Stemming the Tide of Young Person Suicide and Self-Harm

ABSTRACT

Emeritus Professor Alan Glasper from the University of Southampton discusses strategies to reduce the incidence of suicide and self-harm in young people.

Introduction

On 29 January 2019, the UK government published its suicide prevention plan, which aspires to tackle the high levels of death by suicide in the country (Gov.UK, 2019). All political parties in England find it of concern that 4,500 people end their lives by suicide each year with approximately 13 people ending their life every day. Importantly and worryingly, suicide is now a leading cause of death in young people.

By coincidence, this latest UK government report was published shortly after the death of 14-year-old Molly Russell whose suicide was featured widely in the English press. Molly’s parents believed that irresponsible social media played a large part in her death. This is perhaps a poignant reminder of how easy it is for children and young people to access harmful material online. The Guardian newspaper reported that after Molly’s death a review of her Instagram account found numerous citations about depression and suicide (Adams, 2019).

Instagram is a photo- and video-sharing social networking service owned by Facebook. Subsequent to Molly’s death the Church of England criticized social media companies and accused them of failing to take appropriate action to protect children online from abuse, bullying, and exposure to harmful content (Hussain, 2019).

As a consequence a number of companies have agreed to remove harmful images of self-harm from their websites. The UK government has urged social media companies to take greater responsibility for their online content, especially subliminal and overt content that promotes methods of suicide and self-harm. It is important to stress that in response to Molly’s death and the degree of public outrage that followed, Instagram has announced that it will ban all graphic self-harm images as part of a series of changes it is making (Marsh & Waterson, 2019).

The scale of the problem

It is known that self-harm is a key indicator risk of suicide and the evidence suggests that both psychological characteristics and stressful life events are contributory factors in deliberate self-harm among young people (Madge et al., 2011).

With 4,500 suicides each year in England, this equates approximately to one person dying every two hours because of suicide. When someone is so emotionally troubled to take their own life, the effect on their family and friends is overwhelming. Many others involved in providing support and care, including nursing staff, experience the impact of the fatality (Cerel, Jordan, & Duberstein, 2008).

Data from the UK Office of National Statistics shows that there were 177 suicides among 15- to 19-year-olds in 2017, compared with 110 in 2010. Fifty-six girls/young women and 121 boys/young men took their own lives in 2017 in the UK. This gives a percentage rate of 3.5 per 100,000 people for girls/young women and 7.1 per 100,000 for boys/young men (Office of National Statistics, 2018).

In comparison in the USA in 2017, the American Foundation for Suicide Prevention shows that adolescents and young adults aged 15 to 24 had a suicide rate of 14.46 per 100,000 (American Foundation for Suicide Prevention, 2019).

It is widely acknowledged that emotional problems in childhood are increasingly a cause for concern, with up to 10% of children suffering from a diagnosable mental health disorder, and with half of all mental health conditions beginning before the age of 14. Children and young people today face emotional demands that did not exist in previous generations. The growth in social media and access to the internet, for example, has led to unexpected consequences. Hawton, Saunders, and O’Connor (2012) highlight the effects of social media on self-harm and suicide rates among young people. A report from the UK Education Policy Institute has shown that more than a third (37.3%) of UK 15-year olds in the country were classed as extreme internet users, who use the internet for more than six hours outside of school on a typical weekday. Nearly a third (27.6%) were 6 years old or younger when they first used the internet (Frith, 2017).

Crucially there is now a greater a greater awareness of childhood mental health problems in society and a growing expectation that mental health issues be viewed more positively. This has been helped by a high-profile royal campaign led by Prince Harry who has openly spoken of his own mental health concerns following the tragic death of his mother Princes Diana after the high profile fatal Parisian car crash in 1997 (Booth, 2017).

Actions to tackle childhood suicide and self-harm

In context, Beautrais (2000) has identified a number of risk factors for suicide and attempted suicide among young people. These include social and educational disadvantage, childhood and family hardships, exposure to stressful life events and where suicidal actions may reflect this milieu of influences. Other reasons as to why young people are vulnerable to self-harm include individual factors such as drug or alcohol abuse and social factors such as bullying or media and internet influences.

Perhaps in light of the growing concerns about childhood self-harm researchers at the English University of Oxford Department of Psychiatry have developed a guide for parents and carers (University of Oxford Department of Psychiatry, Medical Services Division, 2019). This guide shows that 10% of young people in the UK have harmed themselves through a variety of ways including, for example, cutting, taking an overdose, or hanging themselves. Although not all self-harmers have suicidal intentions, some do so accidentally when self-harming. Repeated self-harm in a young person is commonplace once it commences. Self-harmers have higher risk of suicide, which is mitigated if early interventions are put in place. Although intended for parents or carers, the Oxford guide to self-harm should help children’s nurses better understand the complexities of self-harm in childhood. In particular, this guide gives details of alternatives to self-harm that can be used by children and young people. These include the use of distraction and the utilization of stress management techniques such as exercise, pet therapy, or listening to music. In any event, children’s nurses should not shy away from discussing self-harm with a child or young person. It is important for children’s nurses to have sufficient training on self-harm and suicide as part of overall safeguarding training as this will ensure that suicide awareness within staff training becomes widespread and that key competencies and capabilities can be identified for suicide prevention training. It is because self-harm is a significant predictor of future suicide that children’s nurses need to factor this into any patient assessment.

Health Education England (HEE) and the National Collaborating Centre for Mental Health (NCCMH) have recently launched a series of self-harm and suicide prevention frameworks (NHS Health Education England, n.d.). Importantly and in light of of Molly Russell’s death, one of these frameworks is designed to help those professionals who work with children and young people. HEE launched its new learning resource on World Mental Health Day, 10 October 2018, which aimed to raise vital awareness about suicide and self-harm among healthcare professionals and the wider public.

Entitled “We need to talk about suicide” this e-Learning resource module takes between 60 and 90 minutes to complete and it aims to provide support for health care professional and others. It specifically aspires to enable them to recognise early warning signs of suicide, support patients and their families, as well as offering additional health services in this time of need (NHS Health Education England, 2018).

Conclusion

All children’s nurses need to be aware of self-harm and potential suicide in children and young people they provide care to on a day-to-day basis. Importantly these nurses also need to be aware of the stress and anxiety that caring for sick children can cause among health care professionals. My own colleague Michael Clift, to whom I dedicate this editorial, took his own life in 2018 after suffering chronic depression for many years. Michael was an esteemed and valued children’s nurse who worked at London’s Royal Free Hospital as the lead for clinical practice education in nursing across children’s services. He was especially interested in providing optimum care for young people with mental health problems.

I recommend readers to undertake the “We need to talk about suicide” e-Learning resource module.

Key points

• The parents of Molly Russell, whose suicide was featured widely across the English press, believe that irresponsible social media had a large part to play in her death.

• The increasing levels of self-harm among the young are especially concerning throughout society, and in light of this Instagram is removing explicit imagery of self-harm from its photo-sharing site.

• Data from the UK Office of National Statistics shows that there were 177 suicides among 15- to 19-year-olds in 2017.

• Repeated self-harm in a young person is commonplace once it commences, and self-harmers do have higher risk of suicide, which is mitigated if early interventions are put in place.

• 10% of young people in the UK have self-harmed through a variety of ways including, for example, cutting, taking an overdose, or hanging themselves.