There has been a threefold increase in the number of teenagers who self-harm in England in the last decade, according to a World Health Organisation collaborative study.
The Health Behaviour in School-Aged Children (HBSC) report, due to be published in the autumn, will reveal that of the 6,000 young people aged 11, 13 and 15 surveyed across England – up to one in five 15-year-olds say they self-harm.
There is no comparative data from other countries as England is the first country to ask this question on self-harm since the global study, which is conducted every four years, began in 1983. The decision to include it follows a rise in anecdotal evidence from teachers in secondary schools across the country.
The last comprehensive study of self-harm in England was published by the British Medical Journal in 2002. It surveyed around 6,000 15- and 16-year-olds in 41 schools and found that 6.9% of them said they had self-harmed over the past year. This compares with the 2013-14 WHO study, which puts the figure at 20% of 15-year-olds.
Self-harm includes actions such as cutting, burning and biting oneself. Professor Fiona Brooks, head of adolescent and child health at the University of Hertfordshire, is the global study’s principal investigator for England. She says: “Our findings are really worrying, and it’s [self-harm] considerably worse among girls. At age 11, both girls and boys report a good level of emotional wellbeing. But by the age of 15, the gap has widened and we get 45% of adolescent girls saying they feel low once a week compared with 23% of boys.”
She warns of a ticking timebomb unless the rise in poor mental healthamong young people is addressed. “We don’t yet know enough about why this [poor mental health] is but parents are busy and stressed, and children’s lives are becoming more pressurised. They know they need better grades to get to university, but there’s no guarantee of a job at the end of it all.”
Brooks believes that young people are “turning to strategies such as self-harm to manage stress in the short term”.
“Although there has been a decline in traditional risk behaviours like smoking and drug and alcohol abuse, there hasn’t been a transition to more positive health behaviours,” she says.
Grace, 16, appears to be a bubbly and confident teenager who loves music, singing and netball. She is studying for her GCSEs. However, when she was 12, Grace began self-harming.
“I began cutting my wrists using scissors and razor blades, which I disinfected myself,” she says. “As time went on and I got worse, it progressed all the way up my left arm and my upper thighs. I just bandaged it up and left it.”
Years of cutting have left her with deep scars that she covers up when around people she doesn’t know very well. “At my worst, I was hurting myself once a week or even more. Sometimes it was once a month. It just depended what was going on around me,” she explains. “It calmed me down but then I’d immediately wish I hadn’t done it as it hurts and you need to hide it.”
Despite celebrities, including actor Angelina Jolie and singers Miley Cyrus and Demi Lovato, going public that they have self-harmed, and a number of pro-self-harm websites putting the behaviour on young people’s radar, Grace says she wasn’t aware of anyone else doing it. She never confided in her mum, but finally a teacher noticed.
“I was hauled into the headteacher’s office one morning, and my mum and my teacher and the head were all sitting there. I was totally bowled over when they said they knew what I’d been doing, ” she recalls. As a result of the meeting, Grace retreated further into her world, self-harmed more and concealed it better. “Even when I wanted to stop, I couldn’t – and it took me longer than I care to admit to get things under control,” she says.
The local child and adolescent mental health service (Camhs) in Oxfordshire said it couldn’t help Grace because she had not been formally diagnosed with any condition. She did receive counselling via her school, but says it didn’t help because she couldn’t relate to the older counsellor.
Although her mum says she feels she has failed her, Grace doesn’t blame anyone for what she went through. “It’s no one’s fault. I just wish I’d been able to cope with things better,” she says.
“When I was 12, my mum was moving in with my now stepdad, I wasn’t getting on very well with anyone at school, and the few friends I did have weren’t being very kind. I struggle with change, so from all aspects it was hard. It had always been me, my mum and my sister, and it was all so new with my stepdad. My real dad worked abroad a lot so I felt I didn’t have anyone to talk to and I didn’t have any way of dealing with it.”
Of her gradual recovery, Grace says: “Maybe I just got used to the changes around me and things got better at school. I have a close group of friends, and for the first time I have a best friend which I’ve never had before. My family has been very supportive too.”
But she adds that being diagnosed with depression a year ago was a huge relief and she believes that an earlier diagnosis would have helped. “It stopped me being confused about why I felt this way,” she says. “Although it sucked to have a label, being diagnosed helped me to realise that there was a reason behind what I was doing and once I dealt with the reasons, I knew I wouldn’t have to revert back to self-harm any more.”
Selfharm.co.uk is a website set up in 1993 to support the emotional and social needs of all young people. It provides a forum where self-harmers can seek advice and feel connected with others going through similar experiences. Grace was asked to pilot its Alumina scheme, which provides weekly online meetings with counsellors and doctors and she participates in various activities that help to analyse what she is doing.
Rachel Welch, the director of Selfharm.co.uk, says catching the problem early makes it easier to stop. “We know that the earlier you intervene, the easier it is to break this habit.”
Technology is enabling young people to seek help much more quickly – even within a day of first self-harming, she believes. The Samaritans reports that self-harm is the main reason people use its text messaging service, which, it says, is proving hugely helpful to young people.
Self-harm has only been recognised as a diagnosis across Europe since May last year. It is diagnosed as “non-suicidal self injury”. Professor Peter Fonagy, clinical adviser to NHS England’s Improved Access to Psychological Therapies programme, says: “Only a small fraction, up to 15% [of people self-harming] ever present to clinical services – so it really is only the tip of the iceberg, as is the case with most mental disorders, where the unmet need is very high.” He adds that young people who self-harm are more likely to go to a trusted adult such as a teacher or a policemen or even A&E. “This is why it’s important that these people are given the right tools to assess the risk and take appropriate action,” he says. He points to MindEd.org.uk, an online resource, launched by the Department of Health, for anyone working with children and young people’s mental health issues.
Dr Jacqueline Cornish, national clinical director for children and young people at NHS England, who is responsible for the Camhs service, says for those young people who do seek help from a health professional: “It is vital we have the right services in place when children, young people or indeed adults need them. But this must be combined with greater public understanding of the reasons why someone might self-harm and how to get help.”
Brooks believes research is telling us a closer look is needed at what has caused such a dramatic increase in self-harm in the past decade. “We need to know what strategies to put in place to help young people navigate adolescence successfully.”
Grace advises any young person who is self-harming to “talk to someone, reach out”. She welcomes celebrities, such as Lovato, who have used social media to raise awareness about fans who self-harm. “I don’t think they glamorise it. She has dealt with many mental health issues herself and now puts her experiences to the good of others,” she says.
Of her own experience of speaking out, Grace says: “I’ve had overwhelming support. I’m in a good place and I can pretty much say 100% I’m not going to go back to it.