Self-harm is a compulsive behaviour exhibited by a wide range of age, gender, socioeconomic and racial demographics. However, it remains most prevalent amongst adolescents, in particular teenaged girls. Let’s look at some numbers around the world:
- In the US, the rate of girls aged 10 to 14 arriving in American emergency rooms with self-inflicted injuries has increased by 19% per year since 2009. The rate of increase for boys is 1%.
- In the UK, the rate of increase is much higher, with a 68% rise in rates of self-harm among girls aged 13 to 16 since 2011. It must, however, be noted that the UK study included GP visiting rooms, whereas the US study only covered emergency room admissions, which may account for the high difference.
- In Australia, the same trends are apparent. The Australian Health Ministry released a report showing that the number of young Australians seeking help for suicide and self-harm has doubled from 2000 to 2015. Furthermore, the survey also alarmingly found as many as one in 10 teenagers (about 186,000 Australian youth) had engaged in some form of self-harm in their life, including a staggering quarter of Australian teenage girls aged 16-17.
Unlike the US and NHS studies, the Australian report did not rely on GP or emergency room visits for data. Arguably this study then reveals the clearest picture of what some commentators are referring to as a “crisis”. Studies such as those of the UK and US are only taking a shallow reading of the actual instances of self-harm since they are only using data from medical centres.
We can conclude that incidents of self-harm are rising. With that rise comes a correlated risk of increased suicide and suicide attempts. While causality is fluid in these cases, diagnoses of anxiety and eating disorders are also highly likely to rise in parallel with incidents of self-harm. In fact, the University of Columbia recently concluded that the risk of suicide increases sharply in the months after an incident of self-harm.
Practitioners refer to NSSI (Non-suicidal self-injury), a term also used by Australian academics, but the term “deliberate self-harm” (DSH) is also frequently used. For the purposes of remaining colloquial, let us adhere to the term “self-harm” here. The term, in fact, defines a wide array of physical manifestations. It must be noted that causally psychological and emotional factors preempt physical self-harm, and could be defined as a form of mental self-harm – low self-esteem, negative self-talk and self-denial. Typically, although not uniformly, the self-harm occurs in private, in a controlled or ritualistic manner. According to the Mayo Clinic typical acts of self-harm include:
- Cutting (cuts or severe scratches with a sharp object)
- Burning (with lit matches, cigarettes or hot, sharp objects like knives)
- Carving words or symbols on the skin
- Hitting or punching
- Piercing the skin with sharp objects
- Pulling out hair
- Persistently picking at or interfering with wound healing
Mental Health America, estimates that the most common forms of self-harm are:
- Skin cutting (70-90%),
- Headbanging or hitting (21%-44%), and
- Burning (15%-35%).
People who self-harm may use more than one method to harm themselves. Less-typical acts of self-harm include:
- Cyber self-harm
- Binge drinking
- Inserting objects into body openings
- Purposefully breaking bones
The Causes, The Consequences
Studies have found that behind the behaviour of self-harm lies a consistent distal risk factor (i.e. an underlying vulnerability for a condition) that points to familial environments playing a disproportionally large role in increasing the risk of self-harm. The diagram below, from the same study, illustrates this relationship.
Further to the familial environment of childhood abuse, are further underlying causes related to mental health. Self-harmers describe the act as a relief from negative feelings, a way of externalizing internal or emotional pain, and cathartic – specifically when watching the injuries heal. Self-harm is seen by mental health practitioners and psychologists as a way for individual’s to control their bodies, when they don’t feel like they can control anything else – a coping mechanism. Self-harm induces a positive feeling after a challenging emotional incident, particular interpersonal conflicts. Emotionally, self-harmers typically have low self-esteem, difficulties expressing their feelings, difficulties coping with stress or “adult” responsibilities.
Adolescence is generally a trying time for anyone. Teenagers are discovering an identity outside of their families – a process often expressed in outright rebellion, hormonal fluxes lead to extremes of emotion, and an entire world of new social realities is opening up to them, alongside an increasingly acute sense of self-awareness, within that sometimes unsympathetic social landscape. Having said all of that self-harm is certainly not, and should never be deemed “normal attention-seeking”. Unequivocally self-harm is a consequence of a mental health issue, and in many cases indicates an underlying psychiatric disorder such as personality disorder, borderline personality disorder, bipolar disorder (manic depression), major depression; anxiety disorders, obsessive-compulsive disorder as well as psychotic disorders such as schizophrenia. Even when self-harm does not indicate these medical conditions, it nonetheless indicates extreme stress, inability to cope and most certainly a “cry for help”.
A 2017 study by the Australian Institute of Family Studies recorded high percentages of self-harm amongst the 3, 318 teenagers surveyed. 10% said they had self-harmed in the previous 12 months, and 5% said they had considered suicide. When adjusting for gender, that figure jumps to 15 per cent of girls who had self-harmed in the previous 12 months, and 25% have thought about self-harming in that period.
In the Australian school context, the numbers equate to around 2-3 students per high school class that are self-harming. Effectively every Australian high school teacher is in contact with a self-harmer daily. While a student under stress, and self-harming, is more likely to admit their behaviour to a peer, the attendant issues associated with self-harm, as described above, make identifying and treating it an “all-round effort.” The concerned teacher should look out for the following behaviours, especially amongst their female students:
- Inexplicable or sudden withdrawal from school activities
- Wearing long sleeves, even in summer
- Struggling to cope with a divorce or other trauma
- Being bullied
- Difficulty coping
Having understood firstly that students who are, or are considering, self-harm are most likely to be secretive, but also that the consequences of untreated self-harming behaviour are dire, there exists a strong argument for class- or school-wide education with a view to prevention.
Adopting a universal approach to prevention will not only create awareness amongst the self-harmer’s peers but may also address the self-harmer that is not outwardly displaying typical characteristics and who therefore may not have attracted the attention of a school psychologist or counsellor. Additionally, educating the broader community about steps to take when a young person admits to self-harm will ensure that parents of friends, sports coaches, mentors and older students and youth leaders are aware of the significance, and know what steps to take.
Are schools equipped to deliver mental health services?
The Australian Government report Mental Health of Children and Adolescents (August 2015) revealed that not only had incidents of mental health disorders increased from 2.1% in 1998 to 3.2% in 2014 but also that access to school-based services by students with mental health disorders increased from 19.2% 1998 to 54% in 2014. It naturally follows that school-based interventions are not only required but in many cases preferred. As such the Australian government continues to support a number of school-based mental health initiatives that school administrators and principals are encouraged to make use of. These include:
- In WA: Gatekeeper Suicide Prevention Workshops
- State-sponsored school mental health resources: KidsMatter (Primary Schools) MindMatters (Secondary Schools)
Additionally, it is well worthwhile to learn how technology can play a role in delivering mental health services to young people here.
Where to go for help
With suicide being one of the leading cause of death for young Australians, a number of organizations are specifically geared to help Australia’s youth with mental and social issues. Should you be self-harming or be the teacher, parent or friend, of someone who self-harms, be sure to seek help on their behalf.
The old humbug “It takes a village” comes to mind when contemplating the diverse, yet important subject of Australian youth’s mental health, but it is nonetheless apropos. While some studies show that the causes and underlying reasons for self-harm may be beyond the ambit of the concerned teacher, counsellor or principal that certainly does not mean they have no agency in affecting healthy and necessary change. Awareness, as is so often the case, is the first step. Thereafter, a willingness to embrace our broader responsibility to young people, who at times are less in need of a review of their calculus term paper, than perhaps a shoulder to cry on.
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At Saasyan we have developed Assure to help schools to proactively ensure the online safety of their students. Assure uses artificial intelligence to detect students at risk of self-harm, based on their web searches, social media messages, and online activity. Assure then notifies pastoral care staff and the student’s teacher of this activity. Read more at the Assure page or contact us if you would like to know how your school can use Assure to prevent student self-harm.