another way is that we seek permission. We might say something like, "Max, if we talk a little bit about this idea of you not existing, but would that be like for you?" So we tread very carefully. We ask permission, especially when we go into really tangled territory. 

Maybe if we get some time I can speak more about this, but we understand that there is double stories, and we can understand that there is double tone. There is the story of the despair but there is always ways Max is responding. There are always ways Max is showing up in his life, and we want to be interested in both stories. 

The double tone thing is really important too. That is, if we have an unrelentingly intensive conversation, that is in the interests of despair. So if we bring some potential playfulness, that can help to interrupt the intensity in these conversations and can be helpful. 

I do a round of dad jokes when I do group therapy with young folks. Generally they have nothing to say, but anyway, it's a chance for me to share some bad jokes. Anyway. 

DAN MOSS: That was great. Lots of information there. Lyn, when talking to children like Max, who might tell practitioners about their thoughts or their intentions that they might want to end their life, this is not without effects on practitioners, is it? It can have lots of effects on us as practitioners. 

Can you share with us some of your own insights about how practitioners might manage those emotions all reactions when they are hearing children talk about suicidal ideation? 

DR LYN O'GRADY: It's a big topic for people and it's not something that people are doing every day, so I guess it can come as a shock. In the case study, where you perhaps have already heard, or it's being heard via the mum, so it is not directly from Max, so you have some time to process it and the mum is aware, and you have a container around it. But if it comes as a surprise when you are working with a child and they share that with you, can come as quite a shock. So you've kind of got to be ready all the time for what people will share with us, and this is one of those things. 

So there is a tendency then for people who are not ready for that or prepared for it to maybe overreact and ask a lot of questions and jump to it quickly, and not do the listening and gathering information and sitting with it that we are talking about as being very important, or overreact because they are scared to ask the questions, that you don't want to ask direct questions because you are worried about what that might mean. So you are hesitating. 

So we can have those extremes and either of them are unhealthy. So I guess managing yourself means that you can be ready to respond in the most useful way. 

It might be a range of feelings. Often there is a sadness that comes, bearing witness to stress in children. Again, what I said before about how we might see childhood and how we might think about what children's lives should be like - that can be part of that. 

Sometimes we can feel quite angry that children are put in these situations of injustice or unfairness. So we have those feelings as well that can come up in this space. 

I think we've got the in-session kind of recognition, reflection of what's happening and what we need to do in this space, then your out of session reflection. Preparation before, ideally, in terms of the work we do, and training like this, but then the support we have for ourselves outside of the session. 

Sometimes people contact me and do some peer consultation or have some conversations around the different contexts. So having people that you can talk to in regular ways or as part of a group is really important, so that you can do this kind of reflecting space. 

Thinking about, what is my role here? It's really important. So you don't feel you are carrying all of this, which I think is often one of the things in the children particularly. There's a lot of other people part of their lives, somehow to be sort of share - be responsible for our part but share that load and encourage children to talk about this with people who need to know, and it's important for them to know. So you don't feel that you are the only person that is carrying this load as well. 

Beforehand, in the session, giving yourself that. So a lot of preparation beforehand, and then recognising that this is impactful, difficult work, and so a chance to explore our own worries and feelings about it as well is important. So I think a gamut of different approaches is what we need to have. 

DAN MOSS: And is some of this preparation is important for practitioners, to have us noticing when we might be stepping into that problem solver or quick fix mode? 

DR LYN O'GRADY: Yeah, I think that can happen, that we want to fix it. And we think, here is the problem, we just need to fix it. If someone tells you that if we are told that in a school setting, we just need to jump to that and that is not helpful. So not including the child in the planning and coming up with ideas for that. So it's the ability to do the listening, create the space, encourage the child to come up with their own ideas as much as possible. Or who else can help? 

Because if a problem is solved with other people in their lives or their own ideas, well, that's going to be more meaningful to them - are more likely to be successful. And also in the future they can see themselves as being able to solve some of their own problems and not needing to come and see somebody all the time to solve problems that happen. 

So I think there's a place for problem-solving, sometimes a really important thing to be doing, but not too early and not with us being the problem solvers. I think it's more of a collaborative, supported space for the child. 

So being able to sit on our hands a bit and not trying to jump in and fix everything straight away, because we want people to feel better. We want children to feel that things are going to be better. But they will also feel good if we are listening and helping to understand what's happening first. That would be most helpful. 

DAN MOSS: Lyn, we're getting quite a few questions around safety planning and what it is that safety plan conversations can offer, what are the important components of those plans, and how we can ensure that Max's voice and what he wants is central to those plans. 

DR LYN O'GRADY: I think people are probably familiar with safety planning in general in suicide prevention work, but they may not think about them in relation to children. We use the same concept and the language, as David said, that the child is using. 

I think it's helpful to think about, safety is really important here. So we are hearing the distress and problems on the child's life that is leading them towards having thoughts about dying, and we need to work with safety in keeping them safe at the same time. So we are needing to sort of balance both those things. 

So the safety planning would involve conversations about understanding it. The information you gather from hearing the child's story can go into the safety plan. Things like, when do you feel like you want to die? Do those thoughts come at home? At night time? Do they happen at school, randomly? When something happens - when someone says something? So you gather that information to put into the safety plan and it becomes the first part in terms of triggers or warnings we need to maybe keep ourselves safe at that point. 

Then what things do you do when those thoughts come? How do you manage that? What have you done to keep yourself come? It becomes the self soothing strategies that are the next part of the safety plan. Can you change the environment, go to a different place, go to a different part of the school, go and have a shower, go outside and play? 

Can you do some things? That is changing the environment. And then there could be people that help you feel better, people you can talk to, that are fun and good people that you can enjoy. That could be part of it as well. 

And if none of those things are working, who can you talk to and let them know? That's really important, that you let them know. That comes back to the adults in the child's life who are going to listen. 

Part of the safety planning is letting those people know that they are part of the safety plan. That opens a conversation around, who are the people that are good to talk to, that you would like to know? And then, as part of this, fill them in on the safety plan, or let them know what is happening. 

That might be where Kids Helpline fits in. There might be times when those people are not available, not hearing. Let's put the number down as well. That's a really important part of that. 

How can we keep the environment safe? You've got to have a sense of, if they have a plan, if they are thinking about hurting themselves, if they have tried to, how do we make the environment as safe as possible? That's about methods. 

And the reasons for living is the other part of that. What is important in your life? Why is it important? Why are we talking about this now? Because we want to help you to be safe, and to make things better. What is that about? 

That can be people, or future goals, or pets, and other reasons. Things that they do enjoy, and they want to do more of. That's a safety plan, that you gather all of that information, and you use it to go into the safety plan. It's important to keep us safe, so that we can work on the other problems and make things better, and then have conversations with the relevant people that we need to. 

There might need to be separate, different kinds of plans for school and home. That's another discussion point with the school, if some of this is happening at school. What might be needed to be done at school? There can be a plan with the school, to make school as safe as possible as well. 

I think it's a really important part of the conversation, and I think it comes out naturally and collaboratively through the conversation with Max at the time, gathering this information. Let's put it into a plan. And in a positive way, what have you done so far that has kept yourself safe? How do you do that? 

Trying to put that positive, affirming frame around it as well, I think is really important. 

DAN MOSS: Thanks, Lyn. Wonderful information, thank you so much. 

Arianne, you spoke a bit before about the importance of supporting Semmy. We have some questions around some details around that. Particularly navigating parental blame and shame and fear, and some of the support mechanisms that Semmy might need throughout the process, as Max navigates some of his feelings that he is having. 

ARIANNE COAD: I think affirming a parent is always a good place to start. The fact that she is talking about what Max is going through, affirming she is paying attention, that she is doing a good job, that she is a safe enough person that Max has told her how he is feeling. 

Not all children have parents like that, and I think we would be - it would be a very different conversation if the parent hadn't initiated this. Obviously this case study has really come from a parent bringing their information about their child. 

Sometimes parents don't. But in this situation, I think the fact that she is doing that, affirming her is the best place to start. Affirming the bond that she has with her son, that he is able to tell her how he feels. 

That means that she is doing a good job. There is a connection there. She is maintaining that connection. Even though her son is struggling in so many areas, he is talking to her about it. 

I think, also, giving her tools to know how to practically help. This situation, where a child is struggling with despair and suicidal ideation, is something that happens inside the private life of a family. Not necessarily inside of a therapeutic environment. 

You talk about it in that environment, but it's really happening in our home environment. And so your parent, your caregiver, is the person who is best situated on the ground 24/7 to be able to provide support, but they don't always know what that support is. 

They don't always know how to do it. We have heard some amazing skills today, and I think, some of those things, I'm scribbling notes as we go, because there are so many practical tools. 

I think giving her tools would be incredibly helpful. Things... How to help him regulate his emotions. Web tools or apps that might be possible to help, mood trackers. I know one of the things that really helped us is, our therapist give us letters to the school to explain what my child might need for a period of time, to make them feel safer and more able to talk about how they are feeling. 

What to do when they needed a space to retreat to. Even something practical like a letter. I often think of a practitioner as a bit of an anchor. You are going through the storm in your private life. You are struggling to keep your child alive, you are struggling to keep your family together, you are struggling to keep yourself sane, and to not sink under the load. 

A therapist can be a really good anchor for you. Somebody who will just be stable, somebody who can think straight and see straight and offer some perspective. 

And I think encouraging Semmy to seek her own support, to make sure Max has his support, and that she has her support. That might be therapy for herself, peer support online or in person. 

I think encouraging her to call on her village. Who in their lives are safe adults who can invest into Max's life? Is there an uncle or a brother or a cousin who would love to play with him, or could help build his self-esteem? 

Encouraging her to look after herself, and to keep her own oxygen mask on. I think mums are encouraged to put their children first, and often do feel that they are being selfish if they take care of themselves. 

Self-care is not a facemask and a manicure. Self-care is like doing the things that enable your soul to stay refreshed, help you to maintain your own peace. I think encouraging Semmy to keep herself well, as well. 

And encouraging them to invite joy back into their lives. To find those moments. One of the things our therapist really did so well was give us this idea of making every therapy session a little reward. 

We would go to therapy, then we would go and have boba together. Or do something that made it not hard work, but a special time together. 

If those little lifelines of hope that you need when despair feels so overwhelming, to know that you can carve out a little minute in your day to do something simple that brings you joy, get into nature, play a card game together. So that all of your interactions don't revolve around this big idea of feeling depressed, and being in despair. 

And I think another thing that is really good is to name the things that are good about the way Semmy interacts with her child. Say the things that are great about Max. Sometimes hearing those things from outside, it's so powerful. Because somebody else is saying, "I see that you're a good parent. I see how smart you are, Max. I see how brave you are being through all of these changes." 

Those words have a lot of power. And then, I think that Lyn had a great point there, letting the parent know what that safety plan is, and what their role in it is, and when and how to escalate if things are getting worse. To know what to be looking for, and what to do when you see those things, so that you are not in crisis, in the moment, trying to find those answers. 

I think all of those are things that will help. 

DAN MOSS: Thank you so much, Arianne. That comes to the end of our formal questions, unfortunately. We are going to do some Q&A at the end of the webinar recording, which will be available on the AIFS and Emerging Minds website at a later date. We will try to get through some of the many more questions that have been asked today and previously. 

Thank you again to our participants and audience members, for asking those. What I am going to ask now is for each of our presenters to provide some final thoughts final suggestions on this topic to end today's session. 

David, I might start with you, if that's OK. 

DAVID NEWMAN: Yep. I think my microphone is on now. 

I will go straight in, is what you are saying. The first thing is pretty odd, but I'm going to share it anyway. I'm going to suggest that if you are troubled, you are unsettled, or you are unsure about how to deal with this whole thing, about wanting to die and children - you are on the right path. 

And the inverse might be true too, to some extent. If we really are clear on this, I don't think we have engaged enough with the complexity of it. I don't think we have engaged enough with the incredible ethical quagmire that is this realm. 

That's maybe a strange thing to say, but you're on the right path if you are unsettled, I think. If we are not unsettled, maybe things are going wrong. 

The other one is, I would say accountability and co-research is key to this. I think if we can regularly seek feedback about what we're doing, how we are doing it, the effect of what we are doing, from children especially, because their voices get most marginalised, or very much marginalised. 

I have developed a document when I worked at the psychiatric unit, it was just featured around the question "How would you like carers and mental health workers to respond to you when you are really grappling with wanting to live, and wanting to die?" 

I created a document called 'How you can help us'. It's a really great collection of ideas these young people have very generously offered. I think we can just consult. 

We can really put children at the centre of the know-how, the epistemologies can really revolve around children's knowledges. 

The third thing I would say is, therapy and counselling and sometimes our field can really individualise this. That can be lifesaving. Let's not trivialise what can happen in counselling and family work. 

But I would really hope for, how can we make this a collective responsibility, not an individual responsibility? Especially the individual responsibility of young people and children who are grappling with wanting to die. 

There is, I think, a lot we can do to make life much more livable. We have issues of climate catastrophe, we have issues of incredibly problematic child-abuse, we have issues of racism, transphobia, et cetera. How can we make this a collective responsibility? 

DAN MOSS: Thank you so much, David, and for all of your insights today. Arianne, how about for you, a final takeaway message? 

ARIANNE COAD: I would just say that I think it's really, working in this area, it is a collaboration between the families, the parents, the child, and the practitioners. 

None of us have to do this on our own. It is overwhelming for any one person to carry the responsibility of an outcome in a child's mental health. But if we all work together, that load is shared. 

If we all work together, we have the same goal. We want a child who can go through this, and learn the skills that they need, and have a fulfilling life. It's something we can do together. The pressure is not on any one person to get it right, we can work together, and pool our experiences, and knowledge, and get there in the end. We want healthy kids, that's what we want. 

DAN MOSS: Thank you, Arianne. Really appreciate your lived experience today, it's been wonderful. 

Lyn, a final takeaway message from you. 

DR LYN O'GRADY: All of the above. I think I agree with everything that has been said. But I think one of the things in practitioners working in this space, it can feel a bit overwhelming, perhaps.

Thinking that you really need to do things differently. I think thinking about what we do well, what our strengths are, what works best with children when we are working with them. And their parents, because we can't really think about working with children without thinking about families. 

Thinking about what we do well, and holding onto those things, and keep doing that, because you have those skills already if you are doing this work, and you continue to develop them. 

Then I will just add on some of the things I talked about today, in terms of things for you to be aware about, about doing some of your own processing, about being prepared for it. But don't feel like you have to view things completely differently or learn a lot of new skills. 

The importance of listening, the importance of collaborating, the importance of being with the child, being playful when you need to be and can be. All of the skills you have for working with children and families will hold you well, and then you just gather a little bit more information about the specialist things that will help you be well equipped to do this work. And you have a level of confidence to do it as well, so that you are not missing things, so that you can go to spaces at the conversations you need to have. 

DAN MOSS: Thank you. Would you please thank our presenters today, Dr Lyn O'Grady, Arianne Coad, and David Newman. I think you will agree that the level of insight and practice that we have been able to hear about today has been fantastic. Thank you very much. 

Thank you to our audience. Wonderful questions, and if David's comment around considering the ethical complexity within this work is a guideline, then the questions really do show that an audience like this is really engaged in some of those questions, and ethical complexities. Which is really great to see. 

Please subscribe to Emerging Minds or the AIFS website to get the recording of this webinar, which will come out in the coming weeks. And other resources we talked about today are both on the AIFS and Emerging Minds website. 

Please take time to complete the survey as your feedback for today, as further webinars are important to us. Thanks so much for being with us today and for your continued contribution and commitment to working with children and their families. 

Take care and we look forward to joining you next time. Thank you.

DAN MOSS:Hi, everybody, and welcome back to what is the extended Q&A section of our webinar. Please welcome back our panellist, Doctor Lyn O'Grady, Arianne Code and David Newman. We've got some more questions for you folks, which we've been, provided by our, our learners who have been through this webinar, for the last hour with us. And we're going to start with you, David. A question around the importance for the practitioner to facilitate the child's own understandings of what's going on, and how as practitioners, we can ensure that our own assumptions about the problem don't overshadow Max's own experiences or perspectives.

DAVID NEWMAN:Yeah. Thanks for the question, Dan. Look I'm not sure how many people are familiar with the work of David Webb, when he completed his PhD, he said it was the first PhD written by someone who was actively suicidal. The name of the book that came from his PhD research was ‘Contemplating the urge to die’. Now, one of the key critiques he made of the realm of suicidology is that it almost entirely misses the experience of those who have been suicidal. And he calls for what he named as a first person approach to suicidology, narrative therapy terms that could be insider knowledge or insider accounts. So there's that, that realm, that, those who are contemplating dying can be left out of knowledge. They can on the other hand be on the other side of knowledge plus. So that's one realm of marginalization. The other realm of marginalization, of course, is the power relations of age. So when we're talking with children, their knowledge, their understandings just get, they get marginalized, they get discounted as not enough, as immature, etc. So we really do want to think about this double marginalization that can happen with children when they are experiencing or grappling with wanting to die. So that's, what I'd say would be we might call that in the ethical realm. In terms of the practice of it, if we include, children's understandings we're much less likely for them to experience isolation. And I think isolation is just one of the key ingredients for despair to just grow and to have more tentacles in people's lives and families lives, communities lives. So we interrupt isolation if we're facilitating children's understandings. The other thing. Look, we are much. If we don't facilitate children's understanding, we're missing out on children's skills and knowledges. And I would say that's a key thing we ought to be doing here. We ought to be, shining a light on what children know, what children have been responding to, what they've been grappling with. I was speaking the other day with a family, and a brother said that he did speak to his sister about how he's contemplating dying.

Now, this is a very it was a small act. It only happened for 30 seconds or something. But this is a very significant act. And these things could be storied, you know? This is children's know. About how they might support each other through some of the darkest of times, rather than, for instance, how practitioners or adults support children? Yeah. So that's one thing we really, I think, want to be doing. And why we might want to be facilitating child's understandings. Now, the second question you had is how practitioners can become aware of their own assumptions and not overshadow, say, for instance, Max's perspective. Look, I think I'd just say two things here. There's probably a lot to say, but one would be, just, developing the practice, developing the skill of asking a question rather than making a statement. If you feel like you want to make a statement, try and turn it into a question. That's a simple practice, kill development.

The other is, I think if practitioners and people who aren't practitioners are aware of the models and the psychological theories that they hold, okay, because then then they know when they're implementing these models and psychological theories and specifying people's lives. So, because we all have ideas, we've all if we're in this field, we've been trained. But also broadly, we have ideas about what is psychological health. But when we impose them, we're I think we're really robbing people of, agency and an opportunity for them to know their own expertise. So, I think just really being aware of, the theories and models that we hold and just trying to keep it at the edge of the conversation. So when we're tempted to say, really, I think affect regulation is required here. We might just think, well, that's a psychological theory. Maybe I don't need to impose that onto this child's life. And in fact, if we were talking 30 years ago, we would be talking about affect discharge like so these things are cultural. They are contextual. They're contingent about, what is apparently psychological health.

DAN MOSS: Great. Thank you. David, one more question I have for you is that there's been some further questions around this idea that you talked about, about double listening, about the importance of listening to both the stories of the hardship that children and their families are navigating, but also listening to the ways in which children in particular are dealing with or, you know, the skills and know how they're using to, you know, attempt to overcome some of those hardships. We're wondering if you could just talk a little bit more about, your experience of using double listening in practice?

DAVID NEWMAN:Yeah. Look, I think it's, it's a question of kind of practicing it if is an if you have an interest in it. So never just rushing to whatever it is the response is or whatever it is that we might call the solution story or something, but to really get a sense of just what's tough, what the turmoil is, making room for that is really is really so very important, especially in the context of power relations of age, when children often can't speak or find it very hard to speak of hardship. But I think we are always listening for what's outside of it, and sometimes that can be the smallest of things. So when I hear young people, for instance, or children say, look, I just, I just don't want to go on because I'm a burden to everyone, okay? That's the expression of despair, perhaps. But there's also something we might listen for in that. And that is the importance, maybe, that that child has for the effect that they have on other people. You know, they might really care about the effect that they have on other people. And this might be a very this might be quite a loving or caring kind of gesture that would be maybe an opening to another story. Okay. So sometimes these other stories, when we're doing double listening are very slim, but we really want to pick up on it. Sometimes people will say things like, I've kept, I've tried and I've tried and I'm always back at square one. Now, we might want to acknowledge that can be hard, but we also might want to acknowledge the steps and the effort and the trying. And where did they go to if it wasn't at square one? Okay, so that's another opening for a second story with, say the story that's not despair. How come they tried? What was the effort that they made? These are questions we can ask to just prise open the other territory that's out of despair's territory.

DAN MOSS: Wonderful. Thanks so much, David. Lyn. In the case study that we've considered today, where we've been working with Max and Semmi, there's some mention of dad, who's recently separated from Semmi and a worry for Max is that his father doesn't want to spend time with him. How important are you know, even though dad's not present in these conversations at the moment, would it be for you as a practitioner to be kind of bringing that into the room or to be considering that, within this, to kind of in ways that don't make invisible his effect on Max.

DR LYN O’GRADY: Yeah. Look, I think it's a really important point and people in our audience have picked up on it. We don't even know dad's name. So we're talking about Max's dad, and he's obviously important in Max's life. He's someone that Max is spending quite a lot of time with. And Max has got some strong worries perhaps about his relationship with dad. So I think this is not an uncommon scenario for me where I have the mum often bringing the child along. And so I'm always wanting to ask about dad and thinking about whether it's appropriate for dad to come to some sessions. Sometimes it ends up being mum and dad and this is a complexity working with children and under Medicare it doesn't capture this very well. So some of this, you know, we would do better in some organisations in some ways are working then under Medicare, where the child is the client. It doesn't kind of capture all of this. So we have to work out where we're working and how do we work and what are the ways of working with dad. But I think we need to bring dad into the conversation with Max for sure. It's one of those potential risk factors and a potential protective factor. If we could be working out, how can we improve that relationship or what are some, some ways that that that could happen and how might that happen? So we need to have that conversation and get more information. I think if we're talking about safety planning, we need to include dad's awareness in that as well, particularly if Max is having these thoughts at dad's place. We also need to think about risk, and we need to be realistic around that in terms of what Max is telling us and why he's got such strong views about dad hating him, and whether there are actual any actual risks that are there that we might need to be thinking about mandatory reporting, for example. So we've got to do our usual groundwork, I think, in all of this that we would typically do. And if we can include dad physically in the conversation, including some contact with him, whether he comes to a session or whether we follow up with phone calls, with permission of Max. And do send me about that. I think that would be really important. And getting dad's perspective. So we're missing a piece of the puzzle as well. Dad may well have some input into all of this, and often that is the case that each person in the family has their own perspective. And that can be really helpful to hear that. But to bring that in include dad in the conversation, I think is really important. And make sure that he's aware of, what, what work we're doing and that he can be part of that is really important and be taking out the risks at the same time, I think is a really good pick up from people that it is something we need to think about.

DAN MOSS: Thanks, Lyn. Some questions around this notion of strength-based practice. with children who are experiencing distress and despair. can you talk a little bit about your practice, in invoking this idea of strength-based practice in your work?

DR LYN O’GRADY: Yeah. Look, I think David and Arianne both talked about this as well. And I think it is important. And again, we don't throw this out because we're talking about something as difficult as suicide risk. I think coming back to strength base where we can is really important. So, what are the strengths and abilities that, that the child has? And, even though they're feeling so, so down and in such despair, it doesn't mean that there aren't strengths. So trying to eliminate those and noticing those and encouraging others to do that as well, and to get the balance, I think is important. So we do that through careful listening, through noticing, observing, being curious, noticing some things, helping the child to identify their own strengths as well is really important. So and I think David's example around you. That you care about people or you're worried about people, and that tells us something about, that others are important and you've got these this care factor and you really care about others and you care about your relationship.

So I think we can identify through the gathering information that we can identify some of these things and capture them. And of course, with children, there may be activities that we do that do that are very actively identifying strengths. And there are strength cards from Saint Luke's and, ways of actually balancing our hard conversations with some of these strength filled conversations as well. So validating listening, taking opportunities to notice, the positives as well as hearing the challenges. So doing that, balancing of both of those things I think.

DAN MOSS: Yeah. Thank you. Lyn. Arianne, you talked a little bit today about working within your own family with a really helpful practitioner, who really supported your children and family when things were, were quite tough. I’m wondering whether you could, speak to some of the specific, skills or values that the practitioner demonstrated, which was so helpful for you and your family.

ARIANNE COAD: Yeah, I think probably the first thing was, of course, that our practitioner believed us. You know, we presented with, I'm thinking, one child in particular who, came out to us and expressed that she did not feel comfortable the gender she'd been born and that she felt like a girl trapped in a boy's body. and the the therapist that we went to straight away just believed her. I think it's, uh, was incredibly refreshing to not have to fight to be listened to. You know, we had to fight with our GP to kind of get her to give us the referral to the psychologist. so just listening and believing what you're saying is actually incredibly powerful. I think everybody wants to be seen, and to be seen and to be validated is such a powerful thing. Simple thing, powerful thing. I think also our therapist really encouraged me to be curious. I think that's where I learnt it was be curious about what my child thinks. Be curious about how they feel. Be curious about what they want. Be curious about why they want it. To not just accept a piece of information as fact, but be curious about it. Which was a great basis for some very powerful conversations because of course, you only have an hour when you're with a therapist. But my child and I have many hours in the week. Five minutes here, five minutes there. We have a conversation about Rapunzel, and then we have an opportunity to be curious about, well, why does Rapunzel's long hair like, why do you love that so much? And so, I think she really encouraged us to be curious, which is very, very powerful for building my knowledge and my understanding of what was happening inside my child's head. I think other things like, our therapist always asked first what we thought we might like to do, uh, and how something might go. So, for example, with my trans daughter, they would ask, what? Okay, so you want to get your ears pierced. How do you think you might handle it if a kid at school teases you about that, what do you think you would do? And then we would workshop it together to find what my child felt comfortable with. And then she gave us a letter that would explain it. If a teacher gave my child trouble. So she had that letter in her back pocket if she needed it. So it was it was a very collaborative process. And I think, you know, bringing in my child's own wisdom and her what her comfort level was for dealing with things, that was really good. We would role play those difficult conversations, things like a mood tracker. I found that incredibly helpful that my child would track her mood. And so, it was developed an awareness in my child of when she was feeling lower and lower because there would be more, you know, light blue and dark blue days, but it also gave me a very easy way to have a look, because my child's at school for half the day, more than half the day. But I can have a look at the tracker and go, actually, we've had a lot of blue days. I need to be paying attention here. So that was really helpful. And, you know, pointing out things like apps that would be useful. one of the things, you know, interestingly, Lyn was talking about the dad, one of the things that was difficult for us at the beginning is my husband and I were not on the same page even about my child being at therapy, which was difficult. And so we spent a lot of sessions talking about his reticence, talking about, uh, what he might be feeling and what he might be thinking. And one of the things that was really powerful is the therapist really helped always to reframe that in a way that was not that, that my child could believe the best about her dad, which protected the relationship, which I thought was really, really, intuitive and really positive and actually long term has been relationship saving for them that, you know, she would reframe it as maybe your dad feels anxious about having this conversation because he really wants to protect you and do what's best for you. And he's nervous about X, y, z, you know, and so there would always be that perspective to protect the connection. Our therapist would always, positively reinforce the connection between me and my child. So next time you're feeling that way, do you think you could tell mum? You know, because, you know, mum will listen to you. Always reinforcing in small ways, in big ways that connection, which made me want to up my game big time because I was, I was being told I could do this in very subtle ways. So I think those things are really, really helpful. And I think, yeah, being seen and for me, just knowing I didn't have to do it on my own was incredibly freeing because I wasn't the whole weight of this wasn't on my shoulders. You know, it felt like it for a long time because I had to help my husband get on board. And all of that can be very difficult. But I wasn't alone. There was somebody else who could see what we were going through. Someone else who appreciated it was difficult, and someone who would help us find our way through those things were really, really helpful.

DAN MOSS: Thanks, Arianne. That's such a great answer, yeah. Really appreciate you contributing that lived experience to our conversation. Thanks also to our panellists, Dr Lyn O'Grady and David Newman. Thank you to all of those fantastic questions that have come through registration. But also, as we've gone along today and, we look forward to, joining you, during our next webinar that's held between Emerging Minds and AIFS. Thank you very much. Bye.