Teen Suicide Risk Assessment Interview – Educational video (enactment)
This film is one of several outcomes arising from a long-term collaborative at the University of South Australia between academics, mental health consumers, carers, clinicians, and policymakers called Shared Learning in Clinical Practice. Our work involves the coming together through a ‘communities of practice’ initiative. Communities of practice are groups of people who share a common concern, a set of problems or a passion about a topic, and who deepen their knowledge and expertise in this area by interacting on an ongoing basis. Communities of practice often involve people that don’t necessarily work together every day but they meet because they find value in their interactions. As they spend time together, they typically share information, insight and advice. In our community we discuss situations faced in mental health, consider common issues, explore ideas and act as sounding boards. In our community we make films, create tools, newsletters and other documents. Today’s film involves an interview between a psychiatrist, Dr Conrad Newman, and a young woman called Jessica. The interview takes place within hours of Jessica’s attempt to end her life. The interview features a component of social media as something that is increasingly used by young people, both as a precursor to end their life, and as part of the suicide awareness and communication process. The filming of the interview is designed to assist students, practitioners and others involved in mental health care, understanding how to approach similar situations – situations that they may encounter in professional practice. Watch and listen carefully as recent events in Jessica’s life are revealed. Such activity is central to the practice of narrative based, person-centred mental health care. Jessica.
– Hi. Hi, I’m Conrad. Oh sorry we’ll have to shake this one, you’ve got a drip in that one. – I’m one of the psychiatrists here. I
understand you came in overnight.
– Yeah. Okay. I know you’ve spoken to lots of people tonight. I think you’ve met a lot of doctors and nurses. Have you had any sleep at all? – I may have drifted off once or twice, but
no not much.
– Okay. Did you have any breakfast at all? Can I
get you anything to drink? – I’m fine, I’m fine.
– Okay. So as I said my name’s Conrad Newman. I’m one of the psychiatrists that works down here in the emergency
department and I guess you know what I need to do is find out a bit more about
what’s happened. Obviously things are pretty awful.
– Yeah. So what’s happened for things to get to
that point? From what I understand the people that saw you overnight told me that you took a fairly large amount of Panadol and that you also tried to hang yourself at some point. Yeah, um, I guess I took like a whole packet of Panadol and, um, Yeah there was some…yeah. It’s a belt… – Yeah, so that’s what happened.
– I figure things have got really, really bad for you to get to that point. I don’t think anybody gets to that point unless they’re feeling that that’s the only option for them. – Yeah.
– What’s happened for things to get that bad? – Um, it’s silly things…it’s just people, just people.
– Who? What sort of people?
– Everyone. – Just people that you think you know… It just seems like everyone’s out to get me.
– In what way? – What do they want to do to you?
– I think it would be better for everyone if I just wasn’t here. – Better for everybody if you weren’t alive, is that what you mean?
– Yep. – How have you been feeling that way for?
– It’s been the worst that it’s ever been lately… …a few months ago… people started sending messages and taking, taking my pictures online and I’d just find them places.
– So what kind of messages have people been sending you? Just… stuff that I thought that they wouldn’t
know, messages that I’d sent in confidence. Stuff about calling me fag
and ugly, slutty whore, just stupid things I guess. – So awful messages. Who from? Who sent these to you?
– I don’t know.
– Okay. Is it people you know, or…?
– It seems… I don’t… The only people who could know some of these things with people that I’ve talked to, friends, or not friends but people that I’ve been talking to online.
– I was going to ask you, is this people that you know socially, or is this messages, say, on the computer? Computer, sometimes text, tumblr.. I don’t play xbox anymore ’cause I just, I can’t, the messages I get are pretty pretty bad at the moment.
– I don’t know a lot about Xbox, so in what way with Xbox can people send you messages?
– Voice message or just random texts, I mean usually it’s just stupid things like send me your picture or have you got nice tits or whatever. But I’ve just been
getting, really, why don’t you go die slut… – So very very hurtful messages, very, very aggressive messages I guess I’d say.
– Yeah. – And you mentioned pictures, that they’ve done things with your pictures.
– Yeah, just pictures that I put on on Facebook I’ve been finding on other sites, people have been sending me links to other sites and usually with with just messages words scribbled on on top… – And how have they got your pictures?
– I don’t know, I don’t know.
– I guess it’s fairly easy with Facebook if you’ve got photos that people can access…
– Probably. I mean it only takes someone that I’ve friended to send it out… And the things they’ve done to your pictures obviously upset you a great deal as well.
– I guess so. Does anybody know what’s been happening? Have you spoken to anybody about it? Oh, No. And it’s been happening for a few months is that right, did I get that right? And how you’ve been feeling just recently and particularly yesterday, is this the worst you’ve ever felt? Yeah. – I’m sorry that there’s no tissues in here.
– That’s fine.
– When one of the nurses comes by I’ll ask if she can get a box of tissues, okay? Can I ask you a little bit about your life, where are you living at the moment? Just at home with my parents, I can’t really afford to move out. I’m studying, I’m studying at the moment and
so, so until I sort of finished I’ll probably living with my parents and younger brother.
– How do you get on with your parents? – Um, not really.
– Are they worried about you? – I guess so, I mean, it’s hard to talk to them sometimes.
– I understand they’re in the waiting room at the moment. We’ll talk about that a little bit later on. And your brother who you live with, how do you get on with him? He’s fine. My older brother’s just moved out recently and so I guess they’re, they
were always maybe a bit closer. We don’t really talk that much, he’s off doing
his own thing and I’m doing my thing and And all families are different, but in
your family can you talk about things or do you talk about things when there are
– Not really. My brother and I we just talk about books or games or movies Okay. Prior to this past few months have you ever felt this way in the past?
– No. And have you ever tried to end your life
in the past? Or have you tried to cut yourself in the past? Not really, just stupid, just little… just dumb cliché teenage girl things I guess.
– Okay. In what way, what happened?
– Just, you know, just scratches and just nothing serious really.
– How often in the past would you scratch yourself? Um, Just whenever I felt down.
– Okay. Would that be every day?
– Sometimes. And when it was everyday how long would that last for? How many days do you think it would go for?
– I don’t know, it’s hard to say.
– What would you scratch yourself with?
– My nails are short because I chew them, so pins or a Stanley, like a blade cutter.
– Like a Stanley knife. Is that like one of those ones where the knife pops out.
– No, not like a box cutter like just, just for cutting, one of those cutting paper tools.
– Oh okay, the kind of thin, paper…that’s still very sharp. Did you ever need to have stitches?
– And did anybody know that you were cutting?
– No. And when you used to cut, what would it do
for you, would you feel worse or better or did it do anything for you in
terms of how you felt?
– It just gave me something to do I guess… um, I don’t know, I just I just did it.
– You know some people I meet, they tell me about when they, when they, well they tell me a number of things, but one of the things they tell me is when they cut they actually get some relief when they might be feeling really distressed when they cut.
– Yeah. It was just a little sort of pick-me-up, like just to focus sort of. I mean I read somewhere that you know, so if you feel different sorts of pain it helps refocus your mind.
– Yeah, I’ve had other people tell me that as well. Is that what it did for you, did it refocus your mind?
Yeah sort of, it’s like when you pinch something, like when you’ve you’ve
hurt someone and someone pinches you and all you can think that’s the pinch as
opposed to other stuff. If we could just go back to to more recent times what was happening yesterday? Can you take me through what happened on the day? I just got a message on my, on my Facebook and it was from someone I knew and I just think I couldn’t, I just I couldn’t
deal with uni that day so I took the day off and I um, was pretty close just un-enrolling that day and I sent a friend a text saying that I wouldn’t be in, I wasn’t gonna go anymore I said, you know she’s my friend and I love her and that’s, I sent her that text and then I um, was just sort of lying around for a bit just listening to music I guess and um, just took some Panadol and after a while I didn’t know, I didn’t feel it was working so I, yeah, that’s what happened. Is the friend who you sent the message to a close friend? Closest friends would you say?
– Was that like a goodbye message, did you know that you were going to die and that was a way of saying goodbye to her?
– I just wanted to tell her that, that’s all.
– You said you wouldn’t be going back to uni.
– What were you studying? You may have told me but I don’t quite remember. I’m, I’m doing a Bachelor of Arts and I’m majoring in creative writing and I’m doing some other stuff on the side like linguistics and just beginners French, I just wanted to pick up a language.
– What year are you in? – Just first year. I took a gap year just kicking around for a bit.
– Had you been enjoying uni at any point?
– Yeah, yeah no I I love my course. The lecturers, they’re they’re so insightful and they’re so passionate about what they do and yeah, I want to do… I like writing so that’s why the Creative Writing courses I’ve always
liked, sort of stories and sort of maybe plays as well, maybe poems like, I mean
sort of Wilde, like Oscar Wilde, he did it all, he did poetry and he did plays and he did essays and children’s stories and so, yeah writing, that’s what I wanted
to do. – Have you stopped enjoying writing? Have you stopped writing?
– I haven’t written anything for a while.
– You still obviously enjoy it a great deal.
– Yeah. And in the text message to your friend I think you said you were thinking that maybe you wouldn’t continue with uni. Was that because you were going to die, or because it just felt hopeless that you just didn’t feel you could enjoy it or couldn’t do it?
– I just, yeah, I didn’t think I could do it anymore and it’s feeling pretty…I’m just producing shitty stuff and it’s you know not up to the standards of what you were hoping to be and it’s, why bother when you have these amazing lecturers to just waste their time, you don’t want to waste their time with shitty writings. You don’t want to waste your own time with shitty writing.
– So you weren’t feeling good about it.
– You mentioned you took some Panadol, where did you get the Panadol from?
– Just the pantry.
– The pantry at home? – Yeah.
– Was anybody else at home?
– No, my my parents work during the day and Luke, my brother, he’s at school so I just sort of have the house to myself.
– Do you remember how many Panadol you took? Were there any left in the packets? – I don’t, I don’t know, I don’t think so.
– Did you take anything else besides the Panadol? – No, we don’t have a lot stuff in our pantry.
– When you took them what did you hope would happen? I just hoped I would just go to sleep for a bit, I couldn’t really sleep. I was just hoping to just rest, stop just not have to deal with anything, just… Did you want to die, was that the feeling at the time? Uh…I guess so. Did you write a note to anybody? No I I sort of, to myself maybe, I just tried to pick up a pen and I just, I don’t think I have it in me anymore.
– What would you have written to yourself? I don’t know, I think that’s why my writing’s just been so bad, there’s nothing, it’s nothing new, it’s just the same stuff, same boring cliched stuff and I just can’t make anything new or worthwhile or interesting Did you send any messages on Facebook or any other messages apart from the one you sent to your friend?
– Just her. I haven’t, I haven’t really been sending much stuff out lately.
– Can I ask a favour, if you go past another cubicle and there’s some tissues could you drop some into us? That’d be great. You also said you took them to get some some rest and you mentioned about your sleep, how has sleep been for you recently?
– Um, not great, I haven’t been sleeping much at all. I’ve usually been getting into bed about 3:00 4:00 in the morning. – And how many hours would you be asleep for?
– I’d probably get up at 7:00.
– Oh, so not many hours at all. Do you feel rested in the morning?
– No, I feel like shit. – How’ your energy being lately?
– I haven’t had any. I just go to uni and then get home by like three, four.
– Thank you. There you go, some tissues.
– Thanks. Um, yeah, I get home at like three or four and then I’ll just do nothing I guess. Sometimes I’ll go for a walk but usually I just end up lying in bed watching, watching TV or something, just on the internet surfing. You mentioned a little while ago too you’d taken the Panadol but then you said something about a belt, which is I think what I heard from my colleagues this morning as well. I heard that actually you tried to hang yourself, is that right?
– Yeah. – What happened? Do you remember after you’ve taken the Panadol? No, I don’t, I don’t really remember much after that. I just, yeah, put it around my neck and, and then I don’t remember much at all. I guess once again just to check, when when you put it around your neck, what were you hoping would happen? It would sort of, I don’t know, give me some sort of way to move, give me some sort of direction or just something to do I’m not sure I completely understand that in terms of, when you say direction… I don’t know I just, just to give me something finite hold on to Did it feel like, at that point in time, that you want to do life to be over? Yeah. Yeah I guess that’s what it was all about. What people sometimes tell me is that they
feel like it’s, it’s a solution, that they can’t stand feeling that way, they can’t stand being in so much pain, emotional pain anymore. Do you feel like that at all? I mean some of that day was really nice, I was just by myself. It’s just all these people, even when they’re not there, they’re still there and you know that they’re there and you know that they’re talking about you or worrying about you. I just, I just didn’t want to be a part of it anymore. I understand that after you tried to hang yourself your mum got home shortly after that, is that right?
– Yeah, I think, I think my friend rang her or something.
– Was this the friend that you sent the text message to? Okay. So she must have been worried about you. Yeah, well I guess she, I mean she was meant to be at work so I guess she must have come home during her lunch break or something like that. – So your mum came home and then what happened from there?
– I don’t, I don’t remember. – I remember bits.
– What bits do you remember?
– Just sort of, lying on the floor and just hearing the roller door, that’s about it.
– Do you remember being in the ambulance or anything like that? – Nah.
– I imagine you’ve met probably about a hundred people since you came in. I understand they did a cat-scan, is that right, of your neck, do you remember going for that?
– Not really. It’s just all been, I just, I mean not the same, I mean it’s just all been a blur, I guess. And I hope they explained to you what’s going in through the trip in your arm is sort of the antidote to the Panadol, just so you don’t get any liver damage. Yeah they said something like that. How are you feeling about still being here, about still being alive? Just another thing that I didn’t do well I guess.
– So are you feeling bad that it didn’t work, is that what you mean?
– I just, I really don’t want to have to see people after this and them knowing what I did and then just always worrying and I don’t want to be wrapped up in bubble wrap because everyone’s scared. I guess I just don’t want people don’t know that I’ve fucked up again. Do you have any hopes that things can get
better? It’s just really scary It just… Someone could like just snap their fingers and make everything better, I don’t know, of course I’d probably take it but everything is tangled up. It’s too many people involved. It seems like there’s no real easy way out. This might sound like an unusual question to ask at this point time but how do you feel about yourself? – What do you mean?
– Do you like yourself? Do you not like yourself? Some people I meet who are going through a similar kind of point in their life sometimes tell me that they hate themselves. – Yeah, it’s probably that.
– That you hate yourself? It… seems silly to sort of, all these messages, I mean I can’t defend myself ’cause they’re basically right, I mean, hating, hating me or whatever they do I’m just not someone of worth. Are there any reasons for living? Any reasons to keep going with life? Well, there’s people that I love, like Luke and Adrian, mum, dad, my friend. – Are Luke and Adrian your brothers?
– And your mum and dad? Yeah, I mean I love them and everything, I just… everything’s so tangled up. Everything is easier when it’s just disconnected from everything I guess. It’s just more people to worry about, more people to disappoint or have worry about you. Do you feel like you’re a burden on anybody, like your family? Adrian is up now moving out and he’s working and he graduated. He studied languages so he’s you know working with kids and he’s got heaps of things in the pipeline so he’s, you know, he he um, he was depressed a few years back but he got over it.
– Did he have to have any treatment back then?
– Um, he, he went to talk to someone, but I mean after that he was normal again. I just, I don’t know, it was probably just stress to do with his study. Has anybody else in the family tried to end their life? Or anybody had a problem with depression or any other kind of psychological problem?
– Um, no. We have, like an aunt who’se bipolar and has big swings but nothing…
– That’s your mum’s sister or your dad’s sister?
– Has she had treatment for her bipolar, do you know? – I don’t know really that much about it. I just know that she has it.
– I might check that with your family anyway. Just in the past few days, you mentioned that you haven’t been sleeping at all well and you’ve been feeling generally pretty lousy. Have you felt agitated? Have you felt very anxious and almost a kind of a can’t sit still feeling? Sort of like in my head, does that make sense? Like all I want to do is just sit and lie somewhere but I just feel like, I think it happens when you’re tired, it when you just feel like weirdly far away, far away and small and yeah, you’re sort of in your own body at the same time. That’s just kind of what it’s been like. Yeah I can’t really, I haven’t been doing much, just lying, and I can’t, I haven’t been focussing much on any one thing, like I’ll click an article to read it and get halfway through and just give up.
– The concentration hasn’t been that good? When would you say you last felt happy or that you’re enjoying life, how long ago is it? I don’t, I don’t know. Um, there’s things that I like doing, you know when I get a group of friends together and we, we dress up or we’ll go to, when someone has a video game night at their house it’s nice, I just don’t have to think about anything. It’s just when it finishes it’s back to the same.
– Back to feeling awful and back to feeling, pretty alone I guess? is the feeling I get. Is that fair to say, that you you have been feeling pretty isolated?
– Yeah. But yeah there’s all these people at the same time but I don’t, it’s not like I see their face or anything. I mean, it’s just sort of that feeling of being alone and claustrophobic at the same time. It’s just all these people that surround you and you don’t know who they are or where they are If I were to ask you and once again this is a fairly difficult question to answer but if I were to ask you where you thought your own risk for suicide at the moment is – zero is no risk for suicide, 10 is you, you know definitely want to die and that suicide is the solution to how you feeling, where would you put yourself between zero and
ten? Six maybe. And the desire to live, where zero is just no desire to live at all and ten is definitely wanting to be alive, where would you put yourself on that scale? – One.
– So not very much at all. – I just, I just don’t want to see anyone.
– Has anybody been in to see you this morning? – I notice your phone’s there, have you had any calls or messages?
– It’s been turned off. It’s been turned off, okay. Did you turn it off or did it go flat? It must have gone flat. Last time I touched it wouldn’t turn on so I just assumed I hadn’t charged it or anything. It’s got a pretty short battery. Okay. What would you like to happen at the moment? Where would you like to go to from here? I just want to go to sleep, maybe. I just, I don’t want to see anyone at the moment. Just away. Is there anything you could think of that would help? I don’t know. Probably stop doing so much online shit. But I mean, it sounds so stupid, but it feels weird like being disconnected like it feels weird to disable my Facebook and it just it feels like I’m, like I can’t like I’m being silly because I can’t deal with it.
– It has a pretty huge impact on a lot of people now, that’s certainly what we’re seeing. I mean I do everything through it, I do everything online.
– It’s life for most people, for a lot of people.
– I mean it’s how I contact people and I have, we have groups for different uni classes and like you know, game nights or game groups, we have groups and so you organise it online, that’s just how it’s done. – Is there anything else I should know at the moment that I haven’t asked you? – I don’t think so.
– I’ve asked you more than 20 questions, more like 120 questions, – Yeah.
– What questions would you have for me? – So did my parents contact you or?
– They’ve left messages, yeah. And I work as part of a team here in the emergency department. You might have met one of the nurses, psychiatric nurses that I work with this morning. You’ve probably met so many people it’s hard to tell who’s who, but they told me in a meeting shortly before I came here that your mum and dad are very keen to talk with me, they’re in the waiting room at the moment. How would you feel about me talking with them? – Just you going out and talking with them?
– Fine. – I just don’t want to see them.
– Why is that? – I just, I don’t want to see their reaction.
– How do you think they will react? Not well. Are you worried they’ll be upset… or angry, or…? I just find it really hard to talk to them and they’ll be really concerned, and blame themselves, I just, I can’t talk to them. Okay. What other questions would you have? What happens now?
– This is what we need to figure out, I guess I can say at the moment, and this is the first time I’ve met you, but I’m very very worried about what you’ve been through and I’m very sorry to hear just how hard life has become for you, and that’s what I’d like to look at is how we can help you in any way that we can, just to get
through what’s obviously the most difficult period in your life to date, I would think.
– So do I go home, or? – Have people told uni I…
– I don’t know, that’s all the stuff we need to sort out, and rather than trying to sort it out right now, I’d like to come back and see you a little bit later on. After I’ve spoken to your parents too, and I know you’re very worried about how they might be reacting to this, but they’ve known you all your life so it’s very important for me to talk to them as well. But obviously we want to do what’s best for you, and for you to understand what’s happening and why we might make decisions that we’re making. Okay? So I’ll head off and see them and be back probably in the next couple of hours or so. This is called Parvolex, the stuff that’s going through the drip into your arm. That needs to run until the early hours of this evening. So you certainly need to stay at the moment, just to get
that antidote. Once again hopefully they told you that they’ll do some more blood tests after that finishes, just to check what’s happening. – Can I get you any water at all or juice or a tea or a coffee?
– No, I’m fine.
– Or a sandwich? – No, I’m okay.
– Hospital sandwiches aren’t the best. Thank you very much for talking with me, I imagine you’re incredibly tired having been awake all night, and that’s I think one of the things as
well, is we need to make sure we get a little bit of rest during the day, okay? Okay. Thanks very much. I’ll shake this hand cause your other one’s in the drip. Okay, see you soon.