A study published in The Lancet recently outlines again an epidemic of self-harm among this generation of teenage girls. Around 20-25 per cent of 16- to 24-year-old girls have tried self-harm, usually by cutting themselves. This is up from around 6 per cent who had self-harmed in 2000.
Some of the increase in self-harm is likely to be accounted for by more accurate reporting. Previously the secrecy and stigma about mental health, and particularly about self-harm, contributed to an under-reporting of the problem.
It is also clear that under-reporting does not account for all of the increase in self-harm, as we frontline professionals can see that the overall level of distress has increased among young people. While the content of the distress seems to have stayed the same – exams, school, family, friends, the world, their place in it, belonging and the future – more children are clearly suffering, and their suffering seems more urgent or intense.
The risk of self-harming
The teenage years are – and always have been – difficult, emotional times. But this generation is experiencing its teenage years in a perfect, toxic storm of psychological and social factors, which act to intensify and amplify their worries and distress:
- A 24/7 online world creates information and stimulation overload. While it is difficult to measure objectively, it seems that young people are subject to more ideas, more images, more objects and more people than ever before, and, as a result, have hyperalert brains, which receive less sleep.
- The pace of life is faster, giving young people less time to process more information.
- Increased sense of comparison and competition. This visually orientated, global consumer society seems to have created a constant striving for improvement – if not perfection – in bodies, minds and possessions.
- Increased academic and career demands on young people. School accountability for outcomes has morphed into school scrutiny, with children prepped and primed to pass Sats and GCSEs.
These factors have led to more pressure and more dissatisfaction – or, in other words, more anxiety and more depression. Mentally, our young people are in bad shape.
Young people's mental health
Many depressed and anxious young people use self-harm as a way to show, reduce or simply bear this distress. They want people to know how much they are hurting. Alternatively, they want to reduce their psychological pain, and the physical pain of self-harm does that. On many occasions, they feel they need to punish themselves for their perceived lack of achievement or success.
Yet there is another factor to consider as well in understanding self-harm: the fact that mental health is a continuum.
At one end, we have people who are mentally well. Mentally well people do still feel sad or worried, but they don’t feel these things for very long, or very strongly, or feel that they impact on their lives too much.
At the other end, we have people who are extremely mentally unwell: who feel life isn’t worth living, or who may be beyond caring. Like all continuums, there are many different shades in between the two extremes.
Self-harm can be contagious
In a school setting, or among a group of friends, mental illness can be contagious. If one friend is extremely unwell, this can cause distress among her friends. Then self-harm behaviour, which previously seemed out of reach or unusual, becomes part of the group’s lived experience.
I have known self-harm pictures to be posted on a class WhatsApp group. As girls glimpse their friend’s scars, slowly self-harm becomes something commonplace.
Subliminally, self-harm may even become the way that their generation expresses distress. It becomes normal; it is something anyone can do when they are upset.
And, like many other emotional coping methods, it can become addictive. If a young person tries self-harming, and finds it “works” by taking away their mental distress or getting them the attention they need, they will repeat it, and probably escalate it.
The symptom of self-harm has become the solution to the problem of mental distress for the young person. We need to help them find better solutions.
The Lancet article concludes that “self-harm needs to be discussed with young people without normalising it. Young people should be offered help … to find safer ways to deal with emotional stress.”
But I’m not sure we know with any clarity how to do this yet. Often, when working with children and young people, we, as adults, are playing catch up with how to cope with or manage the problems they are experiencing.
In my view, schools need a two-pronged approach. Firstly, schools need to think about reducing the stress their young people are under. Secondly, they need to give young people more positive coping methods when they are stressed. These two messages are strongly interrelated.
Schools should be mindful of the levels of stress their pupils are experiencing. Children need a balanced approach to their school work, which also encourages stopping work and having some fun, too.
Finally, schools should watch out for an “outbreak” of mental illness or self-harm among their pupils, and think carefully about the impact of one young person’s distress on the surrounding group. Some mentally unwell young people may need help with appropriate boundaries for their friendships, although many mentally unwell people self-isolate, which is not desirable either. Sometimes, their friends may need to be “given permission” to think about how they protect themselves in their friendship group, while still supporting the person who is unwell.
This is complicated stuff, and a good school counsellor or pastoral lead will be able to help.
Dr Tara Porter is a clinical psychologist at the Royal Free London NHS Trust and Anna Freud National Centre for Children and Families, as well as Tes' mental health columnist. The views expressed are her own