Managing risk and self-harm: Keeping young people safe

Abstract

Suicide is the second leading cause of death among adolescents worldwide, yet adequate mental health services for children and adolescents are lacking across the globe. Likewise, youth who engage in non-suicidal self-injury (NSSI) are at heightened risk for suicide, but few pediatric settings have established protocols for screening and responding to youth who engage in NSSI and/or endorse thoughts of suicide. In this article, we highlight similarities and differences of managing suicide and NSSI across cultures, including persisting stigma associated with youth at risk for self-harm. We summarize current guidelines for screening youth at risk for suicide and NSSI across services, consider the use of online and telehealth services, and offer recommendations for a multidisciplinary approach to treating youth who engage in self-harming behaviors as well as how healthcare professionals can communicate with each other using common, non-stigmatizing language. We conclude with a discussion of future policy recommendations and areas for research.

Two pathways to self-harm in adolescence

“…31 The persistence of psychopathology among Group 1, furthermore, suggests that early screening measures if combined with prompt access to effective intervention could reduce the risk of future self-harm as well as improve mental health in the short term. 7 A second and highly tractable target for intervention is bullying, which casts a shadow over adult as well as childhood mental health. 32 This was a strong and early predictor of self-harm for children in the psychopathology pathway, preceding self-harm reports by 7 years.…”

“…Despite its prevalence and lifelong consequences, there has been little progress in the accurate prediction of self-harm, 7 partly due to the unclear interaction(s) between the individual and external risk factors that predict it. 8 A study on adolescents in the UK found that repeated self- harm was strongly linked to personality disturbances, depression, substance use, troubled relationships with peers/family, poor school performance, and chronic psychosocial as well as behavioural problems.…”

25 years of suicide research and prevention: How much has changed?

“…Mental illness and suicide are highly stigmatized, which decreases the likelihood that some individuals will seek help (Corrigan et al, 2014). In some countries still today, suicide is considered illegal, and suicide attempts are punishable by time in prison rather than supported by time in mental health treatment and recovery (Westers & Plener, 2020). Moving away from criminalization of suicide behavior involves changing how we talk about it, such as ceasing use of the term “commit suicide” and replacing it with a more appropriate, non-criminalized description like “died by suicide.” We are also in the process of moving forward as a field by separating the person from the behavior.…”

“…Moving away from criminalization of suicide behavior involves changing how we talk about it, such as ceasing use of the term “commit suicide” and replacing it with a more appropriate, non-criminalized description like “died by suicide.” We are also in the process of moving forward as a field by separating the person from the behavior. For instance, rather than call individuals “suicide attempters,” we may instead state, “an individual who attempted suicide.” Similarly, we are cautious to avoid using the terms “manipulative” or “gamey” when referencing suicide attempts, regardless of lethality, as these terms are inherently pejorative and stigmatizing (Westers & Plener, 2020).…”

“…For instance, rather than call individuals "suicide attempters," we may instead state, "an individual who attempted suicide." Similarly, we are cautious to avoid using the terms "manipulative" or "gamey" when referencing suicide attempts, regardless of lethality, as these terms are inherently pejorative and stigmatizing (Westers & Plener, 2020).…”