Walk into any high school and you can be confident that there are young people who self-harm. Research suggests that around one in ten teens will self-harm at least once. That equates to 2-3 students per classroom. So we know that self-harm is fairly common.
What is self-harm?
The most common form of self-harm in teenagers is cutting, followed by overdose. Other methods include scratching or piercing the skin, banging your head or other body parts, cigarette burns, hair pulling, wound interference, and jumping from heights.
Why is self-harm a concern?
There can be some skepticism around self-harm, and some people dismiss the behaviour as ‘attention seeking’. However, there are some very real reasons to be concerned about youth self-harm:
• The most obvious concern is that self-harm involves physical pain and damage, which can leave permanent scars or injury. Young people who self-harm often do not receive medical help for serious injuries.
• While most young people who self-harm do not intend to die, there is still an increased risk of non-fatal and fatal attempts to end their life. It is hard to know which self-harming young people might be at increased risk of suicide, since suicidal thoughts can be ambiguous and transient. In fact, engaging in repeated self-harm can gradually desensitize a person and, over time, make it easier to engage in more serious suicidal behaviour.
• Young people who self-harm are more likely to experience mental health difficulties. This includes anxiety, depression, and low self-esteem. They are also more likely to engage in other self-destructive behaviours, including eating disorders and risk taking behaviour, and to use or abuse drugs and alcohol.
• Teachers often fear that self-harm may spread among students. These fears are valid: self-harm research identifies the occurrence of social modeling in self-harm initiation and continuation.
But do we know which young people are self-harming?
Naturally, teachers and welfare staff are concerned about self-harm among their students. In most schools, staff strive to keep an eye out for young people who show signs of self-harm, in order to provide further support to students in need. While the intention is good, how easy is it to identify young people who self-harm? It might be harder than we first think.
Despite the prevailing stereotype that young people self-harm to receive attention, in reality most young people keep self-harm hidden. When a young person discloses self-harm, it is not usually to a mental health professional. They are most likely to disclose to a peer, and when disclosing to an adult it is more likely to be a parent than a teacher or counsellor.
Identifying a risk profile for self-harm
So what is the best way to keep an eye out for self-harm? What are we looking for?
One way of approaching this question is to produce a list of psychological and social risk factors that are known to increase the risk of self-harm. This research can assist school staff in identifying young people at risk of self-harm, by providing a ‘typical’ profile of greatest risk. Risk factors include: female gender, depression and anxiety, low self-esteem, parental divorce, being bullied, impulsivity, and difficulty coping.
However, the research I did in Australian high schools with colleagues Jennifer Hudson and Michael P. Jones, found that not all young people who self-harm fit the ‘typical’ profile. Our longitudinal study involved 326 students (68.1% female) from five Independent high schools (four co-educational and one girls school) in Sydney and the NSW Central Coast. Students completed an online questionnaire as part of the Youth Coping Project which explored youth coping, mental health, and wellbeing. The longitudinal data discussed here were part of a larger baseline sample (n=1,521 from eight schools).
Our study explored whether psychological profile at baseline was related to self-harm rate at six-month follow-up. We found that there were several different psychological groups with an average risk for self-harm, including anxiety, difficulty with coping strategies, and an often overlooked or misunderstood group: students who displayed impulsivity and externalising behaviours. Our research identified considerable diversity in psychological risk factors among young people who self-harm.
In fact, some young people who self-harm did not report any of the typical risk factors for self-harm. This is a key finding: there are young people who self-harm who are not depressed and anxious, and are likely not on the radar of the pastoral care team as ‘at risk’.
These findings have critical implications for how we support young people in our schools. How will we identify these young people, in the absence of the usual risk markers? This is particularly concerning given that only around half of those who self-harm will disclose their behaviour.
Implications for practice
How can we apply these findings in schools, families, churches, and youth services?
1. Be aware of less typical risk profiles.
For example, young people who self-harm may be male, may engage in antisocial behaviour, or may not display any psychological or social risk factors.
2. Ask. If in doubt, ask.
Ask young people whether they have thought about or engaged in self-harm or other self-destructive behaviours. Ask with empathy and compassion, and be prepared to hear an honest answer. If a young person discloses self-harm, respond in a calm and gentle way. Listen to their story and journey with them to seek help.
3. Provide a supportive environment that encourages disclosure.
We need to develop supportive environments in which young people are willing to disclose, and people know how to respond in a safe and supportive way. Barriers to disclosure include fearing a negative response, concern that the disclosure would be spread in the community, and not viewing self-harm as problematic
4. Undertake prevention strategies
Since self-harm is often hidden, and yet the consequences are serious, prevention is essential. Prevention should be universal, that is, including all students. Targeting only the students that appear to be at risk is likely to exclude many who are struggling.
5. Educate the broader community
When a young person discloses self-harm, they are unlikely to go straight to a trained mental health professional. The first conversation is likely to happen with a peer, parent, teacher, youth leader, sports coach, mentor, or friend’s parent. Providing support for young people who self-harm extends far beyond the counsellor’s office. The broader community needs self-harm education.
We can’t expect to see self-harm right in front of us. And we can’t assume that if there’s nothing to see, then there’s nothing to be concerned about. There is a critical need for education as we develop supportive communities that can respond to and prevent youth self-harm.
Sarah Stanford is a writer, speaker, and researcher focusing on self-harm and mental health. Drawing on her experience in youth work and Ph researching self-harmD, Sarah is assisting schools to identify self-harm and develop parent and staff education programs. Sarah delivers workshops on understanding and responding to self-harm in schools and churches for parents, teachers, welfare staff, and youth leaders. Speaking with young people, Sarah brings a message of hope to those struggling with self-harm. Sarah completed her Psychology PhD at Macquarie University in Sydney, Australia, where she is an Honorary Postdoctoral Associate. Based in WA, Sarah works locally and interstate.