Self-harm

What is self-harm?

Self-harm is when a person deliberately causes pain or hurts themselves – usually as a means of coping with difficult emotions when they feel under pressure or distressed.

Recent Australian research suggests that self-harm is relatively common in young people. The research found: 

• around one in ten adolescents (10.9%) reported having ever self-harmed
• self-harm was more common among females than among males
• self-harm was more common in older adolescents, with 16.8% of females aged 16-17 years having self-harmed in the previous 12 months and 22.8% having ever self-harmed
• one in ten of the young people aged 12-17 years who had self-harmed in the previous 12 months had received medical treatment as a direct result of injuries incurred by an act of deliberate self-harm.

In addition to this, most young people who self-harm don’t seek professional help, so school staff play an important role in assisting young people to get the professional support they need.

Self-harm versus non-suicidal self-injury (NSSI) 

There is a distinction between ‘self-harm’ and ‘non-suicidal self-injury’ (NSSI) in that NSSI has no suicidal intent whereas self-harm may have. It’s not realistic or necessary for educators to determine the intent of a student engaged in self-harm, as the same immediate response following the school’s protocols is required (a risk assessment will be completed by a healthcare professional). For this reason, we’ll focus on, and refer to, self-harm only.

When school staff recognise and support a young person who may be self-harming, and follow the school’s procedures and protocols, there’s every chance the young person can develop healthier coping strategies.

Dealing with self-harm can be challenging and confronting for educators, so it’s useful to seek support from a healthcare professional. 

It’s vital to note that self-harm is a risk factor for suicide, and can result in accidental death, so working in partnership with healthcare professionals can make addressing self-harm and suicidal behaviour more manageable for schools and provide clearer understandings of roles and responsibilities. It’s also important to maintain your own wellbeing and to seek support from leadership and wellbeing staff if needed.

Common myth: self-harm is just attention seeking or manipulation

Self-harm isn’t about attention-seeking. Most young people who self-harm go to great lengths to draw as little attention as possible to their behaviour by self-harming in private and by harming parts of the body that aren’t visible to others. Even those closest to the young person are often unaware of it. Self-harm is most often an attempt to change how they’re feeling, rather than trying to get attention from, or manipulate, other people.

Why do young people self-harm?

Young people may self-harm as a way of coping with overwhelming feelings for which they may have no other effective coping mechanism. 

Recent research demonstrates that the most common motivation for self-harm was to manage emotions (57.2%), followed by self-punishment (24.7%). Over half also reported other motivations for self-harm, including ‘habit’, ‘compulsion’, ‘distraction’ and ‘curiosity’. The most common method of self-harm in adolescents is self-cutting; however, other methods may include a broad range of behaviours such as scratching, hitting, bruising and ingesting toxic substances.

Other factors independently increasing the risk of self-harm were depressive symptoms, alcohol misuse and the onset of sexual activity. The link between self-harm and puberty might be related to emerging evidence that this period of cognitive development brings increased risks of emotional disorders and risk-taking behaviours.

Adolescents might also be more susceptible to negative social cues, such as exclusion and the expectations of others. There’s growing evidence that perfectionism and self-criticism are also associated with self-harm. One aspect of perfectionism – an individual’s belief that others hold unrealistic expectations of them – needs particular attention because it can lower the level above which negative life events lead to distress.

Common myth: self-harm is fashion or a trend

Self-harm isn’t a new behaviour that arrived within a certain subculture or ‘trend’ among young people. Mental health professionals have been studying and treating self-harm for decades. Despite this, self-harm has been and continues to be associated with certain subcultures, resulting in stereotyped beliefs that only ‘certain kinds of people’ self-harm. These stereotypes aren’t helpful and self-harm is a behaviour that staff need to look out for in all students.

What has self-harm got to do with mental health?

Self-harm is most often a function of an underlying mental health issue. Be You’s Understand module introduces mental health and provides useful information on the protective and risk factors that young people may have in their life.

Self-harm and suicide

Self-harm can be related directly to a suicide attempt and can be a risk factor for suicide – however, self-harm usually occurs without suicidal intent. Individuals who self-poison – by overdoing on prescription medication, for example – are more often motivated by suicidal intent, while those who cut are more often motivated by self-punishment and tension relief. 

Without a thorough risk assessment by a trained mental health professional, the intentions of the young person will not be known. There’s a risk that underestimating the level of distress a young person is experiencing could lead to an escalation of self-harming behaviours and, potentially, a suicide attempt.

Youth suicide prevention

There are strong links between suicidal behaviour and self-harm; however, there are also fundamental differences. Most young people who self-harm aren’t involved in suicidal behaviour. Be You’s Suicide Prevention resources explore youth suicide and presents practical information for educators and schools.

People who self-harm and those who attempt suicide may have similar feelings of hopelessness, often believing things will never improve or they have lost all control over their life. If self-harm doesn’t relieve tension or control negative thoughts and feelings, the person may harm themselves more seriously or may start to believe they can no longer control their pain and may consider suicide. 

Most young people who self-harm have no intention of dying, and harming themselves is their way of coping. However, all self-harm needs to be taken seriously and acted upon. Even if there’s no suicidal intent accompanying the self-harm, the risk of accidental death is very real.

Some groups are at higher risk

Females 

In the most recent Australian survey (the second Australian Child and Adolescent Survey of Mental Health and Wellbeing), it was found that one in four people identifying as female aged 16 and 17 years have engaged in self-harm, with one in five meeting the clinical criteria for major depressive disorder.

Common myth: only females self-harm 

Between the ages 12 and 15 years, females are five times more likely to self-harm than males. However, in the later teenage years the number of males who self-harm increases. Overall, 30-40% of people who self-harm are male.

Aboriginal and Torres Strait Islander Peoples 

Rates of hospitalisation from self-harm for Aboriginal or Torres Strait Islander Peoples are around two to two-and-a-half times as high as the rates for non-Indigenous young people. 

The nature of self-harming behaviour, and the stigma and secrecy connected with it, makes it difficult to gain a true picture of how common self-harming is among Aboriginal and Torres Strait Islander people for whom some cultural practices may be misread as self-harming behaviours. 

It’s therefore important for people working with Aboriginal and Torres Strait Islander communities to understand the warning signs for self-harm that are relevant to the particular community, such as differences between ‘ceremony’ or ‘sorry business’ and self-harm, and how this may apply to young people.

LGBTIQA+ communities

Young people from LGBTIQA+ communities are at increased risk of mental health conditions and suicide, not because of their sexuality, sex, gender identity or intersex status, but due to discrimination and exclusion. 

The 2014 Growing Up Queer report found that of the 1,032 young people aged 16-23 years identifying as same-sex attracted or gender diverse, who participated in an online national survey, 41% reported they had thought about self-harm or suicide, 33% had harmed themselves and 16% had attempted suicide.

People in rural or remote communities 

People in rural and remote areas face a range of stressors unique to living outside a major city. Despite this, the prevalence of people with mental health issues and behavioural problems, and with high levels of psychological distress, is similar across the nation. However, rates of self-harm do increase with remoteness.

Young people with disabilities 

Self-harming behaviour may occur in young people with specific genetic syndromes, severe intellectual disability, autism spectrum disorder and impulsive or repetitive behaviours due to factors related to their disability. For example, the occurrence of self-harm has been found to be highest in young people with an intellectual disability who have no speech. Chronic pain is also a factor related to self-harm in young people with an intellectual disability.

Young people with a mental health condition 

Estimates of the prevalence of mental health conditions in people who self-harm range between 48% and 87%. The highest rate of self-harm was in adolescents with major depressive disorder. Young people with other mental health conditions have rates of self-harm more than twice as high as those with none.

Common myth: if someone self-harms, they must have a mental health condition 

Self-harm is a behaviour or symptom, not a disorder or an illness. Self-harming behaviour is strongly suggestive of an underlying psychological or emotional problem, but many young people who self-harm don’t meet the criteria for any specific mental health condition. It’s important that the young person is able to access a risk assessment and support to explore their self-harming behaviour. This may include a referral to a mental health professional for further assessment in relation to mental health.

Risk and protective factors

Self-harm occurs within a context of complex individual, social, cultural, religious, political, economic and spiritual factors which interact for the person. The same life event can have varying effects on a young person depending on what else is happening for them, their ability to cope and their support system. 

Protective factors that help to prevent self-harm include: 

• family connectedness
• connections to other non-parental adults
• closeness to caring friends
• academic achievement
• school safety
• neighbourhood safety
• awareness of and access to local health services. 

Family and friends are often the first to notice that a young person has been self-harming or intends to self-harm, so they have an important role to play in protecting that person. Self-harm may reduce if family and friends show acceptance, understanding, trust, kindness and support – positive connections that are often sought by those who self-harm. Family and friends also have a key role to play in encouraging the young person to engage in treatment.

The most-effective models for preventing and responding to self-harm include students having a positive school community where they feel they belong, resilience skills to help them cope with challenges, supportive family and friends who believe in them, and the ability and confidence to seek effective help when they’re experiencing difficulties.

Risk factors associated with self-harm may include: 

• young person and family adversity, inadequate parenting and parental divorce
• child and adolescent sexual and physical abuse
• exposure to negative life events
• exposure to self-harm and suicide of others (family and friends)
• belonging to one of the high-risk groups.

Bullying

There’s significant evidence that being bullied directly increases a young person’s likelihood of self-harming. A study published in the Journal of the American Academy of Child & Adolescent Psychiatry reports that when a young person has been bullied between the ages of 7-10, the subsequent risk of self-harm four times that of their un-bullied peers.

Find out more in Be You's Bullying Fact Sheet on why bullying occurs and how educators and the school can help to effectively reduce bullying.

How can young people develop resilience skills?

Be You’s Learning Resilience domain looks at developing resilience in young people and provides practical information on resilience programs and planning.

Help-seeking

It's estimated that around one-third to one-half of young people who self-harm don’t seek support for this behaviour.

Barriers to help-seeking may include: 

• the belief that others won’t understand their self-harming behaviour
• fear of confidentiality being breached
• fear of being seen to be attention-seeking
• uncertainty over whether families or educators could do anything to help
• fear that others will react negatively if self-harm is disclosed
• fear of being stigmatised
• the presence of depression, anxiety and suicidal ideation
• minimisation of self-harm as a problem
• the belief that one could or should be able to cope on one’s own.

Young people may also be prevented from seeking help because they simply don’t know where or who to turn to for support. In this situation, young people are more likely to turn to family and friends.

The internet is a resource for information and communication on self-harm, although research suggests it’s more commonly used as a tool for self-disclosure rather than asking for help. Young people may prefer to discuss their self-harm on the internet because it can provide them with a sense of anonymity, acceptance, validation and support at a ‘safe distance’.

On the other hand, concern has been raised about the use of the internet by young people who self-harm, as it may maintain or normalise such behaviour or the young person may receive a hostile response. Recent evidence has also shown that online communities that promote and glorify self-harm have been developing around hashtags designed to mask the intent of the communities. One such hashtag related to self-cutting had more than 56 million search results.

Technology and mental health

Technology and online mental health sites can help young people build a range of mental health strengths that may be protective against self-harming behaviours. In addition, technology can provide support and crisis help for young people engaged in self-harm.

Knowing the warning signs can help

Young people tend to hide their self-harming behaviours. In some cases, they may have one or two close friends they’ve told, but other friends and family may be completely unaware or might only suspect that something is going on. While there are obvious signs that someone is self-harming, such as exposed cuts or burns, and overdoses that require intervention, there are some less obvious signs to look out for. 

Physical signs: 

• unexplained injuries, such as scratches or burn marks
• unexplained recurrent medical complaints, such as stomach pains and headaches
• wearing clothes inappropriate to conditions – for example, long sleeves and pants in the middle of summer
• pulling hair or picking at fingers or skin when upset or stressed
• hiding matches, tables, razors or other sharp objects in unusual places
• use of drugs.

Psychological signs (many of which aren't unique to self-harming): 

• dramatic changes in mood
• changes in eating and sleeping patterns
• losing interest in friends and social activities
• breakdown in regular communications with family or friends
• hiding clothes or washing own clothes separately
• no longer interested in favourite things or activities
• problems with relationships
• low self-esteem
• being secretive about feelings
• avoiding situations where they must expose arms or legs – for example, swimming
• strange excuses for injuries
• dramatic drop in performance and interactions at school.

Want to know more about warning signs? 

Many of the warning signs of self-harm are also related to a range of mental health issues. Be You’s Notice module looks at changes in a young person’s behaviour that may indicate the presence of these.

 

You play an important role

As incidents of self-harm aren’t that unusual, you may find yourself in a position of recognising and providing support to a young person who is self-harming. It is important to reach out and try not to be judgemental or to freak out at their injuries. Listening, using a supportive and curious approach and following the school’s policies and procedures are the best things you can do. 

You may feel unprepared or challenged by the thought of having a conversation with a young person you are concerned may be harming themselves. Your school will have policies and procedures in place to support you and there are excellent resources available to help you build your confidence to take the most appropriate action.

Ways you can assist with prevention of self-harm: 

• know the warning signs and high-risk groups, and be alert to problems that may suggest students are at risk of or are self-harming
• take action if concerned about a student who’s self-harming by following the school’s agreed policies and procedures
• reach out to a student who may be at risk by listening to and using a supportive and curious, rather than judgmental, approach
• recognise that peers of the student who’s self-harming may also require support.

Look after yourself

Self-harm can be disturbing and confronting. Consider whether you might benefit from some advice and support for yourself. Explore Wellbeing tools for educators for a range of information and resources.

 

A whole-school approach is key

The most effective models for preventing and responding to self-harm include: 

• students having a positive school community where they feel they belong
• resilience skills to help them cope with challenges
• supportive family and friends who believe in them
• the ability and confidence to seek effective help when they’re experiencing difficulties. 

A whole-school approach to mental health and wellbeing is fundamental in providing and building these strong protective factors. It’s essential for schools to have an effective self-harm policy and procedures for educators on what to do when they’re concerned that a student is self-harming. Student wellbeing and leadership staff in schools can play an active role in ensuring these policies and procedures are current, effective and understood by all staff. 

In general, a school’s self-harm policy should provide staff with: 

• an understanding of self-harm
• a clear statement of the expectations for school staff in responding a student who’s self-harming
• warning signs
• procedures to follow once they identify that a student is self-harming (including clear referral pathways).

How should I communicate with families? 

Families play an integral part of the wider school community and may provide important protective factors against self-harm by their young people. It’s important to inform them of any concerns the school has relating to their young person and provide them with relevant evidence-based information. It’s always best to assess what’s in the best interest of the student when planning an approach to working with families. Talk to your school leadership and wellness staff for guidance on this matter.

Be You‘s Partner module provides strategies and skills for communicating with families, while the Inquire module looks at how you can have difficult conversations around mental health concerns.

How does a school build support pathways? 

A whole-school community includes connection with community support services and health professionals. Be You’s Provide module can help you understand how your school can build external mental health connections.