Avneet Sharma
More than 700 000 people die by suicide annually worldwide, and many more engage in self-harm. Suicide is preventable, and many acts of self-harm occur with no or low suicidal intent at times of personal crisis. Youth is heightened period of risk of suicide and suicidal behaviour. The National Crime Records Bureau (NCRB) released data on suicidal deaths in India in August, 2022 A total of 1,64,033 suicides were reported in the country in 2021 and as many as 13,039 students died of suicide in 2021. Academic failures and relationship issues dominate the causes of suicide in the young. Other causes reported in literature include substance abuse and impulsivity.
Too often suicide attempts and suicides especially among the young become family secrets that are not investigated or dealt with in ways that might protect others from a similar fate.
In this article we take a look at ways to arrive at an understanding of young persons who self harm- as this particular group remains a high risk group for completed suicide
Self-harm is a term used when someone injures or harms themselves on purpose rather than by accident. Common examples include ‘overdosing’ (self-poisoning), hitting, cutting or burning oneself, pulling hair or picking skin, or self-strangulation. Self-harm is always a sign of something being seriously wrong.
Why do young people harm themselves?
Unfortunately some young people use self-harm as a way of trying to deal with very difficult feelings that build up inside. This is clearly very serious and can be life threatening. People say different things about why they do it. Some say that they have been feeling desperate about a problem and don’t know where to turn for help. They feel trapped and helpless. Self-injury helps them to feel more in control.
Some people talk of feelings of anger or tension that get bottled up inside, until they feel like exploding. Self-injury helps to relieve the tension that they feel.
Feelings of guilt or shame may also become unbearable. Self-harm is a way of punishing oneself.
Some people try to cope with very upsetting experiences, such as trauma or abuse, by convincing themselves that the upsetting event(s) never happened. These people sometimes feel ‘numb’ or ‘dead’. They say that they feel detached from the world and their bodies, and that self-injury is a way of feeling more connected and alive.
A proportion of young people who self-harm do so because they feel so upset and overwhelmed that they wish to die by suicide. At the time, many people just want their problems to disappear, and have no idea how to get help. They feel as if the only way out is to kill themselves.
Who is at risk?
An episode of self-harm is most commonly triggered by an argument with a parent or close friend. When family life involves a lot of abuse, neglect or rejection, people are more likely to harm themselves. Young people who are depressed, or have an eating disorder, or another serious mental health problem, are more likely to self-harm. So are people who take illegal drugs or drink too much alcohol.
Many young people who self-harm with a wish to commit suicide also have mental health or personality difficulties; often the suicide attempt follows a stressful event in the young person’s life, but in other cases, the young person may not have shown any previous signs of difficulty.
Sometimes the young person is known to have long standing difficulties at school, home or with the police. Some will already be seeing a counsellor, psychiatrist, or social worker.
The risk of suicide is higher if the young person:
* is depressed, or has a serious mental illness
* is using drugs or alcohol when he is upset
* has previously tried to kill himself, or has planned for a while about how to die without being saved
* has a relative or friend who tried to kill himself.
How can I help?
Notice when the young person seems upset, withdrawn or irritable. Self-injury is often kept secret but there may be clues, such as refusing to wear short sleeves or to take off clothing for sports.
Encourage them to talk about their worries and take them seriously. Show them you care by listening, offer sympathy and understanding, and help them to solve any problems.
Buy blister packs of medicine in small amounts. This helps prevent impulsive overdoses. Getting pills out of a blister pack takes longer than swallowing them straight from a bottle. It may be long enough to make someone stop and think about what they are doing.
Keep medicines locked away.
Get help if family problems or arguments keep upsetting you or the young person.
If a young person has injured himself, you can help practically by checking to see if injuries (cuts or burns for example) need hospital treatment and if not, by providing them with clean dressings to cover their wounds.
As a parent, it’s really hard to cope with a child/young person with self-harming behaviour or who attempts suicide. It’s natural to feel angry, frightened or guilty. It may also be difficult to take it seriously or know what to do for the best. Try to keep calm and caring, even if you feel cross or frightened; this will help your child/young person know you can manage their distress and they can come to you for help and support.
This may be difficult if there are a lot of problems or arguments at home. Or, you may simply feel too upset, angry or overwhelmed to effectively help your child/young person. If so, you should seek advice from your GP.
If you are a teacher, it is important to encourage students to let you know if one of their friends is in trouble, upset, or shows signs of harming themselves. Friends often worry about betraying a confidence and you may need to explain that self-harm is very serious and can be life threatening. For this reason, it should never be kept secret.
What to say
If you are worried about a friend or family member, ask how they are doing .Say that you have noticed that they have been acting differently recently and you are concerned. It is OK to ask directly if they are having thoughts about suicide, too. Many people are concerned that they will plant the idea or make someone’s mental heath worse by mentioning it, but experts say that is not the case and if the person opens up to you, give them space to talk about what they are feeling.
It is actually very small things that can make a crucial difference – just engaging with somebody and something as simple as telling a friend or family member that you value them can go a long way.
Where do I get specialist help?
Everyone who has taken an overdose, or tried to kill himself, needs an urgent assessment by a doctor as soon as possible even if he looks OK.
Usually, this means an examination at the nearest Emergency Department .If you are unsure whether the young person was suicidal or not, it is best to act cautiously and take him to hospital. With overdose, the harmful effects can sometimes be delayed, and treatment with medication may be needed…If the young person is self harming himself in one way or other ways, it is still important that they have help.
How is it treated?
All young people who attend hospital following attempting suicide or harming themselves should also have a specialist mental health assessment before leaving.
It is usual for parents or carers to be involved in the assessment and any treatment. This makes it easier to understand the background to what has happened, and to work out together whether more help is needed.
Usually, treatment for self-harm and attempted suicide, other than any immediate physical treatment, will involve individual or family ‘talking therapy’ work for a small number of sessions. They will need help with how to cope with the very difficult feelings that cause self-harm.
Clear plans on how to help and how to keep the young person safe should also be made. Some people who find it very difficult to stop self-harming behaviour in the short term will need help to think of less harmful ways of managing their distress. This normally will include learning new ways namely distraction techniques , grounding themselves through breathing exercises and meditation, talking to friends and family and learning to identify and articulate distressing emotions. Overall approach is to encourage the person to take more responsibility for their lives and seek help appropriately .
In India one can turn to professional help through
Local Mental health services
There are number helplines/on line resources- regional and national (e.g. KIRAN, a 24/7 national helpline that can be accessed) .
Other approaches are based upon involving wider community for example Gatekeeper Training can be relevant as it focusses on skill development to enable community members such as teachers ,coaches ,Doctors, Nurses, Medical and Nursing students, Police personnel to enquire directly about the self harm/suicidal ideations and persuade suicidal individuals to accept help .
(The author is a practising Psychiatrist in UK)
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