Supporting adolescents at risk of suicide in care: an overview of the difficulties and resources of professionals

Source: 📒 Supporting adolescents at risk of suicide in care: an overview of the difficulties and resources of professionals

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Number of pages: 58

1. ANALYTICAL SUMMARY

A known overrepresentation, still fragile practices

The report starts from a documented observation: adolescents monitored by the ASE and the PJJ are particularly exposed to the risk of suicide. The survey, conducted between 2023 and 2025, focuses on four UEHC, two MECS, an ASE service for young people in placement breakdown, a MDA, and a child psychiatric unit, based on 65 interviews, professional writings, and 39 hours of observations. It shows that professionals often identify significant suffering, but within a poorly formalised framework, with incomplete transmissions, health assessments that are not focused on the psychological aspect, and heterogeneous readings of risk.

Direct contributions for action in the home

The document mainly provides a very concrete reading of the moments when support falters: poorly informed admissions, lack of credibility for certain alerts, rejection or excessive tact in the relationship, difficulties in accessing care, refusal of care, hospitalisations under tension, and insufficient inter-institutional coordination. It also highlights real resources: fine clinical observation, small acts of care, peer identification, relational continuity, and partnership work when it exists. Its operational interest lies in this articulation between the description of failures and immediately mobilisable improvement levers.

2. KEY POINTS OF THE DOCUMENT

1. The identification of suicide risk remains poorly formalised and unevenly shared among professionals, even though several members of the same team may identify the same adolescent differently; this lack of consultation weakens collective vigilance (p. 5-14, conclusion p. 30).

2. The survey is based on dense and situated qualitative material.: 65 semi-structured interviews, consultation of files of 9 adolescents identified as suicidal in UEHC and 39 hours of ethnographic observations, which gives the report a strong descriptive value of actual practices rather than an abstract theoretical discourse (p. 4).

3. The identified adolescents often accumulate significant vulnerabilities: family disaffiliation, distance, physical violence, sexual violence, disabilities, mental health issues and behavioural disorders; these dimensions are analysed as essential prerequisites for considering support (p. 15-30).

4. Care practices are central but hindered, caught between rejection, exhaustion, fear of being manipulated and difficulty in maintaining appropriate proximity; however, the report emphasises the importance of “small gestures” in daily protection (chapter 2, p. 32-37).

5. The referral to mental health care is hindered by the saturation of services and still insufficient coordination, which aligns with national observations on the need to better articulate child protection and child and adolescent psychiatry (p. 39-52).

3. ACTIONS FOR LOCAL ACTORS

1. Formalise a collective identification of suicide risk within the team, with short but systematic times for sharing signals, alerts and doubts, in order to prevent information from being held by a single professional or individual intuition (p. 7-14, p. 30).

2. Review the admission procedures and health information collectionto explicitly integrate mental health, suicidal history, hospitalisations, treatments, and traumatic situations; the RIS and DIPC grids appear insufficient on this point in the report (pp. 8-10).

3. Secure the initial health assessments and their psychological aspect, by identifying in advance willing medical and child psychiatry partners, rather than searching on a case-by-case basis for a doctor available at the critical moment (p. 10; art. L.223-1-1 cited p. 10).

4. Work on professional positioning in response to verbalised alerts, to limit responses of scepticism or trivialisation related to the fear of “suicide blackmail”; the report shows that an expressed alert can paradoxically be less raw than a silent act (pp. 11-14).

5. Structure local cooperations with MDA, CMP, emergency services, child psychiatry, and child protection partners, with transmission modalities, referents, and post-crisis continuity, in line with HAS recommendations on early detection, access to care, and avoidance of disruptions (pp. 39-52).

4. ADDITIONAL REFERENCES

1. High Authority of Health. Coordination between child protection and child and adolescent psychiatry (2025).Structuring recommendation for detection, access to care, continuity, and coordination between ASE/PJJ and psychiatry

   https://www.has-sante.fr/jcms/p_3261731/fr/coordination-entre-protection-de-l-enfance-et-psychiatrie-de-l-enfant-et-de-l-adolescent 

2. National Assembly. Report on the shortcomings of public child protection policies, no. 1200 (submitted on 1 April 2025).Useful reference for situating institutional difficulties of continuity, management, and resources within a broader framework than just suicide.

   https://www.assemblee-nationale.fr/dyn/17/rapports/cease/l17b1200_rapport-enquete 

3. Ministry of Justice. Research on the management of suicide risk in PJJ homes (published in 2026).Short resource highlighting the main lessons and work areas of the report for rapid dissemination to teams.

   https://www.justice.gouv.fr/documentation/ressources/recherche-prise-charge-du-risque-suicidaire-foyers-pjj 

5. CROSS-ANALYSIS — VALUES OF HEALTH PRACTICES

• Literacy: The document is not designed as a literacy tool for young people; it primarily aims at analysing professional practices.

• Empowerment: Adolescents mainly appear as whistleblowers or subjects of support; their involvement in designing responses remains poorly formalised.

• Participation: The participation of young people exists indirectly through their alerts and those of their peers, but the co-construction of systems is not structured as such.

• Community health: The collective dimension is present in the attention to the group, the home, and peers, but the approach remains primarily institutional and clinical.

• Ethics: The report identifies the effects of doubt, rejection, trivialisation, and institutional violence, making it a strong resource for the ethical analysis of practices.

• Human rights: Issues of equity, protection, recognition of experienced violence, and continuity of care are clearly present.

• Intersectorality: The report implicitly recommends better coordination between homes, ASE, PJJ, MDA, emergency services, CMP, and child psychiatry.

• Partnership: Forms of collaboration exist but they are described as heterogeneous, tense or insufficiently stabilised.

• Fight against discrimination: The document mentions reading biases, cultural misunderstandings and specific vulnerabilities, but addresses violence and non-access more directly than discrimination as an autonomous category.

6. EVALUATION OF THE RELIABILITY OF THE RESOURCE

Scientific relevance

The resource presents an explicit methodology, a substantial survey corpus, a strong empirical grounding and a bibliography mobilising scientific works, public reports and institutional recommendations. It does not have the scope of a representative epidemiological study, but its qualitative robustness is real for understanding the concrete mechanisms of failure or support in care.

Operational relevance

The field relevance is high as the report finely describes admission situations, team exchanges, alerts, refusals of care, hospitalisations and partnership relations. It is directly usable for training, supervision, revision of reception protocols, building partnerships and analysing practices in care homes.

7. MCQ — 5 QUESTIONS

PART 1 — Presentation of the MCQ

Question 1:What is one of the main materials of the survey?

a) 65 semi-structured interviews

b) A national cohort of 5,000 young people

c) A randomised controlled trial

d) Self-administered questionnaires only

Source: p. 4

Question 2:How many cases of adolescents were retained for the detailed comparison of support?

a) 12

b) 18

c) 22

d) 40

Source: p. 6

Question 3:What difficulty is highlighted in the collection of medical information at admission?

a) An excess of overly detailed psychiatric information

b) Files that are often incomplete and not actively explored

c) The complete absence of written materials

d) A regulatory prohibition on transmission between services

Source: p. 8-10

Question 4:According to the report, what is the most frequent source of alert in documented situations?

a) Hospital emergencies

b) Magistrates

c) Other adolescents in the home

d) The adolescents themselves

Source: p. 11

Question 5:What observation is made regarding specific training for identifying suicidal adolescents?

a) All professionals surveyed have been trained

b) Only 3 professionals out of 33 have been trained

c) Only psychologists have been trained

d) Training is mandatory in all UEHCs

Source: p. 13

PART 2 — Commented correction

Question 1:What is one of the main materials of the survey?

✅ Correct answer:65 semi-structured interviews

📝 Explanation: The methodology is based on 65 interviews, supplemented by the analysis of files and ethnographic observations. This gives the report a strong qualitative depth regarding professional practices. — Source: p. 4

Question 2:How many cases of adolescents were retained for the detailed comparison of support?

✅ Correct answer:22

📝 Explanation: The authors selected 22 recent cases for which the information was most complete, in order to compare the support between ASE and UEHC systems. This selection structures a large part of the analyses in the report. — Source: p. 6

Question 3:What difficulty is highlighted in the collection of medical information at admission?

✅ Correct answer:Files that are often incomplete and not actively explored

📝 Explanation: The report emphasizes the frequent poverty of files, the lack of an active approach to seeking information, and the weak formalisation of the 'red thread' in communications. This sometimes delays the identification of suicidal risk. — Source: p. 8-10

Question 4:According to the report, what is the most frequent source of alert in documented situations?

✅ Correct answer:The adolescents themselves

📝 Explanation: In the majority of documented situations, it is the young people themselves who alert professionals to their distress, suicidal thoughts or actions. However, the report shows that this voice is not always fully believed. — Source: p. 11-12

Question 5:What observation is made regarding specific training for identifying suicidal adolescents?

✅ Correct answer:Only 3 professionals out of 33 have been trained

📝 Explanation: The report highlights a marked deficit in specific training among the non-clinical professionals surveyed. This weakness fuels uncertainty, even if it does not alone explain the difficulties in identification. — Source: p. 13-14

8. FREQUENTLY ASKED QUESTIONS (FAQ)

1. Why is this report important for care homes?

   Because it precisely describes how identification, daily protection, and referral to care are constructed, missed, or delayed for very vulnerable adolescents. Answer in the introduction, summary, and throughout the report, especially pp. 2-5 and 39-52.

2. Which adolescents are analysed in the report?

   The core of the detailed analysis is based on 22 adolescents identified as having suicide attempts, suicidal thoughts, or 'suicidal equivalents', from ASE and UEHC systems. Answer pp. 5-8.

3. What obstacles hinder identification?

   The report points to poor admission information, weak collective formalisation, little specific training, and doubts about the authenticity of certain alerts. Answer pp. 7-14 and conclusion of chapter 1 p. 30.

4. Do young people talk about their suffering themselves?

   Yes, often. In the majority of documented situations, they directly alert professionals, request presence, protection, or hospitalisation. Answer pp. 11-12.

5. What role do other adolescents in the care home play?

   They can be witnesses, messengers, or protectors, particularly in ASE homes, but their alerts are not always well received by professionals. Response p. 12-13.

6. What vulnerabilities are most frequently observed in the situations studied?

   Family disaffiliation, distance, physical and sexual violence, mental health issues, disabilities, and behavioural disorders are very common. Response p. 15-30.

7. What should be prioritised for strengthening in a territory?

   Admissions reporting, collective identification, validation of alerts, mental health partnerships, and continuity between child protection and psychiatry. Response p. 8-14, p. 39-52 and additionally HAS 2025.

9. REWRITING IN EASY TO READ LANGUAGE

Simple summary

Why this document exists

Young people followed by ASE or PJJ have a higher risk of suicide.

The report studies how professionals identify and support them.

What the report shows

Professionals often see the suffering of young people.

But they sometimes lack tools, time, and support.

Information is often incomplete when the young person arrives.

Access to mental health care is often difficult.

This puts teams in difficulty and wears down their work.

Key points in easy to read language

• The report is based on 65 interviews and field observations.

• It studies 22 adolescents identified as being at risk of suicide.

• Medical information is often too sparse at admission.

• Young people often alert professionals themselves.

• Other adolescents can also raise the alarm.

• Teams lack specific training on this subject.

• Many young people have experienced violence, breakups, and isolation.

• Mental health care is difficult to obtain quickly.