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The Findings From Widespread International Research Suggest That The Most ...


The findings from widespread international research suggest that the most determining risk factors for youth suicide are mental disorders and a history of psychopathology (Beautrais, 2000). Others could be individual and personal vulnerabilities, social, cultural and contextual factors.
Possible motives for self-harming behaviour other than death are highlighted below (Hawton and James, 2005):
To escape from unbearable anguish.
To change the behaviour of others.
To escape from a situation.
To show desperation to others.
To make others feel guilty.
To gain relief of tension.
To seek help.
Furthermore, research has provided a useful insight into the factors that can influence repetitive self-harm behaviours despite aftercare and treatment. This is important in the assessment of patients who have self-harmed to identify those who are likely to self-harm again and prevent such episodes. Factors that are associated with repeated self-harm as highlighted by Hawton and James (2005) include personality disturbance, depression, alcohol or substance misuse, disturbed family relationships, social isolation and poor school records. Hawton et al (1999) demonstrated that self-harm repeaters differed from the non-repeaters in having higher scores for depression, hopelessness and trait anger, and lower scores for self-esteem.
Specific reasons that have been cited for self-harm by young people, as highlighted by the National Inquiry (2006) include:
Bullying
Strained relationships with parents
Parental divorce
Unwanted pregnancy
Worry about academic performance
Childhood abuse (sexual, physical or emotional)
Low self-esteem or rejection
Problems to do with race, culture or religion
2. Responding To Young People Who Self-Harm
2.1 Guidelines And Evidence For Good Practice
The National Institute for Clinical Excellence (NICE, 2004) has proposed guidelines for the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. In addition, The Royal College of Psychiatrists (RCPSYCH) also provides guidance on managing young people up to the age of 16 who deliberately harm themselves. Such guidelines are readily applicable to the Health service i.e. Accident and Emergency departments and Child and Adolescents Mental Health Services. Integrating these treatment guidelines and the findings of related research, the management of these young self-harm patients will be extensively discussed under the following sub-titles:
Assessment
Treatment planning
Admission to hospital
Treatment options
Medical and surgical management
Referral and discharge following self-harm
Pharmacological interventions
Family support
Prevention
A comprehensive child and adolescent mental health service needs to take all the above facets into consideration when treating this group of extremely vulnerable patients.

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