There are several hundred thousand cases of deliberate self-harm each year in the UK.
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Definition

Suicide is an intentional, self-inflicted, life-threatening act resulting in death from a number of means. Deliberate self-harm (DSH) is an intentional, self-inflicted, non-fatal act commonly effected by physical means - drug overdose or poisoning. Although distinct from each other as psychiatric emergencies, there are a number of overlapping features involved in both.

The size of the problem

In the UK, several thousand people take their own lives each year and suicide accounts for about 1 per cent of all deaths. Male suicides outnumber female ones in all age groups with most occurring in the age ranges 22-44 and 45-54 respectively.

Cases of DSH (also known as parasuicide) are more than 30 times more common than suicide, although they differ in that there is no direct intention of killing oneself. However, the suicide rate in the following year in these cases is 100 times greater than for the general population.

There are several hundred thousand cases of DSH each year and, unlike suicide, females predominate over males in a 2:1 ratio over all age groups with the highest rate seen in the 15-24 age group.

Who is at risk?

Being male, unemployed, retired, divorced, widowed or separated and living in isolation in a deprived urban area are all risk factors. Unhappy life events such as bereavement, relationship break-ups or financial disaster play a part, as do chronic disabling pain or illness, pre-existing psychiatric conditions such as depression, early dementia, alcohol or other drug abuse, anorexia nervosa and schizophrenia. A family history of self-harm is not uncommon either.

Assessment of risk

Many people who self-harm have spoken to their relatives, friends or doctors in the weeks running-up to the actual act of DSH. Therefore, it is likely that a proportion of self-harming acts are potentially preventable with the right help. Enquiring about suicidal feelings is important - it helps sufferers believe that their hopeless plight is appreciated and sympathetically understood. Ask about the frequency and intensity of any suicidal thoughts and whether any active plans to end life are being considered currently. Feelings of worthlessness and despair are worrying. Depressed mood, weight loss, insomnia and delusions are also very serious risk factors. A doctor should always be approached to assess such symptoms.

In DSH, intolerable stress is a major factor and an impulsive, immature or aggressive personality makes self-harming acts more likely. Drug overdose is implicated in 90 per cent of cases and the rest involve self-mutilation, mainly of wrists and forearms, but occasionally other parts of the body. Motives may be a cry for help, to escape from an awful situation or to manipulate or punish other people. Assessment aims to establish the degree of any suicidal intent now or in the future, and to intervene in any medical disorder or personal or social problem leading to DSH.

Suicidal intent

This is indicated by evidence of premeditation (such as saving up tablets), taking care to avoid discovery, failing to alert potential helpers, carrying out final acts (such as writing a will) and choosing a violent or aggressive means of DSH allowing little chance of survival.

Prevention and treatment

People at risk of suicide should be treated urgently in hospital to recognise and treat underlying problems. Antidepressants or, in certain cases, even ECT together with constant psychiatric nursing supervision may be required. Social intervention, follow-up and counselling can be extremely effective. Most people who self-harm improve when their coping skills improve and when personal and social problems are properly resolved. So on-going counselling is also important.

The Samaritans

This organisation provides a 24-hour nationwide telephone service (08457 90 90 90) manned by trained volunteers offering support and advice to people at times of crisis. Your own GP can provide someone on constant call alert also.

If you are worried about yourself, a friend or relative, don't delay in seeking professional help. It could save a life.