Students who self‐harm: a case study of prevalence, awareness and response in an English university

Abstract

Deliberate self‐harm (DSH) is a perplexing and distressing phenomenon that has received considerable publicity in recent years. It takes many forms, some of which are culturally acceptable while others are considered to be anti‐social and/or mental health problems. It affects a significant proportion of the population, with previous studies in the United Kingdom and elsewhere finding between 5% and 15% of young people with a history of self‐harm. However, there is little published research on DSH in educational settings and how it is handled in schools and universities. This paper reports a mixed‐method study of DSH amongst students in a university in the Greater London area. The methodology took the form of a questionnaire survey (n = 348) of mainly undergraduate students, semi‐structured interviews (n = 30) with students and staff, and two focus groups (n = 9). Significant levels of self‐harming behaviours were found, including cutting, binge‐drinking, risk‐taking, eating disorders and substance abuse. Form and prevalence were found to vary by gender, ethnicity and programme of study, although neither the statistical nor the policy significance of these variations appeared to be great. Interviews accessed case descriptions and perceptions of prevalence, awareness and institutional response, and raised questions about the impact of DSH on other students and on the staff who provide support. Professional and ethical issues raised by cases of DSH were a major topic for discussion at interview. The preliminary findings were presented to two focus groups that considered their implications for policy and practice, including counselling, student induction, and training and supervision for staff. The paper concludes with a typology of self‐harming behaviours in terms of their severity, visibility and cultural acceptability. It is hoped that this may be of use to universities and other institutions in developing policies and procedures for dealing with this issue.

Keywords:

• self‐harm
• self‐injury
• student support
• university students

Acknowledgements

Grants from the Sir Halley Stewart Trust and from the project university are gratefully acknowledged. The author is indebted to all those staff and students who completed questionnaires and/or agreed to be interviewed or to participate in focus groups. For ethical reasons, they must remain anonymous. The author is also most grateful to Catherine Shiplee for her assistance in transcribing interviews, setting up spreadsheets and running the statistical tests. Her patience, efficiency and good humour were invaluable. And thanks to Tim Bagnall for help with the diagrams.

Notes

1. For ethical reasons, the identity of the university in which the study was undertaken is protected in what follows. To prevent identification, the labels of specific services (such as ‘student support department’) are generic and are not necessarily those used by the university in question. The same is true for specific roles (such as ‘course leader’).

2. Grants from the Sir Halley Stewart Trust and from the project university.

3. The protocol approved by the Ethics Committee included procedures for protecting the identities of participants and ensuring the anonymity of questionnaires, and the use of an ‘informed consent’ form distributed and signed in advance by all interviewees and focus‐group participants. For an extended discussion of the ethical issues raised by research on this topic, see Best (2006c).

4. A draft questionnaire was given to five colleagues at my own university (Roehampton) and revised in the light of their comments. The revised version was trialled with a convenience sample of 25 undergraduate students at Roehampton and revised again in the light of their responses and specific feedback before being printed for use in the project university. Altogether, just fewer than 2000 questionnaires were made available within the project university. The return rate was 18%.

5. The respondents were reasonably representative of the undergraduate student population (figures provided by the project university) as follows:

For analysis, respondents were grouped into broad areas of interest according to the subjects for which they were registered. This is not straightforward because the project university offers single‐subject and joint‐honours programmes, so some students are registered for more than one subject and these are not necessarily in cognate areas. Students in the following groups of subjects were over‐represented: education and teacher‐training; English subjects; sciences; creative subjects; business studies. The following were under‐represented: psychology‐related; childhood studies; social sciences; languages.

6. Status of interviewees [Interviewees 1–30]:

1. Student welfare officer

2. Lecturer

3. Disability support staff

4. Student

5. Lecturer

6. Student

7. Lecturer

8. Warden of hall of residence

9. Chaplain

10. Security

11. Student Union representative

12. Lecturer

13. Lecturer

14. Lecturer

15. Student Services

16. Student Services

17. Student Union representative

18. Student

19. Student

20. Counsellor

21. Student

22. Student welfare officer

23. Student welfare officer

24. Lecturer

25. Student

26. Lecturer

27. Lecturer

28. Student welfare officer

29. Lecturer

30. Lecturer

7. Points of interest noted in the phenomenological analysis of interview transcripts and the number of transcripts in which they were mentioned:

• Role‐boundaries (15)

• Impact on other students (14)

• Staff/student/Student Union perceptions of the counselling service (14)

• Eating disorders (10)

• Confidentiality (10)

• Student culture (drinking) (9)

• Psychological factors (9)

• Parents (9)

• How does DSH come to the attention of staff? (9)

• Variations among students studying different subjects (9)

• University ethos/expectations/requirements (7)

• Staff personal and professional experience outside university (7)

• Dance students and eating disorders (4)

• Impact of disclosure/encounter on staff (4)

• Bi‐polar disorder and mental health problems (4)

• Prevalence amongst international students? (3)

• Fatalities (3)

• Counselling/psychology courses seen as attracting students with mental health issues (3)

• Gender (3)

• Record‐keeping (2)

• Students as autonomous adults (2)

• Impact of media treatment of self‐harm (2)

• Support from ‘outside’ agencies (1)

• Referral to ‘outside’ agencies (1)

• Alcohol (1)

• Institutional factors (1)

• ‘Fitness to study’ (1)

• Concepts of ‘displaced’ and ‘anchored’ students (1)

• Ethnicity (1)

• Self‐harm among staff (1)

• Drugs (1)