Professor David Gunnell, Professor of Epidemiology at the University of Bristol
Recent figures show that a large proportion of people (in particular, young adults) who self-harm do not seek any form of help. Why do you think this is the case?
“I think people try to normalise their feelings and try to put aside many of the dark thoughts and emotions that they tell themselves will pass. In reality, without some form of help, this pattern of thinking may intensify the longer the silence continues and can potentially result in a fatal outcome. Self-harm is still an issue that is not openly discussed and from the sufferer’s perspective, taking the step of confiding in someone who will not only understand but also have empathy may feel like a large risk. Studies show that more people seek help from friends or family than from their GP or teacher, but often friends or family can feel at a loss as to how to practically support that person. Recovery from self-harm involves both practical solutions and emotional support.”
Are health professionals fully equipped in terms of knowledge and experience to guide people towards recovery from self-harm?
“There is good evidence to suggest that health professionals don’t know enough about self-harm and that many feel ill-equipped to deal effectively with people who come to them for help. There are issues around professional training in this area and for many GPs it can be hard to relate to young people struggling with self-harm; it wasn’t so much of a concern when they were growing up. Teachers have also expressed to me their feelings of uncertainty when it comes to matters relating to self-harm, many feel under skilled and feel it should be covered within the curriculum and their training to improve awareness and understanding.”
How can we make improvements within this area of mental health?
“In order to work towards finding positive solutions to many of the emotional issues that people face, it is vital that the gap between professionals and sufferers is narrowed. This can be achieved through communication, improved awareness and training that is geared towards an empathetic understanding of self-harm as a coping mechanism in addition to practical suggestions for recovery.”
‘Over a quarter of children interviewed in The Mental Health Foundation’s “Truth Hurts” Inquiry stated that having someone who would listen to them, giving advice and support, was key to their recovery.’ [Truth Hurts; Report of the National Inquiry into Self-Harm among Young People, The Mental Health Foundation, 2006.]
‘Approximately 170 000 adolescents receive hospital treatment for self-harm annually in the UK’ [Barr W, Leitner M, Thomas J. Self-harm patients who take early discharge from the accident and emergency department: How do they differ from those who stay? Accid Emerge Nurs 2004; 12: pp. 108– 13]
‘Population samples suggest that just 12% of episodes result in hospital attendance.’[Hawton K, Rodham K, Evans E, Weatherall R. Deliberate self-harm in adolescents: self report survey in schools in England. BMJ 2002; 325: pp. 1207– 11 (p. 1209)]
‘Parents have a pivotal role in ensuring provision of treatment since mental health assessment for children under 16 years old requires their permission, and parental attitude and involvement influences a child’s treatment adherence.’ [Clarke AR, Schnieden V, Hamilton BA, Dudley AM, Beard J, Einfeld SL, Buss R, Tobin M, Knowles M, Stevens G, Gibbs N., ‘Factors associated with treatment compliance in young people following an emergency department presentation for deliberate self-harm’, Arch Suicide Res 2004; 8: pp. 147– 52 (p.148)]
‘Parents commonly suspected and spotted self-harm prior to disclosure or service contact; however, communication difficulties and underestimating significance led to delays in addressing the behaviour. Parents struggled to understand and cope with self-harm.’ [Anna Oldershaw, Clair Richards, Mima Simic and Ulrike Schmidt, ‘Parents’ perspectives on adolescant self-harm: qualitative study’, in The British Journal of Psychiatry (2008) pp. 140-44, (p.40)].
‘Parents require advice and support from outside services to help them manage self-harming behaviour and its personal impact. This study suggests parents are early to spot signs of self-harm, indicating their key role in reaching young people in the community who remain unknown to health services.’ Anna Oldershaw, Clair Richards, Mima Simic and Ulrike Schmidt, ‘Parents’ perspectives on adolescant self-harm: qualitative study’, in The British Journal of Psychiatry (2008) pp. 140-44, (p.40).
‘Young people are among those least likely to consult healthcare professionals during times of emotional crisis. As few as one in six young adults with mental distress seek help from a healthcare professional.’ [L Biddle, D Gunnell, D Sharp and J L Donovan, ‘Factors influencing help seeking in mentally distressed young adults: a cross-sectional survey’, British Journal of General Practice, April 2004, pp.248-253, (p.248)]
‘97% of young people believe that self-harm should be addressed in schools, with two in three feeling that it should be part of lessons. Greater teaching around emotional awareness and literacy appears a strong and obvious platform for raising the topic of self-harm in context.’ (Cello Group, ‘Talking Self-harm’, in association with Young Minds, pp. 1-56, (p.7)]
‘Currently, there is little open communication and considerable scope for stigma and fear.
Parents associate a young person self-harming with failed parenting and shame; many are frightened to let the issue ‘out of the home’ over a third say they would not seek professional help.
Teachers feel helpless and unsure as to what they can say; 80% want clear practical advice and materials that they can share directly with young people.
Three in five GPs report they are concerned that they do not know what language to use when talking to a young person about self-harm.
Nearly four in five young people say they don’t know where to turn to with questions relating to self-harm.’ (Cello Group, Talking Self-harm, in association with Young Minds, pp. 1-56, (p.7)]
Photo by Gerald Pereira