By Abby Russell, Senior Lecturer in Child and Adolescent Mental Health, University of Exeter
The risk of intentional self-harm is high for adolescents and young adults – around one in four young people report that they have self-harmed (hurt themselves physically on purpose) by their early 20s. Self-harm is concerning for many reasons: it causes physical harm, and it is emotionally distressing for the young person and others who care for them. Research also shows that those who have a history of self-harm are at a higher risk of suicide than other young people. Suicide is uncommon among young people, however the numbers are not insubstantial: 174 young people age 10-19 died by suicide in England and Wales in 2020. Self-harm and suicide do not just affect one person: there are impacts on their friends, families and wider communities as well.
Our new research project within the SPHR’s Public Mental Health Programme, led by researchers at the Universities of Exeter and Bristol, looks at:
- how to talk safely to young people about self-harm and suicide
- how best to provide support after a suicide to prevent potential attempts by others in the community. We will look at these two questions from a settings perspective, working with the organisations attended by young people up to around 18 years old (e.g., schools, colleges, sports clubs, youth clubs), to find out what systems, policies and processes would help them to better support the young people in their care.
It is not clear whether talking openly with young people about self-harm or suicide is a positive thing, if it reduces stigma, if it increases opportunities to provide help, or if it may accidentally increase a young person’s risk. Although the evidence so far leans towards the former, many school staff and other adults who work with adolescents are very concerned about the possibility of ‘giving people ideas’ or unintentionally increasing someone’s risk. Research we did a few years ago showed us that secondary schools are often so worried about this that they will not explicitly mention or discuss self-harm or suicide to their students in a preventative way, and will only discuss this openly with individual students, if they disclose self-harm, thoughts of suicide or a suicide attempt.
When a young person or an adult in their community dies by suicide, this impacts on a wide range of people around them. Staff in settings working with young people might need to consider how they tell others about what has happened, how to reassure and help affected young people and adults to cope with grief, how to manage any media attention, how to convey accurate information that does not sensationalise the tragedy, and how to ensure that others in the community are protected from serious mental health problems or suicidal thoughts themselves (often called ‘contagion’).
We currently know little about how schools/colleges and other youth organisations affected by suicide do respond – do they have policies and plans in place, for example are they included within ‘safeguarding’, or do they only develop a plan after a suicide is experienced? Do they know where they can get help when they experience a suicide or attempted suicide? What are the views of these setting about doing more work with young people to help prevent self-harm or suicide, such as encouraging help seeking when young people have concerning thoughts or feelings? And how can we use existing scientific evidence to reduce concerns and provide better support?
We are starting this project with an initial information gathering phase (phase 1). We will conduct a survey with a large number of settings including schools, colleges and governing bodies of youth organisations to find out what they are currently doing, their approach to the topics of self-harm and suicide, and what they would like to do more of or do differently. We will find and review existing guidance on self-harm and suicide for these settings, and see if they are aware of or using any guidance to inform their current support and/or or prevention work. Finally, we will look at evidence about who young people say they talk to about these topics from existing surveys and other datasets. The project involves collaborative work from start to finish with members of the public, including young people, who have lived experience of self-harm, suicidal thoughts or lost someone to suicide to ensure the work carried out and any recommendations are meaningful and relevant.
We will use what we find in phase 1 to develop phase 2 of the study. In this phase, we will work with youth organisations or schools that have experienced a death by suicide. We will spend time with them understanding how the experience affected them and how they responded, as well as doing more in-depth research into how settings support students who self-harm.
By the end of both phases, we aim to have a much more detailed picture of what the needs and priorities are for youth settings to better support young people at risk of self-harm and of suicide. Specifically, we will use the findings to produce – with input from these settings – guidance that advises what settings can do to help prevent suicide and self-harm, and how best to respond in the event of a suicide within their community.
If you are interested in knowing more about the study, or have relevant experience and would like to consider getting involved, then please contact Abby here: a.e.russell@exeter.ac.uk