Last reviewed 4 December 2020

One in eight young people are said to self-harm, often in secret. Michael Evans considers the extent of the problem and how it is possible to break the cycle.

Why do people self-harm?

According to the mental health charity Mind, self-harm is a way of dealing with very difficult feelings, painful memories or overwhelming situations and experiences. These can include:

  • expressing something that is hard to put into words

  • turning invisible thoughts or feelings into something visible

  • changing emotional pain into physical pain

  • reducing overwhelming emotional feelings or thoughts

  • having a sense of being in control

  • escaping traumatic memories

  • having something in life that they can rely on

  • punishing themselves for their feelings and experiences

  • stopping feeling numb, disconnected or disassociated

  • creating a reason to physically care for themselves

  • expressing suicidal feelings without taking their own life.

There is always a reason why someone begins to hurt themselves, but they need to realise that there are risks involved and that once there is a dependence on self-harm, it can take a long time to stop.

How do people self-harm?

There are many ways to self-harm and here are just a few of those that are listed by Mind:

  • cutting yourself

  • poisoning yourself

  • biting yourself

  • over-eating or under-eating

  • picking or scratching at you skin

  • burning your skin

  • misusing alcohol, prescription or recreational drugs

  • pulling out your hair

  • having unsafe sex.

People of all ages and backgrounds self-harm. There is no typical person and no common reason why people set out to harm themselves.

“The journey is unique, as is the road to recovery.”

Help from Samaritans

Samaritans was founded in 1953 to provide telephone support for people who were contemplating suicide. Over the years the focus has developed to include providing emotional support and now, of the 6 million or so calls it receives each year, only one in five is from someone with suicidal feelings.

What perhaps is less well known about Samaritans is the support that it gives for non-suicidal self-harm. In October 2020 Samaritans released a report, Pushed from pillar to post, that focused on the need to improve the availability and support for those who self-harm. The report highlighted the fact that during the past 20 years the rates of non-suicidal self-harm have increased across all ages, but especially among young people.

Self-harm and suicide

Self-harm is an indication of distress and although most people who self-harm do not go on to take their own lives, there is always a risk that they might. For young people self-harm can lead to suicidal thoughts and it is one of the strongest predictors.

Research indicates that one in eight young people have self-harmed and figures indicate that self-harm is most acute among young women, where rates tripled between 2000 and 2014. Between 2012 and 2019 the suicide rate for young women also increased significantly and now stands at a record level of 3.1 deaths per 100,000.

Samaritans reports that in 2019, more than 272,000 contacts were received that related to self-harm. That was one every two minutes. Callers who discussed self-harm were 2½ times more likely to express suicidal thoughts and behaviours than other callers.

A new analysis of the Adult Psychiatric Morbidity Survey shows that 37% of people who had self-harmed in the past year had also attempted suicide.

Help and support

Support for self-harm is patchy and although it is a declared key priority within the government’s suicide prevention strategy, Samaritans report that only 38% of people who have self-harmed have received medical or psychological help.

For those seeking help, this is often very hard to find. Psychosocial assessments are a key tool to understand the underlying reasons for a person’s self-harm. NICE guidelines state that a comprehensive assessment should be carried whenever someone who has been self-harming comes into contact with the NHS in any clinical setting. GPs are ideally placed to carry out these assessments, but assessments take time and hard-pressed GPs are restricted by the length of appointments. Medication can help, but it does not deal with the underlying problem. It is easy to understand how people can fall through the net.

Self-harm and young people – the schools’ role

The report from Samaritans reveals that 53% of respondents to its survey began self-harming while between the ages of 11 and 15, so schools, especially secondary schools, should be particularly vigilant since they have a key role in identifying those who have self-harmed. Once identified, early preventative support needs to be swiftly provided before needs escalate.

Support from Childline

Distressed school-age children are probably more likely to seek advice from organisations such as Childline rather than Samaritans. In the year 2018 to 2019, Childline provided more than 250,000 counselling sessions to children and young people. There were over 3.5 million visits to the Childline website and over 41,000 posts submitted and published on the Childline message boards.

The top ten issues of concern to children and young people were:

  1. metal or emotional health, such as lack of self-esteem, anxiety, loss and bereavement (30%)

  2. family relationships; conflict, arguments, divorce and separation (11%)

  3. suicidal thoughts, feelings or being actively suicidal (10%)

  4. bullying, either face-to-face or online (7%)

  5. intentional self-harm (6%)

  6. friendship issues (5%)

  7. sex, relationships, puberty or sexual health (5%)

  8. problems in school; academic, workload or general dislike of school (4%)

  9. sexual abuse, including online abuse (4%)

  10. physical abuse (3%).

Every one of these issues could be the cause of the extreme unhappiness that leads to self-harm.

How to break the cycle

Self-harm is complex and there are many factors that can contribute to the risk of self-harm. It is possible to break the cycle, but this usually takes time and requires a good deal of support.

The Samaritan report indicates four key support needs for those who are self-harming. These are essential to provide effective care.

  • Distraction from immediate self-harm urges.

  • Emotional relief in times of stress.

  • Developing alternative coping strategies.

  • Addressing the underlying reasons for self-harm.

Distraction is an important way in which people can help themselves, although different forms of distraction work for different people. Effective distraction will depend on the factors that are causing the self-harm in the first place. Here are some examples.

Anger and frustration can be distracted by exercise, and sadness and fear can be distracted by listening to soothing music. Writing lists is a good form of distraction when there is a need to take control and taking a very cold shower can be a useful distraction for someone feeling numb and disconnected. When someone has an overpowering feeling of shame, it is good to realise that making mistakes is part of being human.

But the only way to stop self-harming is for the person concerned to really want to stop. It is important to understand the patterns of self-harm and to learn to recognise the triggers. These might be particular thoughts or situations, or physical urges, such as a racing heart or strong emotions of sadness or anger. Recognising these urges will assist in taking steps to reduce or stop self-harm.

“I think the best way to stop self-harm is to focus on the underlying issues which trigger you to do it. If you work on these issues, then the self-harm will stop naturally.”

Particular thanks are due to Childline, Mind and Samaritans.

Summary

  • Why do people self-harm? A way of dealing with difficult feelings, painful memories or overwhelming situations and experiences.

  • How do people self-harm? Virtually any way in which a person can harm their body.

  • Help from the Samaritans. A new report that focuses on the need to improve availability and support for those who self-harm was released by Samaritans in October 2020.

  • Links between self-harm and suicide. Most people who self-harm do not take their own lives, but it is an indication that they might do so.

  • Shortage of help and support. In spite of it being a government priority, of those who self-harm, only 38% are reported to have received medical or psychological help.

  • The schools’ role. 53% of respondents to a Samaritan survey said that they began self-harming between the ages of 11 and 15, so schools have a vital role in early detection and treatment.

  • Support from Childline. Distressed children are likely to contact Childline. In the year 2018 to 2019, Childline provided more than 250,000 counselling sessions.

  • How to break the cycle. Distraction from immediate self-harm urges is an important way that people can help themselves. Emotional relief, developing alternative strategies and addressing underlying reasons are all essentials in the provision of effective care.

Contacts

Samaritans: Tel: 116 123; email: jo@samaritans.org; https://www.samaritans.org/how-we-can-help/contact-samaritans/

Childline: Tel: 0800 1111; https://www.childline.org.uk

Mind: Tel: 0300 123 3393; Text: 86463; email: info@mind.org.uk; https://www.mind.or.uk

Shout Crisis Text Line: Text: “YM” to 85258; https://www.giveusashout.org/