Column: Self-harm is a coping mechanism when life becomes overwhelming

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Fans of the soap opera Hollyoaks will be familiar with the character of Lily Drinkwell who cuts her arms when life feels overwhelming. This is a story that is becoming more common as the numbers of young people self-harming are on the rise. Self-harm can be defined as any behaviour where a person has deliberately caused physical harm to themselves.

Rates of self-harm may be greatest in young people but if affects adults too, Between July-September 2017, UK prisons reported a 10 per cent increase in recorded self-harm incidents. Outside of prisons we just don’t know the numbers for people who self-harm as it tends to be a very private and secretive act.

Alcohol and medication abuse are forms of harm which are much less easily detected

We only know about a very small proportion of incidents, which are usually those that receive medical attention. Self-harm is likely to be a much bigger issue than the current numbers suggest.

When people hear that a loved one is self-harming there tends to be a feeling of panic and the assumption is made that the individual is suicidal. However this is not necessarily the case.

Self-harm is a coping mechanism, used by some people who are experiencing extreme emotional distress, which could be caused by a range of factors. Some of these include; all types of abuse, marginalisation, unemployment, depression and various psychological conditions.

Professionals are coming to the realisation that self-harm, ending in suicide, is usually either accidental or occurs when the person’s emotional state is not adequately addressed. This could occur from not getting adequate medical/psychological treatment, further trauma in the person’s life, or from the ascribed treatments re-enforcing the feelings that have led the person to this point.

When a person is found to be harming themselves, a common reaction is to remove all equipment that relates to the method of harm; for example if the person is choosing to cut, to remove all sharp objects.

However if the underlying reasons for the behaviour are unknown, this may just replicate the circumstances and contexts which have led them to this point.

For example, if a person has experienced any sort of abuse this is often accompanied by a feeling that they are not in control of the situation or their body. Part of the reason for their self-harm may then be linked with reclaiming some control of these.

If when self-harm is discovered, this control is then taken away by the removal of anything that could be used to harm themselves, this replicates the original abuse. Research findings show that trying to prevent someone from engaging with self-harm or attempting to control their behaviour just does not help to reduce self-harm behaviour. Only addressing the issues that leads someone to self-harm will help them. There is also evidence to suggest that these enforced ‘treatments’ often lead the person to try other forms of harming themselves which are much less easily detected such as alcohol or medication abuse. They may also carry out an act of self-harm behaviour more quickly and with less care than they might otherwise have done, leading to worse and accidentally fatal consequences.

Research shows that the best way to support someone who self-harms is through harm-reduction techniques. These techniques take an educational approach to treatment, giving the individual the knowledge and resources to use the coping mechanism in the safest way possible. For someone who cuts, they may be taught, amongst other things, how to reduce the risk of causing serious damage to themselves and given access to basic first aid supplies. They would also be taught some distraction techniques to ensure that cutting is only carried out when they feel that there is no other way of alleviating their distress. Lily in Hollyoaks, for example, now taps her wrists rather than cutting them when the pressure starts to build.

By acknowledging and understanding that self-harm is often not a sign of a failed suicide attempt, but a sign of severe emotional distress, we can support the individual through this time in their life in a safe environment which avoids further emotional damage.

Of course this may present some difficult challenges for mental health services which are expected to ‘protect’ their clients from further harm but it can be done. ZEST, an organisation in Northern Ireland is one example of how people who self-harm can be effectively supported. Harm-reduction techniques are promoted by the National Institute for Clinical Excellence (NICE), the body that provides national guidance and advice to improve health and social care, as the best way to treat self-harm. But this has not been widely adopted. Individuals still face stigmatisation from friends, family and service providers if self-harm behaviour is discovered.

In these times when health services are stretched to capacity and self-harm is mistaken for an attention seeking behaviour, unless there is a move for more awareness and understanding the numbers will just continue to rise.

In an attempt to raise awareness of some aspects of self-harm I am holding an event, open to the public at 2pm on February 24 at Sheffield Hallam University.

Booking is essential and further information can be found here: {https://www.eventbrite.co.uk/e/self-harm-a- mini-conference- tickets-39414918081?ref=estw|Self harm - a mini conference tickets|click here}