Are Mental Health Services Equipped To Support Young People Who Are Self-Harming?

Amid a burgeoning mental health crisis among young people and the increased public attention it brings, the growing incidence of self-injury has seemingly escaped the spotlight. Are mental health support services equipped to help people struggling with self-harm?

Self-injury, or self-harm, is when a person hurts themselves as a method of managing difficult feelings, memories or overwhelming situations and experiences. People with a broad spectrum of mental health diagnoses may struggle with self-injury. 

Self-harm among young children has risen significantly in the last six years, with the number of children aged 9 to 12 admitted to hospital after injuring themselves intentionally more than doubling from 221 in 2013-14 to 508 in 2019-20. A shocking 24% of teenagers report having self-harmed, according to a 2020 study by University College London. 

Under-equipped mental health support services could be putting people’s rights at risk. Under the International Covenant on Economic, Social and Cultural Rights, people have a right to an adequate standard of healthcare, which includes mental healthcare and support. Failure to assist people displaying self-injury behaviours could also threaten their right to life – enshrined in Article 2 of the UK’s Human Rights Act – as these behaviour can be connected to suicidal ideation and active attempts at suicide.

A complex behaviour that can confound those without prior education on the subject, self-injury is affecting an increasing number of young people and support services must adapt to help them. 

What Is Self-Injury Or Self-Harm?

For those who have never been exposed to the behaviour, self-injury can be a confusing concept. It is a complex issue that does not have a singular explanation. Self-harm is an umbrella term that encompasses various types of that damage or cause harm to a person, whereas self-injury refers to any deliberate behaviour that inflicts harm on your body. 

Self-injury takes many different forms but commonly manifests as cutting or scratching. However, self-harm behaviours are not limited to using a razor: others may burn themselves, pull out their hair, abuse drugs and alcohol, have unsafe sex or get into fights. Ultimately, the “how” is secondary to the “why”. 

Mental health charity Mind describes a range of reasons why people may engage in self-harm behaviours, such as a need to express feelings they cannot put into words, to try and transform emotional pain into physical pain, to stop feelings of numbness or to punish themselves for their feelings and experiences. 

“I’ve always felt like my feelings were too big for my body and having emotional outbursts was met with ridicule outside of my home, so I learned that expressing emotions authentic to me was wrong,” said Artie Carden, a nonbinary writer who began self-harming as a teenager. “Keeping it pent up inside is what led to self-harming because it was like a release of the emotions or a distraction from the emotional pain.”

Credit: Anh Nguyen / Unsplash

A number of life experiences may trigger self-harming behaviours, including bullying, money worries, abuse, bereavement, homophobia, a health problem or low self-esteem, according to Mind.

While self-harm is not always a symptom of a mental health condition, people who exhibit the behaviour could also have a diagnosed mental health condition like anxiety, depression or Post Traumatic Stress Disorder (PTSD). It can also be an early warning sign of suicidal ideation. 

Jenetta Barry, whose daughter died by suicide aged 16 and had a history of self-harming, explained: “My daughter said that self-harming helped her defer the emotional pain, which was just too overwhelming. So, if she could hurt herself somewhere else, it took the focus away from the main pain, which she just couldn’t handle.”

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Although approximately 10% of young people self-harm, the behaviour is still frequently misunderstood or harshly judged.

“I didn’t tell many people, but the people I did tell had very mixed responses,” said Emily Grimes, a creative manager who also self-harmed as a teenager. “I had some who were brilliantly supportive and helped me through it but then there were others who were very judgemental. It was mainly because, in their eyes, I didn’t have a reason to feel this way because nothing terrible had happened.”

Self-harm behaviours are not necessarily triggered by specific traumatic events and any young person could be susceptible to them. But research suggests that people from marginalised communities can be at greater risk of self-harming. For example, LGBTQ+ people are three times more likely to self-harm than their non-LGBTQ+ peers, according to a survey undertaken by Just Like Us. Research conducted by the University of Manchester indicates that self-harm is rising more rapidly among children and adults from ethnic minority groups.

How equipped are services?

Public services have been struggling to provide robust mental health support for some time, especially as the impact of the pandemic reverberates. 

“Access to mental health services varies across the country – a trend that existed prior to the pandemic and put the reach of those services in a precarious position,” said Stevie Goulding, helpline co-manager at YoungMinds. “Long waiting times and high thresholds for treatment can have devastating consequences for young people. In some cases, young people drop out of school, start self-harming or become suicidal before they get the right support.”

Despite a government promise to invest £500 million into supporting more people with mental health issues through their Mental Health Recovery Action Plan, young people still face long waits for services and support. 

“Even before the pandemic, many young people struggled to access early mental health support, with too many reaching crisis point because they didn’t get the help they needed when they needed it,” continued Goulding. “Our own research suggests that at least a quarter of young people who were receiving some form of mental health support prior to the first lockdown last year had lost access to that support by the summer.”

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In the light of the coronavirus pandemic, research estimates that the increase in demand for services in England will require securing support for 1.5 million children, according to the Centre for Mental Health.

Although a range of mental health care is available through the NHS, some recipients feel that workers are not prepared to help manage the specific needs of those who self-harm. 

“They were not prepared and had no idea how to talk about it,” said Carden. “It was often brushed off or was my way of proving I was struggling. Some of the counsellors I met were nicer than others but they were not equipped to deal with the kinds of things I needed help with.”

Unfortunately, some mental health treatments and educational settings treat self-injury as behaviour to be punished or disciplined, which is something Barry experienced while trying to secure care for her daughter. 

Credit: Priscilla Du Preez / Unsplash

“She was in an Adolescents Ward and they really mishandled her,” said Barry. “They tried to break her, a bit like being in the army.” She subsequently took herself out to the gardens of the hospital and started self-harming, carrying out a plan to end her life while drinking alcohol. “They found her whilst she was in the process of doing all this and ‘expelled’ her for bad behaviour.”

Later, after enrolling in a new school, Jenny was suspended for self-harming in the school toilets, which further isolated her. 

“When Jenny came to me that first time at the age of 14, I think she really believed that I and the system could provide something meaningful that would help her to move on,” continued Barry. “I think even from that first incident in the first hospital, it made Jenny realise that the authorities were useless, really. She just felt that the system really, really didn’t understand.”

A new study carried out by Manchester University revealed that 75% of young people who had harmed themselves non-fatally had consulted with a GP or a practice nurse in the preceding year. The high prevalence of self-harming patients already known to a medical professional indicates that services are struggling to prevent the continuation of self-injuring behaviours. 

How has the pandemic affected mental health among young people?

Throughout the pandemic, research has shown a significant increase in mental health issues for everyone, but young people, in particular, are struggling. 

“The pandemic has had a devastating impact on many young people who we’ve heard from through our research over the last year, as well as the parents who contact our helpline service,” states YoungMinds on its website. “During the January lockdown, some told us that they were deeply anxious, had started self-harming again, were having panic attacks, or were losing motivation and hope for the future. Young people who are already experiencing inequalities are likely to continue to be disproportionately affected, and those who have been bereaved or experienced trauma will be dealing with multiple pressures.”

What is being done to address self-harm?

Aside from accessing the support provided by charities such as LifeSigns and Self Injury Support, people who struggle with the behaviour have found that self-understanding has helped them move past it.

“My neurodivergence has been a big part that was missing, and I understand that sometimes meltdowns happen, and sometimes that includes hitting myself,” said Carden. “Knowing how my brain works and that it isn’t wrong was a big turning point.”

Increased compassion and patience from parents and schools will also help young people open up about their experiences. 

“So often, I could hear my mother’s words coming out of my mouth when I was dealing with Jenny,” said Barry, who now works with young people and families struggling with mental health issues through her organisation The Epiphany Process. “For example, ‘How dare you speak to me like that? I’m your mother. Where’s your respect?’, and all that stuff comes from fear and judgement. Whereas, when one can speak very clearly without that pre-programmed judgement, where you’re listening accurately and responding from a clear, open-hearted place, you can really help people.”

She continued: “There’s no parenting handbook that’s accurate. So, for parents, again, it’s about learning communication skills that enable them to listen more without trying to judge and fix the child.”

While parents and schools improve their education on young people’s mental health, particularly around self-harming behaviour, only improved access to NHS support will make long-lasting change.

“Fewer than 40% of those under the age of 17 with a mental health condition are able to access NHS support,” said Goulding. “Too many young people are being left without support, which can have a devastating effect. This is why we are calling for the government to invest in a national network of early support hubs to provide easy-to-access, drop-in mental health support for young people on a self-referral basis.” 

Following the impact of the pandemic on young people’s wellbeing, YoungMinds is also asking the government to develop a strategy to protect young people’s mental health that addresses the role inequality plays in worsening mental health problems.

An increasing number of people are becoming aware of the devastating impact self-harm can have. However, services must be drastically improved before young people’s right to adequate healthcare is truly protected.