Young people today are struggling with mental health and many are experiencing high rates of psychological distress, reflected in the rates of self-harm and suicidality. Many do not seek help from their GP or mental health services, which highlights school counselling services as a more accessible pathway to support (1,2). School counsellors and school psychologists play a critical role in delivering prevention and intervention strategies and must be equipped with the necessary skills to respond to these types of complex mental health challenges.
A snapshot of youth mental health in Australia
The incidence and prevalence of mental ill health in young people continues to increase (3).
The recent National Study of Mental Health and Wellbeing indicated a 50 per cent increase in the prevalence of mental health disorders in 16 to 24-year-olds, up from 26 per cent in 2007 to 39 per cent in 2021 (3).
Before the age of 18, about half of mental health conditions emerge, with the peak age of onset at 14.5 years (4). This aligns with the finding of high rates of mental ill health and psychological distress in Year 8 students (N = 6388, M = 13.9 years) in the Black Dog Institute’s Future Proofing study (5). This study is Australia's largest and most comprehensive cohort study of mental health, following more than 6,300 students from Year 8 over five years to better understand how and why mental health problems emerge, what the impact is and if they can be prevented using smartphone interventions.
In Year 8 students:
15.1 per cent of the cohort met the clinical threshold for depression
18.6 per cent for anxiety
31.6 per cent for psychological distress
4.9 per cent for suicidal ideation.
These rates were significantly higher in adolescents who identified as female, gender diverse, sexuality diverse or Aboriginal and/or Torres Strait Islander (5).
Suicide continues to be the most common cause of death in children and young people (6). Since 2012, we’ve also seen significant increases in self-harm in children under 14. This is particularly prominent for girls (7). The growth of self-harm rates in females aged 13 to 17 accelerated during COVID, with presentations up by 47.1 per cent from 2019 to 2021 (8).
Suicidality and self-harm: the role of schools
Suicidality and self-harm are responses to extreme distress. The National Suicide Prevention Strategy highlights that suicide can be prevented by ensuring that those who seek support when in suicidal distress experience a rapid, high-quality response that is effective, compassionate and available in a range of settings (9). School counseling services provide a crucial way of reaching children and adolescents who are unlikely to seek help from other services (1,2).
School counsellors and school psychologists, with their mental health expertise, play a lead role in assessing and managing suicidality and self-harm, as well as supporting any broader school response.
However, school counsellors and school psychologists report challenges with the reactivity of the role, as well as pressing and shifting priorities, and the increasing complexity of student needs (10,11). Access to evidence-based and informed suicide prevention training is critical to support wellbeing staff to provide this critical service.
Best practice approaches responding to suicidality and self-harm
When assessing students who may be experiencing suicidality, it is important that this is done as part of a therapeutic conversation (in a safe, culturally appropriate way) that prioritises engagement and collaboration with the student. A thorough assessment of suicidality considers the young person’s current psychosocial context, their presentation, as well as direct questioning around warning signs and protective factors.
Warning signs are indicators that a young person may engage in suicidal behaviour in the near future. Examples of warning signs include changes in behaviour such as a previously engaged young person withdrawing and not completing their classwork or making self-defeating statements like, “I’d be better off dead”.
Protective factors are supports and resources that can be tapped to manage current distress and reduce suicidal thoughts and behaviour. They are a crucial part of the assessment as they help identify what can be leveraged to manage suicidal risk, such as reasons for living and a strong support network, as well as factors that can be built up to reduce future risk.
The assessment process shapes decision-making around the most appropriate immediate response to keep a young person safe and to plan for ongoing support needs. Suicidality and self-harm are best managed with a team approach comprising school support, parents/carers or other trusted adults, as well as external mental health services. As risk is dynamic and can change rapidly, it requires wrap-around support and supervision beyond that provided by schools alone.
Youth in Distress: the Black Dog Institute’s suicide prevention program for school wellbeing staff
The Black Dog Institute works closely with education departments around Australia and across different sectors to understand the unique role of school counsellors and
psychologists in responding to suicidality and self-harm. They have collaborated with key stakeholders in education departments, school counselling services, researchers, clinicians and lived-experience representatives to develop tailored training specifically to support school wellbeing staff.
Their Youth in Distress: Managing Suicidality and Self Harm training prioritises the key components of suicide prevention tailored for a school environment. This training equips school counsellors and psychologists with skills to:
engage with a young person to develop a collaborative relationship.
create a safe space with a clear understanding of confidentiality.
undertake a comprehensive assessment.
determine the appropriate actions to manage immediate risk.
activate a team response to manage current risk.
develop an individualised safety plan including key supports.
determine ongoing support needs.
identify those at risk of and manage contagion.
prioritise self-care with personal and workplace strategies.
Youth in Distress: Managing Suicidality and Self Harm has since 2021 been attended by 1,654 school counsellors and psychologists around Australia, with content updated in 2024. The interactive workshop is delivered by experienced clinical psychologists and is offered in either a face-to-face or online format.
Evaluations from 653 participants of training delivered from July 2021 onwards indicated:
96.1 per cent rate the overall quality of the training as very good or excellent.
94.3 per cent rate the information provided as very or extremely useful.
95.1 per cent would definitely recommend the course.
Directly after the training, participant knowledge of suicidality in young people increased 24.5 per cent and knowledge of self-harm in young people increased 23 per cent. In a smaller sample of participants from a three-month follow-up (N=270), 84.8 per cent reported they had implemented ideas from the training into practice in the previous three months.
“I found the training so valuable for my work with high school students,” says a recent Youth in Distress participant. “At every moment I was able to apply what I was learning to a recent or current case and reflect on how I could improve my practice. Movement between direct instruction, videos of role-played scenarios, whole group discussion and small group discussion made the course engaging throughout. I would highly recommend this course for anyone working with young people in a counselling or wellbeing role.”
School counselling services are critical in supporting student mental health and wellbeing. As they lead the school’s response to suicidality and self-harm, access to evidence-based suicide prevention training helps improve their knowledge and confidence, and ultimately student outcomes. The Black Dog Institute is passionate about supporting those working in schools with a range of free evidence-based tools and resources for student wellbeing staff.
To learn more, visit blackdoginstitute.org.au/school-wellbeing-training.
About the author
Dr Kris Kafer
Clinical Psychologist, Facilitator and Senior Psychology Content Developer
Kris has worked clinically for more than 30 years in the public and private health sectors. Over 15 years with Black Dog Institute, she's facilitated training and developed key resources, most recently focusing on supporting wellbeing roles in schools. Kris is a lead contributor to the institute's Youth in Distress program, a suicide prevention resources for schools that received the Mental Health Service Award in 2022 and the 2018 Winc Knowledge Translation Award.
References
1. Hanley, T., Sefi, A. & Lennie, C. (2011). Practice-based evidence in school-based counselling. Counselling and Psychotherapy Research, 11(4).
2. Hall, S., Fildes, J., Perrens, B., Plummer, J., Carlisle, E., Cockayne, N. & Werner-Seidler, A. (2019). Can we talk? Seven year youth mental health report - 2012–2018. Mission Australia.
3. Australian Bureau of Statistics (2022). National Study of Mental Health and Wellbeing.
4. Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J.B., Jones, P., Kim, J.H., Kim, J.Y., Carvalho, A.F., Seeman, M.V., Correll, C.U. & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: large-scale metal analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295.
5. Werner-Seidler, A., Maston, K., Calear, A.L., Batterham, P., Larsen, M.E., Torok, M., O’Dea, B., Huckvale, K., Beames, J.R., Brown, L., Fujimoto, H., Bartholomew, A., Bal, D., Schweizer, S., Skinner, S.R., Steinbeck, K., Ratcliffe, J., Oei, J., Venkatesh, S., Lingam, R., Perry, Y., Hudson, J.L., Boydell, K.M., Mackinnon, A. & Christensen, H. (2022). The Future Proofing Study: Design, Methods and Baseline Characteristics of a Prospective Cohort Study of the Mental Health of Australian Adolescents. International Journal of Methods in Psychiatric
Research, e1954.
6. Australian Bureau of Statistics (2022). Causes of Death, Australia, ABS Website, accessed 17 October 2023.
7. Australian Institute of Health and Welfare (AIHW) (2020). Mental health services in Australia.
8. Sara, G., Wu, J., Uesi, J., Jong, N., Perkes, I., Knight, K., O'Leary, F., Trudgett, C. & Bowden, M. (2023). Growth in emergency department self-harm or suicidal ideation presentations in young people: Comparing trends before and since the COVID-19 first wave in New South Wales, Australia. The Australian and New Zealand journal of psychiatry, 57(1), 58–68.
9. National Suicide Prevention Project Reference Group (2020). National suicide prevention strategy for Australia’s health system: 2020-2023. Department of Health and Human Services, Victorian Government, Melbourne, Australia.
10. Kelsall, 2023, O’Dea, B., King, C., Subotic-Kerry, M., O’Moore, K. & Christensen, H. (2017). School counselors’ perspectives of a web-based stepped care mental health service for schools: Cross-sectional online survey. Journal of Medical Internet Research.
11. Australian Psychological Society (2016). The framework for effective delivery of school psychological services: A practice guide for psychologists and school leaders. Melbourne, Australia.
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