Why is it Important to Understand What Self-harm is?

Greater understanding can stimulate greater compassion and reduce judgemental responses. It is also more likely to be experienced as therapeutic and helpful by the recipient of care.

Any person who can listen and provide support to a suicidal person or one who is self-harming is making a helpful contribution.

Those people who self-harm or have a history of self-harm often face considerable stigma. This occurs within their communities and from those professionals they come into contact with. Stigma isolates, and may prevent people from seeking help. It can become a barrier to accessing services and support. It can also stop people from responding to those who self-harm in a compassionate, reflective and non-judgemental way.

Missed opportunity for intervention

Too often those who present in distress still feel shame, stigmatised and judged for their self-harm and suicidal behaviours. This is particularly concerning because this contact should be viewed as an opportunity for intervention. In some people who have died through suicide, this contact with services may have been the missed opportunity for intervention.

First point of contact

Those who are the first point of contact need to have the necessary knowledge, skills and attitudes. They need to ensure that compassionate, reflective and supportive evidence-based care is delivered during first contact. This should continue onwards, through referral or sign-posting. This may have a huge impact, on the person and on future help seeking behaviour. There is NICE guidance on the short and longer term management of self-harm which is currently being updated.

Responses to suicidal behaviour

Reducing stigma, improving awareness and understanding of suicidal behaviour amongst professionals is crucial. Such people frequently come in to contact with people at risk of suicide and self-harm (usually but not exclusively) on account of their professional status or occupation. This improved knowledge, understanding and approach, would encourage help seeking behaviours. It will increase the chances of early intervention. This in turn improves our system wide responses to suicidal behaviour.

Target interventions

Stigma may also negatively affect the accurate reporting and recording of self-harm and suicidal behaviours. This, in turn, may impact on our knowledge of emerging trends in these behaviours. As a result, this impacts on how (well or badly) we target interventions to particular high-risk groups across the whole population.

Trends and Patterns of Self-harm

Trends and patterns of self-harm and suicidal behaviour change across the lifespan. In addition, patterns and high-risk groups have not always been as they are now. They are likely to change again in the future.

The UK has one of the highest rates of self-harm in Europe. This may not even represent the true scale of the problem, since most people who self-harm either do not require medical attention or do not seek it. The true scale of self-harm is estimated to be 1 in every 130 people. Self-harm is more common in females and the risk of repetition is extremely high – up to 40% will go on to repeat including 13% in the first year.

A prior suicide attempt (such as where intent is known) is the single most important predictor of suicide in the general population. Around half of those who take their own lives have a history of self-harm (irrespective of motive). Providing those who self-harm with appropriate follow-up care and support is essential.

The most common age for self-harm is during adolescence and young adulthood, indeed self-harm is rare before puberty. There has been an increase in self-harm in the community particularly in older adolescent females.

In 2014, about one in five female 16–24-year-olds reported non-suicidal self-harm (NSSH) in the community (McManus et al, 2019).

Young women aged 15-19 years have the highest rates of hospital presentation for self-harm. This group has also seen increases in rates of self-harm since 2008.

Self-harm and suicide attempts are also common in young adults with one in nine young people (aged 18-34) reporting a suicide attempt (O’Connor et al, 2018). One in six having engaged in NSSH.

Only a small proportion of self-harm occurs in older people (aged over 65 years), but those who do are at substantially higher risk of further self-harm and suicide.

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