A study released by the Children’s Society last week revealed that one in four young women and one in 10 young men aged 14 has self-harmed in the past year. Predictably (and, indeed, rightly) the media was instantly catapulted into a state of frenzy, as journalists got to grips with the reality that their oft-quoted and now seriously out-of-date "one in 10" statistic no longer accurately reflects the estimated number of teenagers experiencing a mental health issue.
To anyone who works with children and young people, no doubt, this "revelation" won’t come as a surprise (albeit desperately sad). What struck me as I listened to and read much of the media coverage, however, was how much misunderstanding and confusion still surrounds the issue of self-harm. Below, therefore, are a few things I believe everyone should know:
Self-harm isn’t new
Often, self-harm is spoken about as though it’s a "trendy" new craze sweeping a "snowflake" generation who use it to seek attention. This is wrong on all counts.
There is evidence of self-harming behaviour throughout human history. Shakespeare wrote his play Julius Caesar in 1599. In it, Brutus’ wife, Portia, "inflicts upon" herself a "voluntary wound". The first instance of self-harm as we understand it today was noted in medical records in 1909. Anecdotally, I know many people in their 30s and 40s who self-harmed in the past, some of whom continue to this day. Whilst self-harm has undoubtedly increased over the past few years, it isn’t new. The reason it seems new is likely to be simply because more awareness has been raised.
Furthermore, the very fact that past generations managed to conceal their self-harm shows the extent to which it is usually a highly secretive behaviour, fraught with feelings of guilt and shame. In the instances when people who self-harm do exhibit their wounds or make their behaviour obvious, this is a way of communicating their distress. They are, as we know, attention-needing.
It isn’t just cutting
Often, people say to me, "I just don’t understand why anyone would harm themselves." This is usually because they have defined self-harm in terms of self-injury and are thinking of cutting.
Yet self-harm can be defined as any activity that one knows is likely to cause one long-term damage, either physically or emotionally, but that gives one temporary respite from stress or other difficult emotions. In that context, if you have ever smoked tobacco, drank alcohol, taken drugs or eaten something high in saturated fat and sugar to "take the edge off" a bad day, you were, technically, self-harming.
Of course, all self-harming behaviour exists on a spectrum. I’m not for one moment suggesting that the odd doughnut or glass of pinot grigio is cause for concern, merely that self-harm exists on a spectrum. I’d defy you to find a human alive who hasn’t done something they knew, logically, wasn’t good for them in the pursuit of distraction from the realities of their life.
It isn’t a mental illness in its own right
Self-harm isn’t defined as a mental illness, although it is often a symptom of one.
Whilst self-harming behaviours very often manifest alongside depression, anxiety or eating disorders, it is by no means certain that a person who is self-harming will receive a diagnosis of mental illness. It’s important to draw this distinction between self-harm as a communication of distress (which could accurately be defined as a "mental health issue") and mental illness.
This is not least because to define self-harm as a mental illness conveniently absolves education policymakers from exploring what might be causing it. The Department for Education, when challenged about self-harm, currently responds that it has invested an additional £300 million into establishing mental health leads in schools. If, however, we acknowledge that soaring levels of self-harm in young people mean increasing numbers of them are experiencing intolerable distress, this creates an obligation to ask what is causing it. After all, prevention is better than cure.
Boys often fly under the radar
It is often stated that self-harm disproportionately affects girls and women and, indeed, the statistics bear this out. However, there is a phenomenon acknowledged amongst psychologists: that boys and men are more likely to self-harm in ways that will be noted in school or medical records as something else. For example, they might punch a wall, or get themselves into a fight they know they can’t win – both of which are likely to be logged as a "behavioural issue". In some instances, even carrying a knife could technically be described as self-harm, if the individual in question is hoping to be injured.
It’s important that this is acknowledged, since suicide currently kills one man every two hours in the UK. Ninety per cent of suicides happen as a result of untreated addiction or depression, the average onset age for both of which is 14. It’s not too much of stretch, then, to suggest that when boys are communicating their distress during adolescence, it is flying under our radar.
Our aim shouldn’t be to stop the self-harm
Self-harm is, at its core, a coping mechanism. Therefore, if it comes to your attention that a young person in your care is self-harming, your aim shouldn’t be simply to stop the behaviour. In fact, there is evidence to show that stopping self-harm whilst not addressing the underlying causes increases the risk of suicide.
Instead, your aims should be twofold: firstly, to communicate with and listen to that person, letting them know they can tell you why they are self-harming without fear of judgment; secondly (and usually further along the line), to help them find a healthier way to achieve whatever it is self-harm is giving them, acknowledging that, however unpalatable it might be to you, it is serving them a purpose.
If you want more information on self-harm, I recommend:
www.satveernijjar.com (Satveer does excellent training on self-harm for schools)
Can I Tell You About Self-Harm? (a book by Dr Pooky Knightsmith)
www.nshn.co.uk (The National Self-Harm Network)
Natasha Devon MBE is the former government mental health champion. She is a writer and campaigner and visits an average of three schools per week all over the UK. She tweets @_natashadevon