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Not 'just a cry for help'...

Self-harm is a significant problem in our society and is a risk factor for suicide. In fact, more than half of all people who die by suicide have a history of self-harming. Read on to find out more...



Introduction


Self harm is when someone intentionally damages or injures their body. It's usually a way of dealing with, or expressing emotional distress.


It's difficult to know exactly, but it's thought that at least 10% of all young people self harm at some point.


Self-harm is common in young people, particularly young women, but anyone, of any age can self-harm.



Causes


The driver behind most self-harm is as a coping mechanism for dealing with overwhelming distress. This can result from:


Societal problems - such as bullying, relationship problems or gender/sexuality issues.


Traumatic experiences - such as physical, domestic or sexual abuse, or the death of someone close.


Psychological causes - such as depression, anxiety, psychosis or personality disorders.


Often, these causes lead to a build up of negative feelings. If the person isn't receiving any support and is dealing with the situation on their own, they can use self-harm as a way to deal with it.


People often describe their self-harming as like a 'release', which makes them feel better and stops things building up.



Ways that People Self-Harm


People self-harm in a variety of ways. This can include, but is not limited to:


  • Cutting or piercing their skin

  • Burning themselves

  • Punching things or hitting them-self

  • Pulling out hair

  • Poisoning themselves with tablets or other chemicals

  • Misusing alcohol or drugs

  • Interfering with wound healing


Whilst these are more 'obvious' ways, people may also self-harm in more subtle ways, such as through their eating or exercising, or causing them-self psychological harm.



Signs and symptoms


The signs and symptoms of self-harm vary from person to person and are often kept secret due to shame or fear of being found out. In fact, it may be the fact that they're always covered up that is the thing you first notice about them.


Look out for...


  • Unexplained injuries, such as cuts or burns

  • Signs of low self-esteem

  • Signs of associated mental health problems, such as depression or anxiety

  • Changes in behaviour, such as becoming withdrawn

  • Misuse of alcohol or drugs (prescription or illicit)


These are just some of the symptoms. If something doesn't seem right and has come to your attention, it's probably worth investigating.



Helping someone who is self-harming


When trying to help someone who is suspected of self-harming, you should apply the principles of the Mental Health First Aid Action Plan, CARE (or ALGEE in the US). I'll talk more about this in a future post, but in summary...


  • Check for risk of harm or suicide

  • Apply non-judgemental listening skills

  • Reassure and provide advice

  • Encourage self-help and professional support


If the person needs it, you should ensure that the person receives first aid treatment and/or call 999 for an ambulance.


Once you've started a conversation with the person and found out a bit about what's going on, you should try to encourage them to get professional help. This is usually accessed through their GP, but may also be through one of the mental health charities, or could even be direct to local NHS mental health services, such as CAMHS.


Whatever the outcome of the conversation, it may be necessary to safe-guard the person. You may have procedures for doing this in your organisation, but if not you should refer people as appropriate to their state of mind.


Once their self-harming behaviour has been assessed, mental health professionals will recommend a suitable course of action. This may involve tackling the cause of the problem, and may also include talking therapy such as CBT or medication.



Suicide


Suicide is when someone deliberately ends their own life. About 6,500 people in the UK die by suicide every year. It's no longer appropriate to use the term 'committed suicide', as this refers to the crime of killing yourself, which was removed in 1961.


About three-quarters of people who die by suicide are men, and the risk varies with age.


Risk Factors


There are some well known risk factors for suicide, which include:


  • Previous attempts

  • Self-harming

  • Mental health problems

  • Significant emotional trauma

  • Isolation and loneliness

  • Financial problems


As well as this, you may become aware of other warning signs:


  • Threatening to kill or hurt themselves

  • Talking or writing about dying or feelings of hopelessness

  • Making preparations, such as organising a will or the means to kill themselves


Checking for suicidal thoughts is part of the CARE action plan, and simply asking someone whether they're considering hurting or killing themselves will usually elicit an honest answer, if done appropriately.



Helping someone who may be experiencing suicidal thoughts


In my experience, people who are having suicidal thoughts don't actually want to die. Instead, they've simply got to a point where they can't see any other way out of the situation they're in.


This means that it's not too late and we can help them.


As with all mental health first aid, apply the principles of the action plan. Once you recognise a risk of suicide you must do everything you can to help.


Most important is the immediate safe-guarding of the person. If you think they are actively contemplating suicide, stay with them until you can get to professional help. This is likely to be an emergency 999 ambulance or the Police.


In the mean time, reassure them that suicide is not the only way out. You care and others will care and want to help. If they're already receiving help, tell them that there are other ways to help if the current ones aren't working.


Encourage them to seek help, whether from existing sources or new ones. This may include NHS 111 or The Samaritans on 116 123.


The Mental Health Foundation use the WAIT mnemonic to help you remember what to do...

It's estimated that 90% of people who attempt suicide have one or more mental health conditions, some that may not have been diagnosed. Once in contact with professional help, the person will be assessed and referred to the appropriate treatment plan.



Summary


In summary, self-harm is a common condition in our society. It usually stems from an underlying emotional problem that can be dealt with.


Suicide is a rare but devastating event that can also be dealt with if caught early enough.


Once you recognise a potential issue, start a conversation with the person and encourage them to seek help. If you believe they're in immediate danger, stay with them and call 999.



If you'd like to know more about mental health and what to do if you suspect someone has a problem, why not book on to one of our mental health courses.


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