Mental health is a way of describing social and emotional wellbeing. Good mental health is central to a child’s healthy development. It is associated with feeling happy and positive about oneself and enjoying life; healthy relationships with family and friends; participation in physical activity and eating a healthy diet; the ability to relax and to get a good night’s sleep and community participation and belonging.

We need good mental health to build strong friendships/relationships, adapt to change and deal with life’s challenges. Puberty is a time of great physical and psychological change for young people and can test young people’s resilience and that of the people around them!

When some young people are struggling to regulate their emotions, they may self-harm. Self-harm often goes unnoticed. It is commonly done in private and most young people who self-harm don’t actively seek help or come to the attention of health services.

What is Self-harm?

Self-harm is a term used to describe a range of behaviours associated with people deliberately harming themselves regardless of their intention. Self-harm is a behaviour, not an illness. In contrast, suicidal behaviours refer to suicidal ideation (serious thoughts about taking one’s own life), making suicide plans and suicide attempts where the self-injury is intended to end in death.

The most common type of self-harm among young people is cutting. Other types include:

• burning the skin until it marks or bleeds
• picking at wounds or scars
• hitting themselves
• pulling hair out by the roots.

More extreme self-harm can include breaking bones, attempted hanging and deliberately overdosing on medication.

There are other deliberate behaviours that can be harmful to one’s health that are not normally included in the definition of self-harm. These include self-starving, binge drinking, and substance abuse. These behaviours are usually considered ‘indirect self-harm’ as the intent to harm is not necessarily present; rather there is a preparedness to take risks.

Other terms commonly used to describe self-harm are:

• self injury
• non suicidal self injury (NSSI)
• deliberate self-harm (DSH)
• direct self-harm.

Young people who occasionally self-harm may present differently to those who use self-harm repetitively as a coping strategy. The frequency and duration of self-harming behaviour needs to be considered when assessing the significance and risk of the behaviour.

How Many Young People Self-harm?

In the second Australian Child and Adolescent Survey of Mental Health and Wellbeing, conducted by the Australian Government in 2014 on 6,300 families with children and/or adolescents aged four to 17 years, around one in 10 adolescents (10.9%) reported having ever self-harmed. It is important to note that some young people reported that “they would prefer not to say”, so this may be an underestimate of the prevalence in this cohort at that time.

Self-harm usually occurs after the onset of puberty and it is more common among girls than boys. However, self-harm can occur in anyone, regardless of their age, gender, socio-economic status or culture/ethnicity.

Self-harm in young children is developmentally unusual; consequently advice from a mental health professional should be sought as soon as possible if a primary school child is self-harming.

Why do Young People Self-harm?

Self-harm is generally a response to intense emotional or psychological distress. For some young people, it may seem that they have no other way of managing their distress. Although self-harm may offer some initial relief, it usually does not resolve their problems over time.

There are a range of reasons that people use this behaviour. The type of self-harm behaviour does not necessarily indicate the reasons behind it. The behaviour is used by different people for different reasons at different times. In fact, many young people engage in the behaviour for several reasons simultaneously.

There is some evidence to suggest that there is a neurological connection between cutting and the release of reinforcing endorphins in the brain. This may help to explain why self-harm can have a pleasurable or calming effect on some people and become somewhat addictive or a difficult coping strategy to give up.

There is also evidence to suggest that some self-harming behaviour is not done with conscious awareness; the young person may not understand or be aware of how they feel. This includes rage towards others or oneself; a feeling of abandonment, guilt or desperation, and ambivalence. There may be a strong wish to escape intense emotional pain, prefer to feel physical pain but not necessarily to die.

Although self-harm is a behaviour and not an illness, many young people using the behaviour may have an undiagnosed mental health problem. Most commonly, the research suggests that these are depression and/or anxiety.

Who is Most At Risk?

In the Growing up In Australia: The Longitudinal Study of Australian Children (LSAC) report, for 14-15 year olds, individual characteristics and experience of peer victimisation were the only key risk factors associated with an increased risk of self-harm. That is, the chances of engaging in self-harm were “significantly greater among females compared to males; adolescents who reported being attracted to the same sex, both sexes, or were not sure who they were attracted to compared to those who were attracted to the opposite sex only; adolescents with a reactive temperament compared to those without; adolescents with depressive and anxiety symptoms compared to non-depressive and non-anxious adolescents; adolescents who engaged in any risky behaviour (substance abuse, drinking, or sexual activity) compared to those who did not; adolescents who did not feel generally happy compared to those who did; adolescents who reported being unfairly treated because of their race, religion, skin colour, look, disability, etc. compared to those who did not”. (Annual Statistical Report 2016; p139)