First, Do No Harm: How Mental Health Service Responses Can Inadvertently Increase Suicidality Among Young People

Youth non-suicidal self-injury (NSSI) and suicidality have increased worldwide, yet funding is limited, and the workforce is stretched. This context of scarcity and risk influences service responses: thresholds for accessing services are raised, with increased gatekeeping. This commentary draws on behavioural and attachment theories to describe how reactive resource allocation can be harmful and inadvertently maintain distress. This occurs through unpredictably providing and then withdrawing access to mental health services. The mental health system itself can be seen as a participant in the therapeutic relationship, providing inconsistent and unpredictable responses to suicidal young people. Trauma- and attachment-related difficulties influence youth perceptions, and small interactions with services can maintain suicidality. When this pattern is recognised, it is possible to alter service responses to emulate interpersonal qualities that provide a sense of safety for those who seek help. For example, predictable responses, clear communication, validation throughout case progression, and consistent adherence to boundaries, all increase trust within the agency-client relationship.