Many factors can push a young person to depression and other mental health issues, but a meaningful connection can help them develop healthy coping skills. — 123rf.com
When it comes to suicide prevention for children and adolescents, trust is paramount. A vulnerable child or a teenager requires someone they trust to connect with, so he or she feels heard and listened to.
Trust is the key to open the door to get a person to confide.
But the nature of modern life – including the dependence on social media for validation – has somehow made young people appear connected on the outside, but unheard deep inside.
Miri Hospital psychiatrist Dr Ravivarma Rao Panirselvam describes this as the hurt/heard dilemma that often exists in adverse environments.
“Sometimes, when young people convey their difficulties, they are met with invalidating statements. When someone is hurt or in pain, what they need is to be heard,” he says.
Last month, the Malaysian Paediatric Association (MPA) ran a suicide prevention workshop for some 40 first responders – including paediatricians, nurses and school counsellors – underlining the current landscape of young people’s mental health; that more and more of them are fighting battles in their heads that even those close to them don’t know about.
One of the main barriers to identify vulnerable groups is connection, and this needs to be addressed.
“When they come to see you, there’s a need to build rapport and establish trust,” Dr Ravivarma told the participants.
But he also understands that creating rapport immediately is a tall and sometimes unachievable order.
“People who are vulnerable could be left in such positions due to promises unfulfilled and trusts that were broken in the first place.
“So creating a safe and dignified space in any conversation is a good start. This means speaking to the young person in a non-judgemental, validating and respectful way.”
That doesn’t mean, however, that adults should agree to everything, especially if something is unsafe.
“Genuine concern helps most of all,” he says.
The National Health and Morbidity Survey (NHMS) 2022 found that one in eight Malaysian teenagers has thoughts about suicide, and one in 10 has attempted it. Both suicidal thoughts and attempts are more prevalent in girls (18.5% and 13.4% respectively) than boys (7.6% and 5.7%).
The same survey recorded that one in four adolescents is depressed, with more than one-third of girls (36.1%) dealing with depression compared to 17.7% of boys.
And when it comes to having meaningful connections, less than half of the respondents (46%) say they have helpful friends. More tellingly, only 24.2% say their parents understand their problems and worries.
Dr Ravivarma says some young people become suicidal when there is overwhelming pain and hopelessness and limited resources which lead to them not wanting to live anymore.
“Social connectedness is helpful in alleviating this situation, providing support in a situation where a person could feel truly alone,” he adds.
Dr Ravivarma says social connectedness is helpful in providing support in a situation where a person could feel truly alone. — Dr RAVIVARMA RAO PANIRSELVAM
Adults need to decode
One of the signs of the lack of connection between teenagers and adults is language. Most of the participants at the workshop were in their 30s and 40s. Some have teenage children of their own and they too spoke of communication gap being an issue.
Clinical psychologist Pheh Kai Shuen, who was another trainer at the workshop, says young people could express self-harm acts in their language, which adults may not understand.
“We need to be aware and understand the languages they speak and what some phrases they use could mean,” he says.
Pheh, who is also head of programme at Universiti Tunku Abdul Rahman’s (UTAR) department of psychology and counselling says understanding the language of young people promotes better communication.
“It’s important to take the time to learn the slang, abbreviations and digital communication methods that they use. This might involve researching, asking for explanations or even using resources like online dictionaries specific to youth language.
“Finally, we must acknowledge and respect the individual and generational identities of young people. Understanding that they may have unique perspectives and experiences helps adults appreciate the nuances of their language,” he says.
Pheh also advises adults to practise “generational humility”, focusing on what matters most to the younger person and maintaining a people-centric approach in their interactions.
“A good place to start is by examining our own biases, assumptions and preconceived notions about the language and communication of young people, because our own experiences and generational differences may influence our understanding.
“Adults should also practise active listening. Give the young full attention and refrain from immediately imposing our own interpretation or judgement on what they are saying,” he says.
The aim of these is to achieve effective communication. “This enables adults to provide the support and guidance that young people need, whether it’s related to personal issues, academics or decision-making. It also helps to prevent or resolve conflicts and misunderstandings, reducing tension and fostering a more harmonious relationship,” he says.
Pheh says understanding the language of young people promotes better communication. — PHEH KAI SHUEN
Telling the truth
In May, the government decriminalised suicide in the hopes that those who need help can do so without fear of legal repercussions.
This development, both trainers say, should be disclosed to patients. Sometimes we believe if something is criminalised or illegal, people will not do it. The fact is not true for suicide attempts. Criminalisation of suicide attempts only deter people from seeking help.
“Even when they tell you that they didn’t do it because it was criminal, you should tell them it no longer is. Nothing good comes out of not disclosing information and I think that’s the cornerstone of trust,” Dr Ravivarma says.
Those who self-harm, he adds, have a significantly increased lifetime risk of suicide, so the act needs to be taken seriously.
While many people are afraid to ask if someone is suicidal, Pheh says asking a young person about suicidal behaviour does not give that person an idea to do so.
“Asking the question is okay, provided that the ecosystem in which that conversation takes place is healthy and accepting,” he says.
For parents who suspect their teenagers are having a hard time mentally, Dr Ravivarma says it does not help to ignore (in the hope that it will go away eventually), panic or blame oneself completely for the problem.
“It will be good to check on them and ask if they are doing okay. Asking them what you could do to help them might work too. Sometimes, when there are no answers, knowing and reaching out to professional services help.”
Suicide is the leading cause of death among those in the 15 to 29 years old age bracket. — TheStar Graphics
Parenting styles and mental health
Parenting styles are often classified based on two key dimensions – demandingness and responsiveness – which map how parents balance setting expectations and boundaries with emotional support and responsiveness to their children’s needs.
The recommended parenting style is authoritative parenting, where parents have clear demands, with expectations and rules for their children. In return, the parents’ responsiveness is also very high. They provide emotional support, open communication and understanding.
“Authoritative parenting typically results in positive mental health outcomes. Children with these parents are clear about the expectations adults have towards them, understand the boundaries that they have, and receive warmth and nurturing emotional support from their parents,” Pheh says.
But despite having authority, Dr Ravivarma cautions parents (and adults in general) against thinking that “they know best”.
“Most young people have a lot of agency for their decisions and have to be supported in making those decisions. There is a lot we can do to listen to their concerns and what works for them before handing out advice. Advice sometimes takes away control which may not be constructive,” he says.
When young people feel that the person they’re confiding in genuinely cares about their well-being, it fosters a sense of trust and emotional connection. Pheh says a pair of attentive ears, complemented by a compassionate and non-judgemental heart, forms a safety net for the emotional struggles and issues that young people grapple with.
“It can reduce feelings of isolation and loneliness, which in turn decreases the risk of mental health problems. When a trusted adult provides a safe and empathetic space for young people to navigate psychological challenges, their emotional burdens are often relieved, and they are more empowered to find healthier ways to cope,” he says.
Dr Ravivarma agrees. “We can also look out for people who are not coping well and reach out to them. Offer a listening ear even when we don’t have solutions. We can also link them to services or people who can help them.”
In the end, Pheh says, establishing strong and positive connections with young people open the channels for adults to provide guidance and help them navigate the challenges and complexities of the modern world, including social, technological, and cultural issues.
“When adults can connect with young people on their terms, it helps build stronger, more positive relationships, which is one of the most important protective factors of young people in adversity,” he concludes.
Those suffering from problems can reach out to the Mental Health Psychosocial Support Service at 03-2935 9935 or 014-322 3392; Talian Kasih at 15999 or 019-261 5999 on WhatsApp; Jakim’s (Department of Islamic Development Malaysia) family, social and community care centre at 011-1959 8214 on WhatsApp; and Befrienders Kuala Lumpur at 03-7627 2929 or go to www.befrienders.org.my/centre-in-malaysia for a full list of numbers and operating hours, or email sam@befrienders.org.my.
