Self-harm in young people is emerging as a major public health problem all over the world. Self-injury and/or self-poisoning regardless the motivation or intention is considered as self-harm. Most of the time self-harm is an expression of underlying mental health problem of an individual.
Usually people from 10 years to 24 years are considered as young people. Mental health problems like depression and suicide are leading causes of death and disability among this group. Violence, poverty, humiliation, hopelessness and feeling devalued can increase the risk of developing mental health problems. Research showed self-harm is most common in 15–24 year olds and more common in females.
As self-harm is strongly associated with both attempted and completed suicides, patients with self-harm should be assessed and treated effectively. Self-harm is often repeated; up to 18% will repeat this behavior within one year of hospitalization- different studies show. Among your people who die by committing suicide have a history of self-harm in the past. So self-harm is the strongest predictor of suicide among young people.
In the last two decades the burden of self-harm increased almost two times in Bangladesh. According to Global burden of Disease (GBD) in 1990 the burden was 0.52% of total disease burden and 1.10% in 2010. Bangladesh alike other countries do not have any community based data on this problem. Hospital based statistics are likely to be “Tip of the Iceberg”, with many cases remaining unreported and untreated.
The reason behind self-harm is “escaping behavior”, wanting to escape or get relief from unbearable feelings or state of mind. Hopelessness, lack of self-esteem, impulsivity, depression and entrapment are important factors that put young person vulnerable to doing self-harm. Experiencing negative life events for example divorce of the parents, domestic violence, sexual abuse, facing bullying from the peers also increases the tendency to do self-harm. Bad relationship with family, friends and partners also play a crucial role. Domestic violence and economic constraints induce self-harm in young females.
Self-harm is often a way of coping with painful and difficult feelings and distress. Qualitative studies suggest that young people who self-harm themselves find it very difficult to talk about their mental stress and sufferings and even if they do, they feel “Not being heard”. Indeed, experiencing negativity and judgmental attitudes from clinicians can be very detrimental to the prognosis of these patients. Unfortunately studies showed that clinical staffs had negative attitude towards these patients.
Dealing these patients compassionately in a competent manner through active, non-judgmental listening should be the bedrock of all clinical practice for self-harm. When these patients come to the emergency department for treatment, besides treating the physical injuries, they should be offered full psychiatric assessment and counseling. Sometimes, if necessary, the family members should also be counseled.
Building life skills in children and adolescents and providing them with psychosocial support in schools and other community settings promote good mental health and reduce the risk of self-harm. Home based family therapy, group therapy and individual sessions with the patients will help to reduce the incidence and recurrence. Appropriate training to doctors and nurses on dealing with self-harm patients are crucial in this regard.
N.B. This article was published on “The Independent Bangladesh” on Monday 08 December 2014.