Providing help for those who self harm

The pace and complexity of modern life, with its associated stresses and strains, is having an increasing impact on people's mental health and wellbeing.

Rising debt levels, job insecurity and redundancy are likely to be on the minds of many, which could be why hospital admissions for stress and anxiety in the UK have risen since the recession.

Yet, it is not just adults who are struggling to cope.

Alarming numbers of young people and teenagers are developing mental health conditions too, with research showing that they are now twice as likely to suffer from anxiety and depression as they were 30 to 40 years ago.

One consequence of this is that more teenagers and young people are being seen with stress-related behavioural conditions.

Eating disorders are one example of this, with cases frequently reported in the press, and rising numbers of teenagers and young people being affected.

Another stress-related behavioural condition, not as widely reported but also rising among younger people, is self-harm.

Often thought of in terms of cutting, self-harm describes a wide range of actions that people may deliberately carry out on themselves that are harmful but that do not kill.

The condition is common, especially among younger people, and more prevalent among girls.

People who self-harm are about 50 to 100 times more likely to commit suicide within a 12-month period than the rest of the population, and to have a range of other psychiatric conditions such as depression and bipolar disorder.

In October, the charity YoungMinds published a report revealing that inpatient admissions for self-harm have increased by 68 per cent over the last ten years.

This is the equivalent of 1 in 15 young people - two in every classroom - feeling the need to hurt themselves due to the stresses and strains of modern living.

Nowhere to turn to

Yet, despite growing numbers of young people self-harming, the help on offer appears to be alarmingly low.

The charity's report found that around three-quarters of those who self-harm do not know where to turn to talk about their condition.

Furthermore, a third of parents said they would not seek professional help if they believed their child was self-harming.

Lucie Russell, Director of Campaigns, Policy and Participation at YoungMinds, says: "What really comes over from our research is that young people who are self-harming have limited places to turn.

"There are lots of conversations about eating disorders, and size zero models, yet self-harm is still a taboo subject, which makes people feel impotent to act and scared of it."

She adds that with parents reluctant to talk about the subject, and teachers feeling unable to deal with it, young people are looking to other sources to get their information.

She says: "What teenagers end up doing quite a lot is seeking a lot of peer support and looking for information online. Sometimes this is positive, but it's a bit of a lottery as to what they'll find."

GPs should refer to NICE guidelines

Ms Russell recommends that if young people want more information about self-harm then they should visit their GP.

However, while GPs are currently being consulted about the problem, awareness of the condition and how to treat it remains low.

Figures show that around 50 per cent of people who attend an emergency department after an incident of self-harm will have visited their GP in the previous month.

Ms Russell says: "Almost half of GPs said they don't understand people who self-harm and their motivations. About 3 in 5 worry about language they use, and 8 out of 10 feel they haven't had specific training.

She adds: "GPs are saying they are very concerned about self-harm and want to help, but they are concerned about how they can do so."

NICE has produced guidance on self-harm that featuring recommendations to help primary care professionals deal with the condition.

NICE says if a person who has self-harmed presents in primary care, GPs should urgently establish physical risk and mental state in a respectful and understanding way.

Further risk of self-harm should be assessed, and GPs should consider depression, hopelessness and suicidal intent. Other relevant staff and organisations should be informed of the outcome of this assessment.

The pathway also includes recommendations on referral to an emergency department, and referral to secondary mental health services.

NICE says that if a person who self-harms is receiving treatment in both primary care and secondary care, both primary and secondary health and social care professionals should ensure they are working cooperatively.

This includes routinely sharing up-to-date care and risk management plans.

Ms Russell comments that following NICE's pathway of care would help GPs tackle this growing condition, especially as around 45 per cent saying they have never used NICE guidelines.

She says: "GPs have said in our research that they lack guidelines and lack knowledge.

"The NICE Pathway and guidelines have been produced by an accredited organisation, and developed by experts in the field. It is important that they are used as much as possible."

16 November 2012