Young people need our support to stop the rising tide of self-harm

Harriet Williamson writes movingly of her own experience of self-harm (Journal, 6 June), and the social and political implications, following the Lancet study showing one in five young women aged 16-24 have self-harmed.

I worked as a child and adolescent psychiatrist for 33 years. I believe psychiatry is currently overdependent on medication, with prescribing seen as the main “treatment” intervention for doctors. The therapeutic psychiatry that I trained in during the 1980s has largely disappeared. This is partly a result of continual financial cuts over those 33 years, partly the hegemony of the pharmaceuticals in funding a lot of psychiatric research and debate, and I suspect partly the result of psychiatrists wanting the greater sense of validity prescribing seems to offer. We still have a huge emphasis, even though the scientific evidence is at best flimsy, on chemical imbalance and the “brain” being at the core of what is a mental illness.

Poverty, the current obsession with exam results, Instagram, lack of resources in psychiatry, and lack of medical training in how to deal with young people cutting themselves are important. Bullying and child abuse feature strongly. Self-harm is a powerful way of expressing emotional pain that is otherwise inchoate. Understanding a person who self-harms requires a wide-angle lens.

It is clear that as a rapidly increasing phenomenon self-harm is not an illness so much as a cultural movement. Thinking of despair, hopelessness and getting lost on life’s path involves a broader approach than medicalising psychological issues. It seems likely that there are numerous reasons for young people to despair – although their climate-change actions could be a partial antidote – and the emptiness of much of what is on offer in our materialistic society, with inane politicians intent in other ways on self-harm, provides an understandable context for despair. We urgently need more mental health resources for young people, and a change of focus on the way we see these despairing self-destructive actions.
Dr Miles Clapham
London

• Figures on growing rates of self-harm among girls and young women come as a distressing reminder that our children are facing huge challenges when it comes to mental health (Report, 5 June).

Shockingly, our Good Childhood Report showed even younger children were experiencing high rates of self-harm, with nearly a quarter of girls aged 14 saying they had self-harmed in just a year and one in six of more than 11,000 children surveyed reported self-harming at this age, including nearly one in 10 boys. Based on these figures we estimated that nearly 110,000 children aged 14 may have self-harmed across the UK during the same 12-month period.

There are often complex reasons why a young person might self-harm. Contributing factors can include everything from issues around school and appearance, to negative experiences of social media, bullying and even sexuality and gender stereotypes.

It’s important that children’s mental health and wellbeing are taken more seriously and they are able to access support quickly and easily before issues spiral out of control. We know that the long waiting times and high thresholds to access CAMHS mean many young people are falling under the radar and suffering in silence, often meaning they only get support when they hit breaking point.

We want to stop these issues in their tracks and make sure all children and young people can get early help at local community mental health drop-in centres, which give them space to talk in their own time without needing an appointment. Without urgent investment and meaningful action, more vulnerable children and their families won’t get the help they so desperately need.
Sam Royston
Director of policy and research at The Children’s Society

• In relation to real concerns (Report, 8 June) we have a duty to find ways of preventing mental illness, involving school-age children. For the first time, on 10 May 2019, the Royal College of Psychiatrists and the Faculty of Public Health held a joint conference: the theme was prevention. Both organisations have a role in setting professional standards and training, and a new collaboration around these was forged. Many of the speakers addressed evidence of interventions at the child and family level. There was also a growing awareness of the community and policy determinants of mental health. Preventing mental illness is not rocket science, but it is definitely a team sport.
Prof Woody Caan
Former chair of the School Health Research Group, Duxford, Cambridge

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