It’s time to change the conversation around self-harm - in our own lives and in national policy

Self-harm - that’s a phrase many of us may feel uncomfortable bringing up in conversation. Even as we’ve become more comfortable talking about mental health and wellbeing in recent years, about recognising that it’s okay not to be okay, about challenging stigma and encouraging open, honest conversations, some words are still difficult. Some topics still feel too dangerous, too complex and the risk of saying ‘the wrong thing’ feels too great - to the point where we may decide to say nothing at all.

At Samaritans, we know topics like self-harm aren’t easy to talk about. Whether someone is seeking help because they are concerned about their own self-harm or reaching out to a loved one who they are worried about - these aren’t easy conversations to have. But when we do take that brave first step, when we do start the conversation, we can begin to change things for the better.

While self-harm is often hidden, making it hard to understand its true scale, data from the Scottish Health Survey shows that the proportion of adults in Scotland who say they have self-harmed more than doubled from three per cent in 2008-09 to seven per cent in 2018-19 while the same survey found that 1 in 6 (16 per cent) young people aged 16-24 have self-harmed at some point. Whether we talk about it or not, it’s clear that self-harm is something affecting many individuals, families and communities across Scotland.

In our recent report Hidden Too Long: uncovering self-harm in Scotland we engaged with people with lived experience, stakeholders across sectors and services, and the general public to understand what needs to change to challenge stigma, strengthen support and address the underlying causes of self-harm.

We were encouraged to find that the vast majority of the Scottish public - nearly 9 in 10 (89 per cent) - feel that self-harm is a serious issue and want to see further action to address it. But despite this clear public will for further action, self-harm is not currently a focus of national mental health policy.

We are concerned that - just as we may struggle to talk about self-harm in our own lives - we’re also struggling to have these conversations at a national level, leaving self-harm to fall too far off the policy agenda for too long. And as the current uncertainty around coronavirus continues to impact daily life and exacerbate mental health challenges, it’s even more pressing that we renew our efforts around self-harm.

That’s why we’re calling for a new, distinct national strategy to improve understanding, strengthen support and address the underlying causes of self-harm.

Our research to develop a more comprehensive picture of self-harm in Scotland highlighted many challenges. We found that while the majority of people who had self-harmed had sought support from a range of sources over their lifetime, only half did so following their most recent experience of self-harm. When we asked people why they didn’t seek support, fear of judgement, feeling uncomfortable speaking openly about self-harm and a perception that services couldn’t or wouldn’t help them were all common themes. And while the wider public was supportive of further action to address self-harm, 2 in 5 (40 per cent) people in Scotland said they would not know how to support a loved one who was self-harming.

Similarly, our conversations with stakeholders working across frontline services revealed genuine ambition to deliver a compassionate, person-centred response to self-harm that addressed both the immediate need and the underlying causes, but we found many barriers to realising this aspiration. These included a lack of training so frontline workers felt confident in responding to self-harm, a lack of specialist support services to refer onto or - where such services did exist - long waiting lists and restrictive eligibility criteria.

But this research also uncovered areas of untapped opportunity - including many points at which safe and supportive conversations about self-harm are already taking place to some extent and where more conversations like these could take place in future. Our research found that when people did seek support for self-harm, they did so from a range of informal and formal sources. Yes, healthcare services played a significant role, but so too did support from family and friends, from online forums and community groups, and, to a lesser extent, from workplaces, schools and universities. By strengthening these wider support networks and the connections between different sources of support, sectors and services we can ensure that everyone who reaches out receives the right help, at the right time and in the right way for them.

But realising this vision requires national leadership.  If we’re going to encourage people to have safe and supportive conversations about self-harm across services and community settings and even among family and friends, we need to see that same willingness in our leaders across the political spectrum. We don’t need to have all the answers to start this conversation; what we need is a shared commitment to listening, learning and acting together to ensure that whenever anyone asks for it, the right support is there.  

Rachel Cackett, Executive Director of Samaritans Scotland

Anyone can contact Samaritans FREE any time from any phone on 116 123, even a mobile without credit. This number won’t show up on your phone bill. Or you can email jo@samaritans.org or visit www.samaritans.org