TW - self harm/suicide - Counsellor didn't tell us

[Ffffffffffucksake]

I have name changed for this. I have a teenager who has always struggled with mental health. She had counselling arranged through school earlier this year for a number of sessions which helped at the time, but I noticed she was starting to decline and get very anxious again after these sessions had finished. The deal is that you only get a set number of sessions and I think it was about 6.

It came to light a couple of months after these sessions that she had been self harming and had become suicidal (written notes to family/close friends). I found out about the self harm as I saw it and that opened up a discussion that she hadn't wanted to have with me for fear of making me upset. I discovered that she had divulged the self harm and severe anxiety to the counsellor. My child is 14.

AIBU to think this should have been reported by the counsellor to either the school or us as parents? There was no handover following these sessions and I can't help but feel that if I hadn't by chance discovered the self harm and suicidal notes that it could have been a very different story.

Does anyone know if youth counsellors are meant to report this sort of thing and what, if anything, would you do about it? Report the counsellor? Speak to them?

Thanks

I'm so sorry OP and I think it's shocking. I don't know what standard procedure is, but what kind of careless moron would allow a child who disclosed suicidal thoughts and self-harm to just leave the sessions with zero follow-up or hand-over to anyone?! I'm angry on your behalf and it's lucky you discovered what you did in time.

Yes they are supposed to break confidentiality if they believe your child is a danger to themselves. They should have made this clear at the beginning start. I’m sorry you’re going through this.

Just to add, my daughter was advised by the counsellor to download an app called 'I am sober' which helps people to stop harmful practices such as drinking and self harm. I feel this should have been shared as well. I saw this app on her iPad lock screen (notification) and my mind went into over drive wondering what it could be for based on the name but I was 99.9% certain she doesn't drink. When we talked she told me it was for the self-harm and recommended by counsellor.

The active self harm should've been shared. The app recommendation is a slightly different issue and there's no reason for that to have been disclosed.

I'm sorry you're going through this. My daughter saw a school psychologist while in primary school. The three of us met at her first session. It was made clear to me at the time that nothing she said to the psychologist would ever be reported back to me, no matter what it was. The only exception was if there was abuse suspected, in which case she would be reporting directly to the police.

The course worked, it helped my daughter enormously. But I did find it tough picking her up each day, not knowing what had gone on.Not knowing, and not being told must be very hard for you, but in your shoes, I would not have been informed either.

Yes they are supposed to break confidentiality if they believe your child is a danger to themselves
Confidentiality can be broken only if there immediate and significant risk of harm. The counsellor would have assessed whether your daughter was at risk of taking action in the very near future.

She really should have discussed it with a supervisor though.

My dc had counselling at a similar age.

no, they will not tell anyone what is discussed in the sessions unless there is immediate danger of harm and then it is more likely to be police if abuse is disclosed or further services if self harm or suicidal.

they are not reporting to you. You are not the client. At 14 your dc has almost certainly been judged competent to make her own medical decisions.

What is considered 'significant risk of harm'? Surely cutting yourself is significant?

I appreciate this and not expecting to be updated about what they talked about, however I do think self-harm and suicidal thoughts are significant and should be reported so the parents can monitor/understand how severe things are.

I mean you can think that but they won’t do it.

your other post, self harm covers a wide range of behaviour some of which is more harmful than others.

the main things counsellors will break confidentiality for are abuse (which is usually reported to the police) - and they are usually very clear with the clients that they will need to do that right at the start of the process when they talk about confidentiality.

i used to work in a secondary school and at one point we had three counsellors working full time in the school doing therapy sessions with teens. Self harm and suicidal thoughts are really quite common amongst teens.

many teens are not keen to do any kind of counselling or therapy because they believe their parents will be told everything that they have said and often they are scared of their parents’ reaction - many parents try to punish self harm (not effective) or are rabbit in headlights.

we had to make clear that the sessions were confidential except for specific things.

generally, self harm is actually a protective factor against suicide because the person has an outlet for their pain and suffering. Most therapy and counselling for it thus focuses on finding ways of relieving the emotional pain that don’t leave scars and are less impactful.

How did you see the written notes to her close friends?

I am a mental health professional and would get in really serious trouble if I failed to tell a parent about active self harm and suicidal thoughts. I also deliver self harm and suicide prevention training and the key to this is that risk trumps confidentiality.

I would be putting in a complaint. Anyone saying these things should not be shared with parents is wrong. It would be a safeguarding failure not to share the information and also share a safety plan.

I don't know much about this sorry. But a woman I work with was going through the same with her teen ds he had anxiety and thoughts of suicide and the mental health team informed her not to leave her ds alone for any length of time and to lock all medications, knifes etc away so he couldn't access them.

It depends tbh, in a school setting I’d expect they need to share concerns about risk which suicidal ideation would fall into, self harm less so depending on the behaviours. In private practice therapists will make their own decisions about how much risk they’re happy to carry, some will share any self harm/suicidal ideation, some won’t unless they believe there’s an immediate threat to life.

In any event the counsellor should provide you with a copy of their confidentiality policy and safeguarding procedures when asked. I’d start there and see what their policies say they should be doing.

They can't. A therapist will not break confidentiality for low risk self harm. Not unless your child is or is in immediate danger. Cutting does not qualify unless she intends to take her life.

I am a counsellor.

Self-injury is very, very common amongst teens. The counsellor will (if competent) have done a risk-assessment that will have determined if your daughter was a risk to her own life, and if the self-injury was significant enough to potentially cause hospitilisation or a 'real' injury.

If not, counsellors would be breaking confidentiality for nearly every teen they saw, and teens would no longer go to them as the trust would be broken. Many self-injuries are superficial meaning they do not actually put the child at risk of death or a serious injury. Exploring the reasons your daughter felt that way, and allowing her the trust to do this, is important.
Disclosing it would not have done that.

Sorry but this is not how I practice, not how the large team I supervise practices, and not how any course from PG Cert to 1 day courses on self harm and suicide would ever advise. Risk needs to be shared collaboratively with parents and carers. Active self harm needs to be shared as although self harm is not always with the intention of ending life, the risk of premature death from self harm is extremely high. There is no world where myself or anyone I manage would not share this with parents or carers. There is no world where we would agree to keep this secret. The fact that anybody does is mind boggling to me. The responsibility placed on that young person to keep themselves safe is too much surely?

Deciding that you can catergorise self harm into 'real' or 'life threatening' is wild to me too. If a young person is harming themselves to manage their emotions then as professionals our duty is to make a robust, holistic safety plan, and to collaboratively share this with the people around that CHILD so they can also keep them safe.

Also - I share risk about my young people allllll the time (4 times this week off the top of my head) and they all come back! Every last one of them. I share the risk so that their parents can keep them safe. I tend to share it with my young people present so they can hear exactly what Im saying.

I think 14 is judged as being able to make their own medical decisions. I’m so sorry OP.

I think 14 is judged as being able to make their own medical decisions. I’m so sorry OP

@DungareesTrombonesDinos, you are protecting yourself by reporting any disclosure of risk with parents, but if the young person made a complaint about you disclosing confidential information against their wishes when they were not at imminent and significant risk, they would legally be in the right and you'd be in the wrong.

Young people have a right to confidentiality too. What any service should do is ask they can talk to their parents about it or strongly encourage them to discuss it with them.

Seriously this is a crazy attitude. You'd rather a young mentally ill person (who clearly can't make sensible choices) commits suicide than breach their confidentiality by telling their parents?!

Surely that depends on the contracting though, if a therapist/counsellor tells the young person that they will disclose active self harm the young person can then choose to talk about it (knowing the person may not keep confidentiality) or decide not to speak about it. Working in a school will also change things because the counselling service will have a service level agreement outlining safeguarding and confidentiality arrangements. Whether an individual counsellor is behaving correctly will depend on those agreements/policies.

Wrong. Risk and safeguarding trumps confidentiality. I hardly ever do it without my young person agreeing to me sharing the information, but if I really couldn't convince them that it would be better for an adult to share then I still would share it.

This is written into guidelines up and down the land.

Wrong. Risk and safeguarding trumps confidentiality. I hardly ever do it without my young person agreeing to me sharing the information, but if I really couldn't convince them that it would be better for an adult to share then I still would share it.

This is written into guidelines up and down the land.

Seriously this is a crazy attitude. You'd rather a young mentally ill person (who clearly can't make sensible choices) commits suicide than breach their confidentiality by telling their parents?!
Why are you making it about my views. I'm telling you the law.

Risk and safeguarding trumps confidentiality
Which is exactly what I've written! But it needs to be both immediate and significant and it's for the counsellor to make that assessment. In any instance of doubt, they should pass it by their safeguarding lead for advice.

The point is that the need or wish of a parent to know doesn't trump a young person right to confidentiality.