“This is a question we have to ask everyone”: Asking young people about self-harm and suicide

Introduction: Questions about self-harm and suicide are essential in risk assessments with children and young people, yet little is known about how mental health practitioners do this. Aim: The core aim was to examine how questions about self-harm and suicidal ideation are asked in real world practice. Method: A qualitative design was employed to analyse 28 video-recorded naturally occurring mental health assessments in a child and adolescent mental health service. Data were analysed using conversation analysis (CA). Results: In 13 cases young people were asked about self-harm and suicide, but 15 were not. Analysis revealed how practitioners asked these questions. Two main styles were revealed. First was an incremental approach, beginning with inquiries about emotions and behaviours, building to asking about self-harm and suicidal intent. Second was to externalise the question as being required by outside agencies. Discussion: The study concluded that the design of risk questions to young people had implications for how open they were to engaging with the practitioner. Implications for practice: The study has implications for training and practice for psychiatric nurses and other mental health practitioners in feeling more confident in communicating with young people about self-harm and suicidal ideation.