youngminds2Treating young people who self-harm with compassion, dignity and respect could help to save lives, according to a report by the Royal College of Psychiatrists (RCPsych).

The report ‘Managing self-harm in young people’ has been written by psychiatrists to support and guide professionals working with young people, individuals and their families. It is an updated version of the College’s 1998 report on self-harm, and is endorsed by YoungMinds, the Royal College of Paediatrics and Child Health and the Royal College of Nursing.

The report’s authors make 14 recommendations. Key areas include:

Courage and compassion in asking about self-harm from community to hospital settings

Reduction of stigma and the importance of treating young people who have self-harmed in a non-judgemental and respectful manner

High-quality assessment at all levels of service to best support young people

That routine admission of 16 and 17-year-olds attending acute hospital is not expected. But if there is any doubt about the safety of the young person, the arrangement, or the quality of assessment, then admission to an acute hospital should follow.

The document also updates guidance on self-harm and the internet. The authors advise that it is critical for professionals to include an assessment of a young person’s digital life as part of clinical assessments, especially when there are concerns about self-harm.

Sensitive responses

Dr Andrew Hill-Smith, a consultant child and adolescent psychiatrist and a member of the Faculty of Child and Adolescent Psychiatry at the RCPsych, said: “Suicide remains the second most common cause of death among young people. Self-harm is an important signal of distress so it needs sensitive responses with careful handling.

“Our actions can make a difference for young people and turn lives around. Our actions can save lives.”

Dr Max Davie, a community paediatrician of the Royal College of Paediatrics and Child Health, added: “Self-harm is more common among young people than many realise. A survey of people aged 15-16 years carried out in the UK in 2002 estimated that more than 10% of girls and more than 3% of boys had self-harmed in the previous year.

“In most cases, people who self-harm do it to help them cope with unbearable and overwhelming emotional issues. These issues can lead to a build-up of intense feelings of anger, hopelessness and self-hatred. Often it is not easy for someone to admit that they have a problem, let alone to confide in anyone about what they are doing.

 “Therefore it is important healthcare professionals approach the subject with care and understanding. These guidelines will help tackle the stigma around the issues of self-harming, which can often put young people off seeking help and advice.”

Harsh environment

The report has been welcomed by young people’s mental health charity YoungMinds. “Self-harm is often dismissed as merely attention seeking behaviour but it’s a sign that young people are feeling terrible internal pain and are not coping,” said Lucie Russell, director of campaigns at YoungMinds.

“Young people today are growing up in a harsh environment with ever increasing stress to perform at school, bullying both on and offline, sexual pressures and next to zero job prospects.  The report rightly says that NHS services must treat young people who self-harm with more dignity and compassion but schools must also play their part in placing much more emphasis on teaching emotional resilience and coping skills and mental health services must have the resources and capacity to respond to every young person who is experiencing extreme distress. Parents too should have places they can go and experts to talk to if their child is self-harming.

“We are also really pleased to see recognition in the report of the vitally important role digital technology plays in young people’s lives-both negatively and positively and how all clinicians must take account of this when assessing and treating young people who self-harm.”