Self-harm describes a wide range of things that people do to themselves in a deliberate and usually hidden way. In the vast majority of cases self-harm remains a secretive behaviour that can go on for a long time without being discovered.

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Self-harm can involve:

• cutting
• burning
• scalding
• hitting or scratching
• breaking bones
• hair pulling
• swallowing toxic substances or objects.

Although some very young children and some adults are known to self-harm and it often continues from childhood into adulthood, the majority of people who self-harm are aged between 11 and 25 years.

Why do young people self-harm?

Self-harm is a symptom of underlying mental or emotional distress. Young people who self-harm mainly do so because they find it helps relieve distressing feelings and helps them cope with problems in their lives. It is rarely about trying to end their life.

A wide range of factors may be involved. Very often there are multiple triggers, or daily stresses, rather than one significant change or event. Factors can include:

• feeling isolated
• academic pressures
• suicide or self-harm by someone close to the young person
• family problems, including parental separation or divorce
• being bullied
• low self-esteem.

But self-harm is not a good way of dealing with such problems. It provides only temporary relief and does not deal with the underlying issues.

How common is self-harm among young people?

There is relatively little research evidence about the prevalence of self-harm among young people. Hospital records show only part of the picture. The majority of young people who self-harm will either not harm themselves in a way that needs medical treatment or they will deal with it themselves.

Can self-harm among young people be prevented?

There are ways to prevent self-harm among young people. Anti-bullying strategies and whole-school approaches designed to improve the general mental health and well-being of young people appear to have a positive effect, though there is no specific evidence as yet on their impact on self-harm.

Evidence from young people themselves suggests that social isolation – and believing that they are the only one that has self-harmed – can be a key factor in self-harm for some. It is likely that better information for young people about self-harm would increase their understanding and might help reduce or prevent self-harm. Similarly, better awareness and understanding among parents, teachers and others who come into contact with young people is also likely to have a positive impact.

Do we have good responses to young people who self-harm?

Anecdotal evidence suggests that many young people benefit very much from these, but to date there is not a strong evidence base to demonstrate their effectiveness.

There is stronger evidence – mostly direct from young people – that finding ways to distract from, or alternatives to, self-harm can be very important for many young people. Distraction techniques that are reported as being effective for some young people include using a red pen to mark rather than cutting, rubbing with ice, hitting a punch bag or flicking elastic bands on the wrist.

Conclusion

Self-harm among young people is a serious public health challenge. There is a need for much better data about prevalence. There is also a need for better awareness and understanding of self-harm and its underlying causes both among young people themselves and those who come into contact with them. Stronger and clearer evidence about what might prevent self-harm and about effective responses to self-harm among young people is also needed.