tag:theconversation.com,2011:/africa/topics/self-harm-7506/articlesSelf-harm – The Conversation2023-11-05T19:12:40Ztag:theconversation.com,2011:article/2139832023-11-05T19:12:40Z2023-11-05T19:12:40ZSomeone has told you they’re self-harming. Now what?<figure><img src="https://images.theconversation.com/files/556983/original/file-20231031-15-1mr2b6.jpg?ixlib=rb-1.1.0&rect=4%2C1%2C994%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/friends-sitting-together-on-beach-watching-374294413">Shutterstock</a></span></figcaption></figure><p>For many people, self-harm can be a difficult behaviour to understand. It also comes with a lot of stigma. </p>
<p>This can make talking about it difficult as people who self-harm often anticipate <a href="https://www.tandfonline.com/doi/abs/10.1080/09515070.2018.1489220">negative responses and judgement</a>. </p>
<p>But if someone tells you they’re self-harming, how you respond is critical to their health and wellbeing.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/its-not-only-teenage-girls-and-its-rarely-attention-seeking-debunking-the-myths-around-self-injury-120214">It's not only teenage girls, and it's rarely attention-seeking: debunking the myths around self-injury</a>
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<h2>What is self-harm? Why do people do it?</h2>
<p>The term self-harm could mean someone’s intentional damage to their body as a way of coping <em>or</em> an attempt to end their life. But we think these are very different behaviours.</p>
<p>So we prefer the term self-injury to describe the range of <em>non-suicidal</em> behaviours people use mostly to cope with <a href="https://pubmed.ncbi.nlm.nih.gov/29689691/">difficult feelings</a> (such as intense distress or anxiety) and thinking styles (for instance, self-criticism).</p>
<p>Self-injury is common. About <a href="https://pubmed.ncbi.nlm.nih.gov/24422986/">one in six adolescents</a> report having self-injured at some point in the past.</p>
<p>But no two people’s experiences are alike. And people self-injure for many reasons other than to cope. This includes to punish themselves or to feel something when feeling emotionally numb. </p>
<p>So, if someone tells you they self-injure, it is critical to avoid assuming why they do it.</p>
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<h2>Telling someone is a big step</h2>
<p>Given its associated <a href="https://psycnet.apa.org/record/2020-57492-001">stigma</a>, many people who self-injure do not tell anyone. When they disclose, it is usually to <a href="https://www.sciencedirect.com/science/article/pii/S0272735820300957">friends or family</a>. </p>
<p>When <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/jclp.23503#:%7E:text=NSSI%20disclosure%20can%20be%20associated,Rosenrot%20%26%20Lewis%2C%202020">disclosing to friends or family</a>, someone values the quality of the relationship, disclosing to people they trust. They may not be seeking tangible aid (for instance, professional support). Instead, they are looking for social support, understanding, and a safe space to talk about their experiences. </p>
<p>Someone with more severe self-injury, or who also has <a href="https://www.csmh.uwo.ca/docs/publications/Armiento,%20Hamza,%20and%20Willoughby%202014.pdf">suicidal thoughts or behaviours</a>, is more likely to disclose their self-injury, perhaps as a way of accessing professional or medical support.</p>
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Read more:
<a href="https://theconversation.com/its-ruok-day-but-how-can-i-help-might-be-a-better-question-to-ask-190064">It's RUOK Day – but 'how can I help?' might be a better question to ask</a>
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<h2>What not to do</h2>
<p>When someone tells you they self-injure, you may feel concerned about their safety and wellbeing. You might be upset someone you care about appears to be struggling. You might feel overwhelmed and unsure how to respond. These and other reactions are understandable and expected.</p>
<p>But it is important not to over-react or respond with high-intensity emotions. This can signal you are uncomfortable, which may make the person less likely to talk.</p>
<p>It is also not advised to ask a large number of questions (such as, what they do, when they do it) as this can seem like an interrogation. </p>
<p>Another common reaction is to stress the importance of stopping self-injury. Although this is usually because they care for the person and want them to be safe, a problem-solving approach may not be what people need. The person disclosing may simply want a chance to share their experience. </p>
<p>Many people have <a href="https://www.tandfonline.com/doi/full/10.1080/01639625.2023.2228451">mixed feelings</a> about stopping – wanting to stop self-injury, but also wanting to hold onto a trusted coping strategy. </p>
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Read more:
<a href="https://theconversation.com/why-do-people-intentionally-injure-themselves-90451">Why do people intentionally injure themselves?</a>
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</em>
</p>
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<h2>What to do</h2>
<p>If someone discloses they self-injure, it is important to respond supportively, with compassion, and without judgement. It is important to give the person space to share what they want in their own words, to <a href="https://www.sciencedirect.com/science/article/pii/S0272735820300957#s0030">actively listen</a>, and to validate this is likely a difficult conversation for them. </p>
<p>It is also important to recognise someone may share a bit about their experience now but may not be ready to talk about everything yet. Being patient is therefore important. </p>
<p>Telling someone you are there to listen and support them can go a long way in letting them know they can come to you again if they need to and they are not being rushed or pressured if they are not yet ready.</p>
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<a href="https://images.theconversation.com/files/556984/original/file-20231031-15-wlsd1x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close up of a person holding another person's hand, on their knee" src="https://images.theconversation.com/files/556984/original/file-20231031-15-wlsd1x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/556984/original/file-20231031-15-wlsd1x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/556984/original/file-20231031-15-wlsd1x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/556984/original/file-20231031-15-wlsd1x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/556984/original/file-20231031-15-wlsd1x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/556984/original/file-20231031-15-wlsd1x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/556984/original/file-20231031-15-wlsd1x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Disclosure may happen over several conversations.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-on-lgbt-gay-couple-holding-1794638155">charnsitr/Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/teens-with-at-least-one-close-friend-can-better-cope-with-stress-than-those-without-126769">Teens with at least one close friend can better cope with stress than those without</a>
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<h2>What can I say?</h2>
<p>To <a href="https://www.amazon.com/Understanding-Self-Injury-Person-Centered-Stephen-Lewis/dp/0197545068">support someone</a> who discloses they self-injure, we recommend using a low key, compassionate tone that communicates you are concerned and are there to listen without judgement. </p>
<p>This involves acknowledging self-injury can be a difficult topic to discuss. You can say:</p>
<blockquote>
<p>I recognise this isn’t an easy conversation. However, I appreciate you’re willing to share and I’d like to understand what it’s been like for you lately.</p>
</blockquote>
<p>Part of this can also involve a “respectful curiosity”. This involves communicating a genuine interest in a person’s experience. You can say:</p>
<blockquote>
<p>I know people self-injure for different reasons. I’m wondering if you can help me understand what self-injury does for you?</p>
</blockquote>
<p>Recognise self-injury is often not something someone can just stop. This can go a long way in making the person not feel judged and therefore more likely to talk about it. You can say:</p>
<blockquote>
<p>I can appreciate self-injury has been helpful to you, which I can see would make it pretty difficult to stop right now.</p>
</blockquote>
<p>Finally, it is important to take care of yourself. Supporting someone who self-injures can take its toll. Be sure to take notice of how you are feeling. It is OK to tell someone you need a break right now and to find some time to look after yourself.</p>
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Read more:
<a href="https://theconversation.com/most-people-thinking-about-suicide-dont-tell-anyone-heres-why-and-what-we-can-do-about-it-197402">Most people thinking about suicide don't tell anyone. Here's why and what we can do about it</a>
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<h2>What can I expect?</h2>
<p>If a person discloses their self-injury, take the time to listen to what they are saying, and what support they need right now.</p>
<p>While learning someone self-injures can be challenging, you may find that not only can you support the person, it can <a href="https://psycnet.apa.org/record/2016-49708-002">bring you closer</a> and strengthen your relationship.</p>
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<p><em>People who self-injure and those who support them can find more information from the following resources: the book <a href="https://www.amazon.com/Understanding-Self-Injury-Person-Centered-Stephen-Lewis/dp/0197545068">Understanding Self-Injury: A Person-Centered Approach</a>; the <a href="https://sioutreach.org/">Self-injury Outreach & Support</a> website; and resources in 11 languages from the <a href="https://icsesgroup.org/resources">International Consortium on Self-Injury in Educational Settings</a>. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/213983/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>How you respond is critical to their health and wellbeing. Here’s what to say to support someone who self-harms.Penelope Hasking, Professor of Psychology, Curtin UniversityStephen P. Lewis, Professor of Psychology, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2067022023-10-04T19:04:49Z2023-10-04T19:04:49ZI think my teen is depressed. How can I get them help and what are the treatment options?<figure><img src="https://images.theconversation.com/files/544471/original/file-20230824-29-js41sa.jpg?ixlib=rb-1.1.0&rect=29%2C0%2C4891%2C3260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Unsplash</span></span></figcaption></figure><p>Moody, withdrawn, down. These words are often used by parents of teens. And young people may say they feel so “depressed” about upcoming exams, or that the world is “just so depressing” these days.</p>
<p>But how do you know if your teen is experiencing what health professionals call “major depression”? And when should you seek help? </p>
<p>First, let’s understand what is meant by this term. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10228578/">Major depression</a> is characterised by persistent low mood and/or irritability and loss of interest or pleasure in usual activities for at least two weeks. It also includes physical symptoms, such as sleep disturbance and fatigue, and cognitive symptoms, such as negative thoughts about themselves and the future, difficulty concentrating or making decisions. </p>
<p>Major depression is more than brief sadness, or an expected reaction to loss or a stressful event. </p>
<p>While the diagnosis is the same for adolescents and adults, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10228578/">teens may be more likely</a> to present with irritability and mood changes rather than the low mood typical of adults. </p>
<h2>Increasing over time</h2>
<p>There is evidence depression is increasing among young people, with an <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2782796">international study in 2021</a> estimating 25% of children and adolescents experienced elevated depression symptoms – double pre-pandemic levels. While Australia was not included in this study, a recent Australian study showed psychological distress have <a href="https://doi.org/10.1016/j.psychres.2023.115356">spiked</a> in Australian millennials (born between the early 1980s and late 1990s) and Gen-Z Australians (born late 1990s to early 2010s). </p>
<p>While the cause of this increase is unclear, it is likely due to <a href="https://mentalhealththinktank.org.au/wp-content/uploads/2023/08/Mental_Health_Recovery_Package_Australias-Mental-Health-Think-Tank.pdf">multiple factors</a>, such as financial pressures, social isolation, and climate change, and made worse by the <a href="https://pubmed.ncbi.nlm.nih.gov/36970258/">COVID pandemic</a>. </p>
<p>Given the understandable distress experienced by many young people, how can parents or carers know when to seek help? </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-parents-can-play-a-key-role-in-the-prevention-and-treatment-of-teen-mental-health-problems-192927">How parents can play a key role in the prevention and treatment of teen mental health problems</a>
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<h2>Listen up</h2>
<p>Begin by talking to your child. Let them know you have noticed some changes and you are concerned about them. If your child opens up about their difficulties, listen carefully and validate their feelings. Being able to talk about difficulties, and knowing support is there if they need may be enough for some teens. </p>
<p><a href="https://parents.au.reachout.com/common-concerns/mental-health/depression-and-teenagers">Read up on depression</a> from <a href="https://headspace.org.au/explore-topics/supporting-a-young-person/depression/">reputable sources</a>, so you are better equipped to understand and support a young person. </p>
<p>Try not to dismiss a teen’s feelings or punish irritable behaviour. It can be tempting to remind them of positives or offer solutions – but this can often backfire, leaving them feeling misunderstood. While it might be difficult or uncomfortable to talk openly with your teen about their mental health, it is often a <a href="https://aifs.gov.au/media/most-teenagers-turn-parents-and-friends-help">huge relief</a> for them. </p>
<p>Professional help may be needed if they are highly distressed, or if their difficulties are having a significant impact on their usual activities and relationships (this may include withdrawing from many activities, avoiding school, or avoiding friends and family most of the time). </p>
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<h2>Start with a GP</h2>
<p>The good news is, effective treatments are available. </p>
<p>The first step to finding appropriate treatment will likely be supporting your teen to see a GP. Again, simply talking through their concerns with the doctor may be very helpful. Your young person might prefer to discuss this with the GP without you.</p>
<p>The GP may <a href="https://www.health.gov.au/our-work/better-access-initiative">refer them to a mental health professional</a>, such as a <a href="https://psychology.org.au/psychology/about-psychology/seeing-a-psychologist-faqs">psychologist</a> or <a href="https://www.healthdirect.gov.au/psychiatrists-and-psychologists">psychiatrist</a>. </p>
<p>Teens can also go directly to an organisation like <a href="https://headspace.org.au">Headspace</a>, which provides information, support and services to young people aged 12 to 25 and their families and friends via centres across Australia.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-first-sleep-health-program-for-first-nations-adolescents-could-change-lives-206286">The first sleep health program for First Nations adolescents could change lives</a>
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</p>
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<h2>What does depression treatment look like?</h2>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10228578/">recent review</a> on recognising and managing teen depression examined clinical practice guidelines from Canada, Australia, the United Kingdom, the United States and New Zealand found a comprehensive treatment approach is typically used. </p>
<p>Treatment can include:</p>
<ul>
<li><p>education about depression and its treatment</p></li>
<li><p>lifestyle interventions (such as improving sleep, diet and exercise)</p></li>
<li><p>psychological therapy (often focused on understanding and changing unhelpful thinking patterns)</p></li>
<li><p>prescription of antidepressants when needed. </p></li>
</ul>
<p>Whether to start a teen on <a href="https://australianprescriber.tg.org.au/articles/antidepressants-in-adolescence.html">antidepressant medication</a> can be a difficult decision. It should be a collaborative decision involving the teen, their parents and health professionals. </p>
<p>Like all medication, antidepressants have side effects and potential risks. They are typically used in cases of severe depression, or if psychological treatments have been unsuccessful. Suicidal thoughts or behaviour are a <a href="https://www.aacap.org/aacap/medical_students_and_residents/mentorship_matters/developmentor/Do_Antidepressants_Increase_the_Risk_of_Suicide_in_Children_and_Adolescents.aspx">possible side effect of antidepressants</a> for a small proportion of adolescents and should be carefully monitored. However, untreated depression is also a risk factor for suicide, so the potential benefits and risks of antidepressant use by teens needs to be carefully considered. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CxAZ5ZTBrhe/?img_index=1","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Assessing risk</h2>
<p>Suicidal thoughts and self-harm are common in depression but can be effectively treated. </p>
<p>Suicide risk assessment is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10228578/">critical part</a> of any treatment for depression, and should include the development of a <a href="https://au.reachout.com/articles/how-to-make-a-safety-plan">safety plan</a> with the teen and their parents or carers. Safety plans can be very helpful in times of distress, listing helpful coping strategies and contact details for family, friends and health professionals.</p>
<p>If you are concerned your teen <a href="https://parents.au.reachout.com/common-concerns/mental-health/suicide-and-teenagers">might be at risk of suicide</a>, take it seriously. Ask them direct questions, such as “Are you thinking about suicide?”. Get professional support as soon as possible and take the young person to the nearest emergency department or call 000 if you are worried about their immediate safety. You can also contact Kids Helpline 24 hours a day 1800 55 1800.</p>
<p>Importantly, look after yourself. Supporting a teen with depression can take a toll and lead to significant tension in a household. </p>
<p>Find someone (other than your child) you can confide in. Make sure you’re getting rest, nutrition and exercise. Seek professional support if you find yourself struggling. Taking care of yourself means you are better equipped to support your child. </p>
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<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call <a href="https://www.lifeline.org.au/">Lifeline</a> on 13 11 14 or <a href="https://kidshelpline.com.au/">Kids Helpline</a> on 1800 55 1800.</em></p><img src="https://counter.theconversation.com/content/206702/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Louise Birrell receives funding from the National Health and Medical Research Council, the Australian government and Australian Rotary Health. </span></em></p><p class="fine-print"><em><span>Andrew Baillie is employed by the University of Sydney in a position half funded by Sydney Local Health District and he receives funding from the National Health and Medical Research Council and the Medical Research Future Fund. </span></em></p><p class="fine-print"><em><span>Maree Teesson is Chair of Australia's Mental Health Think Tank which is funded by the BHP Foundation. She is Director of The Matilda Centre, The University of Sydney. She is chair of the Million Minds Mission. She receives funding from the National Health and Medical Research Council, the Australian Government, BHP Foundation, Paul Ramsay Foundation and other research organisations. She is co-director of OurFutures Institute a not-for-profit company established to distribute evidence resources to education organisations. </span></em></p><p class="fine-print"><em><span>Erin Kelly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Teen depression is on the rise but effective help is available. We look at what parents can do to support their teen.Louise Birrell, Researcher at The Matilda Centre for Research in Mental Health and Substance Use, University of SydneyAndrew Baillie, Professor of Allied Health, University of SydneyErin Kelly, Research Fellow and Clinical psychologistMaree Teesson, Professor & Director of The Matilda Centre. Chair, Australia's Mental Health Think Tank, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2080622023-06-21T14:53:54Z2023-06-21T14:53:54ZEating disorders and self-harm rose among teenage girls during the pandemic – new UK study<figure><img src="https://images.theconversation.com/files/533124/original/file-20230621-29-qag769.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6720%2C4466&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/teen-depression-concept-stressed-indian-teenage-2018791433">Prostock-studio/Shutterstock</a></span></figcaption></figure><p>Evidence tells us the COVID pandemic and measures put in place to contain the virus negatively affected the mental health of adolescents and young people in the UK and elsewhere. One <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2782796">review study</a> published in August 2021 estimated that the global prevalence of children and adolescents with depression and anxiety had doubled since the start of the pandemic.</p>
<p><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61141-0/fulltext">Self-harm</a> and <a href="https://www.dovepress.com/the-epidemiology-of-eating-disorders-genetic-environmental-and-societa-peer-reviewed-fulltext-article-CLEP">eating disorders</a> typically start during adolescence or early adulthood. As well as being major health issues, both are coping mechanisms that often indicate <a href="https://onlinelibrary.wiley.com/doi/abs/10.1521/suli.2007.37.4.409">underlying psychological distress</a>.</p>
<p>In a <a href="https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(23)00126-8/fulltext">new study</a>, we found that GPs in the UK recorded a large rise in eating disorder diagnoses and self-harm episodes among teenage girls in the first two years of the pandemic.</p>
<p>The study was conducted jointly by the University of Manchester, Keele University, the University of Exeter and the <a href="https://mcpin.org/">McPin Foundation</a>, a mental health research charity. We also worked with an advisory group of young people with lived experience of mental health difficulties, as well as parents and carers.</p>
<h2>Comparing predictions and observed case numbers</h2>
<p>We used data from the <a href="https://cprd.com/">Clinical Practice Research Datalink</a>, a database of anonymised primary care electronic health records. We included over 9 million patients aged ten to 24 (both males and females) from 1,881 general practices across the UK.</p>
<p>We calculated the monthly incidence rates of eating disorder diagnoses and self-harm episodes from January 2010 through to March 2022. Based on data from the ten years preceding the pandemic, and using statistical models, we predicted what the rates of eating disorders and self-harm would be had the pre-pandemic trends continued. We then compared the rates actually observed in March 2020 until March 2022 with these predictions.</p>
<p>In the two years after the onset of the pandemic, we found that eating disorder diagnoses were 42% higher than would be expected for girls aged 13–16, and 32% higher for girls aged 17–19. There was little difference between observed and expected incidence for the other age groups.</p>
<p>The increase in rates of self-harm was also greatest among girls aged 13–16, 38% higher than expected. There was no evidence of an increase in self-harm in females in the other age groups.</p>
<p>Among males, the rates of eating disorders and self-harm were lower than, or close to, the expected rates across all age groups.</p>
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Read more:
<a href="https://theconversation.com/people-with-eating-disorders-saw-their-symptoms-worsen-during-the-pandemic-new-study-140487">People with eating disorders saw their symptoms worsen during the pandemic – new study</a>
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<p>In the ten years before the pandemic, eating disorder diagnoses in females were more common among those from less-deprived areas than those from more-deprived communities. This socioeconomic difference widened following the onset of the pandemic. Since March 2020, eating disorder diagnoses for females living in the least-deprived communities were 52% higher than expected, compared with 22% higher for those in the most-deprived areas.</p>
<p>In contrast, self-harm rates before the pandemic were higher for those in the most-deprived compared with the least-deprived areas. Since March 2020, self-harm incidence for females in the least-deprived areas was 31% higher than expected, while there was no significant difference between observed and expected incidence for those in the most-deprived areas, therefore narrowing the pre-pandemic gap.</p>
<h2>Limitations and possible explanations</h2>
<p>Our study is large, but episodes of self-harm that were not treated by health services were not captured in our data, so the rise in self-harm incidence might have been even greater than we observed. However, it’s also possible that cases of self-harm not coming to the attention of services might have exhibited a different pattern.</p>
<figure class="align-center ">
<img alt="A teenage girl sits on the floor against her bed." src="https://images.theconversation.com/files/533126/original/file-20230621-19-vbgdqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533126/original/file-20230621-19-vbgdqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533126/original/file-20230621-19-vbgdqm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533126/original/file-20230621-19-vbgdqm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533126/original/file-20230621-19-vbgdqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533126/original/file-20230621-19-vbgdqm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533126/original/file-20230621-19-vbgdqm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Eating disorders and self-harm can indicate underlying psychological distress.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/frustrated-sad-teen-girl-child-sitting-2292976519">DimaBerlin/Shutterstock</a></span>
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<p>Previous studies have reported increased hospital admissions and presentations to emergency departments for <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2783854">self-harm</a> and symptoms of <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2798255">eating disorders</a> among teenage girls during the COVID pandemic. Our study complements these findings. </p>
<p>The reasons for the increase in eating disorder diagnoses and self-harm episodes among teenage girls are likely to be complex and could be due to a combination of factors. These include <a href="https://link.springer.com/article/10.1007/s12144-022-03651-5">social isolation</a>, anxiety resulting from changing routines, disruption to education, unhealthy <a href="https://www.mdpi.com/1660-4601/19/16/9960">social media influences</a>, and increased awareness of mental health difficulties. </p>
<p>It’s also pertinent to note that youth mental health had been deteriorating even in the years <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03235-w">before the pandemic</a> in the UK, though at a less substantial rate of change.</p>
<p>The greater increases in eating disorders and self-harm among female teenagers living in less-deprived areas, relative to those in more-deprived areas, may reflect differences in service provision and access to clinical care between these areas.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/melatonin-use-may-reduce-self-harm-in-young-people-research-shows-202895">Melatonin use may reduce self-harm in young people, research shows</a>
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<h2>What next?</h2>
<p>The substantial rise in eating disorder diagnoses and self-harm episodes among teenage girls highlights an urgent need for intervention. Early identification of mental health difficulties in children and young people by primary care clinicians (including GPs, nurses and psychologists) is extremely important, as this facilitates timely access to treatment. </p>
<p>Potential barriers to help-seeking, including <a href="https://bjgp.org/content/71/711/e744">fear of stigma</a> and concerns about long waiting lists to access services, need to be tackled. Given the current pressures on the NHS in both primary and specialist care, our study emphasises the need for sufficient capacity in mental health services to meet growing demand.</p><img src="https://counter.theconversation.com/content/208062/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Pearl Mok receives funding from the National Institute for Health and Care Research. </span></em></p><p class="fine-print"><em><span>Alex Trafford does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We analysed the primary care records of more than 9 million young patients across the UK.Pearl Mok, Research Fellow, Centre for Pharmacoepidemiology and Drug Safety, University of ManchesterAlex Trafford, Research Associate in Epidemiology, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1987312023-05-05T12:14:36Z2023-05-05T12:14:36ZMindfulness, meditation and self-compassion – a clinical psychologist explains how these science-backed practices can improve mental health<figure><img src="https://images.theconversation.com/files/521937/original/file-20230419-16-ly31ug.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7951%2C5304&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Studies show that consistent meditation practice is key.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/peace-relax-and-happy-mindset-of-a-woman-from-royalty-free-image/1421420537?phrase=meditation%20sitting%20in%20chair&adppopup=true">pixdeluxe/E! via Getty Images</a></span></figcaption></figure><p>Mindfulness and self-compassion are now <a href="https://www.forbes.com/sites/payout/2017/09/29/mindfulness-is-more-than-a-buzzword-a-look-at-the-neuroscience-behind-the-movement/?sh=55bb4905372f">buzzwords for self-improvement</a>. But in fact, a growing body of research shows these practices can lead to real mental health benefits. This research – ongoing, voluminous and worldwide – clearly shows <a href="https://doi.org/10.1371/journal.pone.0191332">how and why these two practices work</a>. </p>
<p>One effective way to cultivate mindfulness and self-compassion <a href="https://doi.org/10.1016/j.jpsychores.2016.11.006">is through meditation</a>. </p>
<p>For more than 20 years, as a <a href="https://www.seattleu.edu/artsci/about/directory/profile/rachel-turow.html">clinical psychologist, research scientist and educator</a>, I taught meditation to students and clinical patients and took a deep dive into the research literature. My recent book, “<a href="https://www.penguinrandomhouse.com/books/706228/the-self-talk-workout-by-rachel-goldsmith-turow-phd/">The Self-Talk Workout</a>: Six Science-Backed Strategies to Dissolve Self-Criticism and Transform the Voice in Your Head,” highlights much of that research. </p>
<p>I learned even more when I evaluated <a href="https://doi.org/10.1080/10503307.2021.1878306">mental health programs</a> and <a href="https://www.insidehighered.com/advice/2023/01/04/how-teach-practicable-mental-health-skills-classroom-opinion">psychology classes</a> that train participants in mindfulness and compassion-based techniques. </p>
<h2>Defining mindfulness and self-compassion</h2>
<p>Mindfulness means purposefully paying attention to the present moment with an attitude of interest or curiosity rather than judgment. </p>
<p>Self-compassion involves being kind and understanding toward yourself, even during moments of suffering or failure. </p>
<p><a href="https://doi.org/10.1016/j.cpr.2011.04.006">Both are associated</a> with <a href="https://doi.org/10.1037/a0025754">greater well-being</a>.</p>
<p>But don’t confuse <a href="https://doi.org/10.1111/j.1467-6494.2008.00537.x">self-compassion with self-esteem</a> or self-centeredness, or assume that it somehow lowers your standards, motivation or productivity. Instead, research shows that self-compassion is <a href="https://doi.org/10.1177/0146167212445599">linked with greater motivation</a>, <a href="https://doi.org/10.1080/15298868.2013.763404">less procrastination</a> and <a href="https://doi.org/10.1007/s12671-020-01566-5">better relationships</a>.</p>
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<figcaption><span class="caption">Could mindfulness meditation be the next public health revolution?</span></figcaption>
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<h2>Be patient when starting a meditation practice</h2>
<p>I didn’t like meditation – the specific practice sessions that train mindfulness and self-compassion – the first time I tried it as a college student in the late ‘90s. I felt like a failure when my mind wandered, and I interpreted that as a sign that I couldn’t do it. </p>
<p>In both my own and others’ meditation practices, I’ve noticed that the beginning is often rocky and full of doubt, resistance and distraction. </p>
<p>But what seem like impediments can actually enhance meditation practice, because the mental work of handling them builds strength.</p>
<p>For the first six months I meditated, my body and mind were restless. I wanted to get up and do other tasks. But I didn’t. Eventually it became easier to notice my urges and thoughts without acting upon them. I didn’t get as upset with myself. </p>
<p>After about a year of consistent meditation, my mind seemed more organized and controllable; it no longer got stuck in self-critical loops. I felt a sense of kindness or friendliness toward myself in everyday moments, as well as during joyful or difficult experiences. I enjoyed ordinary activities more, such as walking or cleaning. </p>
<p>It took a while to understand that anytime you sit down and try to meditate, that’s meditation. It is a mental process, rather than a destination. </p>
<h2>How meditation works on the mind</h2>
<p>Just having a general intention to be more mindful or self-compassionate is unlikely to work.</p>
<p>Most programs shown to make meaningful differences <a href="https://doi.org/10.1037/pas0000268">involve at least seven sessions</a>. Studies show these repeated workouts <a href="https://doi.org/10.3389/fpsyg.2018.00668">improve attention skills</a> and <a href="https://doi.org/10.2147/PRBM.S31458">decrease rumination, or repeated negative thinking</a>. </p>
<p>They also <a href="https://doi.org/10.1016/j.invent.2016.10.001">lessen self-criticism</a>, which is <a href="https://doi.org/10.1016/j.jad.2018.12.069">linked to numerous mental health difficulties</a>, including <a href="https://doi.org/10.2147/PRBM.S31458">depression</a>, <a href="https://doi.org/10.1002/cpp.1918">anxiety</a>, <a href="https://doi.org/10.1002/eat.23284">eating disorders</a>, <a href="https://doi.org/10.1348/014466509X479771">self-harm</a> and <a href="http://doi.org/10.1002/eat.23284">post-traumatic stress disorder</a>.</p>
<p>Meditation is not just about sustaining your attention – it’s also about <a href="https://doi.org/10.1016/j.janxdis.2011.03.013">shifting and returning your focus</a> after the distraction. The act of shifting and refocusing cultivates attention skills <a href="https://doi.org/10.2147/PRBM.S31458">and decreases rumination</a>.</p>
<p>Trying repeatedly to refrain from <a href="https://doi.org/10.1016/j.cpr.2016.10.011">self-judgment during the session</a> will train your mind <a href="https://doi.org/10.1016/j.invent.2016.10.001">to be less self-critical</a>. </p>
<p>An interconnected group of brain regions called <a href="https://www.psychologytoday.com/us/basics/default-mode-network">the default mode network</a> is <a href="https://doi.org/10.1073/pnas.98.2.676">strikingly affected by meditation</a>. Much of this network’s activity reflects repetitive thinking, such as a rehash of a decadeslong tension with your sister. It’s most prominent when you’re not doing much of anything. Activity of the default mode network is <a href="https://doi.org/10.1093/scan/nsv132">related to rumination, unhappiness</a> and <a href="https://doi.org/10.1016/j.biopsych.2011.02.003">depression</a>. </p>
<p>Research shows that just one month of meditation <a href="https://doi.org/10.1016/j.neuroimage.2017.01.044">reduces the noise of the default mode network</a>. The type of meditation practice <a href="https://doi.org/10.1073/pnas.1112029108">doesn’t seem to matter</a>.</p>
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<figcaption><span class="caption">Don’t be discouraged if your mind wanders as you meditate.</span></figcaption>
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<h2>Establishing the formal practice</h2>
<p>A common misconception about mindfulness is that it’s simply a way <a href="https://doi.org/10.1177/1534735417699514">to relax or clear the mind</a>. Rather, it means intentionally paying attention to your experiences in a nonjudgmental way. </p>
<p>Consider meditation the formal part of your practice – that is, setting aside a time to work on specific mindfulness and self-compassion techniques. </p>
<p>Cultivating mindfulness with meditation often involves focusing on paying attention to the breath. A common way to start practice is to sit in a comfortable place and bring attention to your breathing, wherever you feel it most strongly. </p>
<p>At some point, probably after a breath or two, your mind will wander to another thought or feeling. As soon as you notice that, you can bring your attention back to the breath and try not to judge yourself for losing focus for five to 10 minutes. </p>
<p>When I was just getting started meditating, I would have to redirect my attention dozens or hundreds of times in a 20-to-30-minute session. Counting 10 breaths, and then another 10, and so on, helped me link my mind to the task of paying attention to my breathing.</p>
<p>The most well-established technique for cultivating self-compassion is called loving-kindness meditation. To practice, you can find a comfortable position, and for at least five minutes, internally repeat phrases such as, “May I be safe. May I be happy. May I be healthy. May I live with ease.” </p>
<p>When your attention wanders, you can bring it back with as little self-judgment as possible and continue repeating the phrases. Then, if you like, offer the same well wishes to other people or to all beings.</p>
<p>Every time you return your focus to your practice without judging, you’re flexing your mental awareness, because you noticed your mind wandered. You also improve your capacity to shift attention, a valuable anti-rumination skill, and your nonjudgment, an antidote to self-criticism. </p>
<p>These practices work. Studies show that brain activity during meditation results in less <a href="https://doi.org/10.1186/s13030-019-0145-4">self-judgment, depression and anxiety</a> and <a href="https://doi.org/10.1016/j.janxdis.2011.03.013">results in less rumination</a>. </p>
<p>Mindfulness also occurs when you tune into present-moment sensations, such as tasting your food or washing the dishes.</p>
<p>An ongoing routine of formal and informal practice can transform your thinking. And again, doing it once in a while won’t help as much. It’s like situps: A single situp isn’t likely to strengthen your abdominal muscles, but doing several sets each day will. </p>
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<figcaption><span class="caption">When thoughts pop up during meditation, no worries. Just start again … and again … and again.</span></figcaption>
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<h2>Meditation reduces self-criticism</h2>
<p>Studies show that <a href="https://doi.org/10.1037/pas0000268">mindfulness meditation</a> and <a href="https://doi.org/10.1016/j.invent.2016.10.001">loving-kindness meditation</a> reduce self-criticism, which <a href="https://doi.org/10.3389/fpsyt.2020.00147">leads to better mental health</a>, including lower levels of <a href="https://doi.org/10.1037/ccp0000040">depression</a>, <a href="https://doi.org/10.1007/s10488-021-01170-2">anxiety</a> and <a href="https://doi.org/10.1016/j.psychres.2018.03.007">PTSD</a>. After an eight-week mindfulness program, participants experienced <a href="https://doi.org/10.1186/s13030-019-0145-4">less self-judgment</a>. These changes were linked with decreases in depression and anxiety.</p>
<p>One final point: Beginning meditators may find that self-criticism gets worse before it gets better. </p>
<p>After years or decades of habitual self-judgment, people often judge themselves harshly about losing focus during meditation. But once students get through the first few weeks of practice, the self-judgment begins to abate, both about meditation and about oneself in general. </p>
<p>As one of my students recently said after several weeks of mindfulness meditation: “I am more stable, more able to detach from unhelpful thoughts and can do all of this while being a little more compassionate and loving toward myself.”</p><img src="https://counter.theconversation.com/content/198731/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Goldsmith Turow does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many studies show that consistent meditation practice lowers depression, anxiety and self-criticism.Rachel Goldsmith Turow, Adjunct Assistant Professor in Population Health Science and Policy, Seattle UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2028952023-04-05T13:37:48Z2023-04-05T13:37:48ZMelatonin use may reduce self-harm in young people, research shows<figure><img src="https://images.theconversation.com/files/518789/original/file-20230331-26-oz0lfg.jpg?ixlib=rb-1.1.0&rect=9%2C0%2C6330%2C4220&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/full-length-stressed-young-teenage-child-1971215000">fizkes/Shutterstock</a></span></figcaption></figure><p>Melatonin is a naturally occurring hormone that regulates the <a href="https://www.nccih.nih.gov/health/melatonin-what-you-need-to-know">sleep-wake cycle</a>. It’s also often used as a medication for people who have difficulty sleeping. Since there are known links between <a href="https://www.sciencedirect.com/science/article/abs/pii/S0163834318300380">sleep problems, depression, and self-harm</a>, we were interested in exploring whether treating sleep problems with melatonin would lead to fewer instances of self-harm. </p>
<p>Our findings, <a href="https://acamh.onlinelibrary.wiley.com/doi/10.1111/jcpp.13785">recently published</a> in the Journal of Child Psychology and Psychiatry, suggest that melatonin could have this effect in young people.</p>
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Read more:
<a href="https://theconversation.com/melatonin-should-i-take-it-to-help-me-sleep-179053">Melatonin: should I take it to help me sleep?</a>
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<p>Melatonin is the most common sleep medication recommended for children and adolescents <a href="https://www.lakemedelsverket.se/sv/behandling-och-forskrivning/behandlingsrekommendationer/sok-behandlingsrekommendationer/behandling-av-somnstorningar-hos-barn-och-ungdomar--kunskapsdokument">in Sweden</a>. It’s safer than many other types of medications used for sleep problems, with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419450/pdf/12967_2019_Article_1835.pdf">low risks</a> of serious side-effects, overdose, or dependence.</p>
<p>Using data from Sweden, we identified more than 25,000 children and adolescents, aged six to 18, who started using melatonin between 2006 and 2013. During this time, melatonin was available in Sweden only by prescription, which enabled us to capture all melatonin use.</p>
<p>We looked at the rates of accidental and intentional injuries in the year before and after starting to use melatonin. We also examined whether the young people in our study had any psychiatric diagnoses.</p>
<p>Observational studies usually compare two different groups of people, such as melatonin users and non-users. However, these groups may differ in other ways which can cloud interpretation of the results, such as in their genetics, family environment and psychiatric diagnoses. To account for the influence of factors unique to each person, we used a study design which compares each person to themselves when they are taking or not taking melatonin.</p>
<h2>A strong link</h2>
<p>We observed that accidental injuries, such as falls or transport accidents, occurred at fairly similar rates before and after starting melatonin. Intentional self-harm and poisoning, however, increased shortly before melatonin was prescribed and decreased by about half in the months following the initiation of treatment.</p>
<p>The increase in self-harm prior to beginning to take melatonin may be related to the symptoms that led to the doctor visit in which the medicine was prescribed. Girls were approximately five times more likely to harm themselves compared with boys, so the reduction following melatonin use was more dramatic for girls.</p>
<p>About 87% of the young people starting melatonin treatment also had a psychiatric diagnosis. The most common one was ADHD, followed by anxiety, depression and autism spectrum disorders. The reduction in self-harm and poisoning was particularly evident among adolescent girls with depression or anxiety disorders.</p>
<p>To check whether the use of other medications might have affected our findings, we repeated the analyses excluding antidepressant users. The same pattern of results emerged. This suggests that melatonin might be responsible for the reduced self-harm rates, but we cannot exclude the possibility that psychotherapy or the use of psychiatric medications other than antidepressants may have influenced the findings.</p>
<figure class="align-center ">
<img alt="A young woman asleep in bed." src="https://images.theconversation.com/files/519005/original/file-20230403-24-an9a8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519005/original/file-20230403-24-an9a8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519005/original/file-20230403-24-an9a8q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519005/original/file-20230403-24-an9a8q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519005/original/file-20230403-24-an9a8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519005/original/file-20230403-24-an9a8q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519005/original/file-20230403-24-an9a8q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">There are known links between sleep problems and mental health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-sleep-bed-2204059989">F8 studio/Shutterstock</a></span>
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<h2>Why melatonin?</h2>
<p>There are a few reasons melatonin might have this effect. The primary reason is likely to be that people make better decisions <a href="https://psycnet.apa.org/record/2000-02426-006">when they are well rested</a>. Treating the sleep problems that often accompany anxiety and depression may lead people to have fewer thoughts about harming themselves or to choose not to act on these thoughts when they occur. </p>
<p>Research has also shown that melatonin <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012243/pdf/jpr-13-331.pdf">modifies how people feel pain</a>, potentially making people who take it less sensitive to pain. They may be less likely to hurt themselves intentionally if this is the case.</p>
<p>Finally, melatonin may represent just one aspect of the care that young people receive when they’re experiencing sleep and other problems. In addition to psychotherapy and other medications, increased monitoring from parents and doctors may also play a role in the behavioural changes we observed.</p>
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Read more:
<a href="https://theconversation.com/melatonins-role-in-protecting-the-heart-the-evidence-so-far-179387">Melatonin's role in protecting the heart – the evidence so far</a>
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<p>Our findings suggest that melatonin could reduce acts of self-harm in young people, particularly adolescent girls with anxiety or depression. Whether this is also true for adults is a question that warrants further research.</p>
<p>For young people struggling with sleep problems, and perhaps anxiety or depression as well, melatonin could be helpful. However, a doctor should always be consulted before starting any new medication, even if it’s available without a prescription.</p><img src="https://counter.theconversation.com/content/202895/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This study was funded by the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement no. 721567. Two of the authors were employees of Johnson & Johnson during this study. One author reports receiving grants from Shire Pharmaceuticals; personal fees from and serving as a speaker for Medice,Shire/Takeda Pharmaceuticals and Evolan Pharma AB, all outside of the submitted work. The funders and companies had no part in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.</span></em></p>There are a few reasons melatonin, a medication commonly taken for sleep difficulties, might have this effect.Sarah Bergen, Principal Researcher, Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1984742023-03-28T19:29:00Z2023-03-28T19:29:00ZSuicide prevention: Protective factors can build hope and mitigate risks<figure><img src="https://images.theconversation.com/files/517342/original/file-20230324-24-cfiq1p.jpg?ixlib=rb-1.1.0&rect=233%2C17%2C1523%2C1053&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Protective factors like supportive relationships can counteract suicide risk factors.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/suicide-prevention--protective-factors-can-build-hope-and-mitigate-risks" width="100%" height="400"></iframe>
<p>Globally, an estimated <a href="https://www.who.int/news-room/fact-sheets/detail/suicide">700,000 people take their own life every year</a> — a statistic that underscores the importance of suicide prevention. </p>
<p>Suicidal thoughts (ideation), plans and attempts are suprisingly common: <a href="https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/healthy-living/suicide-canada-key-statistics-infographic/ENG.pdf">12 per cent of Canadians have thought about suicide during their lifetime, 4.3 per cent made a plan and 3.1 per cent attempted it</a>.</p>
<p>Past suicide prevention efforts have emphasized the <a href="https://doi.org/10.1111/acps.13059">identification and mitigation of risk factors</a>. Most guidelines comprise <a href="https://pubmed.ncbi.nlm.nih.gov/27841450/">lists of non-specific factors such as mental illness, physical illness, life stress, special population status or access to lethal means</a>. This leaves room for improvement.</p>
<p>The focus is increasingly shifting toward protective factors that make it less likely that individuals will consider, attempt or die by suicide. Protective factors can help counterbalance the effects of risk factors on mental health. For example, <a href="https://doi.org/10.1016/j.genhosppsych.2013.10.006">optimism and gratitude may reduce suicidal ideation even if someone is experiencing depression</a>.</p>
<p>This emerging field offers evidence-based strategies to protect against suicidal thoughts and behaviours and reduce their frequency.</p>
<h2>Social support and connectedness</h2>
<p>The interpersonal theory of suicide describes the social nature of suicide and emphasizes <a href="https://doi.org/10.1016/j.jrp.2013.04.007">two key elements explaining why people consider suicide</a>: feelings of not belonging, and the sense of being a burden to others.</p>
<figure class="align-center ">
<img alt="Illustration of a stick figure preventing a line of dominoes from falling over" src="https://images.theconversation.com/files/517346/original/file-20230324-22-65cut6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517346/original/file-20230324-22-65cut6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517346/original/file-20230324-22-65cut6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517346/original/file-20230324-22-65cut6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517346/original/file-20230324-22-65cut6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517346/original/file-20230324-22-65cut6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517346/original/file-20230324-22-65cut6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Anyone — especially those with whom a trusting relationship has been established — can be a source of support by both offering and asking for help.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1016/j.jad.2013.01.033">Research on social support</a> suggests that the perception that one is cared for, loved, esteemed, and a member of a network of mutual obligations, contributes to a sense of belonging, making it a protective factor against suicide. Different <a href="https://doi.org/10.1192/bjp.bp.115.169094">social networks can provide emotional support, practical help or information</a>. </p>
<p>Individuals who perceived they had strong <a href="https://doi.org/10.1001/jamanetworkopen.2020.27491">social support had an approximately 40 per cent reduced risk of suicidal ideation and attempts</a>. Connection with others may also be protective for people experiencing interpersonal adversity in one sphere of their life. For instance, <a href="https://doi.org/10.1001/jamapediatrics.2014.1223">strong family connections may protect against suicidal ideation for a youth experiencing bullying in school</a>. </p>
<p>Social support is a key protective factor for suicide, and anyone — especially those with whom a trusting relationship has been established — can be a source of support by both offering and asking for help. </p>
<h2>Beliefs and sense of meaning</h2>
<p>Several therapeutic approaches promote searching for meaning in life. Meaning has been described by Michael Steger, director of the Center for Meaning and Purpose at Colorado State University, as having two key components: <a href="https://doi.org/10.1080/17439760.2015.1137623">a sense of comprehensibility, and the pursuit and attainment of goals</a>. </p>
<p>Both the <a href="https://doi.org/10.1186/s12888-020-02485-4">presence and search for meaning can protect against suicidal behaviours by decreasing hopelessness</a>, a negative attitude about future life events. Furthermore, <a href="https://doi.org/10.1016/j.jrp.2013.04.007">gratitude indirectly buffers against suicidal ideation by contributing meaning in life</a>. Gratitude exercises, such as daily journaling, are easily implementable interventions. </p>
<figure class="align-center ">
<img alt="Illustration of three silhouettes of a human head with different emotional expressions" src="https://images.theconversation.com/files/517347/original/file-20230324-20-mdnoy8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517347/original/file-20230324-20-mdnoy8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517347/original/file-20230324-20-mdnoy8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517347/original/file-20230324-20-mdnoy8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517347/original/file-20230324-20-mdnoy8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517347/original/file-20230324-20-mdnoy8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517347/original/file-20230324-20-mdnoy8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Several therapeutic approaches promote searching for meaning in life.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Cultural, religious and personal beliefs are also recognized sources of guidance to perceive life as meaningful. For instance, <a href="https://doi.org/10.1080/07481187.2014.970299">a study of Asian-American students found that for some, a desire to not let loved ones down was protective against suicide attempts</a>. </p>
<p>Other studies suggest <a href="https://doi.org/10.1080/19349637.2012.744620">spiritual faith provides the ability to find personal meaning amidst stressful life circumstances</a>. The relationship between religion and suicide is complex. Several studies have found religion to play a protective role <a href="https://doi.org/10.1093/med/9780198834441.003.0002">against suicidal ideation and attempt</a>. This arises from social factors (mutual care of members of supportive community), ethical considerations (condemnation of suicide) and fear (God’s wrath), as well as by <a href="https://doi.org/10.1080/13811118.2015.1004494">interpreting suffering in a tolerable way</a>. </p>
<p>A <a href="https://doi.org/10.1001/jamapsychiatry.2016.1243">study of U.S. women showed that those who frequently attended religious service</a> had approximately five-fold lower rate of suicide mortality compared to those who never attended. </p>
<h2>Mindfulness and self-compassion</h2>
<p><a href="https://doi.org/10.1007/s12671-021-01815-1">Self-compassion and mindfulness</a> have received increasing attention for their potential to buffer against suicidal thoughts and behaviours. </p>
<p>Educational psychologist <a href="https://self-compassion.org/the-three-elements-of-self-compassion-2/">Kristin Neff</a> defines <a href="https://doi.org/10.3389/fpsyg.2021.633482">self-compassion as kindness towards oneself in a time of pain</a>. </p>
<p>Self-compassion decreases negative self-judgments, which helps counteract negative emotional states such as self-loathing and self-isolation. Adopting a compassionate stance may help individuals accept difficult thoughts and emotions as a way out of suffering, and is critical for <a href="https://doi.org/10.1007/s10879-022-09550-x">moving individuals toward a life that is not structured around avoidance or escape from painful thoughts, emotions and physiological sensations</a>.</p>
<p>A related concept is mindfulness, defined as the practice of purposely bringing one’s attention to the present moment without judgement. Mindfulness-based interventions may be a promising practice to help navigate suicidal thoughts and behaviours. </p>
<p>Most interventions are a form of mental training to develop skills such as mindful awareness, focused attention and well-being. These skills allow one to <a href="https://doi.org/10.1080/13811118.2020.1833796">respond rather than react to stimuli, enhancing cognitive and emotional regulation</a>. </p>
<p><a href="https://doi.org/10.1001/jamapsychiatry.2018.1109">Dialectical behaviour therapy, the gold-standard treatment for chronic suicidality, also promotes acceptance while advocating for change by focusing on emotion regulation</a>. Dialectic thinking allows an individual to hold two seemingly opposite ideas as part of the same truth. Accepting that opposites can co-exist by engaging in more flexible thinking is a valuable strategy to regulate intense emotions.</p>
<p>Recent research in the field of mindfulness has begun to describe the role played by the mind-body connection in mechanisms related to suicide. In the presence of suicidal ideation, individuals with reported <a href="https://doi.org/10.1016/j.psychres.2019.112661">low levels of dissociation, defined as detachment from reality, were less likely to attempt suicide</a>. </p>
<p>Subsequent studies have shown the benefit of interventions aimed at improving interoception — the ability to sense and accept internal sensations and emotions — in reducing suicidal ideation. Engaging in <a href="https://doi.org/10.1016/j.beth.2021.02.001">self-guided progressive body relaxation exercise led to improved body trust and reduced identification with suicide</a>.</p>
<h2>Healthy lifestyle and habits</h2>
<p>Sleep hygiene and physical activity promote overall well-being in both physiological and psychological ways, given the strong mind-body connection.</p>
<figure class="align-center ">
<img alt="Red umbrella against gray stormy sky, with blue sky under the umbrella" src="https://images.theconversation.com/files/517357/original/file-20230324-25-7x7gzd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517357/original/file-20230324-25-7x7gzd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517357/original/file-20230324-25-7x7gzd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517357/original/file-20230324-25-7x7gzd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517357/original/file-20230324-25-7x7gzd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517357/original/file-20230324-25-7x7gzd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517357/original/file-20230324-25-7x7gzd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Protective factors such as optimism and gratitude may reduce suicidal ideation even if someone is experiencing depression.</span>
<span class="attribution"><span class="source">(Canva)</span></span>
</figcaption>
</figure>
<p>Sleep serves critical roles in <a href="https://doi.org/10.5665/sleep.4886">cognitive functions</a>, <a href="https://doi.org/10.3389/fpsyt.2022.920789">mood regulation and impulse control, among other things</a>. Research has shown an association between sleep duration and suicide risk. One study observed the lowest risk for suicidal ideation and attempts for <a href="https://doi.org/10.1016/j.smrv.2018.07.003">people sleeping eight to nine hours per day</a>. The same study suggested an 11 per cent reduction in risk of suicide plans for every one-hour increase in sleep.</p>
<p>Evidence also shows the benefits of physical activity. A recent systematic review has shown that physically <a href="https://doi.org/10.1016/j.jad.2017.08.070">active individuals reported almost 50 per cent lower suicidal ideation</a>. </p>
<p>Physical activity <a href="https://doi.org/10.1080/00223980.2021.1992334">can also be perceived as a form of self-compassion and an exercise in gratitude by recognizing the importance of treating the body with care</a>. Emerging evidence also suggests that the documented benefits of physical activity, such as walking, are larger when it takes place in nature. A study found that <a href="https://doi.org/10.1016/j.jad.2022.08.121">people with treatment-resistant major depressive disorder who walked in nature experienced fewer negative internal feelings than those who walked in urban streets</a>. </p>
<h2>Protective factors and resilience</h2>
<p>Suicide is complex. <a href="https://doi.org/10.3389/fpsyt.2016.00108">People considering or who have attempted suicide are suffering from tremendous emotional pain</a>. There is no one-size-fits-all recipe for prevention, but sharing knowledge about things that can help guard against suicide is critical. It raises hope and is part of the solution. </p>
<p>These protective factors for suicide can be regarded as <a href="https://doi.org/10.1111/acps.13059">pillars of resilience</a>. As a society, it is imperative to continue bringing more awareness to the discussion of suicide and to help people build resilience individually and collectively. </p>
<p><em>If you or someone you know is thinking about suicide, call 911 for emergency services. For support, call Canada Suicide Prevention Service at 1-866-277-3553 (from Québec) or 1-833-456-4566 (other provinces), or send a text to 45645. Visit <a href="https://talksuicide.ca/crisis-services-canada">Crisis Services Canada</a> for more resources.</em></p><img src="https://counter.theconversation.com/content/198474/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marie-Claude Geoffroy holds a Canada Research Chair (II) on Youth Suicide Prevention and receives fundings from numerous public and private funding organisations including a FRQ-SC research team.</span></em></p><p class="fine-print"><em><span>Massimiliano Orri receives funding from the Canadian Institutes of Health Research, the Fonds de Recherche du Québec, the American Foundation for Suicide Prevention, the Helsefonden, the Brain and Behavior Research Foundation, and the MQ Foundation. </span></em></p><p class="fine-print"><em><span>Bassam Khoury and Naomie Gendron do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The focus of suicide prevention is shifting toward protective factors: characteristics that make it less likely that individuals will consider, attempt or die by suicide.Naomie Gendron, Medical Student, McGill UniversityBassam Khoury, Associate Professor, Department of Educational and Counselling Psychology, McGill UniversityMarie-Claude Geoffroy, Assistant Professor, Department of Educational and Counselling Psychology and Canada Research Chair in Youth Suicide Prevention, McGill UniversityMassimiliano Orri, Assistant Professor, McGill Group for Suicide Studies, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1845052022-06-13T13:43:18Z2022-06-13T13:43:18ZBurned-out heroes: why bedside nurses should not have to be martyrs to be valued<p>In 2020, we saw windows pasted with rainbows, hospitals flooded with donations and NHS workers regularly <a href="https://theconversation.com/nurses-dont-want-to-be-hailed-as-heroes-during-a-pandemic-they-want-more-resources-and-support-167763">described as heroes</a>. While linked to <a href="http://doi.org/10.1136/medethics-2020-106398">heightened risks</a> faced by health workers during the pandemic, notions of self-sacrifice in nursing are not new. In fact, they have long underpinned the very nature of the role. </p>
<p>With the professionalisation of care work in the 19th century, in a society where a woman’s role was defined by caregiving, nurses were considered married to the job. Like military or monastic life, nurses were expected to not only suffer hardships without complaint but embrace them as part of <a href="https://theconversation.com/nurses-on-the-front-lines-a-history-of-heroism-from-florence-nightingale-to-coronavirus-137369">your life’s service</a>. </p>
<p>As written by E Glover, in a letter to the <a href="https://victoriancollections.net.au/items/6034a2bbacc7b00d389f7323">Nursing Journal</a>, published in 1903: </p>
<blockquote>
<p>A good nurse can never be compensated by money, She must be paid … but her work must be something better, something higher, and I may add purer and holier than the ordinary commerce of today.</p>
</blockquote>
<figure class="align-center ">
<img alt="A scene in a 19th century hospital ward, in black and white." src="https://images.theconversation.com/files/468240/original/file-20220610-28923-53ga7v.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/468240/original/file-20220610-28923-53ga7v.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=445&fit=crop&dpr=1 600w, https://images.theconversation.com/files/468240/original/file-20220610-28923-53ga7v.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=445&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/468240/original/file-20220610-28923-53ga7v.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=445&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/468240/original/file-20220610-28923-53ga7v.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=560&fit=crop&dpr=1 754w, https://images.theconversation.com/files/468240/original/file-20220610-28923-53ga7v.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=560&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/468240/original/file-20220610-28923-53ga7v.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=560&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If medicine has long been seen as a professional specialism, nursing has been sidelined – and undervalued – as an altruistic vocation.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Baron_Lister_%28seated%29_with_his_staff,_Victoria_ward,_King%27s_Wellcome_V0027907.jpg">Wellcome Images | Wikimedia</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Women’s and workers’ rights have come a long way since then. Yet bedside nurses’ role, job autonomy and even salaries are still defined by the notion that, as naturally compassionate individuals, they should be willing to sacrifice parts of themselves to provide care to others.</p>
<p>“Bedside nursing” refers to direct patient care and includes registered, associate and assistant nurses across a range of settings. The majority work day and night shift patterns and are not paid above band six (at which level, you can earn <a href="https://www.healthcareers.nhs.uk/working-health/working-nhs/nhs-pay-and-benefits/agenda-change-pay-rates/agenda-change-pay-rates">a maximum of £39,027</a>, once you have over five years of experience). Above that, you move into management or become a specialist practitioner.</p>
<p>Over my 15 years of working bedside, I have seen hundreds of ward staff experience <a href="https://theconversation.com/high-rates-of-covid-19-burnout-could-lead-to-shortage-of-health-care-workers-166476">burnout</a>. My doctoral <a href="https://www.ucl.ac.uk/anthropology/people/rebecca-williams">research</a> into ward-based care distribution shows how bedside nurses are particularly vulnerable to distress and burnout. Such stresses are only compounded by hero narratives.</p>
<h2>The enduring ideal of nursing as a calling</h2>
<p>The historic division of employment by gender and class underpins a <a href="https://www.routledge.com/Nursing-History-and-the-Politics-of-Welfare/Rafferty-Robinson/p/book/9780415138369">hierarchy of labour</a> within modern healthcare systems. Despite performing the majority of patient care and being subject to the most risk, bedside nurses occupy the lowest clinical pay bands.</p>
<p>Medicine has long been considered a professional specialism. Nursing, conversely, was seen as a vocation. This is rooted in the idea that care work is <a href="https://pubmed.ncbi.nlm.nih.gov/8970856/">altruistic</a>, and that caring is a disposition – not a skill.</p>
<p>Following this traditional demarcation between cure and care, the continued efforts of regulators and unions to cement nursing as a <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9780203864319-8/challenge-nursing-anne-witz-ellen-annandale">skilled profession</a> have, sadly, led to an increased devaluation of direct patient care and bedside nursing. </p>
<p>With diagnostic and life-promoting treatments prioritised, the fundamentals of healthcare – observation, hygiene, nutrition and comfort – are framed as the basics and, therefore, least valuable. This is defined by a pay structure that effectively rewards staff financially for moving away from bedside nursing and into a nine-to-five role, despite their having the biggest direct impact on patient care outcomes. </p>
<figure class="align-center ">
<img alt="A nurse in green scrubs holds up a poster demanding better pay." src="https://images.theconversation.com/files/468267/original/file-20220610-20-kj24ws.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/468267/original/file-20220610-20-kj24ws.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/468267/original/file-20220610-20-kj24ws.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/468267/original/file-20220610-20-kj24ws.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/468267/original/file-20220610-20-kj24ws.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/468267/original/file-20220610-20-kj24ws.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/468267/original/file-20220610-20-kj24ws.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In August 2020, nursing staff staged a protest in front of Downing Street to demanding a pay rise.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/london-uk-8th-august-2020-nhs-1810969111">John Gomez | Shutterstock</a></span>
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<p>This divestment does not reflect either the necessity or demands of bedside nursing. It is <a href="https://www.youtube.com/watch?v=VC4FajTFpRU&ab_channel=TEDxTalks">physically and emotionally laborious</a> work, and it comes at a price. <a href="https://pubmed.ncbi.nlm.nih.gov/33434920/">Cross-workforce studies demonstrate</a> that nurses across the board are unquestionably more at risk of post-traumatic stress disorder, anxiety, depression, alcohol dependency, self-harm and suicidal thinking. </p>
<p>While research has shown a link between <a href="https://pubmed.ncbi.nlm.nih.gov/33434920/">increases in mental health disorders</a> among staff and peaks in COVID admissions, this has less to do with the <a href="https://theconversation.com/heroes-or-just-doing-our-job-the-impact-of-covid-19-on-registered-nurses-in-a-border-city-143787">trauma of COVID-specific care</a> than it does the increased adverse impacts of being overstretched and under-resourced. </p>
<p>This was most keenly felt beyond the COVID critical-care wards into which resources were pooled, something I witnessed firsthand. </p>
<h2>How rationing care causes distress to patients and staff</h2>
<p>During the first wave I was redeployed to a COVID high-dependency unit, looking after patients who were critically ill. This left me shocked, stressed and upset. But nothing prepared me for my return to a depleted and overburdened oncology ward for the second wave.</p>
<p>There, patients were neglected because we were unable to adequately meet their needs. It was there – and not on COVID wards – that I felt unsafe, that I witnessed more drug errors, longer wait times, inadequate levels of basic care and limited lifesaving interventions.</p>
<p>When need is limitless and resources are finite, patients suffer <a href="https://doi.org/10.3389/fpsyg.2021.676970">indignity, harm and neglect</a>. How bedside nurses prioritise who gets their time and attention forms the crux of my research. I have found that the process of denying care to some in order to provide to others – which experts refer to as care “<a href="https://www.kingsfund.org.uk/publications/thinking-about-rationing">rationing</a>– has a seriously detrimental effect on bedside nurses.</p>
<figure class="align-center ">
<img alt="A nurse in protective gear sits on the floor in an empty corridor." src="https://images.theconversation.com/files/468271/original/file-20220610-24020-nb7217.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/468271/original/file-20220610-24020-nb7217.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/468271/original/file-20220610-24020-nb7217.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/468271/original/file-20220610-24020-nb7217.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/468271/original/file-20220610-24020-nb7217.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/468271/original/file-20220610-24020-nb7217.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/468271/original/file-20220610-24020-nb7217.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">COVID saw nurses around the world pushed beyond their limits.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/9/9c/Covid-19_San_Salvatore_09.jpg">Alberto Giuliani/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>Healthcare rationing is a <a href="https://www.euro.who.int/__data/assets/pdf_file/0007/118582/E60144.pdf">human rights issue</a> and not being able to provide good care is a significant cause of <a href="https://doi.org/10.1016/j.ijnurstu.2020.103688">distress</a>. Unlike policy and macro-level rationing, where institutions are ultimately held responsible for the effective neglect in which the rationing results, care rationing shifts the moral responsibility to the carer. </p>
<p>Nurses must <a href="https://doi.org/10.1177%2F0969733018759831">bear the burden</a> of deciding who gets fed their meals while still hot, who lies in soiled sheets and who is left to die alone. To try and mitigate these injustices, they get in early and stay late. They skip meals, they work through breaks, and they burn out. </p>
<p>I am currently working with the <a href="https://eur01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fcovidandsociety.com%2F&data=05%7C01%7Crebecca.williams.12%40ucl.ac.uk%7Ca7bcfa9d445e4ae4f81508da4ac005ff%7C1faf88fea9984c5b93c9210a11d9a5c2%7C0%7C0%7C637904485830829545%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=YG%2Fm12j0wh9GtjZQJDIwW0RBUBPTENUm8mF1QVnjco0%3D&reserved=0">International Public Policy Observatory</a> on a <a href="https://www.eventbrite.co.uk/e/nhs-staff-wellbeing-what-works-and-the-case-for-investment-tickets-327333050967">rapid evidence review</a>, demonstrating how poor mental health among NHS staff is placing an overwhelming operational burden on the service. This comes at a significant financial cost.</p>
<p>While statistics on nurses’ mental wellbeing and its wider impact draw much-needed attention to the subject, surveys and reporting cannot do justice to the reality of working on an understaffed, under-resourced, and overstretched acute NHS ward. They cannot adequately convey the physical, emotional, and mental stress bedside nurses <a href="https://theconversation.com/covid-19-frontline-nurses-did-not-receive-the-mental-health-support-they-deserved-166377">endure</a>.</p>
<p>As long as the role itself continues to be devalued and as long as bedside nurses are held to an impossible standard, this will not change.</p>
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<p><em>On Friday June 17, The Conversation’s partner organisation, the <a href="https://covidandsociety.com/">International Public Policy Observatory</a>, is hosting an online event to launch its rapid evidence review on NHS staff wellbeing and mental health. Speakers will include Dr Steve Boorman CBE and Professor Dame Carol Black. Sign up <a href="https://www.eventbrite.co.uk/e/nhs-staff-wellbeing-what-works-and-the-case-for-investment-tickets-327333050967">here</a> for this free event.</em></p><img src="https://counter.theconversation.com/content/184505/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca Williams' research work receives funding from The European Social Research Council and UCL Dean's Strategic Fund.</span></em></p>Nursing has long been seen as a vocation, not a skill. This impacts nursing staff and patients both.Rebecca Williams, PhD researcher in Anthropology, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1824162022-05-05T05:48:25Z2022-05-05T05:48:25ZPerpetrators of family violence sometimes use threats of suicide to control their partner<figure><img src="https://images.theconversation.com/files/461439/original/file-20220505-20-7lmfd1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/silhouette-man-sitting-window-rain-mood-1373817245">Shutterstock</a></span></figcaption></figure><p>Men’s suicide is <a href="https://www.aihw.gov.au/suicide-self-harm-monitoring/data/behaviours-risk-factors/social-factors-suicide">often linked to</a> social and economic factors such as financial problems, legal issues and unemployment.</p>
<p>But when seeking to understand men’s suicide, we shouldn’t overlook important questions of responsibility, choice, and agency – especially in the case of men who kill themselves in the context of relationship conflict and intimate partner violence.</p>
<p>Our research, <a href="https://onlinelibrary.wiley.com/doi/10.1111/1467-9566.13476">published this week</a>, found threats of self-harm and suicide were a tactic of coercive control men used against female partners.</p>
<p>Together with other forms of physical, emotional, economic and psychological controlling behaviour, threats of self-harm and suicide were intended to instil fear and exert power over women.</p>
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Read more:
<a href="https://theconversation.com/why-victims-of-domestic-abuse-dont-leave-four-experts-explain-176212">Why victims of domestic abuse don't leave – four experts explain</a>
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<h2>What did we study?</h2>
<p>Our research team included University of Newcastle psychiatric epidemiologist Tonelle Handley, UNSW senior research fellow in epidemiology Bronwyn Brew Haasdyk, and University of Newcastle professor of rural health David Perkins. </p>
<p>We examined cases of completed suicide from the <a href="https://www.ncis.org.au/">National Coronial Information System</a> and used a subset of data involving 155 suicide cases between 2010 and 2015 in rural Australia. We then qualitatively analysed 32 cases in detail to explore emerging patterns in the data. </p>
<p>Of the 2,511 male suicide cases in our <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245271">larger study sample</a>, family and intimate partner violence were identified in around 6% of cases.</p>
<p>The use of violence and suicide by men in our study took place primarily during times of separation, divorce, and custody battles. Men’s actions appeared to be based on a belief that threats of self-harm would force women into changing their behaviour. </p>
<p>When changes did not occur, suicide became a final act by which some men sought to punish women who they felt had wronged them. In some cases, men left spiteful messages or damaged (ex) partners’ personal belongings.</p>
<h2>What drives this behaviour?</h2>
<p>Suicide can be seen as a social act that draws on <a href="https://muse.jhu.edu/book/38475">culturally established meanings</a>. Here we might think of particular “types” of suicide such as the “protest suicide”, or “revenge suicide”. </p>
<p>Alternatively, we might think of acts of suicide that seek to express specific meanings such as grief, shame, honour or suffering. </p>
<p>These approaches are useful for considering how men in our study used suicide as a distinct form of violence to punish women, exact revenge, or lay blame and guilt on women. </p>
<p>The <a href="https://guilfordjournals.com/doi/abs/10.1521/suli.2008.38.4.375">grief and guilt associated with suicide</a> can be especially disruptive to relationships within families, including those between mothers and their children. For some men, suicide may be way of exerting control over (ex) partners, even in death. </p>
<p>These approaches also bring to light masculine ideals around marriage, family, authority, and control over women’s bodies. These were evident in the experiences, expectations, emotions, and actions of men in our study who suddenly found intimate partners out of reach. </p>
<figure class="align-center ">
<img alt="Woman in silhouette." src="https://images.theconversation.com/files/461456/original/file-20220505-16-kdcl86.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461456/original/file-20220505-16-kdcl86.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461456/original/file-20220505-16-kdcl86.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461456/original/file-20220505-16-kdcl86.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461456/original/file-20220505-16-kdcl86.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461456/original/file-20220505-16-kdcl86.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461456/original/file-20220505-16-kdcl86.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some men threaten suicide as a way of punishing their partner.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/silhouette-womans-head-waving-hair-back-563555992">Shutterstock</a></span>
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<h2>How do police respond?</h2>
<p>The proportion of men in our study who were in contact with police and/or health services in the weeks before suicide was high. </p>
<p>Police face challenges when managing incidents of violence and threats of self-harm. As primary responders to intimate partner violence and mental health crises, police <a href="https://www.mdpi.com/2076-0760/10/2/42">make important decisions</a> about whether the criminal justice or mental health systems are the most appropriate pathway. </p>
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<strong>
Read more:
<a href="https://theconversation.com/recruiting-more-mental-health-workers-wont-stop-suicides-preventing-child-abuse-and-neglect-will-171110">Recruiting more mental health workers won't stop suicides. Preventing child abuse and neglect will</a>
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<p>Our study found that in cases of physical violence, property damage, or other criminal offences, including violation of a domestic violence order, men were charged with a criminal offence. </p>
<p>However, in cases involving threats of self-harm, police regularly chose a health system pathway for these men.</p>
<h2>What about health providers?</h2>
<p>Once in health settings, health professionals <a href="https://www.cmtedd.act.gov.au/__data/assets/pdf_file/0003/864714/DVPC-Review-of-Domestic-and-Family-Violence-Deaths.pdf">typically viewed</a> men’s violence (including threats of suicide) as a temporary crisis, with mental illness and/or alcohol or other drug use seen as important contributory factors. </p>
<p>Treatment then focused on management of these crises, primarily using medication, with a tendency to downplay men’s violent behaviour. </p>
<p>We found there was little evidence for the effectiveness of these interventions, with coroners’ findings identifying several problems in patient discharge, follow-up, and support.</p>
<p>Despite the involvement of police and health services, there was no indication the men in our study received any treatment to address their violent behaviour. </p>
<p>Further, the health and criminal justice interventions they did receive served as short-term responses, were disjointed, and did not directly communicate with each other. </p>
<h2>So what needs to happen?</h2>
<p>Health service and criminal justice interventions provide <a href="https://www.cmtedd.act.gov.au/__data/assets/pdf_file/0003/864714/DVPC-Review-of-Domestic-and-Family-Violence-Deaths.pdf">important opportunities</a> for intervening to prevent further violence, including suicide.</p>
<p>Our study highlights the need for interventions that provide access to well-targeted, well-resourced, collaborative health and community services. There is a particular need for long-term integrated treatment, care, and social support for men experiencing alcohol or other drug use problems.</p>
<p>This requires a <a href="https://www.cmtedd.act.gov.au/__data/assets/pdf_file/0003/864714/DVPC-Review-of-Domestic-and-Family-Violence-Deaths.pdf">whole-of-government response</a> to fund coordinated, collaborative approaches that do not treat social and health problems in isolation.</p>
<p>Also needed are mandated <a href="https://www.cmtedd.act.gov.au/__data/assets/pdf_file/0003/864714/DVPC-Review-of-Domestic-and-Family-Violence-Deaths.pdf">perpetrator programs</a> that hold men responsible for their actions. These need to address the harmful norms of masculinity and consider the needs of men in their entirety.</p>
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<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p>
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Read more:
<a href="https://theconversation.com/how-challenging-masculine-stereotypes-is-good-for-men-114300">How challenging masculine stereotypes is good for men</a>
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<img src="https://counter.theconversation.com/content/182416/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Scott Fitzpatrick does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research shows how threats of self-harm and suicide are a tactic of coercive control men use against female partners.Scott Fitzpatrick, Research Fellow, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1820102022-04-30T12:01:54Z2022-04-30T12:01:54ZAutism, ADHD and school absence are risk factors for self-harm: new research<p><a href="https://theconversation.com/mental-health-one-in-three-young-people-in-england-are-struggling-new-report-130149">Self-harm</a> – physically hurting yourself – is common in young people, affecting about <a href="https://capmh.biomedcentral.com/articles/10.1186/1753-2000-6-10">one in five</a> teens by the age of 18. </p>
<p>Only about <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/attendance-at-the-accident-and-emergency-department-in-the-year-before-suicide-retrospective-study/373A148B712A0A45061F0AE574ACAD98">one in eight</a> self-harm episodes in teenagers are seen at hospital emergency departments. However, attending hospital for self-harm is one of the <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/suicide-following-deliberate-selfharm-longterm-followup-of-patients-who-presented-to-a-general-hospital/2A40FE4860E86668306A98F07F21D6FC">strongest risk factors</a> for future suicide. </p>
<p>In our <a href="https://doi.org/10.1186/s12916-022-02329-w">newly published study</a>, we identified some of the risk factors for self-harm by combining information from hospital assessments with other sources of information, such as school attendance, special educational needs and free school meal status. Bringing sources of information which relate to the same individual together in this way is is called data linkage. It is a powerful tool to maximise the value of public health data.</p>
<h2>Girls are at higher risk</h2>
<p>Self-harm refers to any act of self-injury carried out by a person, regardless of their motivation. This commonly involves self-poisoning with medication or self-wounding by cutting.</p>
<p>Our findings show that the risk for self-harm was nearly three times higher for boys with autism spectrum disorder (ASD) compared to those without. ASD was not a significant risk for self-harm in girls, though this may be due to an <a href="https://childmind.org/article/autistic-girls-overlooked-undiagnosed-autism/">underdiagnosis of ASD</a> in <a href="https://theconversation.com/why-many-women-with-autism-and-adhd-arent-diagnosed-until-adulthood-and-what-to-do-if-you-think-youre-one-of-them-179970">girls</a>. In general, though, the risk of self-harm was higher in girls (1.5%) than in boys (0.3%), which chimes with what previous research <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-13-328">has shown</a>.</p>
<p>Although evidence suggests that ASD is a risk factor for <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)70248-2/fulltext">self-harm in adults</a>, much less research has been conducted on risk among teenagers. The research that does exist has often included small, selective studies, using clinical samples rather than whole population samples. </p>
<p>By contrast, data linkage allowed us to study a huge amount of information. We assessed data from over 113,000 young people aged 11-17 years from four boroughs in south London, collected between 2009-2013. Our findings of increased risk for self-harm in boys with ASD are therefore important in addressing this research gap. </p>
<p>We also found that attention deficit hyperactivity disorder (ADHD) was a strong predictor of self-harm for both boys and girls. Young people with ADHD were approximately four times more likely to self-harm than those without the condition. Adolescents who had previously attended mental health services for ADHD were at four times the risk of self-harm than those who had not attended services for ADHD. These are important findings due to a gap in evidence: there have been <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-14-133">very few UK studies</a> exploring the association between ADHD and self-harm, particularly in girls.</p>
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<img alt="A teenage boy in a green t-shirt and jeans sits on the ground holding a book over his head." src="https://images.theconversation.com/files/460521/original/file-20220429-15-narlv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460521/original/file-20220429-15-narlv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460521/original/file-20220429-15-narlv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460521/original/file-20220429-15-narlv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460521/original/file-20220429-15-narlv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460521/original/file-20220429-15-narlv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460521/original/file-20220429-15-narlv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Boys on the autism spectrum are at greater risk of self-harming that girls.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tired-high-school-student-using-book-102482045">michaeljung | Shutterstock</a></span>
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<h2>Socio-economic risk factors</h2>
<p>We also discovered that young people who spend time away from school, either through exclusion or absence, were at greater risk of self-harm. For those with less than 80 per cent attendance, the risk of hurting themselves was three times greater than those with more than 80 per cent attendance. These findings do not show that school absence causes self-harm. They do, however, suggest that this is an important group of young people at whom to target preventive interventions. </p>
<p>Previous research examining socio-economic risk factors for self-harm has shown that girls who receive <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/abs/ethnicity-socioeconomic-status-and-selfharm-in-swedish-youth-a-national-cohort-study/07AFBBB6EB0BCB48E687BB0AB9ECE130">free school meal status</a> are also significantly more likely to engage in self-harm. Similarly, <a href="https://pubmed.ncbi.nlm.nih.gov/15819745/">looked-after children</a> have been shown to be at heightened risk. </p>
<p>Our research also led to some unexpected findings. Having English as a second language seemed to act as a protective factor for self-harm. However, this may be due to adolescents with English as a second language perhaps not presenting to mental health services. <a href="https://link.springer.com/article/10.1007/s10903-013-9971-9">Previous research</a> has found language barriers to be an important contributor to disparities in access to services. </p>
<figure class="align-center ">
<img alt="Three teenagers in school uniform walk away from the camera, outside." src="https://images.theconversation.com/files/460524/original/file-20220429-20-kiaipt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460524/original/file-20220429-20-kiaipt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460524/original/file-20220429-20-kiaipt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460524/original/file-20220429-20-kiaipt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460524/original/file-20220429-20-kiaipt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460524/original/file-20220429-20-kiaipt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460524/original/file-20220429-20-kiaipt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Adverse community experiences with the mental health system mean that not all children at risk of self-harm will be identified.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/three-black-teenagers-walking-backpacks-park-691135204">Katarzyna Golembowska | Shutterstock</a></span>
</figcaption>
</figure>
<p>Additionally, although we found associations between free-school-meal status and self-harm, we did not find a connection between neighbourhood deprivation and self-harm. While this is at odds with <a href="https://linkinghub.elsevier.com/retrieve/pii/S0277-9536(17)30568-3">previous research</a>, our findings do support <a href="https://link.springer.com/article/10.1007/s00127-018-1601-3">recent research showing</a> that some deprived inner-city areas, such as parts of London, have lower rates of self-harm. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750675/">Factors</a> that might explain this include, on the one hand, community solidarity and what researchers have termed a culture of self-reliance and, on the other hand, a collective sense that being identified as being mentally ill is risky – that mental health services are intrusive and coercive.</p>
<p>Data linkage allows whole populations to be studied. It is less intrusive than asking people to complete surveys. And it allows research to include people who may not proactively take part in traditional studies. We have also been able to take a lens to the risk factors behind self-harm in young people and identify those groups who may be most vulnerable. These findings are an important step in the development of strategies to prevent self-harm and demonstrate the power of data linkage to tackle public health issues.</p><img src="https://counter.theconversation.com/content/182010/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Widnall receives funding from the NIHR School for Public Health Research. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.</span></em></p><p class="fine-print"><em><span>Johnny Downs receives funding from National Institute for Health Research (NIHR) Biomedical Research Centre
at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. </span></em></p>Data linkage, assessing information from over 113,000 teenagers in South London, addresses important gaps in research on the mental health and socio-economic risk factors for self-harm.Emily Widnall, Senior Research Associate, Population Health Sciences, University of BristolJohnny Downs, Senior Clinical Lecturer, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1814192022-04-28T15:50:24Z2022-04-28T15:50:24ZWhy do teens engage in self-harm? Clinical psychologists explain how to help teens reduce their emotional distress<figure><img src="https://images.theconversation.com/files/459399/original/file-20220425-22-7zvx20.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6720%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nearly 1 in 5 young people worldwide intentionally injure themselves every year.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sadness-teenage-girls-sitting-in-tunnel-royalty-free-image/1309858578?adppopup=true">xijian/E! via Getty Images</a></span></figcaption></figure><p>Emotions are tricky things. They allow for humans to fall in love, wage war and, as it turns out, engage in self-harm. </p>
<p>It is hard to imagine an era in which young adults were more distressed than today. Recent Centers for Disease Control and Prevention data indicates that more than 40% of high school students <a href="https://www.cdc.gov/media/releases/2022/p0331-youth-mental-health-covid-19.html">reported they felt</a> persistently sad or hopeless over the past year. In the same survey, about 20% reported that <a href="https://www.washingtonpost.com/education/2022/03/31/student-mental-health-decline-cdc/">they seriously considered suicide</a>. Worldwide, approximately 17% of youths ages 12-18 <a href="https://doi.org/10.1016/j.jaac.2018.06.018">intentionally injure themselves each year</a>.</p>
<p>By all accounts, young people are experiencing a seemingly <a href="https://www.nytimes.com/2022/04/23/health/mental-health-crisis-teens.html">unprecedented level of emotional distress</a>. </p>
<p>Humans tend to behave in a way to <a href="https://doi.org/10.1016/j.cognition.2021.104904">seek pleasure and avoid pain</a>. Why then would some intentionally hurt themselves? In a new meta-analysis, a summary of research studies that we and our colleagues published in the journal Nature Human Behavior, we reported that people felt better <a href="https://www.nature.com/articles/s41562-022-01340-8">immediately after they self-injured or thought about suicide</a>. </p>
<p><a href="https://scholar.google.com/citations?user=SeU_WBkAAAAJ&hl=en&authuser=1">We are a doctoral candidate</a> in clinical psychology at the University of Washington, researching why youths and young adults self-injure, and <a href="https://scholar.google.com/citations?user=ifgFwvcAAAAJ">a clinical psychologist</a> studying young adult substance use. Our research suggests that this reduction in emotional distress following acts of self-harm and suicidal thoughts likely maintains these types of thoughts and behaviors. </p>
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<figcaption><span class="caption">Research shows that people often cut as a way to deal with strong emotions.</span></figcaption>
</figure>
<h2>The challenges with studying self-harm</h2>
<p>In his book “<a href="https://www.worldcat.org/title/about-behaviorism/oclc/805018">About Behaviorism</a>,” the preeminent psychologist <a href="https://psychology.fas.harvard.edu/people/b-f-skinner">B.F. Skinner</a> coined the term “reinforcement” to explain why behaviors are more likely to occur if that same behavior previously resulted in a desired outcome. Over the past 20 years, <a href="https://doi.org/10.1037/0022-006X.72.5.885">leading theories have hypothesized</a> that self-injury operated in the same manner. That is, if someone experienced relief from emotional suffering after they injured themselves, they would be more likely to repeat the behavior in the future. </p>
<p>Self-injury is difficult to research. Until the last decade, most researchers asked people to reflect on what they were thinking or feeling when they were self-injuring, but those episodes could have been months or even years ago. We humans, though, are remarkably bad at accurately reporting on our own behaviors, <a href="https://doi.org/10.1126/science.3563494">especially when we try to explain why things happened</a>. It’s especially challenging for researchers to get a clear timeline of events, which makes it difficult to pinpoint how someone was feeling immediately before or after they self-injured. </p>
<p>Recently, researchers have tried to fill those gaps by making use of the <a href="https://doi.org/10.1016/j.copsyc.2017.07.026">ubiquity of cellphones</a>. In those studies researchers asked participants to complete brief surveys about how they’re feeling multiple times per day over their cellphones as they go about living their lives. </p>
<p>Our meta-analysis <a href="https://www.nature.com/articles/s41562-022-01340-8">analyzed 38 such survey-based studies</a>, with data contributed from researchers around the U.S. and Europe, involving 1,644 participants. In all the studies, participants rated the intensity of their emotions and indicated whether they had thought about self-injury in the past few hours. </p>
<p>We found that the participants reported higher levels of distress right before they self-harmed or thought about suicide, and reported significantly reduced levels of distress immediately following. Together, this suggests that relief from distressing emotion acts as a powerful reinforcer, likely increasing the probability that people continue to experience self-injurious thoughts and behaviors. It also implies that treatments should focus on how to help people replace self-injury with alternative ways of relieving stress. </p>
<p>Since roughly 40% of people who attempt suicide <a href="https://www.nytimes.com/2022/01/19/health/suicide-attempts-us.html">do not receive mental health services</a>, we think it is important to share strategies for helping individuals at risk of self-harm talk about their emotions and to offer resources for finding professional help. </p>
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<figcaption><span class="caption">Family and the broader community play a role in reducing suicide risk.</span></figcaption>
</figure>
<h2>Strategies for discussing self-harm</h2>
<p>Teens who <a href="https://doi.org/10.1111/sltb.12841">self-injure and/or think about suicide are a heterogenous group</a> – people are unique, after all. However, our finding suggests that self-harm serves an important function for youth: to help regulate emotions. </p>
<p>It is essential that teens experiencing self-injurious thoughts and behaviors <a href="https://doi.org/doi:10.1001/jamapsychiatry.2018.4358">find adults and/or peers</a> to whom they feel connected. The previously mentioned CDC survey showed that <a href="https://www.cdc.gov/media/releases/2022/p0331-youth-mental-health-covid-19.html">youths who felt connected</a> were much less likely to contemplate or attempt suicide than those who did not feel connected. Thus, ensuring that teens feel cared about and supported or that they “belong” at home and school may be one way to protect against self-injury.</p>
<p>We’ve found in our clinical work with youths who self-injure that it’s important to balance validating their emotions – in other words, acknowledging and accurately understanding their feelings – while not responding to self-injury in ways likely to inadvertently reinforce it. If, for example, teens felt as if the only way they received support or validation were to self-harm, then it would be important to ensure that validation is provided when they are not self-harming. </p>
<p><strong>Here are some key ways to validate and show support:</strong></p>
<p>– Pay attention: We all know what it feels like to speak with someone who is not paying attention or is looking at their phone. Make eye contact and show you’re interested in what the person is feeling. </p>
<p>– Reflect back: Summarize what the person is saying to demonstrate that you are listening and taking in the information. You could say something like, “Let me make sure I understand …” and then paraphrase what you’re hearing.</p>
<p>– Try to read their thoughts: Imagine yourself in the person’s shoes or guess what they may be feeling, even if they haven’t said it directly. You could say something like, “I imagine you must be feeling like nobody understands what you’re going through.” If the teen says you’re wrong, give up on being right and try again later. </p>
<p>– Validate based on prior events: Show that you understand how the feelings make sense given what you know about the person. For example, you could ask, “Are there times when you’ve had experiences similar to now?” You could say something like, “I could totally see how you would feel afraid about failing this test, since you studied hard for the last one but didn’t do as well as you wanted.” </p>
<p>– Acknowledge how the feelings make sense in the present: Would other people in that exact same situation have the same feelings? For example, “Anyone would feel afraid.” This communicates to the other person that there isn’t anything wrong with the way they’re thinking and feeling. You won’t be able to validate everything; for instance, you shouldn’t validate that self-injuring is an effective response to distress. However, you can validate that self-injuring is understandable because it can provide temporary emotional relief even if it causes problems in the long run.</p>
<p>– Be “radically genuine”: Be authentic and try to show the other person you respect them and care about them. Treat them as a person of equal status who has important expertise about how to help solve the problem of their self-harm.</p>
<h2>Extending a helping hand</h2>
<p>It’s important for people to know that help is available. The National Suicide Prevention Lifeline (800-273-8255) is free for anyone experiencing emotional distress. <a href="https://nowmattersnow.org/">Now Matters Now</a> is another free resource that offers coping strategies to manage self-harm and suicidal thoughts from individuals with lived experience. </p>
<p>[<em>Over 150,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-150ksignup">Sign up today</a>.]</p>
<p>Prior research has shown that certain behavioral interventions, such as <a href="https://doi.org/10.7326/M19-0869">cognitive behavioral therapy</a> – an approach that focuses on the interplay among thoughts, emotions and behaviors – or <a href="https://doi.org/10.1080/15374416.2019.1591281">dialectical behavioral therapy</a> – a comprehensive treatment package that teaches mindfulness, emotion regulation, distress tolerance and interpersonal coping skills – are effective at reducing self-injurious thoughts and behaviors. Both treatments are designed to provide individuals with skills for recognizing their emotions as well as changing their feelings without self-injuring. </p>
<p><a href="https://services.abct.org/i4a/memberDirectory/index.cfm?directory_id=3&pageID=3282">Find a cognitive behavioral therapist</a></p>
<p><a href="https://behavioraltech.org/resources/find-a-therapist-app/">Find a therapist who provides dialectical behavioral therapy</a>, ideally a therapist who has been certified by the <a href="https://dbt-lbc.org/index.php?page=101163">DBT-Linehan Board of Certification</a> who has demonstrated the knowledge and ability to deliver DBT with adherence to the manual.</p><img src="https://counter.theconversation.com/content/181419/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kevin Kuehn received funding from the National Institute of Mental Health.</span></em></p><p class="fine-print"><em><span>Kevin King receives funding from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism</span></em></p>New research shows that many young people report a sense of temporary relief following episodes of self-harm. But there are clear ways to help teens replace injurious behaviors with healthy ones.Kevin Kuehn, PhD Student in Clinical Psychology, University of WashingtonKevin King, Professor of Psychology, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1746492022-01-17T16:30:50Z2022-01-17T16:30:50ZHow going from care to prison compounds women’s trauma – new research<figure><img src="https://images.theconversation.com/files/441307/original/file-20220118-17-lgee9s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Of the women in custody, those who have been through the care system are over-represented. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/silhouette-womans-head-waving-hair-back-563555992">MikeDotta | Shutterstock</a></span></figcaption></figure><p>In the year to June 2021, for every 1,000 women in custody in England and Wales, 3,808 incidents of self-harm were recorded. This represented a shocking increase of <a href="https://www.gov.uk/government/statistics/safety-in-custody-quarterly-update-to-june-2021/safety-in-custody-statistics-england-and-wales-deaths-in-prison-custody-to-september-2021-assaults-and-self-harm-to-june-2021">16%</a> on the previous year. Between March 2007 and March 2018, 37 women in prison <a href="https://www.inquest.org.uk/Handlers/Download.ashx?IDMF=8d39dc1d-02f7-48eb-b9ac-2c063d01656a">took their own lives</a>. </p>
<p>Evidence suggests that the link between self-harm and suicide is <a href="https://webarchive.nationalarchives.gov.uk/ukgwa/20130206102659/http:/www.justice.gov.uk/publications/docs/corston-report-march-2007.pdf">stronger in prisons</a> than in the wider community. For a <a href="https://journals.sagepub.com/doi/10.1177/17488958211067914">recent study</a> we conducted interviews with 37 women in three closed prisons in England between September 2019 and February 2020. A key aim of our research was to amplify women’s voices. Self-harm was not an issue we had set out to explore in this study, but it was a topic that many nevertheless chose to share. </p>
<p>Our findings show that having prior experience of living in care can provide crucial context for understanding why some women in prison might self-harm. All the women we spoke with had experience of the <a href="https://theconversation.com/new-laws-in-england-will-leave-16-year-olds-living-alone-167756">care system</a> before going to prison. Self-harm was raised as a key issue by some.</p>
<h2>Unmet needs</h2>
<p>Women who have been through the care system are over-represented in prisons in England. While there are challenges in obtaining accurate data, estimates suggest that <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/278837/prisoners-childhood-family-backgrounds.pdf">31% of female prisoners</a> (compared to 24% of imprisoned men) spent time in the care of the state as children. </p>
<p>This is, of course, <a href="https://theconversation.com/why-have-so-many-people-in-prison-spent-time-in-care-as-children-66941">not inevitable</a>. Many care leavers go on to do very well when appropriately supported. But a significant minority do come into contact with the justice system, with challenging behaviour such as minor damage to property still <a href="http://www.prisonreformtrust.org.uk/Portals/0/Documents/In%20care%20out%20of%20trouble%20summary.pdf">more likely to be criminalised</a> in some care settings than for those living at home with their birth families. This is often compounded by the stigma attached to being in care. Negative attitudes assume some care leavers will inevitably be troublesome.</p>
<p>Many of the women we interviewed described backgrounds of abuse and neglect and being taken into care for their welfare and protection. As one interviewee, Mandy, explained:</p>
<blockquote>
<p>I was a traumatic child … very, very out of control … I didn’t know how to ask for help. Because in the care system I was never shown all that. </p>
</blockquote>
<p>For some, self-harm became a way of communicating their trauma. Several described harming themselves as a way of alleviating psychological pain. In the most severe cases, for those women who tried to take their own lives, it became an attempt to end that pain. </p>
<figure class="align-center ">
<img alt="A woman with a clipboard holds another woman's hands in a therapy setting." src="https://images.theconversation.com/files/441050/original/file-20220117-19-1v0so5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441050/original/file-20220117-19-1v0so5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441050/original/file-20220117-19-1v0so5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441050/original/file-20220117-19-1v0so5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441050/original/file-20220117-19-1v0so5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441050/original/file-20220117-19-1v0so5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441050/original/file-20220117-19-1v0so5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women describe having difficulty accessing mental health support and medication when arriving in prison.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-female-doctor-hold-woman-patient-1714751662">fizkes | Shutterstock</a></span>
</figcaption>
</figure>
<h2>Systemic failure</h2>
<p>There has been a tendency for research to focus on <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30190-5/fulltext">the personal factors</a> that might lead an individual to self-harm. Research on the sociology of punishment, however, has highlighted how self-injury may be <a href="https://journals.sagepub.com/doi/10.1177/1362480615595283">linked</a> to the painful experiences of imprisonment for some women, such as separation from loved ones.</p>
<p>Our own research draws attention to what is lacking in the systems designed to support these women. Women described delays in accessing medication on entry to prison and in obtaining mental health appointments, among other challenges. Not feeling listened to in care was a common theme often repeated in prison. As Leanne put it:</p>
<blockquote>
<p>There’s a lot of self-harm in this prison, a lot. Because they don’t feel heard … they don’t get dealt with in the right manner. They just get locked away and … labelled.</p>
</blockquote>
<p>For some, experiences of the prison system echoed experiences the women described from their time in care, which was often characterised by instability and a lack of support. Their mental health needs went unmet – they were frequently moved from placement to placement. </p>
<p>For women who were previously in the care of the state as children, access to mental health support is crucial, as is making sure that those who leave care are <a href="http://wp.lancs.ac.uk/care-custody/files/2019/10/CareCustodyLiteratureReview.pdf">not abandoned</a>. More broadly, our findings raise serious questions about how we, as a society, use imprisonment as a punitive measure for these women. </p>
<p>While there are ongoing efforts to identify and improve the <a href="https://hmppsintranet.org.uk/uploads/6.6018_HMPPS_People%20with%20care%20experience%20strategy_WEB.pdf">support</a> available to those who have gone from care to prison, research also shows the <a href="https://theconversation.com/why-rehabilitation-not-harsher-prison-sentences-makes-economic-sense-132213">potential of community sentences</a>, such as deferred prosecution schemes, to be credible, cost-effective alternatives to custody that avoid the trauma of imprisonment. Even better, however, is to ensure that children in care receive all the support they need. This would help to <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/765082/The_national_protocol_on_reducing_unnecessary_criminalisation_of_looked-after_children_and_care_.pdf">prevent</a> those who have been in care from being unnecessarily criminalised in the first place.</p>
<p><em>All names have been changed to protect the identity of the participants. If you are affected by any of the issues in this piece, please consider talking to someone. The Samaritans helpline - 116 123 - is available 24 hours a day.</em></p><img src="https://counter.theconversation.com/content/174649/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The study on which this piece is based was carried out with Dr Katie Hunter (Lancaster University), Dr Julie Shaw (Liverpool John Moores University) and Dr Jo Staines (University of Bristol). This research was funded by the Nuffield Foundation, but the views expressed are those of the authors and not necessarily the Foundation. Visit <a href="http://www.nuffieldfoundation.org">www.nuffieldfoundation.org</a></span></em></p>Care leavers are over-represented in the justice system. Rising rates of self-harm show an urgent need for greater mental health support.Claire Fitzpatrick, Senior Lecturer in Criminology, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1709832021-11-09T13:40:14Z2021-11-09T13:40:14ZSchool surveillance of students via laptops may do more harm than good<figure><img src="https://images.theconversation.com/files/430803/original/file-20211108-13-1sa677z.jpg?ixlib=rb-1.1.0&rect=35%2C0%2C5807%2C3897&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">School laptop surveillance systems monitor students even when they're not in school.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-woman-eyes-watching-a-computer-screen-royalty-free-image/1330207239?adppopup=true">Jacques Julien/Getty Images</a></span></figcaption></figure><p>Since the start of the pandemic, more public school students are using laptops, tablets or similar devices issued by their schools.</p>
<p>The percentage of teachers who reported their schools had provided their students with such devices doubled from 43% before the pandemic to <a href="https://cdt.org/insights/report-online-and-observed-student-privacy-implications-of-school-issued-devices-and-student-activity-monitoring-software/">86% during the pandemic</a>, a September 2021 report shows.</p>
<p>In one sense, it might be tempting to celebrate how schools are doing more to keep their students digitally connected during the pandemic. The problem is, schools are not just providing kids with computers to keep up with their schoolwork. Instead – in a trend that could easily be described as Orwellian – the vast majority of schools are also using those devices to keep tabs on what students are doing in their personal lives.</p>
<p>Indeed, <a href="https://www.theguardian.com/commentisfree/2021/oct/11/us-students-digital-surveillance-schools">80% of teachers and 77% of high school students</a> reported that their schools had installed artificial intelligence-based surveillance software on these devices to monitor students’ online activities and what is stored in the computer.</p>
<p>This student surveillance is taking place – at taxpayer expense – in cities and school communities throughout the United States.</p>
<p>For instance, in the Minneapolis school district, school officials <a href="https://www.the74million.org/article/dont-get-gaggled-minneapolis-school-district-spends-big-on-student-surveillance-tool-raising-ire-after-terminating-its-police-contract/">paid over $355,000</a> to use tools provided by <a href="https://www.gaggle.net/">student surveillance company Gaggle</a> until 2023. Three-quarters of incidents reported – that is, cases where the system flagged students’ online activity – took place <a href="https://www.the74million.org/article/gaggle-spy-tech-minneapolis-students-remote-learning/">outside school hours</a>.</p>
<p>In Baltimore, where the public school system uses the <a href="https://www.washingtonpost.com/local/education/baltimore-school-laptops-monitored/2021/10/24/be2c6b6e-2d2a-11ec-8ef6-3ca8fe943a92_story.html">GoGuardian</a> surveillance app, police officers are <a href="https://therealnews.com/cops-in-baltimore-schools-are-monitoring-students-laptops">sent to children’s homes</a> when the system detects students typing keywords related to self-harm.</p>
<h2>Safety versus privacy</h2>
<p>Vendors claim these tools <a href="https://www.eff.org/deeplinks/2020/02/schools-are-pushing-boundaries-surveillance-technologies">keep students safe</a> from self-harm or online activities that could lead to trouble. However, <a href="https://www.govtech.com/education/k-12/privacy-groups-uneasy-with-monitoring-students-for-self-harm">privacy groups</a> and <a href="https://www.vice.com/en/article/8xwze4/schools-are-using-spyware-to-prevent-shootingsbut-theres-no-evidence-it-works">news outlets</a> have raised questions about those claims.</p>
<p>Vendors often <a href="https://www.bloomberg.com/news/features/2021-10-28/how-goguardian-ai-spyware-took-over-schools-student-devices-during-covid">refuse to reveal</a> how their <a href="https://www.buzzfeednews.com/article/carolinehaskins1/gaggle-school-surveillance-technology-education">artificial intelligence programs were trained</a> and the type of data used to train them.</p>
<p>Privacy advocates fear these tools may <a href="https://www.the74million.org/article/democratic-lawmakers-demand-student-surveillance-companies-outline-business-practices-warn-the-security-tools-may-compound-risk-of-harm-for-students/">harm students</a> by <a href="https://www.govtech.com/education/k-12/privacy-groups-uneasy-with-monitoring-students-for-self-harm">criminalizing mental health problems</a> and <a href="https://scholarship.law.unc.edu/cgi/viewcontent.cgi?article=6749&context=nclr">deterring free expression</a>.</p>
<p>As a researcher who <a href="https://scholar.google.com/citations?user=g-jALEoAAAAJ&hl=en&oi=ao">studies</a> <a href="https://www.sciencedirect.com/science/article/abs/pii/S0308596114001542?via%3Dihub">privacy</a> and <a href="https://utorontopress.com/9781487523626/cybersecurity-management/">security</a> issues in various <a href="https://link.springer.com/book/10.1007/978-3-319-40554-4">settings</a>, I know that intrusive surveillance techniques cause <a href="https://scholarship.law.unc.edu/cgi/viewcontent.cgi?article=6749&context=nclr">emotional and psychological harm</a> to students, <a href="https://www.wired.com/story/borrowed-school-laptop-mind-open-tabs/">disproportionately penalize minority students</a> and <a href="https://www.bleepingcomputer.com/news/security/proctoru-confirms-data-breach-after-database-leaked-online/">weaken online security</a>.</p>
<h2>Artificial intelligence not intelligent enough</h2>
<p>Even the <a href="https://bdtechtalks.com/2020/07/13/ai-barrier-meaning-understanding/">most advanced artificial intelligence</a> <a href="https://sloanreview.mit.edu/article/what-weve-learned-so-far-about-blockchain-for-business/">lacks the ability</a> to understand human language and <a href="https://www.pwvconsultants.com/blog/computers-are-hard-ais-language-obstacle/">context</a>. This is why student surveillance systems pick up a lot of <a href="https://www.vice.com/en/article/8xwze4/schools-are-using-spyware-to-prevent-shootingsbut-theres-no-evidence-it-works">false positives</a> instead of real problems.</p>
<p>In some cases, these surveillance programs have flagged students discussing music deemed suspicious and even students <a href="https://www.govtech.com/education/k-12/privacy-groups-uneasy-with-monitoring-students-for-self-harm">talking about the novel</a> “To Kill a Mockingbird.”</p>
<h2>Harm to students</h2>
<p>When students know they are being monitored, they are <a href="https://www.bestcolleges.com/news/analysis/2021/10/01/students-on-school-devices-under-constant-surveillance/">less likely</a> to share true thoughts online and are more careful about what they search. This can <a href="https://www.the74million.org/article/new-research-most-parents-and-teachers-have-accepted-student-surveillance-as-a-safety-tool-but-see-the-potential-for-serious-harm/">discourage vulnerable groups</a>, such as students with mental health issues, from getting needed services. </p>
<p>When students know that their every move and everything read and written is watched, they are also <a href="https://scholarship.law.unc.edu/cgi/viewcontent.cgi?article=6749&context=nclr">less likely to develop into adults with a high level of self-confidence</a>. In general, surveillance has a negative impact on students’ <a href="https://eric.ed.gov/?id=EJ778214">ability to act and use analytical reasoning</a>. It also <a href="https://scholarship.law.unc.edu/cgi/viewcontent.cgi?article=6749&context=nclr">hinders the development</a> of the skills and mindset needed to exercise their rights.</p>
<h2>More adverse impact on minorities</h2>
<p>U.S. schools <a href="https://www.usatoday.com/story/news/investigations/2021/09/08/police-schools-black-and-disabled-children-face-harsher-discipline/5436023001/">disproportionately discipline</a> minority students. African American students’ chances of being suspended are <a href="https://www.nytimes.com/2018/03/18/us/politics/school-discipline-disparities-white-black-students.html">more than three times higher</a> than that of their white peers.</p>
<p>After evaluating flagged content, <a href="https://www.lgbtqnation.com/2021/10/minneapolis-schools-spying-queer-students-reporting-teachers-parents/">vendors report any concerns to school officials</a>, who take disciplinary actions on a case-by-case basis. The <a href="https://www.wired.com/story/borrowed-school-laptop-mind-open-tabs/">lack of oversight</a> in schools’ use of these tools could lead to further harm for minority students.</p>
<p>The situation is worsened by the fact that Black and Hispanic students rely <a href="https://www.wired.com/story/borrowed-school-laptop-mind-open-tabs/">more on school devices than their white peers do</a>. This in turn makes minority students more likely to be monitored and exposes them to greater risk of some sort of intervention.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430808/original/file-20211108-21-f3t4nn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A Black girl stares at her laptop." src="https://images.theconversation.com/files/430808/original/file-20211108-21-f3t4nn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430808/original/file-20211108-21-f3t4nn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430808/original/file-20211108-21-f3t4nn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430808/original/file-20211108-21-f3t4nn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430808/original/file-20211108-21-f3t4nn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430808/original/file-20211108-21-f3t4nn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430808/original/file-20211108-21-f3t4nn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Students of color are more likely to rely on school-issued laptops than their white peers are.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/teenage-girl-studying-and-drinking-juice-sitting-on-royalty-free-image/1149149239?adppopup=true">Igor Alecsander/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>When both minority students and their white peers are monitored, the former group is more likely to be penalized because the training data used in developing artificial intelligence programs often <a href="https://www.dataversity.net/making-machine-learning-datasets-unbiased/">fails to include enough minorities</a>. Artificial intelligence programs <a href="https://civic.mit.edu/2019/01/24/how-automated-tools-discriminate-against-black-language/">are more likely to flag</a> languages <a href="https://homes.cs.washington.edu/%7Emsap/pdfs/sap2019risk.pdf">written and spoken by such groups</a>. This is due to the <a href="https://www.unite.ai/minority-voices-filtered-out-of-google-natural-language-processing-models/">underrepresentation of languages written and spoken by minorities</a> in the datasets used to train such programs and <a href="https://www.thenationalnews.com/arts-culture/comment/2021/11/07/accents-and-ai-how-speech-recognition-software-could-lead-to-new-forms-of-discrimination/">the lack of diversity of people working in this field</a>.</p>
<p>Leading AI models are <a href="https://www.vox.com/recode/2019/8/15/20806384/social-media-hate-speech-bias-black-african-american-facebook-twitter">50% more likely to flag tweets written by African Americans as “offensive”</a> that those written by others. They are 2.2 times more likely to flag tweets written in African American slang.</p>
<p>These tools also affect sexual and gender minorities more adversely. Gaggle has reportedly flagged <a href="https://www.lgbtqnation.com/2021/10/minneapolis-schools-spying-queer-students-reporting-teachers-parents/">“gay,” “lesbian” and other LGBTQ-related terms</a> because they are associated with pornography, even though the terms are often used to describe one’s identity. Gaggle says it monitors this language to prevent cyberbullying.</p>
<h2>Increased security risk</h2>
<p>These surveillance systems also increase students’ cybersecurity risks. First, to comprehensively monitor students’ activities, surveillance vendors compel students to install a set of certificates known as root certificates. As the highest-level security certificate installed in a device, a root certificate <a href="https://www.makeuseof.com/tag/what-is-root-certificate/">functions as a “master certificate”</a> to determine the entire system’s security. One drawback is that these certificates <a href="https://attack.mitre.org/techniques/T1553/004/">compromise cybersecurity checks that are built into these devices</a>.</p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters/the-daily-newsletter-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>.]</p>
<p>Gaggle scans digital files of more than <a href="https://www.mprnews.org/story/2021/09/15/gaggle-software-that-monitored-mpls-students-online-activity-sparks-debate">5 million students</a> each year.</p>
<p>In addition to working with Gaggle, some schools also contract with a vendor like <a href="https://www.contentkeeper.com/blog/what-to-look-for-in-a-school-web-filter">Contentkeeper</a> to install <a href="https://www.barringtonschools.org/page/contentkeeper-certificate">a root certificate on students’ computers</a>. This tactic of installing certificates is similar <a href="https://www.makeuseof.com/tag/what-is-root-certificate/">to the approach that authoritarian</a> regimes, <a href="https://www.zdnet.com/article/kazakhstan-government-is-intercepting-https-traffic-in-its-capital/">such as the Kazakhstani government</a>, use to <a href="https://www.eff.org/deeplinks/2019/08/browsers-take-stand-against-kazakhstans-invasive-internet-surveillance">monitor and control their citizens</a> and that cybercriminals use to <a href="https://www.trendmicro.de/cloud-content/us/pdfs/security-intelligence/white-papers/wp-finding-holes-operation-emmental.pdf">lure victims to infected websites</a>.</p>
<p>Second, surveillance system vendors use insecure systems that hackers can exploit. In March 2021, computer security software company McAfee found <a href="https://www.mcafee.com/blogs/enterprise/mcafee-enterprise-atr/finding-0-days-with-jackalope/">several vulnerabilities</a> in student monitoring system vendor Netop’s Vision Pro Education software. For instance, Netop did not <a href="https://www.mcafee.com/blogs/other-blogs/mcafee-labs/netop-vision-pro-distance-learning-software-is-20-20-in-hindsight/">encrypt communications between teachers and students to block unauthorized access</a>.</p>
<p>The software was used by over 9,000 schools worldwide to monitor millions of students. The vulnerability <a href="https://www.fastcompany.com/90686770/netop-student-monitoring-software-hack">allowed hackers to gain control over webcams and microphones in students’ computers</a>.</p>
<p>Finally, personal information of students that is stored by the vendors is <a href="https://cdt.org/wp-content/uploads/2021/04/2021-04-05-CDT-FCC-Emergency-Connectivity-Fund-Comments-Draft-Final.pdf">susceptible to breaches</a>. In July 2020, criminals stole <a href="https://www.bleepingcomputer.com/news/security/proctoru-confirms-data-breach-after-database-leaked-online/">444,000 students’ personal data</a> – including names, email addresses, home addresses, phone numbers and passwords – by hacking online proctoring service ProctorU. This data was then leaked online.</p>
<p>Schools would do well to look more closely at the harm being caused by their surveillance of students and to question whether they actually make students more safe – or less.</p>
<p><em>Editor’s note: This story was updated to correctly identify the company that installs root certificates and to add a statement from Gaggle about LGBTQ-related terms.</em></p><img src="https://counter.theconversation.com/content/170983/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nir Kshetri does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Monitoring of student behavior often extends beyond schoolwork and normal school hours. A privacy expert explains the harmful effects.Nir Kshetri, Professor of Management, University of North Carolina – GreensboroLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1690802021-10-07T12:24:44Z2021-10-07T12:24:44ZFacebook’s own internal documents offer a blueprint for making social media safer for teens<figure><img src="https://images.theconversation.com/files/424806/original/file-20211005-19-iga3jf.jpg?ixlib=rb-1.1.0&rect=385%2C242%2C6963%2C4660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What if there were a social media blackout for teens during certain hours of the night?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/the-girl-under-a-blanket-with-a-smartphone-royalty-free-image/1085732990">NitaYuko/iStock via Getty Images</a></span></figcaption></figure><p>Right at the time social media became popular, teen mental health began to falter. Between 2010 and 2019, rates of <a href="https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf">depression</a> and <a href="https://www.nytimes.com/2021/07/31/opinion/smartphone-iphone-social-media-isolation.html">loneliness</a> doubled in the U.S. and globally, <a href="https://www.cdc.gov/nchs/data/nvsr/nvsr69/nvsr-69-11-508.pdf">suicide rates soared for teens in the U.S.</a> and <a href="https://doi.org/10.1001/jama.2017.13317">emergency room admissions for self-harm</a> tripled among U.S. 10- to 14-year-old girls. Social scientists <a href="https://scholar.google.com/citations?user=YsAsEXUAAAAJ&hl=en">like myself</a> <a href="https://www.simonandschuster.com/books/iGen/Jean-M-Twenge/9781501152016">have been warning for years</a> that the ubiquity of social media might be at the root of the growing mental health crisis for teens.</p>
<p>Yet when Facebook CEO Mark Zuckerberg was <a href="https://www.npr.org/2021/05/18/990234501/facebook-calls-links-to-depression-inconclusive-these-researchers-disagree">asked during a congressional hearing</a> in March to acknowledge the connection between social media and these troubling mental health trends, he replied, “I don’t think that the research is conclusive on that.”</p>
<p>Just six months later, The Wall Street Journal reported that Facebook had been <a href="https://www.wsj.com/articles/facebook-knows-instagram-is-toxic-for-teen-girls-company-documents-show-11631620739">doing its own research for years</a> on the <a href="https://theconversation.com/facebook-has-known-for-a-year-and-a-half-that-instagram-is-bad-for-teens-despite-claiming-otherwise-here-are-the-harms-researchers-have-been-documenting-for-years-168043">negative effects of Instagram</a>, the company’s photo-sharing app popular with teens and young adults. <a href="https://www.wsj.com/articles/facebook-documents-instagram-teens-11632953840">Six internal documents</a> summarizing the research, leaked by a whistle-blower, were posted in full on Sept. 29, 2021. </p>
<p>The details in the 209 pages are revealing. They suggest not only that Facebook knew how Instagram could be harmful, but that the company also was aware of possible solutions to mitigate those harms. Facebook’s own research strongly suggests that social media should be subject to more stringent regulation and include more guardrails to protect the mental health of its users. </p>
<p>There are two primary ways the company can do this: enforcing time limits and increasing the minimum age of users.</p>
<h2>A ticking time bomb for mental health</h2>
<p>Academic research shows that the more hours a day a teen spends on social media, the more likely she or he is to <a href="https://doi.org//10.1001/jamapediatrics.2019.1759">be depressed</a> or <a href="https://doi.org/10.1007/s00127-020-01906-9">to self-harm</a>. </p>
<p>That’s important because many teens, especially girls, spend large amounts of time on social media. </p>
<p><a href="https://doi.org/10.1016/j.eclinm.2018.12.005">One study in the U.K.</a> found that one-quarter of 15-year-old girls spent more than five hours a day using social media – and 38% of those girls were clinically depressed. Comparatively, among girls who used social media less than one hour a day, only 15% were depressed.</p>
<p>Although the internal Facebook research didn’t examine links between time on Instagram and mental health, they did ask teens about what were, in their view, the worst aspects of Instagram. One of the things teens disliked the most about the app was how much time they spent on it. </p>
<p>Teens, the report said, had “an addict’s narrative about their use. … They wish they could spend less time caring about it but they can’t help themselves.” </p>
<p>They knew they were spending too much time online, but had a hard time controlling how much time they spent. One-third of teens suggested Instagram should remind them to take a break or encourage them to get off the app. </p>
<p>That would be a step in the right direction, but simple nudges might not be enough to get teens to close the app and keep it closed. And while parents can already set time limits using <a href="https://support.apple.com/en-us/HT201304">the parental controls</a> included on most smartphones, many of them don’t know how to use these controls or are unaware how much time teens are spending on social media. </p>
<p>So better regulations might need to put teeth into time limits, such as limiting the number of hours teens under 18 can spend on social media apps. A blackout period overnight might also be useful, as <a href="https://theconversation.com/awake-online-and-sleep-deprived-the-rise-of-the-teenage-vamper-34853">many teens use their smartphones at night</a> when they should be sleeping. </p>
<h2>ID, please</h2>
<p>One <a href="https://s.wsj.net/public/resources/documents/appearance-based-social-comparison-on-instagram.pdf">internal Facebook study of more than 50,000 people</a> from 10 countries found that half of teen girls compare their appearance to others’ on Instagram. Those appearance-based comparisons, the study found, peaked when users were 13 to 18 and were much less common among adult women. </p>
<p>This is key, as body image issues seem to be <a href="https://doi.org/10.1016/j.eclinm.2018.12.005">one of the biggest reasons</a> why social media use is linked to depression among teen girls. It also dovetails with research I reported in my book, “<a href="https://www.simonandschuster.com/books/iGen/Jean-M-Twenge/9781501152016">iGen</a>,” finding that social media use is more strongly linked to unhappiness among younger teens than older ones.</p>
<p>This suggests another avenue for regulation: age minimums. A 1998 law called the <a href="https://www.ftc.gov/enforcement/rules/rulemaking-regulatory-reform-proceedings/childrens-online-privacy-protection-rule">Children’s Online Privacy Protection Rule</a> already sets the age minimum for social media accounts at 13. That limit is problematic for two reasons. First, 13 is a developmentally challenging time, right as boys and girls are going through puberty and <a href="https://www.prevnet.ca/sites/prevnet.ca/files/fact-sheet/PREVNet-SAMHSA-Factsheet-Age-Trends-in-the-Prevalence-of-Bullying.pdf">bullying is at its peak</a>. </p>
<p>Second, the age minimum is not regularly enforced. Kids 12 and under can simply lie about their age to sign up for an account, and they’re rarely kicked off the platform for being underage. <a href="https://www.wsj.com/articles/facebook-instagram-kids-tweens-attract-11632849667">During a Facebook event with Instagram head Adam Mosseri</a>, the young celebrity JoJo Siwa noted she had been using Instagram since she was 8 years old, forcing Mosseri to acknowledge that it’s easy to lie about your age.</p>
<p>The problem is how to enforce an age limit online for a population that is too young for IDs. Raising the minimum age to create a social media account to 16, 17 or 18 could solve two problems at once: It would prevent kids from signing up until they’re a bit more developed and mature, and it would be easier to enforce. For example, potential users might be asked to submit a photo of their state-issued ID, which most teens have by 16.</p>
<p>Verifying age would also make it easier to construct a safer app for younger users that might, say, hide follower counts or restrict access to celebrity accounts, both of which Facebook’s research found negatively impacted girls’ body images. </p>
<h2>Curtailing that fear of missing out</h2>
<p>It’s tempting to think regulations like these would cause teens to riot in the streets – after all, they love keeping up with their friends on social media. But the teens interviewed by Facebook for its internal research were well aware of social media’s downsides.</p>
<p>“The reason why our generation is so messed up and has higher anxiety and depression than our parents’ is because we have to deal with social media. Everyone feels like they have to be perfect,” one teen girl told the researchers. Other teens have <a href="https://www.logoffmovement.org/">spoken publicly</a> about the negative effects of social media. </p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p>
<p>More stringent regulation would help with another issue teens know all too well: the unwritten mandate to use social media or be left out.</p>
<p>“Young people are acutely aware that Instagram can be bad for their mental health yet are compelled to spend time on the app for fear of missing out,” Facebook’s internal research concluded. </p>
<p>If age limits were enforced, the peer pressure of being on social media would vanish; no or few classmates would be there. Regulating time on the app could also help if teens knew their friends wouldn’t constantly be online.</p>
<p>Facebook’s research demonstrates something else: The company was aware of the issues with Instagram but <a href="https://www.npr.org/2021/10/04/1042921981/facebook-whistleblower-renewing-scrutiny-of-social-media-giant">chose not to set these limits itself</a>. <a href="https://www.nytimes.com/2021/09/30/technology/facebook-senate-hearing.html">Congress is now considering taking action</a>. </p>
<p>Until they do, it will be up to parents and teens themselves to set limits. That won’t be easy, but teens will be safer for it.</p><img src="https://counter.theconversation.com/content/169080/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jean M. Twenge has received speaking honoraria and consulting fees for presenting research and receives royalties from books, most recently iGen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy – and Completely Unprepared for Adulthood. </span></em></p>It’s tempting to think limits would cause teens to riot in the streets. But Facebook’s own research reveals that young people are well aware of social media’s downsides.Jean Twenge, Professor of Psychology, San Diego State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1674362021-09-07T20:10:22Z2021-09-07T20:10:22ZMore children are self-harming since the start of the pandemic. Here’s what parents and teachers can do to help<figure><img src="https://images.theconversation.com/files/419694/original/file-20210907-13-1z0fnk2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-asian-preteen-teenager-boy-hugging-1476187649">Shutterstock</a></span></figcaption></figure><p>There has been a reported spike in young people attending emergency departments for self-harm and suicide during the pandemic. In New South Wales, <a href="https://www.smh.com.au/national/it-s-completely-shocking-when-it-s-your-child-what-s-driving-the-youth-mental-health-crisis-20210902-p58oa5.html">presentations to emergency departments</a> for self-harm and suicidal thoughts are reportedly up by 47% since before the pandemic. </p>
<p>In the year to July 29 2021, there were <a href="https://www.smh.com.au/national/nsw/more-than-40-nsw-children-and-teenagers-rushed-to-hospital-for-self-harm-every-day-20210827-p58mg7.html">8,489 presentations to NSW emergency departments</a> for self-harm in people aged up to 17. This was up from 6,489 presentations in the year to July 20 2020. </p>
<p>A <a href="https://about.unimelb.edu.au/newsroom/news/2020/december/study-finds-some-primary-school-aged-children-self-harm,-as-experts-call-for-earlier-intervention">study published in December 2020</a> found children as young as in primary school are harming themselves intentionally.</p>
<p><a href="https://www.smh.com.au/national/calls-to-kids-helpline-surge-in-melbourne-and-sydney-20210813-p58ijs.html">Services like</a> <a href="https://www.abc.net.au/news/2021-08-04/lifeline-records-highest-daily-calls-on-record/100350522">crisis help lines</a> and emergency departments are <a href="https://www.theage.com.au/national/victoria/system-overload-why-victoria-s-health-network-is-on-its-knees-20210901-p58nry.html">not meeting the increased demand</a> for mental health support.</p>
<p>If you are a parent or teacher, there are several things you can do when you learn your child or student has self-harmed.</p>
<h2>What is self-harm?</h2>
<p>Self-harm, also known as self-injury or non-suicidal self-injury, describes people’s intentional acts to inflict harm on their own body. Self-harm includes cutting skin, burning, self-hitting and scratching skin — or <a href="https://headspace.org.au/young-people/understanding-self-harm-for-young-people/">any other behaviours</a> that cause body injury, pain and wounds.</p>
<p>People who <a href="https://www.lifeline.org.au/get-help/information-and-support/self-harm/">intentionally harm themselves</a> do so to relieve stress, anxiety and sadness, to bring their attention to the present moment or to punish themselves because of self-loathing and self-hatred. </p>
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Read more:
<a href="https://theconversation.com/why-do-people-intentionally-injure-themselves-90451">Why do people intentionally injure themselves?</a>
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<p>Self-harm may be something a young person does once, twice or repeats over and over. Young <a href="https://headspace.org.au/young-people/understanding-self-harm-for-young-people/">people who repeatedly self-harm</a> often have other mental health problems or have experienced significant stress in their life.</p>
<p>As <a href="https://au.reachout.com/articles/what-is-self-harm">self-harm is often a response</a> to mounting stress and uncertainty, it’s not surprising rates have gone up during the pandemic. Self-harm can be a means to cope and establish control over emotions. </p>
<p>Self-harm and physical pain <a href="https://au.reachout.com/articles/what-is-self-harm">can provide a sense of relief</a> from emotional pain.</p>
<h2>What can you do?</h2>
<p>If you know a child who is harming themselves, there are some things you can do.</p>
<p>First, it is <a href="https://raisingchildren.net.au/teens/mental-health-physical-health/mental-health-disorders-concerns/self-harm">essential parents and teachers</a> do not respond with shock, horror, anger or judgement when they identify their child or student has self-harmed. Young people often report feeling shame after they have intentionally harmed themselves which leads them to hide their wounds under clothing and jewellery. </p>
<p>Many may not participate in activities which might reveal their wounds, such as swimming or other sports.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/419704/original/file-20210907-13-1da6pcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Father with his arm around his son." src="https://images.theconversation.com/files/419704/original/file-20210907-13-1da6pcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/419704/original/file-20210907-13-1da6pcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419704/original/file-20210907-13-1da6pcf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419704/original/file-20210907-13-1da6pcf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419704/original/file-20210907-13-1da6pcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419704/original/file-20210907-13-1da6pcf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419704/original/file-20210907-13-1da6pcf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It’s important not to react with judgement if you find out a child has been intentionally harming themselves.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/father-parenting-his-son-535653202">Shutterstock</a></span>
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<p>The second thing you can do as a parent or teacher is remove objects which may be used to self-harm. The purpose of this should not be to punish or shame the child but to remove a child’s easy access to things that could be used to inflict injuries. And you can remind the child you are not removing these objects to punish, but rather to help them.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/its-not-only-teenage-girls-and-its-rarely-attention-seeking-debunking-the-myths-around-self-injury-120214">It's not only teenage girls, and it's rarely attention-seeking: debunking the myths around self-injury</a>
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</p>
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<p>When treating young people who self-harm we instruct them to <a href="https://www.orygen.org.au/Training/Resources/Self-harm-and-suicide-prevention/Guidelines/Coping-with-Self-Harm-Guide-for-Parents-and-Carers/Orygen-coping-with-self-harm-web">create a delay</a> between the urge to self-harm and the act of self-harm. Removing implements used to self-harm can help to do this too.</p>
<p>Activities to <a href="http://www.selfinjury.bctr.cornell.edu/perch/resources/distraction-techniques-pm-2.pdf">distract young people</a> from self-harm, such as cooking and exercise, is another highly recommended strategy to prevent further injury. </p>
<p>Some recommend so-called “<a href="http://www.selfinjury.bctr.cornell.edu/perch/resources/distraction-techniques-pm-2.pdf">substitution activities</a>” for self-harm such as holding ice or snapping a rubber band on your wrist. But <a href="https://www.talkspace.com/blog/time-retire-self-harm-alternatives">these are controversial</a> as they come from the same self-destructive mindset and are similar behaviours, just in a different wrapper. </p>
<h2>How to treat a child’s wounds</h2>
<p>It is important parents, a school nurse or school first aid trained staff have an opportunity to inspect and treat a child’s wounds. Parents and school staff should be <a href="https://www.self-injury.org.au/t-respond-to-adolescents">pragmatic, sensitive and show unconditional positive regard</a> for their child and students during this interaction.</p>
<p>This can include comments like: “Can you tell me a little bit about what happened?”; “Have you ever done this before?”; “Where on your body did you do this?” and “How many times did you do this?” </p>
<p>Finally, <a href="https://www.taylorfrancis.com/chapters/oa-edit/10.4324/9781003025955-13/self-injury-response-intervention-policy-emily-berger-janis-whitlock">parents and school staff should ask</a>, “How do you normally care for the wounds?”</p>
<p>Understanding how young people care for their wounds and teaching them about wound care, as well as the importance of seeking help after self-harm, should be the goal of these interactions.</p>
<p>Parents and school staff can then make decisions about the next stages of action. This can be discussed with their child to allay any fears they may have about seeking further help from medical or mental health services. It may include booking a session with the child’s GP or psychologist.</p>
<p>A mental health professional will be able to help address the underlying feelings that led the young person to self-harm and provide the young person with different ways of coping. They will also be able to determine whether the young person is also having suicidal thoughts.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-every-teacher-needs-to-know-about-childhood-trauma-132965">Why every teacher needs to know about childhood trauma</a>
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</em>
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<p>A <a href="https://www.taylorfrancis.com/chapters/oa-edit/10.4324/9781003025955-13/self-injury-response-intervention-policy-emily-berger-janis-whitlock">recently published policy</a> for schools has outlined other ways for teachers to respond after a student has self-harmed. All schools should have a self-harm policy to support teachers by telling them what steps to follow if they become aware a student has self-harmed.</p>
<p>A school policy on self-harm should include information about how to support students, how to talk to parents, how to minimise contagion of self-harm between students, and how to support teachers managing the issue of self-harm of students.</p>
<p><em>If you or anyone you know has self-harmed or thought about it, contact <a href="https://www.lifeline.org.au/">Lifeline</a> on 13 11 14 or <a href="https://kidshelpline.com.au/">Kids Helpline</a> on 1800 55 1800.</em></p><img src="https://counter.theconversation.com/content/167436/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Berger does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Self-harm is often a response to mounting stress and uncertainty. So it’s not surprising rates have gone up during the pandemic. Self-harm can be a means to cope and establish control over emotions.Emily Berger, Lecturer, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1579312021-04-08T12:44:38Z2021-04-08T12:44:38ZWhy young people feel safer talking about suicide online than in real life<figure><img src="https://images.theconversation.com/files/391916/original/file-20210326-15-1rc3e6u.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3840%2C2160&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Being dismissed in real life is a key reason that people turn to online spaces for support</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/black-teenager-playing-video-games-on-1492475858">Motortion Films/Shutterstock</a></span></figcaption></figure><p>After <a href="https://theconversation.com/meghan-and-harrys-oprah-interview-why-british-media-coverage-could-backfire-156424">Oprah Winfrey’s interview with Meghan Markle and Prince Harry</a>, much-needed conversations about mental health and specifically suicide opened up in society. Viewers heard Meghan talk candidly about a very difficult time in her life, describing how gradually, a claustrophobic sense of being trapped with no way out had left her feeling like she didn’t want to be alive anymore.</p>
<p>Although Meghan’s openness was praised by many mental health charities and experts across the world, her account was questioned and even mocked <a href="https://www.dailymail.co.uk/news/article-9338343/PIERS-MORGAN-Meghan-Harrys-nauseating-two-hour-Oprah-whine-athon-disgraceful-diatribe.html">in some news outlets</a>.</p>
<h2>Seeking support</h2>
<p><a href="https://www.mdpi.com/1660-4601/18/4/2120">Our research</a> at the University of Birmingham shows that invalidating people’s experiences of suicidality (another term for suicidal ideation and suicide attempts) is common. It’s also deeply distressing for those on the receiving end. In the study, which explores how 17-23-year-olds who are at risk of suicide seek help, participants shared how health professionals would often dismiss their experiences of self-harm and suicidality. As this research participant told us: </p>
<blockquote>
<p>They asked me “are you getting suicidal thoughts? Are you suicidal?” and when I said “yes”. Especially this one doctor, I won’t name names, but he was like “you wouldn’t do it anyway”.</p>
</blockquote>
<p>Such dismissive attitudes often leave people feeling hopeless and helpless, as this participant revealed: </p>
<blockquote>
<p>The GP said, when I went into my low mood, he was like “you have got a really nice supportive family so you are going to be okay”. I was just thinking “you don’t know anything”. He not only made that assumption, but he introduced that concept in the room. I had nowhere to go.</p>
</blockquote>
<figure class="align-center ">
<img alt="Teenage girl in flannel shirt looking at person in purple top opposite her" src="https://images.theconversation.com/files/391918/original/file-20210326-15-5cxp4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/391918/original/file-20210326-15-5cxp4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391918/original/file-20210326-15-5cxp4u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391918/original/file-20210326-15-5cxp4u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391918/original/file-20210326-15-5cxp4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391918/original/file-20210326-15-5cxp4u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391918/original/file-20210326-15-5cxp4u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People don’t share these experiences because they don’t think they’ll be taken seriously by friends, family and even professionals.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/teenage-girl-suffering-depression-visiting-counsellor-343220099">SpeedKingz/Shutterstock</a></span>
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<p>One of the main reasons people gave for not sharing these experiences was that they didn’t believe they’d be taken seriously – by friends, by family and even by professionals. Many feared being shunned, misunderstood or ridiculed if they sought help or spoke out. As another participant revealed:</p>
<blockquote>
<p>If you try and seek help and you get like a “you are doing this on purpose for a different reason, or for attention”, it makes a mockery of what you were feeling.</p>
</blockquote>
<p>Young people in our study described how they wished professionals would address suicidality, with many detailing their experiences of asking for help from health professionals only to be turned away or dismissed.</p>
<blockquote>
<p>If you are sat there explaining you are struggling and you need help, then they should listen and not be like “you are just having a bad week” kind of thing.</p>
</blockquote>
<h2>Safe spaces online</h2>
<p><a href="https://acamh.onlinelibrary.wiley.com/doi/10.1111/jcpp.13245">Another</a> <a href="https://www.birmingham.ac.uk/research/perspective/covid-and-suicide-prevention.aspx">study</a>, also at the University of Birmingham, has explored self-harm and suicide related discussions across social media. It shows that invalidating people’s experiences of suicidality in real life is a key reason that young people turn to online spaces for support and understanding.</p>
<figure class="align-center ">
<img alt="Three young people sitting on a sofa using phones with social media notification graphics over their heads" src="https://images.theconversation.com/files/391921/original/file-20210326-15-goep3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/391921/original/file-20210326-15-goep3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391921/original/file-20210326-15-goep3o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391921/original/file-20210326-15-goep3o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391921/original/file-20210326-15-goep3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391921/original/file-20210326-15-goep3o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391921/original/file-20210326-15-goep3o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The fact that young people feel so much safer online says a lot about how society handles mental health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-adults-on-couch-using-social-1356777203">Rawpixel.com/Shutterstock</a></span>
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</figure>
<p>Against the background of having been dismissed as “attention seeking” in hospital, for example, or ostracised by friends, participants recounted feeling “safe”, “heard” and “accepted” in online spaces that might appear from the outside to be anything but that. The internet and social media may be typically associated with confrontation and other unpleasant experiences, but they can provide incredibly supportive environments for some people.</p>
<p>Though it’s not without risk, social media offers spaces in which people’s stories of self-harm and suicide, and their complex social causes, can be listened to openly and without judgement. One participant said:</p>
<blockquote>
<p>Having someone else acknowledge what you’re going through and to say that they care about you and to show that they see you, it helps a lot to feel like you’re…like you matter.</p>
</blockquote>
<p>That a person at their most vulnerable may feel the need to turn to strangers online, however, is a damning indictment of how we, as a society, treat those experiencing suicidality. Dismissive or negative attitudes are often the reason some people are worried about disclosing the true extent of their suicidality and feel shameful about seeking help from loved ones. <a href="https://www.mdpi.com/1660-4601/18/4/2120">Our study</a> shows that some young people feel more comfortable sharing their experiences with those who aren’t close to them. And although social media could also foster unhealthy attitudes towards suicide, for some it offers a vital space to speak openly.</p>
<p>Suicide can affect anyone regardless of age, ethnicity, socioeconomic status, and gender. While for many, suicide may be unthinkable and at the far edges of everyday experience, for others feeling suicidal is a lived daily reality; one that we need to acknowledge, listen to and take responsibility for.</p>
<p>There’s an urgent need to create safe spaces in society (and in mental health services) in which people can share their experiences without being dismissed, disbelieved or rejected. Although online spaces may be at times concerning, the lack of judgement that they offer to people who describe feeling suicidal needs to be mirrored in the offline world. Invalidating these experiences only serves to perpetuate our culture of secrecy and stigma.</p><img src="https://counter.theconversation.com/content/157931/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Lavis received funding from the Wellcome Trust and Samaritans to undertake the research on which this article draws. She acts as an advisor to Facebook/Instagram on tackling online harms.</span></em></p><p class="fine-print"><em><span>Maria Michail does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Social media doesn’t always offer comfort, but the space and support it can provide should be mirrored offlineMaria Michail, Senior Birmingham Fellow, University of BirminghamAnna Lavis, Lecturer in Medical Anthropology, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1533592021-01-20T17:08:45Z2021-01-20T17:08:45ZFewer people sought help for mental illness during the UK’s first lockdown – new research<figure><img src="https://images.theconversation.com/files/379748/original/file-20210120-23-1niqedl.jpg?ixlib=rb-1.1.0&rect=26%2C13%2C8648%2C5761&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many peoples' mental health worsened during the pandemic – but many didn't seek support or treatment. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/covid19-pandemic-coronavirus-woman-home-isolation-1694471026">Dragana Gordic/ Shutterstock</a></span></figcaption></figure><p>During the first COVID-19 lockdown in the UK, people were encouraged to help control the virus with the message to “<a href="https://www.gov.uk/government/publications/coronavirus-covid-19-information-leaflet/coronavirus-stay-at-home-protect-the-nhs-save-lives-web-version">stay at home, protect the NHS, save lives</a>”. While there was no specific instruction to avoid seeking medical care, the number of people contacting <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30201-2/fulltext">general practices</a> and visiting <a href="https://www.health.org.uk/news-and-comment/charts-and-infographics/how-is-covid-19-changing-the-use-of-emergency-care">emergency departments</a> fell dramatically. At the same time, <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30308-4/fulltext">people’s mental health was worsening</a> due to the pandemic. </p>
<p>My colleagues and I wanted to know how the COVID-19 pandemic, and the public health messaging surrounding it, affected the mental health care people received during the pandemic. We studied the <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30288-7/fulltext">health records of more than 14 million people</a> aged ten years and over who were registered at general practices across the UK. We looked at how many people sought mental health help for the first time, from their general practice or at a hospital A&E department. We discovered that while the UK was in its first lockdown, the number of people seeking help for depression dropped by 43%, anxiety disorders by 48% and self-harm by 38%.</p>
<p>But does this drop in help seeking for mental illness and self-harm simply reflect the public’s compliance with government messaging? One possible reason for the drop could be that rates of mental illness and self-harm in the population were lower during this time. There’s evidence that some <a href="https://emergingminds.org.uk/wp-content/uploads/2020/06/CoSPACE-Report-4-June-2020.pdf">young people experienced improvements</a> in their mental health during the spring 2020 lockdown.</p>
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Read more:
<a href="https://theconversation.com/fitter-better-rested-more-appreciative-research-reveals-the-positive-changes-experienced-by-some-during-lockdown-152907">Fitter, better rested, more appreciative: research reveals the positive changes experienced by some during lockdown</a>
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</p>
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<p>But most research shows this lockdown had a <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30308-4/fulltext">negative impact on rates of mental distress</a>. Additionally, some mental health charities reported <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30528-9/fulltext">increases in people asking for help</a>, showing there was still a need for mental health and self-harm treatment, but said people weren’t seeking it out from clinical settings. This also suggests that the gap between the number of people needing treatment for mental illness and self-harm and the number of people receiving treatment widened considerably during this period. </p>
<p>We found significant reductions in the number of working-aged people (ages 18 to 64) and people living in the most deprived communities seeking help for anxiety and depression. Reductions in the number of people seeking help for episodes of self-harm were greatest for people under the age of 45 and women. The pandemic has been shown to have a particularly negative impact on the <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30288-7/fulltext">mental health of these groups</a>. Our findings suggest that the groups of people most in need of mental health treatment were least likely to receive help. </p>
<figure class="align-center ">
<img alt="Woman struggling to work on her laptop with her toddler beside her." src="https://images.theconversation.com/files/379750/original/file-20210120-15-qfcf9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/379750/original/file-20210120-15-qfcf9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/379750/original/file-20210120-15-qfcf9k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/379750/original/file-20210120-15-qfcf9k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/379750/original/file-20210120-15-qfcf9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/379750/original/file-20210120-15-qfcf9k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/379750/original/file-20210120-15-qfcf9k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Other responsibilities – such as balancing childcare while working from home – might be keeping some groups from seeking help.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/worried-woman-working-home-holding-her-1694473675">Dragana Gordic/ Shutterstock</a></span>
</figcaption>
</figure>
<p>There may be a number of reasons for this. <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(71)92410-X/fulltext">Research shows</a> that the availability and quality of medical care can often be lower in deprived communities. It may be possible the pandemic has further contributed to existing problems – which might partly explain the drop in help seeking in this group. In addition, the <a href="https://www.kcl.ac.uk/news/why-has-covid-19-impacted-the-mental-health-and-wellbeing-of-women-the-most">widening of existing gender inequalities</a> brought about by the pandemic could have affected women’s ability to seek support. For example, some may be balancing additional childcare duties on top of work, making it more difficult to reach out for treatment or support.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lockdown-quarantine-and-self-isolation-how-different-covid-restrictions-affect-our-mental-health-153595">Lockdown, quarantine and self-isolation: how different COVID restrictions affect our mental health</a>
</strong>
</em>
</p>
<hr>
<p>Although <a href="https://www.health.org.uk/news-and-comment/charts-and-infographics/how-has-covid-19-affected-service-delivery-in-gp-practices">GPs adapted rapidly</a> during the pandemic to by providing remote appointments, and many hospital-based mental health care units <a href="https://www.rcpsych.ac.uk/docs/default-source/members/faculties/liaison-psychiatry/alternatives-to-eds-for-mental-health-assessments-august-2020.pdf?sfvrsn=679256a_2">diverted services away from hospital emergency departments</a> to ensure they were still accessible, our findings show that people still sought help less during the lockdown period. Although some people may not have sought help for fear of contracting the virus, it’s clear that public health messaging played an important role in this drop in help seeking.</p>
<p>As the pandemic continues, public health messaging should reinforce that help from GPs and hospital mental health services is available. <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/duration-of-untreated-symptoms-in-common-mental-disorders-association-with-outcomes/BA40509E756D5B358D55FB3853891753">Delays</a> in treatment for mental illness and self-harm could lead to people suffering with more severe mental illness by the time they receive help – which <a href="https://www.england.nhs.uk/wp-content/uploads/2020/08/C0716_Implementing-phase-3-v1.1.pdf">mental health services reported</a> was the case following the spring 2020 lockdown. Providing people with prompt mental health support for <a href="https://www.mentalhealth.org.uk/statistics/mental-health-statistics-prevention-and-early-intervention">mental illness</a> or <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/routine-hospital-management-of-selfharm-and-risk-of-further-selfharm-propensity-score-analysis-using-recordbased-cohort-data/8C94009027663118923818B31BA544F7">self-harm</a> can reduce the risks of ongoing mental health problems. </p>
<p>Our study showed that, by September 2020, the numbers of people seeking help for both mental illness and self-harm were largely back to expected levels. This is likely due to the lifting of restrictions and lower rates of the virus, meaning that people were more willing to use NHS services. But the UK has faced further lockdowns in the autumn and winter of 2020, putting health services under even greater pressure. It’s currently unknown how these current restrictions will affect the number of people seeking help, but based on what we learned from the first lockdown, ensuring people can access mental health support is an urgent priority.</p>
<p><em>Those seeking mental health support can contact their GP and ask for an emergency appointment, or call 111 after hours. For immediate mental health crises, call 999 or go to A&E. For further information about getting mental health help during the pandemic, visit <a href="https://www.mind.org.uk/information-support/coronavirus/">MIND</a>.</em></p><img src="https://counter.theconversation.com/content/153359/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Steeg receives funding from UK Research and Innovation (grant reference grant COV0499). The study was also funded by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre.</span></em></p>During the first lockdown, the number of people seeking help for depression, anxiety and self-harm dropped by up to 48% in some cases.Sarah Steeg, Presidential Research Fellow, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1466792020-10-08T03:04:48Z2020-10-08T03:04:48ZSelf-harm in immigration detention has risen sharply. Here are 6 ways to address this health crisis<figure><img src="https://images.theconversation.com/files/362324/original/file-20201008-16-m8e5o8.jpg?ixlib=rb-1.1.0&rect=156%2C82%2C4238%2C3491&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">DARREN ENGLAND/AAP</span></span></figcaption></figure><p><a href="https://www.sbs.com.au/news/fears-for-immigration-detainees-as-new-figures-reveal-hundreds-of-self-harm-incidents-in-2020">Newly published data</a> have revealed the number of self-harm incidents in Australia’s immigration detention centres spiked during the first seven months of this year.</p>
<p>While rates of self-harm among detained asylum seekers were already known to be high - in fact, <a href="https://www.abc.net.au/news/2019-10-14/asylum-seekers-in-detention-200-more-likely-to-commit-self-harm/11600148">200 times higher</a> than in the general Australian community - this recent increase has fuelled <a href="https://www.ranzcp.org/news-policy/news/covid-19-compounds-poor-mental-health-of-people-in">concerns by health experts</a> that the pandemic has made them even more vulnerable to mental distress. </p>
<p>We have <a href="https://www.sciencedirect.com/science/article/abs/pii/S1752928X17300665?via%3Dihub">researched self-harm among detained asylum seekers</a> for the past decade and our recently published findings shed further light on the extent and nature of self-harm among these detainees. </p>
<p>This includes details about the methods and characteristics of self-harm, which has been little researched due to the lack of accessible data.</p>
<p>In two studies published in recent months, we investigated how rates and methods of self-harm varied over a 12-month period from August 2014 to July 2015 depending on <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-08717-2">the type of detention where asylum seekers were held</a>, as well as the <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003235">time, day and month of the year</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/362326/original/file-20201008-14-aen0e2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/362326/original/file-20201008-14-aen0e2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/362326/original/file-20201008-14-aen0e2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/362326/original/file-20201008-14-aen0e2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/362326/original/file-20201008-14-aen0e2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/362326/original/file-20201008-14-aen0e2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/362326/original/file-20201008-14-aen0e2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Protesters rallying in support of asylum seekers detained at the Kangaroo Point Central Hotel in Brisbane.</span>
<span class="attribution"><span class="source">Glenn Hunt/AAP</span></span>
</figcaption>
</figure>
<h2>Fewer security measures do not reduce self-harm risk</h2>
<p>Immigration detention facilities may appear to be similar, but in reality they are quite diverse. In Australia, asylum seekers are held in <a href="https://humanrights.gov.au/our-work/asylum-seekers-and-refugees/projects/immigration-detention-and-human-rights">four main types of “closed” detention</a> arrangements, with varying levels of security and available support: </p>
<ul>
<li><p>immigration detention centres (IDC), which were designed to detain asylum seekers and those posing a risk to the Australian community, and have high security features</p></li>
<li><p>immigration transit accommodation (ITA), which were designed to hold detainees being transferred between facilities, those needing medical treatment or those being deported</p></li>
<li><p>immigration residential housing (IRH), which can hold families and generally have less stringent security features </p></li>
<li><p>alternative places of detention (APOD), which include hotels that have come <a href="https://theconversation.com/hotels-are-no-luxury-place-to-detain-people-seeking-asylum-in-australia-134544">under scrutiny</a> during the pandemic due to the frequently overcrowded conditions.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/refugees-need-protection-from-coronavirus-too-and-must-be-released-136961">Refugees need protection from coronavirus too, and must be released</a>
</strong>
</em>
</p>
<hr>
<p>Our findings showed self-harm rates were exceptionally high in detention arrangements such as these. On average, self-harm rates were highest among asylum seekers in ITAs (452 episodes per 1,000 people), followed by APODs (265/1,000) and IDCs (225/1,000). </p>
<p>What’s notable about this is self-harm rates were not lower in facilities with fewer security features and more flexible living arrangements (such as ITAs and APODs), as might be expected. Making detention facilities less prison-like, but still “closed”, is thus unlikely to reduce the risk of self-harm. </p>
<p>By comparison, our research shows rates of self-harm among asylum seekers living in community-based settings are <a href="https://www.sciencedirect.com/science/article/pii/S2352827319300850?via%3Dihub">much lower</a>. </p>
<p><a href="https://humanrights.gov.au/our-work/asylum-seekers-and-refugees/alternatives-detention">Community-based options</a> allow asylum seekers to live in homes under supervision or at a place of their choosing, while their claims for protection are being processed. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/362327/original/file-20201008-16-16isyem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/362327/original/file-20201008-16-16isyem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=434&fit=crop&dpr=1 600w, https://images.theconversation.com/files/362327/original/file-20201008-16-16isyem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=434&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/362327/original/file-20201008-16-16isyem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=434&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/362327/original/file-20201008-16-16isyem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=545&fit=crop&dpr=1 754w, https://images.theconversation.com/files/362327/original/file-20201008-16-16isyem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=545&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/362327/original/file-20201008-16-16isyem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=545&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">More flexible living arrangements in hotels do not prevent self-harm incidents.</span>
<span class="attribution"><span class="source">Michael Dodge/AAP</span></span>
</figcaption>
</figure>
<h2>Policies and conditions can increase vulnerability</h2>
<p>In our second study, we found both the frequency and methods of self-harm varied by time of day and month, as well as where asylum seekers were being processed. We also identified numerous factors associated with these variations.</p>
<p>Self-harm most commonly occurred from 12:00–3:59am for community-based asylum seekers, from 4:00–7:59pm for those on Manus Island and from 8:00–11:59pm for those in onshore detention.</p>
<p>There are a number of possible explanations for these patterns. If we take onshore detention as one example, our research shows self-harm most commonly occurs in settings where asylum seekers are mixed and subject to overcrowding. </p>
<p>Frequent transfers between facilities is another trigger. Such transfers <a href="https://theconversation.com/people-are-crying-and-begging-the-human-cost-of-forced-relocations-in-immigration-detention-132193">often occur</a> in the early hours of the morning - with little notice - and result in separation from family and other support systems. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/people-are-crying-and-begging-the-human-cost-of-forced-relocations-in-immigration-detention-132193">'People are crying and begging': the human cost of forced relocations in immigration detention</a>
</strong>
</em>
</p>
<hr>
<p>The peak in self-harm incidents from 8pm to midnight, therefore, could be associated with the state of these detention facilities at this time, fear of transfer during the night and lower levels of supervision and support.</p>
<p>Other factors were also found to be associated with the temporal variations in self-harm across different settings. These included <a href="https://www.theguardian.com/australia-news/2015/jan/06/manus-detainees-recognised-as-refugees-will-be-forced-into-png-community">personal safety and security concerns</a>, <a href="https://www.documentcloud.org/documents/1689988-moss-report-review-conditions-circumstances-nauru.html">physical and sexual assault</a>, <a href="https://www.abc.net.au/news/2014-09-25/scott-morrison27s-message-to-transferees-on-nauru-and-manus-of/5769808?nw=0">visa insecurity</a>, inadequate mental and physical health care, and family separation.</p>
<p>This shows how certain policies and conditions can increase asylum seekers’ vulnerability. It also explains why the <a href="https://humanrights.gov.au/about/news/media-releases/commission-concerned-detainees-during-covid">ongoing lack of a governmental response</a> to the risk of COVID-19 in immigration detention may be associated with the recent spike in self-harm.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/362328/original/file-20201008-18-n4oa5d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/362328/original/file-20201008-18-n4oa5d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/362328/original/file-20201008-18-n4oa5d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/362328/original/file-20201008-18-n4oa5d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/362328/original/file-20201008-18-n4oa5d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/362328/original/file-20201008-18-n4oa5d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/362328/original/file-20201008-18-n4oa5d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Melbourne Immigration Transit Accommodation centre, where a man who had been detained for four years died in August.</span>
<span class="attribution"><span class="source">James Ross/AAP</span></span>
</figcaption>
</figure>
<h2>What can we do to prevent further harm?</h2>
<p>Rising incidents of self-harm in immigration detention <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(19)30221-X/fulltext">constitute a public health crisis</a> and warrant urgent government attention. Here are six ways we can prevent further harm:</p>
<ul>
<li><p><a href="https://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=22710&LangID=E">detention must only be used as an absolute last resort</a> and for the shortest possible time</p></li>
<li><p><a href="https://humanrights.gov.au/our-work/asylum-seekers-and-refugees/publications/risk-management-immigration-detention-2019">hotels are not appropriate places of detention</a> and should not be used as such </p></li>
<li><p>well-established <a href="https://humanrights.gov.au/our-work/asylum-seekers-and-refugees/alternatives-detention">community-based options for processing asylum claims</a> must be used in place of closed detention</p></li>
<li><p>access to adequate social, family, financial and legal support must be provided to detainees</p></li>
<li><p>culturally appropriate mental health services must also be made available, with interpreters where necessary</p></li>
<li><p>transparent <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02709-7">monitoring and reporting of self-harm incidents</a>, based on <a href="https://apps.who.int/iris/bitstream/handle/10665/208895/9789241549578_eng.pdf;jsessionid=E1E160EA9AEA860FF6837D9337058E6B?sequence=1">World Health Organisation guidelines</a>, must be carried out by an independent body of clinical experts. </p></li>
</ul>
<p>We can no longer pretend we do not know about the <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1945-y">harms of immigration detention</a>. We must use the evidence we have to protect those held in detention from further avoidable harm.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/banning-mobile-phones-in-immigration-detention-would-make-an-inhumane-system-even-crueler-145299">Banning mobile phones in immigration detention would make an inhumane system even crueler</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/146679/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kyli Hedrick has received funding from the Australian Government Post-Graduate Research Training Program. She is the founder of Community-Minded Psychological Services, a private practice for people from immigrant, refugee, and asylum seeking backgrounds, which has received funding from the Australian government to provide psychological support to asylum seekers.</span></em></p><p class="fine-print"><em><span>Rohan Borschmann does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New data shows self-harm incidents in immigration detention have spiked his year amid concerns over the pandemic. We must take steps to reduce asylum seekers’ vulnerability and prevent further harm.Kyli Hedrick, Psychologist and PhD Candidate (submitted), Melbourne School of Population and Global Health, The University of MelbourneRohan Borschmann, Dame Kate Campbell Senior Research Fellow, Melbourne School of Population and Global Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1458782020-09-23T11:26:19Z2020-09-23T11:26:19ZWomen and suicide: the dangers of social isolation<figure><img src="https://images.theconversation.com/files/358627/original/file-20200917-14-189aig0.jpeg?ixlib=rb-1.1.0&rect=40%2C40%2C3329%2C2202&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-wearing-black-long-sleeved-shirt-sitting-on-green-grass-field-near-mountain-under-cloudy-sky-691919/">Pexels</a></span></figcaption></figure><p>Men have long been recognised as being <a href="https://www.who.int/gho/mental_health/suicide_rates/en/">most at risk</a> of suicide, but the Office for National Statistics recently reported the highest annual rate of female suicides in the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/latest">UK since 2004</a>. </p>
<p>This increase in female self-inflicted deaths comes at the same time as <a href="https://theconversation.com/covid-lockdowns-have-human-costs-as-well-as-benefits-its-time-to-consider-both-137233">concerns</a> the pandemic may increase the number of people who attempt to take their own lives. It will be some time before accurate UK data on suicides during lockdown is available, but in obeying the instruction to stay home, some people may have been deprived of the opportunity for intervention. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32711683/">Studies already show</a> that the pandemic is having a profound effect on many people’s mental health. <a href="https://www.iser.essex.ac.uk/research/publications/working-papers/iser/2020-08">Ongoing research</a> from the University of Essex indicates this has particularly been the case for women, whose mental wellbeing has declined by twice as much as men’s during this time.</p>
<p>Having less social contact was shown to have the strongest influence on women’s wellbeing – more so than caring and family responsibilities or work and financial pressures.</p>
<h2>Isolation and loneliness</h2>
<p><a href="https://www.local.gov.uk/sites/default/files/documents/22.28%20-%20Loneliness%20Must%20Know_02.pdf">Loneliness</a> is already a recognised public health concern and can increase suicide risk for those <a href="https://www.sciencedirect.com/science/article/abs/pii/S0165032715310442?via%3Dihub">with and without</a> mental health disorders. </p>
<p>Here too, women may be more vulnerable to the impact of loneliness. Yet female suicidal distress is often not taken seriously or worse, dismissed as “<a href="https://twitter.com/AlysColeKing/status/1279905546246774784">attention-seeking</a>” or manipulation when help is sought. This attitude can even come from <a href="http://doi.wiley.com/10.1111/jpm.12171">healthcare professionals</a>.</p>
<figure class="align-center ">
<img alt="Woman sitting in dark room looking at phone." src="https://images.theconversation.com/files/358664/original/file-20200917-14-tcxffr.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/358664/original/file-20200917-14-tcxffr.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=462&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358664/original/file-20200917-14-tcxffr.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=462&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358664/original/file-20200917-14-tcxffr.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=462&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358664/original/file-20200917-14-tcxffr.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=581&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358664/original/file-20200917-14-tcxffr.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=581&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358664/original/file-20200917-14-tcxffr.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=581&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Social isolation can negatively affect mental health, as well as physical health.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/photo-of-woman-using-mobile-phone-3367850/">Pexels</a></span>
</figcaption>
</figure>
<p>Suicide and self-harm are deeply complex issues and <a href="https://www.cambridge.org/core/services/aop-cambridge-core/content/view/A7ACCE748A5FDF0346C8AB9A4ECE3A60/S0007125000162774a.pdf/stigma_as_a_cause_of_suicide.pdf">dismissing</a> the distress these acts signal can be a deadly mistake. </p>
<p>Women are more likely than men to make <a href="https://www.sciencedirect.com/science/article/pii/S0165032711001492">multiple suicide attempts</a>, but this does not mean the attempts are not serious. This is because the chances of a fatal <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825699/#:%7E:text=For%20completed%20suicide%2C%20the%20strongest,impulsivity%20and%20a%20somatic%20diagnosis">outcome</a> increase with more unsuccessful attempts – so it’s essential that intervention is possible. </p>
<h2>Police intervention</h2>
<p>When someone appears to be experiencing extreme distress in a public place, the police have powers under <a href="https://www.mind.org.uk/information-support/legal-rights/police-and-mental-health/sections-135-136/#WhatIsSection136">Section 136</a> of the Mental Health Act to intervene and have the person removed to a place of safety. Involving the police in this way should be a last resort to keep people safe, but <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/841408/police-powers-procedures-mar19-hosb2519.pdf">last year</a> there were more than 33,000 such detentions in England and Wales – the highest number ever recorded. </p>
<p>As the red line on the graph shows, use of Section 136 is increasing despite <a href="https://mentalhealthcop.wordpress.com/2014/04/16/flavours-of-street-triage/">efforts</a> to disrupt this trend. </p>
<figure class="align-center ">
<img alt="A graph showing the increase in the number of section 136 detentions in England and Wales." src="https://images.theconversation.com/files/357690/original/file-20200911-16-12zqlk7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/357690/original/file-20200911-16-12zqlk7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/357690/original/file-20200911-16-12zqlk7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/357690/original/file-20200911-16-12zqlk7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/357690/original/file-20200911-16-12zqlk7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/357690/original/file-20200911-16-12zqlk7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/357690/original/file-20200911-16-12zqlk7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Increase in the number of section 136 detentions in England and Wales.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Nationally, as with suicide rates, more males than females are subject to Section 136 overall –<a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/841408/police-powers-procedures-mar19-hosb2519.pdf">55% in 2018-2019</a>. But <a href="https://doi.org/10.3390/ijerph16234786">my research</a> has explored repeated Section 136 detentions and found that more women are being detained multiple times.</p>
<p>I examined data from all repeat detentions in two neighbouring counties over a period of 28 months. In all, 155 people were detained 563 times. I found more males than females were subject to two or more detentions. But as the number of detentions per individual rose, the gender gap widened and it was almost exclusively females who were detained with the highest frequencies.</p>
<figure class="align-center ">
<img alt="Chart showing numbers of males and females detained on multiple occasions." src="https://images.theconversation.com/files/358838/original/file-20200918-22-17qh2l6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/358838/original/file-20200918-22-17qh2l6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=454&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358838/original/file-20200918-22-17qh2l6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=454&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358838/original/file-20200918-22-17qh2l6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=454&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358838/original/file-20200918-22-17qh2l6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=571&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358838/original/file-20200918-22-17qh2l6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=571&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358838/original/file-20200918-22-17qh2l6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=571&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chart showing numbers of males and females detained on multiple occasions.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Twenty-two people (18 women and four men) had the most detentions (203 in total). Each person in this group was detained between six and 19 times, sometimes more than once within a week. Overall, more than 90% of all the repeat detentions related to suicide or self-harm and repeats made up one-third of all Section 136 detentions in the two counties during this time.</p>
<h2>Surviving short and long-term</h2>
<p>As part of my research, I also interviewed six women who had histories of multiple suicide attempts and Mental Health Act detentions. I found that past traumatic experiences that had not been addressed had fractured their views of themselves and others. This had left them struggling to believe they had a future. As Kate said: “I have a total lack of hope.” </p>
<p>My study found that long-term, reliable support was the key to helping to ease the impact of trauma for some of these women. Yet in the short term, the responses of police and health care professionals also made differences. Heather said police officers had sometimes persuaded her away from a dangerous situation and to return to safety without having to be detained. </p>
<figure class="align-center ">
<img alt="Woman speaking with doctor." src="https://images.theconversation.com/files/358839/original/file-20200918-14-xin9ec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/358839/original/file-20200918-14-xin9ec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358839/original/file-20200918-14-xin9ec.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358839/original/file-20200918-14-xin9ec.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358839/original/file-20200918-14-xin9ec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358839/original/file-20200918-14-xin9ec.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358839/original/file-20200918-14-xin9ec.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Loneliness can exacerbate conditions such as depression and anxiety.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-wearing-face-mask-sitting-on-1784946737">Amorn Suriyan/Shutterstock</a></span>
</figcaption>
</figure>
<p>Without alternative readily available suicide prevention measures in the community, Section 136 is critical to saving lives. Tragically, two of the women involved in my research, who had both survived numerous previous suicide attempts, have since died. </p>
<p>My colleagues and I are now examining data which suggests detentions fell in some areas during the initial lockdown period. Given then that varying COVID-19 restrictions look set to be with us for a considerable time to come – and the widespread impact on people’s mental wellbeing this may have – access to intervention and consistent support must be a priority. This is vital to prevent the next attempt from becoming fatal. </p>
<p><em>All names have been changed.</em></p>
<hr>
<p><em>If you’ve been affected by anything in this article and don’t know who to turn to there are free helplines available to support you.</em></p>
<p><em>In the UK and Ireland – call <a href="http://www.samaritans.org/">Samaritans UK</a> at 116 123.</em></p>
<p><em>In the US – call the <a href="https://suicidepreventionlifeline.org/">National Suicide Prevention Lifeline</a> at 1-800-273-TALK (8255) or <a href="http://www.hopeline.com/">IMAlive</a> at 1-800-784-2433.</em></p>
<p><em>In Australia – call <a href="http://www.lifeline.org.au/">Lifeline Australia</a> at 13 11 14.</em></p>
<p><em>In other countries – visit <a href="http://www.iasp.info/resources/Crisis_Centres">IASP</a> or <a href="http://www.suicide.org/international-suicide-hotlines.html">Suicide.org</a> to find a helpline in your country.</em></p><img src="https://counter.theconversation.com/content/145878/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claire Warrington currently receives funding from ESRC. This research was previously funded by Wellcome Trust.</span></em></p>Lockdowns have a key role in controlling COVID-19 but we must be aware of the risks of isolating people who are vulnerable to suicidal distress.Claire Warrington, Postdoctoral research fellow, University of BrightonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1440712020-08-11T06:58:25Z2020-08-11T06:58:25ZVictorian emergency departments during COVID-19: overall presentations down but assault, DIY injuries up<figure><img src="https://images.theconversation.com/files/352104/original/file-20200811-20-1vymxs6.jpg?ixlib=rb-1.1.0&rect=50%2C0%2C5627%2C3748&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>COVID-19 restrictions in Victoria have had a marked effect on how and where we spend our time. For many people, home has become the workplace, and for most school-aged children, home is also the classroom.</p>
<p>We compared <a href="https://www.monash.edu/__data/assets/pdf_file/0009/2294919/COVID-19-VISU-May-Bulletin-3.pdf">Victorian emergency department presentations</a> in May 2020 to those in May 2019 and found this extra time at home has affected the rates at which people are presenting to hospital with injuries — and the types of injuries they’re presenting with.</p>
<p>Importantly, overall presentations to the emergency department were down. But some categories saw notable increases, including the number of “unintentional home injuries”, which grew by 21%, and the number of injuries caused by “assault in the home”, which was 48% greater than the same time last year.</p>
<p>Although motor vehicle related injuries decreased, there was an increase in bicycle injuries, particularly among children.</p>
<h2>What we did</h2>
<p>At Monash University’s <a href="https://www.monash.edu/muarc/research/research-areas/home-and-community/visu">Victorian Injury Surveillance Unit</a>, we’ve been tracking injury rates throughout the pandemic.</p>
<p>We get our data from the <a href="https://www2.health.vic.gov.au/hospitals-and-health-services/data-reporting/health-data-standards-systems/data-collections/vemd">Victorian Emergency Minimum Dataset</a>, which holds deidentified clinical records of presentations at Victorian public hospitals with 24-hour emergency departments (currently 38 hospitals).</p>
<figure class="align-center ">
<img alt="The outside of a hospital with large red " src="https://images.theconversation.com/files/352109/original/file-20200811-16-1sr22k8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/352109/original/file-20200811-16-1sr22k8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/352109/original/file-20200811-16-1sr22k8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/352109/original/file-20200811-16-1sr22k8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/352109/original/file-20200811-16-1sr22k8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/352109/original/file-20200811-16-1sr22k8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/352109/original/file-20200811-16-1sr22k8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fewer Victorians are presenting to emergency departments during the pandemic.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>We’re also tracking emergency department presentations overall, to determine how much more common different types of injuries are becoming as a proportion of usual emergency department presentations. We call this measure “relative to emergency department caseload”.</p>
<p>So for example, in our <a href="https://www.monash.edu/__data/assets/pdf_file/0009/2294919/COVID-19-VISU-May-Bulletin-3.pdf">most recent bulletin</a>, we took the total emergency department presentations during May 2020. But because we’re looking for the proportion of usual emergency department presentations — that is, outside a pandemic — we excluded presentations directly or indirectly related to the pandemic from the total.</p>
<p>To calculate “relative to emergency department caseload”, we worked out the injuries as a proportion of this total.</p>
<h2>Illness</h2>
<p>Emergency presentations in Victoria were 24% lower in May 2020 than in May 2019 (118,793 versus 156,708 respectively). This decrease should be considered in the context of <a href="https://www.aihw.gov.au/reports-data/myhospitals/sectors/emergency-department-care">steady growth in emergency department presentations</a> in Victoria in recent years. It’s difficult to deny the COVID-19 pandemic is deterring people from presenting to hospital.</p>
<p>Respiratory illness-related presentations (such as asthma or pneumonia) in particular saw a steep reduction. Some 4,748 people presented to Victorian emergency departments with respiratory issues in May — 63% fewer than in May last year, when there were 12,847 such presentations.</p>
<p>Even people with potentially life-threatening conditions were less likely to present to hospital. Heart attack presentations were down 15% compared with the same period one year prior (721 versus 613), and stroke presentations were down 19% (858 versus 693). </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/even-in-a-pandemic-continue-with-routine-health-care-and-dont-ignore-a-medical-emergency-136246">Even in a pandemic, continue with routine health care and don't ignore a medical emergency</a>
</strong>
</em>
</p>
<hr>
<h2>Injuries</h2>
<p>The overall number of injury presentations to Victorian emergency departments was actually 26% lower in May 2020 than in May 2019 (26,991 versus 36,293). </p>
<p>But breaking this down by the place where the injury occurred shows a marked reduction in injuries that took place in sporting venues and schools, and an increase in injuries that occurred in the home and on farms. </p>
<p>Unintentional home injuries, including DIY injuries, increased from 10,105 to 12,265 (21%) from May 2019 to May 2020. Relative to emergency department caseload, this was a 56% increase. At both timepoints, falls were the most common cause of unintentional home injuries.</p>
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<p><iframe id="aVAbY" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/aVAbY/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<hr>
<p>Self-harm injuries did not increase in May 2020 versus May 2019 in terms of the raw numbers (719 versus 773). But relative to emergency department caseload, self-harm injury presentations increased by 20%. </p>
<p>This can be taken with more recent data outside of our research which showed <a href="https://www.theage.com.au/national/victoria/victoria-records-394-new-covid-19-case-17-deaths-20200809-p55jz4.html">a 9.5% rise</a> in the number of overall Victorian hospital admissions for self-harm in the past six weeks.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-not-only-teenage-girls-and-its-rarely-attention-seeking-debunking-the-myths-around-self-injury-120214">It's not only teenage girls, and it's rarely attention-seeking: debunking the myths around self-injury</a>
</strong>
</em>
</p>
<hr>
<p>According to our data, assault in the home increased from 118 presentations in May 2019 to 175 in May 2020: a 48% increase in frequency and a 91% increase relative to emergency department caseload. </p>
<p>Finally, transport injuries overall were not much different in May 2020 compared to May 2019 (1,669 versus 1,766). This was, however, a 22% increase when considered relative to emergency department caseload. While motor vehicle injuries decreased by 30% (833 to 581), bicycle injuries increased 55% from 371 to 576.</p>
<p>For children under 15 years, the rate of transport-related injury presentations to emergency departments increased 78% from May 2019 to May 2020.</p>
<hr>
<p><iframe id="qm16y" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/qm16y/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<hr>
<h2>Staying safe at home</h2>
<p>The bulletins we previously released for <a href="https://www.monash.edu/__data/assets/pdf_file/0005/2224283/COVID-19-VISU-Bulletin-1-03JUN2020.pdf">March</a> and <a href="https://www.monash.edu/__data/assets/pdf_file/0006/2246604/COVID-19-VISU-Bulletin-2.pdf">April</a>, and the data we’re now collating for June, reflect similar trends in the rates and types of emergency department presentations, as compared to the same time points last year.</p>
<p>Our findings have a few different implications.</p>
<p>First, we should encourage people who are sick and need hospital care to present to hospital — not to stay home for fear of contracting COVID-19.</p>
<figure class="align-center ">
<img alt="Young girl riding her bike." src="https://images.theconversation.com/files/352111/original/file-20200811-17-ow8avo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/352111/original/file-20200811-17-ow8avo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/352111/original/file-20200811-17-ow8avo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/352111/original/file-20200811-17-ow8avo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/352111/original/file-20200811-17-ow8avo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/352111/original/file-20200811-17-ow8avo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/352111/original/file-20200811-17-ow8avo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children were disproportionately represented in transport-related injuries.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Second, alongside the messaging we’re receiving to “stay home” and “stay safe” from coronavirus, public health messaging should include advice on staying safe at home. </p>
<p>With reduced face-to-face contact with health practitioners, some injury prevention messaging, such as the information provided through child-maternal health services, general practitioners and nurses, should be made available through other channels. These could include social media, radio, television, and telephone consultations. </p>
<p>Improving awareness of cycling safety, including messaging around <a href="https://www.monash.edu/__data/assets/pdf_file/0010/2186956/Hazard87-FINAL.pdf">cycling road rules</a>, would also be pertinent at this time. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/there-are-ways-to-reduce-injuries-in-kids-that-dont-involve-wrapping-them-in-cotton-wool-79408">There are ways to reduce injuries in kids that don't involve wrapping them in cotton wool</a>
</strong>
</em>
</p>
<hr>
<p>Finally, trends in self-harm and assault in the home need to be closely monitored, particularly during stage 4 restrictions in Victoria. </p>
<p>The stricter lockdown conditions may result in further increases in violence in the home and compound the effects on mental health, and we need to provide support accordingly.</p><img src="https://counter.theconversation.com/content/144071/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The Victorian Injury Surveillance Unit is funded by the Victorian Government</span></em></p>Comparing presentations to Victorian hospital emergency departments in May 2020 to those in May 2019 reveals some important differences.Janneke Berecki-Gisolf, Associate Professor, Accident Research Centre, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1321932020-03-02T00:06:49Z2020-03-02T00:06:49Z‘People are crying and begging’: the human cost of forced relocations in immigration detention<figure><img src="https://images.theconversation.com/files/316989/original/file-20200225-24701-1cbgddo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">RICHARD WAINWRIGHT/AAP</span></span></figcaption></figure><p>Between July 2018 and August 2019, the Home Affairs Department <a href="https://www.aph.gov.au/Parliamentary_Business/Senate_estimates/legcon/2019-20_Supplementary_Budget_Estimates">spent A$6.1m</a> flying refugees, asylum seekers and other immigration detainees around Australia. </p>
<p>This figure includes $5.7 million for charter flights and $400,000 for commercial flights with airlines like <a href="https://accr.org.au/2019/08/28/international-investor-backs-qantas-human-rights-resolution/">Qantas</a>. It does not include the cost of keeping planes on standby and transporting staff who accompany detainees. Neither does it include the cost of transporting detainees by road.</p>
<p>Details of these and other expenses have led <a href="https://www.theguardian.com/australia-news/2020/jan/29/home-affairs-department-racked-up-61m-bill-transferring-refugees-and-asylum-seekers">Labor to ask why minister Peter Dutton’s departmental costs continue to rise</a>. Given revelations the government spent <a href="https://www.sbs.com.au/news/christmas-island-detention-centre-cost-27-million-to-detain-four-people">$26.8 million</a> reopening Christmas Island detention centre to hold <a href="https://theconversation.com/how-the-biloela-tamil-family-deportation-case-highlights-the-failures-of-our-refugee-system-123685">a single family</a> last year, this is a pressing question. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-the-biloela-tamil-family-deportation-case-highlights-the-failures-of-our-refugee-system-123685">How the Biloela Tamil family deportation case highlights the failures of our refugee system</a>
</strong>
</em>
</p>
<hr>
<p>Yet deeper questions about what these relocations involve and how they affect detainees and their supporters have been largely ignored. As a researcher studying immigration detention, I can attest forced relocations impose profound human costs. </p>
<p>Over the past five years, I have conducted over 70 interviews with regular visitors to Australia’s onshore immigration detention centres. Speaking with volunteers and advocates, as well as detainees’ friends and family members, I have collected witness accounts of <a href="https://journals.sagepub.com/doi/10.1177/1440783318796301">conditions and practices within the system</a>.
A constant theme in these interviews has been <a href="https://academic.oup.com/jrs/advance-article-abstract/doi/10.1093/jrs/fez069/5570305?redirectedFrom=fulltext">the harm caused by involuntary transfers</a>. </p>
<h2>How many forced transfers are occurring</h2>
<p>When we think of immigration detention centres, we often imagine places of confinement. This is accurate, but it is not the full picture. </p>
<p>Refugees and asylum seekers in Australia’s onshore detention system are held in <a href="https://academic.oup.com/rsq/advance-article/doi/10.1093/rsq/hdy008/5048429">prison-like facilities</a> on the outskirts of our capital cities or – in the case of <a href="https://www.theguardian.com/australia-news/2020/jan/26/inside-christmas-island-the-australian-detention-centre-with-four-asylum-seekers-and-a-26m-price-tag">Christmas Island</a> and Yongah Hill in Western Australia – in remote parts of the country. </p>
<p>In December 2019, there were at least <a href="https://www.homeaffairs.gov.au/research-and-stats/files/immigration-detention-statistics-31-december-2019.pdf">504 refugees and asylum seekers</a> within the system, as well as hundreds of other immigration detainees, <a href="https://www.theguardian.com/australia-news/2019/sep/08/i-was-petrified-the-new-zealanders-deported-from-australia-despite-decades-working-there">including those about to be deported</a>. Detention can last months or even <a href="https://www.aljazeera.com/news/2019/12/refugee-diaries-10-years-immigration-detention-australia-191228024730946.html">years</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-people-in-immigration-detention-try-to-cope-with-life-in-limbo-106645">How people in immigration detention try to cope with life in limbo</a>
</strong>
</em>
</p>
<hr>
<p>As monotonous as detention can be, detainees are not allowed to become comfortable. Between July 2017 and May 2019, there were <a href="https://www.smh.com.au/politics/federal/the-8000-forced-movements-on-australian-flights-in-two-years-20190906-p52oq8.html">8,000 involuntary movements</a> within the system. Some of these were deportations, but others were forced transfers between facilities.</p>
<p>Detainees are rarely given an explanation when they are moved. The opacity of the practice is undoubtedly one of its concerning aspects, and has been criticised by the Australian Human Rights Commission (AHRC). In a <a href="https://www.humanrights.gov.au/our-work/asylum-seekers-and-refugees/publications/use-force-immigration-detention">report</a> last year, the commission recommended that when a relocation occurs </p>
<blockquote>
<p>the department and facility staff should ensure as far as possible that the person […] receives a clear explanation of the reasons for the transfer. </p>
</blockquote>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/317496/original/file-20200227-24676-gptz6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/317496/original/file-20200227-24676-gptz6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/317496/original/file-20200227-24676-gptz6p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/317496/original/file-20200227-24676-gptz6p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/317496/original/file-20200227-24676-gptz6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/317496/original/file-20200227-24676-gptz6p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/317496/original/file-20200227-24676-gptz6p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Federal police outside Yongah Hill Immigration Detention Centre to monitor a 2012 protest against refugee detention.</span>
<span class="attribution"><span class="source">REBECCA LEMAY/AAP</span></span>
</figcaption>
</figure>
<h2>‘Sheer, random cruelty’</h2>
<p>Participants in my study stressed the secrecy of relocations. Detainees were typically moved with minimal warning or explanation. At times they knew a transfer was pending, but they were often moved with just a few hours’ notice. </p>
<p>In some instances, the staff woke detainees up and gave them minutes to collect their belongings. As one regular visitor to Yongah Hill Detention Centre described it,</p>
<blockquote>
<p>It was always early in the morning - you’ve got 10 minutes to pack your bags. And they would lose things. They were always in such a hurry. It was made to be traumatic for them.</p>
</blockquote>
<p>Confronted with what a visitor to the Brisbane Immigration Transit Accommodation described as “the sheer, random cruelty of it”, detainees felt their vulnerability. So, too, did those left behind.</p>
<blockquote>
<p>There’s constantly distressing scenes as one family or another is being dragged away to be put on a plane with very little notice. And it’s so upsetting for all the other refugees […] that they’re seeing people get hauled off and people are crying and begging […] You never know if it’s going to be you tomorrow morning.</p>
</blockquote>
<p>The AHRC has documented the <a href="https://www.humanrights.gov.au/our-work/asylum-seekers-and-refugees/publications/inspection-maribyrnong-immigration-detention">“excessive” use of restraints</a> during transfers. Just in the last fortnight, <a href="https://www.ombudsman.gov.au/media-releases/media-release-documents/commonwealth-ombudsman/2020/report-into-the-current-state-of-immigration-detention-facilities">the Commonwealth Ombudsman</a> observed that handcuffs had become “accepted transfer practice” during transport operations.</p>
<p>In his recommendations, the ombudsman advised</p>
<blockquote>
<p>the Aviation Transport Security Regulations [to] restrict the use of mechanical restraints to circumstances where there is a genuine risk to the safety of the aircraft that cannot be mitigated by any other option.</p>
</blockquote>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1140916207249481733"}"></div></p>
<h2>The human costs of forced relocations</h2>
<p>Beyond the stress of the transfer process, relocations separate detainees from support networks within the facilities, as well as friends, advocates, doctors and lawyers in the community. As a regular visitor to Melbourne Immigration Transit Accommodation explained, the relocation experience is one of loss. </p>
<blockquote>
<p>They might put down roots and get a few mates where they are, but when they move they lose those bonds that they’ve developed. If they’re getting any medical help they lose that contact with that medical care, their ability to learn English gets less.</p>
</blockquote>
<p>Interstate transfers are particularly devastating for people with families in the community. Partners and children without social or financial resources in Australia can rarely travel to visit loved ones. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-how-australia-decides-who-is-a-genuine-refugee-72574">Explainer: how Australia decides who is a genuine refugee</a>
</strong>
</em>
</p>
<hr>
<p>The despair caused by relocations is perhaps best exemplified by stories I heard of detainees self-harming immediately before or after a transfer. </p>
<p>These testimonies accord with <a href="https://www.ncbi.nlm.nih.gov/pubmed/28601787">previous research</a> at Victoria University that has found a link between forced relocations and self-harm in immigration detention facilities. Forced transfers, this researcher found, are among a number of “precipitating factors or triggers for self-harm” in both immigration detention and prison settings. </p>
<h2>An unconscionable practice</h2>
<p>The practice of moving detainees around Australia’s immigration detention network is doubly unjustifiable on economic and humanitarian grounds. A consistent finding from my research is that forced relocations cause harm. They harm detainees, and they harm the people who love and support them. </p>
<p>As a country, we can find better ways to spend taxpayer money.</p><img src="https://counter.theconversation.com/content/132193/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research was funded by an Australian Government Research Training Program Stipend Scholarship and grants from the University of Queensland and the University of Sydney. Michelle Peterie has received funding from the Australian Research Council for other research projects. </span></em></p>There were 8,000 forced relocations in Australia’s immigration detention system in a nearly two-year span. New research shows how distressing and destabilising these movements are for refugees.Michelle Peterie, Research Fellow, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1301492020-01-23T15:11:22Z2020-01-23T15:11:22ZMental health: one in three young people in England are struggling – new report<figure><img src="https://images.theconversation.com/files/311412/original/file-20200122-117917-cw1zuf.jpg?ixlib=rb-1.1.0&rect=20%2C10%2C6689%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/large-group-shot-high-school-students-1324376948">Shutterstock/Lincoln Beddoe</a></span></figcaption></figure><p>We have seen a dramatic change in health trends for young people in the last ten years. Across most wealthy countries, such as the UK, Australia and Canada, young people’s participation in health risk behaviours such as regular alcohol consumption and getting drunk <a href="http://www.euro.who.int/__data/assets/pdf_file/0007/382840/WH15-alcohol-report-eng.pdf?ua=1">has declined</a>. In many ways this can be attributed to <a href="http://www.euro.who.int/__data/assets/pdf_file/0008/303488/HBSC-No.7_Success-stories.pdf?ua=1">successful policy interventions</a>.</p>
<p>However, against this backdrop of largely positive trends in health risks, concern over young people’s mental health has also grown. Worldwide, it is thought that <a href="https://www.who.int/mental_health/maternal-child/child_adolescent/en/">between 10-20% of young people experience mental health disorders</a>. The World Health Organization (WHO) reports that <a href="https://www.who.int/mental_health/maternal-child/adolescent/en/">50% of all mental health illnesses</a> start in childhood (before 14 years), rising to <a href="https://www.who.int/mental_health/maternal-child/child_adolescent/en/">75% by mid-20s</a>. WHO not only highlights the extent of this mental health issue but also the significant impact of poor mental health on young people’s future life chances.</p>
<p>Our <a href="http://hbscengland.org/wp-content/uploads/2020/01/HBSC-England-National-Report-2020.pdf">latest report</a> presents findings on the mental health and emotional wellbeing of 11-, 13- and 15-year-olds in England. The data was collected as part of the <a href="http://www.hbsc.org/">health behaviour in school-aged children (HBSC) study</a>. HBSC is an international research project that uses a school-based survey to collect information on the health and wellbeing of young people in over 45 countries. We manage the <a href="http://hbscengland.org/">HBSC study in England</a>, and our recently published findings are based on 3,398 young people from secondary schools across the country. </p>
<p>The HBSC study is repeated every four years, which means we can look at how young people’s health, wellbeing and behaviours have changed over time. In England we have collected data from young people aged 11, 13 and 15 years during 2002, <a href="http://wizney.com/hbscengland/wp-content/uploads/2018/11/GB-and-Ireland-2006.pdf">2006</a>, <a href="http://wizney.com/hbscengland/wp-content/uploads/2018/11/HBSC-England-report2011-1.pdf">2010</a>, <a href="http://wizney.com/hbscengland/wp-content/uploads/2018/11/HBSC-England-report-2014-1.pdf">2014</a> and <a href="http://hbscengland.org/wp-content/uploads/2020/01/HBSC-England-National-Report-2020.pdf">2018</a> – so we can examine trends spanning over 15 years.</p>
<h2>Life satisfaction</h2>
<p>It is important to recognise that most young people surveyed in the latest study reported good mental health and emotional wellbeing. Young people were asked to rate how satisfied they were with their life <a href="https://news.gallup.com/poll/122453/understanding-gallup-uses-cantril-scale.aspx">on a scale from zero to ten</a> (where zero describes the worst possible life and ten describes the best possible life). Three-quarters of young people reported a score between seven and ten, which is thought to suggest high life satisfaction. The proportion of 15-year-old girls reporting high life satisfaction increased from 55% in 2014 to 64% in 2018. We also found that more than half (60%) of young people had a positive body image, stating that they felt their body was “about the right size”. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/311415/original/file-20200122-117911-17ykvc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/311415/original/file-20200122-117911-17ykvc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/311415/original/file-20200122-117911-17ykvc4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/311415/original/file-20200122-117911-17ykvc4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/311415/original/file-20200122-117911-17ykvc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/311415/original/file-20200122-117911-17ykvc4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/311415/original/file-20200122-117911-17ykvc4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Parental communication has been linked to positive body image.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-talking-teenage-daughter-on-sofa-715726846">Shutterstock/Monkey Business Images</a></span>
</figcaption>
</figure>
<p>However, our findings show that a large portion of young people in England are struggling with poor mental health. Over a third (38%) of young people said that they “felt low” at least once a week – this is the highest proportion since the 2006 survey. </p>
<p>The <a href="https://www.sdqinfo.com/">strength and difficulties questionnaire (SDQ)</a> was included in our survey as a measure of young people’s mental health. The SDQ identified over a fifth (22%) of young people were experiencing a high level of emotional problems. We also found that a quarter of 15-year-olds had self-harmed. The proportion of 15-year-old girls who said they had self-harmed increased from 32% in 2014 to 35% in 2018, while a larger increase from 11% to 18% was noted among boys.</p>
<h2>Feeling connected</h2>
<p>We recognise that health and wellbeing are often influenced by the social environment. Consequently, our survey includes questions about the young person’s social world. For example, we ask young people how they feel about their family relationships, school experiences and their wider neighbourhood. By gathering data on young people’s environment, we can begin to identify factors that protect against poor health and wellbeing.</p>
<p><a href="https://link.springer.com/article/10.1007/s00038-016-0900-2">Self harming</a> was more prevalent among young people who found it difficult to talk to their parents, who felt as though they didn’t belong at school and who said that they didn’t feel connected to their local neighbourhood. Similarly, parental communication – in particular, with a father figure – has been linked to having a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2524.2009.00888.x">positive body image</a> among young people. We have also worked with our colleagues who carry out the HBSC study in Spain and we found that in both countries young people who reported <a href="https://journals.sagepub.com/doi/full/10.1177/0017896914555039">positive relationships with their teachers</a> were more likely to have positive emotional wellbeing. </p>
<p>While most young people in our study reported positive mental health and wellbeing, our data highlights mental health as an area of concern. We compared our most recent survey findings with the results from previous surveys, and it suggests that the number of young people in England who are struggling with mental health is on the rise. </p>
<p>Identifying factors in young people’s lives that may protect against poor mental health can help in the development of interventions to support young people. Our research has consistently found that the family, school and wider neighbourhood can play an important role in relation to young people’s mental health and emotional wellbeing.</p><img src="https://counter.theconversation.com/content/130149/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ellen Klemera receives funding from the department of health and social care DHSC</span></em></p><p class="fine-print"><em><span>Fiona Brooks receives funding from Department of Health for HBSC England </span></em></p><p class="fine-print"><em><span>Kayleigh Chester does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new report offers data on mental health in young people.Kayleigh Chester, PhD Candidate, University of HertfordshireEllen Klemera, Senior Research Fellow, University of HertfordshireFiona Brooks, Professor of Public Health, Assistant Deputy Vice-chancellor Research, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1249482019-11-04T11:17:10Z2019-11-04T11:17:10ZHomeless: more than a third of people leaving prison say they have nowhere to go<figure><img src="https://images.theconversation.com/files/298174/original/file-20191022-55679-omgux1.jpg?ixlib=rb-1.1.0&rect=57%2C44%2C4173%2C2705&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-sitting-against-brick-building-her-158492999?src=cgYUGvxxiAMYXuaqHoBkNg-1-23">Mikael Damkier/Shutterstock</a></span></figcaption></figure><p>Imagine for a moment you’re being released from prison after a 12-month sentence for theft. You’re clean, off drugs, it’s been tough, but you’re looking forward to starting a new life. You leave prison and head to the nearest probation service to find out where you’re going to live. Only to find out there’s nowhere for you to go. And you’ll be spending your first night out of a cell <a href="https://theconversation.com/fives-ways-that-reading-with-children-helps-their-education-99046">on the streets</a> – with only your clothes from prison to keep you warm.</p>
<p>In 2018, <a href="https://england.shelter.org.uk/media/press_releases/articles/320,000_people_in_britain_are_now_homeless,_as_numbers_keep_rising">320,000 people were recorded as homeless</a> in Britain, according to analysis from housing charity Shelter. This is a rise of 13,000, or 4%, on figures from 2017 – and is equivalent to 36 new people becoming <a href="https://theconversation.com/is-homelessness-a-matter-of-choice-89706">homeless</a> every day. This means one in every 200 people in Britain is homeless – sleeping on the streets or stuck in temporary accommodation, including hostels and B&Bs.</p>
<p>Compounding this figure, is the number of people released from prison who go straight from a cell to sleeping rough. <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/278806/homelessness-reoffending-prisoners.pdf">In a survey</a> published by the Ministry of Justice in 2012, 15% of prisoners reported being homeless when they were sentenced – with 9% sleeping rough. And at the point of release, 37% of former prisoners reported having nowhere to live. This figure is particularly worrying given that two-thirds of prisoners who identify as homeless <a href="https://www.theguardian.com/society/2019/aug/12/two-thirds-of-homeless-ex-prisoners-reoffend-within-a-year">will reoffend within a year of release</a>. </p>
<p>There are several reasons <a href="https://theconversation.com/who-are-the-homeless-and-how-do-we-count-them-52061">why so many people are homeless</a> upon release from prison – but most of them are to do with a system that is failing some of the most vulnerable people. Many lose their accommodation due to rent arrears – because terminating a tenancy is often not top priority when you’ve just been sent to prison. This can then make it difficult for former prisoners to get access to housing upon their release as they’re deemed intentionally homeless as a result of rent arrears. And as the figures above show, many may be homeless or in temporary accommodation already. </p>
<h2>Released without accommodation</h2>
<p><a href="http://www.opportunitynottingham.co.uk/uploadedfiles/documents/41-1567606346-entering_and_leaving_prison_report._opportunity_nottingham._sep_19..pdf">Our recent research</a> was undertaken as part of a national programme <a href="https://www.tnlcommunityfund.org.uk/funding/strategic-investments/multiple-needs">to transform the lives of adults</a> with complex needs –- including homelessness, mental ill-health, substance misuse and offending –- and explored how people’s progress had been impeded by a prison sentence. </p>
<p>Respondents reported that prison exacerbated their complex needs. It exposed them to bullying, violence, abuse, self-harm and suicide. They also said that it revived memories of trauma, reinforced drug problems and worsened their mental health. Many also described chaotic discharge arrangements – and often had no place to go after leaving prison. In many cases respondents only heard of their planned release on the day of discharge, giving no chance for them to find accommodation. Several described being released to “no fixed abode” and how they ended up sleeping rough. </p>
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<p>The former prisoners we spoke to also explained how they didn’t realise that being a resident in a local prison didn’t earn them a “local connection” under <a href="https://www.gov.uk/guidance/homelessness-code-of-guidance-for-local-authorities/chapter-10-local-connection-and-referrals-to-another-housing-authority">homelessness legislation</a>. This means that they were not considered to be entitled to help from the local authority for that area. And in many cases it only gave them a travel warrant back to the place – and the criminal networks – they were wanting to escape. </p>
<p>One respondent described how the only way to avoid sleeping rough was to fund his B&B accommodation by reverting to the very drug dealing that had earned him a prison sentence in the first place.</p>
<h2>Proper help needed</h2>
<p>There is hope though that the <a href="http://www.cih.org/resources/PDF/Policy%20free%20download%20pdfs/What%20you%20need%20to%20know%20Homelessness%20Reduction%20Act%202017.pdf">Homelessness Reduction Act</a> that came into place in 2018 might help to tackle the situation. This legislation obliges local authorities to provide help in finding accommodation for all homeless people whether they have a local connection or not. </p>
<p>It also requires public bodies like prisons to warn local authorities when they are about to <a href="https://www.gov.uk/government/publications/homelessness-duty-to-refer/a-guide-to-the-duty-to-refer">make someone homeless</a>. The hope is that this will allow time for suitable accommodation to be found for people to avoid them having to sleep on the streets.</p>
<p>Our own research has also shown that for former prisoners, having a support worker can make a key difference to the likelihood of successful rehabilitation. This should be someone who works with prisoners before they are released to arrange housing and other services. And can meet them when they leave prison and escort them to prearranged accommodation and appointments if necessary.</p>
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<strong>
Read more:
<a href="https://theconversation.com/four-myths-about-homelessness-voices-from-a-tent-city-96943">Four myths about homelessness: voices from a tent city</a>
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<p>Basically, this is about having someone there, who is able to help former prisoners to reintegrate and prevent their return to criminal lifestyles. And given that two-thirds of short-term prisoners <a href="https://www.theguardian.com/society/2019/aug/12/two-thirds-of-homeless-ex-prisoners-reoffend-within-a-year">reoffend within a year</a> of getting out, it seems that such measures to end, what prison reform charity <a href="https://howardleague.org/blog/homelessness-and-the-penal-system/">The Howard League calls</a> the “merry-go-round” – where people are “swept into prison and then dumped back on to the streets” – cannot come quickly enough.</p><img src="https://counter.theconversation.com/content/124948/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Graham Bowpitt receives funding from Framework Housing Association to conduct research on adults with multiple needs. He is affiliated with Emmanuel House Support Centre where he serves as a trustee. </span></em></p>And homelessness makes reoffending more likely.Graham Bowpitt, Reader in Social Policy, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1260512019-10-31T15:30:40Z2019-10-31T15:30:40ZTeen self-harm: rates have dramatically decreased in Denmark – here’s what other countries can learn<figure><img src="https://images.theconversation.com/files/299438/original/file-20191030-17914-1upy8yo.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C5734%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Having better access to mental health support could be one reason for lower self-harm rates among Danish teens. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/college-counselor-consulting-group-teenage-students-1227003406?src=1F_CP0U3xFMqaPibaYgsAw-1-32">Pressmaster/ Shutterstock</a></span></figcaption></figure><p>Concern has been growing over <a href="https://www.bbc.co.uk/news/health-48514349">rising rates of self-harm</a> in teenagers. In the UK and Ireland, increases began around the time of the <a href="https://www.bmj.com/content/359/bmj.j4351">2008 economic crash</a> and <a href="https://www.bmj.com/content/359/bmj.j4351">show no sign of slowing</a>. One study of the UK found rates among teenage girls <a href="https://www.bmj.com/content/359/bmj.j4351">rose by two-thirds</a> between 2011 and 2014. </p>
<p>But some surprising new findings suggest that stress caused by recession and financial uncertainty does not necessarily lead to rises in suicidal behaviour. My colleagues and I examined rates of <a href="https://link.springer.com/article/10.1007/s00127-019-01794-8">teenagers treated in hospital for self-harm</a> in Denmark. Contrary to expectations, we found that rates of self-harm in Danish teenagers actually fell between 2008 and 2016. Although Denmark experienced an economic recession, why didn’t rates of self-harm among teenagers see a similar spike as in other countries?</p>
<p><a href="https://link.springer.com/article/10.1007/s00127-019-01794-8">Our study</a> analysed <a href="https://journals.sagepub.com/doi/pdf/10.1177/1403494811401482">Danish national patient registers</a>, which contain data on individuals treated in hospitals and outpatient departments in Denmark. Such population-level registers are unique to Scandinavian countries. The registers allowed us to look at the numbers of young people attending hospital or outpatient clinics after having self-harmed and compare them against all teenagers of the same age in Denmark.</p>
<p>We found that the rates of self-harm in young people living in Denmark aged between ten and 19 decreased each year between 2008 and 2016. The rate decreased by more than 40% from the beginning to the end of the study period. This pattern was seen in younger and older teenagers and in both girls and boys.</p>
<p>It has long been accepted that economic recession is associated with <a href="https://www.bmj.com/content/bmj/347/bmj.f5239.full.pdf">increases in suicide rates</a>. Suicidal behaviour is undoubtedly a highly personal experience, but the way that society can influence it has been recognised as early as <a href="https://www.tandfonline.com/doi/full/10.1080/02732173.2016.1148652">the late 19th century</a>. Following the most recent global recession in 2008, increased rates of suicide and self-harm were seen <a href="https://www.wjgnet.com/2220-3206/full/v5/i2/243.htm">across Europe and North America</a>. </p>
<p>In Ireland, rates of self-harm among teenagers <a href="https://link.springer.com/article/10.1007/s00127-018-1522-1">increased by 22%</a> between 2007 and 2016. In the UK, the government’s response to the recession was to impose austerity measures. This resulted in cuts to government spending on healthcare, unemployment benefits and social services, all of which have a proven <a href="https://www.bmj.com/content/363/bmj.k4897">negative impact on mental health and well-being</a>. </p>
<p>But free universal healthcare, widespread <a href="https://jech.bmj.com/content/69/2/110">access to unemployment programmes</a> and increased welfare spending during recession <a href="https://journals.sagepub.com/doi/10.1177/14034948990270020601">can soften the blow of financial hardship</a>. In line with <a href="https://www.bmj.com/content/359/bmj.j4351">findings from the UK</a>, we found that the highest rates of self-harm were among teenagers from the poorest households. But our research found that, even for these teenagers, rates fell between 2008 and 2016. While we can only speculate about the causes of the fall in rates, Denmark appears to have protected its most vulnerable young people from rises experienced by other countries.</p>
<p>Of course, adolescents will be affected by economic recession – but, being less directly affected by the job market, they’re unlikely to experience it in the same way as adults. However, there are a number of other factors that are <a href="https://www.mentalhealth.org.uk/publications/truth-about-self-harm">likely to exacerbate self-harming behaviours</a>, such as pressure at school, difficulties at home, or mental health issues such as depression or anxiety – but certain measures can also protect teenagers’ mental health, which may be especially important during economic upheaval when populations are more vulnerable. </p>
<h2>Social media pressures</h2>
<p>While social media pressure may be particularly intense for teenagers, frequently voiced concerns that it might cause harm to mental health and well-being <a href="https://www.pnas.org/content/116/21/10226">may be overstated</a>. <a href="https://bmjopen.bmj.com/content/9/2/e027006">One study found</a> that most social media content concerning self-harm was positive. The study found that social media was mostly used as a platform to process difficult emotions creatively and share stories of recovery – rather than to promote self-harming behaviours. Social media also has the potential to increase awareness about seeking help for mental health problems – but this would only reduce self-harm rates if mental health support was available and accessible for young people.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/299440/original/file-20191030-17901-10v0wdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/299440/original/file-20191030-17901-10v0wdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/299440/original/file-20191030-17901-10v0wdc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/299440/original/file-20191030-17901-10v0wdc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/299440/original/file-20191030-17901-10v0wdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/299440/original/file-20191030-17901-10v0wdc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/299440/original/file-20191030-17901-10v0wdc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Social media might actually provide much-needed support for teens.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pretty-girl-sending-text-message-home-196627295">Grzegorz Placzek/ Shutterstock</a></span>
</figcaption>
</figure>
<p>More availability and better access to mental health support might be one reason for lower rates of self-harm in Denmark. Since 2007, suicide prevention clinics have been <a href="https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(14)00083-2.pdf">offering psychosocial therapy</a> across Denmark for people at risk of suicide. The program was introduced gradually from 1992 and expanded to cover the whole country. These clinics have been found to have positive effects on reducing self-harm and suicide.</p>
<p>Yet, in many parts of the world, <a href="https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health">adolescents struggle to access mental health services</a>. Evidence from the UK shows that teenagers from the most deprived neighbourhoods are <a href="https://www.bmj.com/content/359/bmj.j4351">more likely to self-harm</a> yet are less likely to receive mental health treatment.</p>
<p>Denmark has also taken steps to <a href="https://www.nice.org.uk/advice/ktt24/chapter/Evidence-context">regulate sales of common painkillers</a> to under-18s. In many parts of the world, <a href="https://www.theguardian.com/society/2018/sep/11/sharp-rise-in-young-people-overdosing-on-painkillers-and-antidepressants">including the UK</a>, there’s been a sharp rise in the number of young adults who have overdosed on painkillers and antidepressants. Tougher regulations of these common painkillers might help to delay access – and research has shown that <a href="https://econtent.hogrefe.com/doi/10.1027/0227-5910.28.S1.4">even a small delay in accessing a suicide method</a> can be enough to halt the act.</p>
<p>Having access to health and welfare services, alongside good social connections within societies, can help reduce the prevalence of self-harm – especially during difficult economic times. Places that young people spend time in – such as schools, colleges, universities and health services – can also offer opportunities for social connection. </p>
<p>Social media that encourages social connections could also help young people build more resilience and better manage uncertainties such as a poor job market and financial insecurity. Better funding for mental health services may also be able to help protect younger populations from the harmful effects of economic turmoil and other stresses.</p><img src="https://counter.theconversation.com/content/126051/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Steeg has previously received funding from the National Institute for Health Research. </span></em></p>Researchers found that between 2008 and 2016, self-harm rates among Danish teenagers actually decreased.Sarah Steeg, Presidential Research Fellow, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1253322019-10-31T14:41:25Z2019-10-31T14:41:25ZSelf-harm: boys are less likely to be admitted to hospital<figure><img src="https://images.theconversation.com/files/299314/original/file-20191029-183142-17774pp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1091909501?src=092EVGT3ck_4u6ZzDYkRSQ-1-89&size=medium_jpg">Dragana Gordic/Shutterstock</a></span></figcaption></figure><p>Self-harm is one of the most important <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60322-5/fulltext">risk factors for suicide</a>. Although rare in young people, suicide is still the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredinenglandandwalesseriesdr/2016">leading cause of death</a> in males and females aged 10-19 years in England and Wales. And with evidence of a rise in rates of suicide among 15-19 year olds in the UK since 2010, it’s important to understand how young people seek help for self-harm and what happens when they do.</p>
<p>Most studies looking at where young people who self-harm go for help have only looked at hospital and GP records. While we know that many young people who self-harm won’t contact healthcare services, we wanted to capture the full spectrum of those who do. So for <a href="https://adc.bmj.com/content/early/2019/09/16/archdischild-2019-317248.info">our study</a> we looked at data from GP clinics, emergency departments and outpatient clinics, as well as hospital admissions for the years 2003 to 2015 in Wales, UK. Our study included 937,697 young people aged 10-24, of whom 15,739 sought help for self-harm.</p>
<h2>Girls more likely to be admitted</h2>
<p>More young people saw their GP about self-harm than in any other service – one in four young people went to primary care only. This has barely changed since 2003. But the number of young people attending emergency departments and subsequently being admitted to hospital after an episode of self-harm has increased. </p>
<p>One of our most interesting findings was that after going to an emergency department to report self-harm, girls and young women are more likely to be admitted to hospital than boys and young men of the same age. This difference was the same even for 10-15 year olds, despite <a href="https://www.nice.org.uk/guidance/cg16/chapter/1-Guidance#special-issues-for-children-and-young-people-under-16-years">guidelines advising</a> that those under 16 years old should be admitted to hospital overnight. </p>
<p>Based on our data we can’t say exactly why this is happening. It could be down to the method used - girls and young women are more likely to take an overdose and so be admitted for drug monitoring than people who have self-injured in other ways, such as cutting themselves. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/299675/original/file-20191031-26419-8jelxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/299675/original/file-20191031-26419-8jelxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/299675/original/file-20191031-26419-8jelxk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/299675/original/file-20191031-26419-8jelxk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/299675/original/file-20191031-26419-8jelxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/299675/original/file-20191031-26419-8jelxk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/299675/original/file-20191031-26419-8jelxk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Girls are more likely to overdose, which would lead to them being kept in hospital for monitoring.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/778823221?src=kCCqDlEh6CDIIyYaeYRlFQ-1-0&size=medium_jpg">Brocreative/Shutterstock</a></span>
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</figure>
<p>The sex difference could also be related to boys and young men being more likely to refuse to be admitted. While it’s difficult to pin down the exact reason, the fact that girls and young women contacting services with self-harm outnumber boys and young men in every healthcare setting except the emergency department makes our emergency departments an important place to provide help. </p>
<p>There is a current focus on initiatives to get more boys and young men to seek help, but we also need to consider if we manage them differently to girls. There may be attitudes we need to change in society. We still need to encourage boys to seek help early, potentially in settings other than emergency departments, which may not be best suited to their needs when in acute distress. But we also need to change how we respond and manage them when they do seek help.</p>
<p>Rates of self-harm were highest among 15-19 year olds across all healthcare services. We know from surveys of the general public that rates of self-harm in this age group are higher, so it’s not a huge surprise. </p>
<h2>Increase in young girls self-harming</h2>
<p>The largest increases in self-harm were seen among 10-14 year olds, particularly girls. Again it’s difficult to say exactly why this is the case, but it is probably due to several factors such as parents being more aware of self-harm and it’s possible causes, making it more likely that they will seek help for their children. So the rise in reported rates of self-harm may ironically be a good thing because it suggests more people are asking for help and getting the support they need. </p>
<p>But the increase could also reflect a genuine rise in self-harm in this age group. There is survey data in older teenagers that shows this is the case particularly in <a href="https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/adult-psychiatric-morbidity-survey-survey-of-mental-health-and-wellbeing-england-2014">older girls and young women</a>.</p>
<p>Young people from the most deprived areas of Wales were most at risk, with rates of self-harm more than double those in young people living in more affluent areas. </p>
<p>Providing the right ongoing support to young people who contact health services is a good start, but many young people who self-harm don’t seek this sort of help and our study does not include them. But it highlights a group of young people where we can offer help in the places they seek it – particularly for hard to reach groups, such as boys and young people from deprived areas.</p><img src="https://counter.theconversation.com/content/125332/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ann John receives funding from MQ, MRC and HCRW. She is a Trustee of the Mental Health Foundation</span></em></p><p class="fine-print"><em><span>Amanda Marchant receives funding from Health and Care Research Wales and the Medical Research Council</span></em></p>NICE guidelines suggest that boys who come to come to A&E because of self-harm should be admitted to hospital. Often, this isn’t happening.Ann John, Clinical Professor of Public Health and Psychiatry, Swansea UniversityAmanda Marchant, Research Assistant/PhD student mental health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1243152019-10-08T09:41:01Z2019-10-08T09:41:01ZThe UK doesn’t spend enough on the mental health of young people – we found out why<figure><img src="https://images.theconversation.com/files/295009/original/file-20191001-173402-10dr3bl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/526087603?src=Sem8gPGJxl0v4k9HZBBB6w-1-0&size=medium_jpg">Dmytro Zinkevych/Shutterstock</a></span></figcaption></figure><p>In 2016 the then health secretary, Jeremy Hunt, <a href="https://www.hsj.co.uk/mental-health/hunt-vows-to-act-on-nhss-biggest-area-of-weakness/7011628.article">declared</a> child mental health services the “biggest single area of weakness” in the NHS. He might have added that it is also vastly underfunded. The mental health of children and young people accounts for <a href="https://youngminds.org.uk/about-us/media-centre/press-releases/children-s-mental-health-funding-not-going-where-it-should-be/">less than 1%</a> of all NHS spending. </p>
<p>That is despite the significant burden that mental health problems impose on individuals, their families and society; despite <a href="https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2017/2017">one in eight</a> young people having a mental health disorder; despite rising rates of <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30188-9/fulltext">self-harm</a> and the fact that suicide is the leading <a href="https://www.mentalhealth.org.uk/statistics/mental-health-statistics-suicide">cause of death</a> among young men; and despite problems being serious enough to prompt the UK government to introduce a minister for suicide prevention in 2018.</p>
<p>Effective treatments exist, such as <a href="https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/">cognitive behavioural therapy</a> and family therapy, and the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414340/">sooner</a> treatment is started, the more <a href="https://bmjopen.bmj.com/content/6/10/e012611?cpetoc">effective</a> it is likely to be. Yet most young people don’t get help. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/new-ways-to-treat-depression-in-teenagers-71965">New ways to treat depression in teenagers</a>
</strong>
</em>
</p>
<hr>
<p>In England, <a href="https://www.england.nhs.uk/publication/mental-health-five-year-forward-view-dashboard/">two in three</a> young people with a mental health problem do not receive support from specialist services. There are long waits for child and adolescent mental health services (CAMHS) and thresholds for entering care are high. </p>
<p>There is a clear disparity between the needs of young people and the resources dedicated to their mental health. Indeed, CAMHS accounts for around <a href="https://www.england.nhs.uk/publication/mental-health-five-year-forward-view-dashboard/">7%</a> of the NHS mental health budget even though children under 18 account for <a href="https://fingertips.phe.org.uk/search/under%2018#page/3/gid/1/pat/6/par/E12000008/ati/102/are/E10000002/iid/92309/age/173/sex/4">21%</a> of the population.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/295008/original/file-20191001-173337-7mlnvn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/295008/original/file-20191001-173337-7mlnvn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=343&fit=crop&dpr=1 600w, https://images.theconversation.com/files/295008/original/file-20191001-173337-7mlnvn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=343&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/295008/original/file-20191001-173337-7mlnvn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=343&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/295008/original/file-20191001-173337-7mlnvn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=430&fit=crop&dpr=1 754w, https://images.theconversation.com/files/295008/original/file-20191001-173337-7mlnvn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=430&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/295008/original/file-20191001-173337-7mlnvn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=430&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Rates of mental health disorders (aged 5-19)</span>
<span class="attribution"><span class="source">NHS Digital</span></span>
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<h2>Why child mental health loses out</h2>
<p>England has a decentralised system for providing healthcare, which means local areas commission most of their own health services, such as emergency services, hospital care, rehabilitation and mental health. NHS England assigns a budget based on how much it estimates an area needs, but it is up to local organisations called “clinical commissioning groups” to decide how to spend it. </p>
<p>Clinical commissioning groups spend widely different amounts on CAMHS, even after differences in population are accounted for. Our <a href="https://bmjopen.bmj.com/content/9/10/e030011.full">latest research</a> shows that differences in spending can be explained not only by variation in the needs of young people but also by spending decisions in other areas. </p>
<p>Simply put, there are trade-offs. The NHS, like many health systems across the world, is under pressure. To increase spending on one area (CAMHS, for example) commissioners must decrease spending in another. That might result in someone waiting longer for surgery or to be seen at A&E. These are difficult decisions.</p>
<p>But CAMHS has been <a href="https://bjgp.org/content/66/651/502">called</a> the “Cinderella of the Cinderella” services, with many convinced that it is consistently overlooked. We think there are several reasons why child mental health may lose out to physical health when commissioners take spending decisions. </p>
<p><strong>Rule of rescue.</strong> Spending decisions may be biased towards the “rule of rescue”, which predicts that spending will go towards immediate, life-threatening cases and away from prevention or early intervention – such as resolving a mental health disorder at a young age.</p>
<p><strong>Lack of data.</strong> NHS targets have traditionally focused on things like A&E waiting times. With little data and, until recently, no targets for CAMHS nationally, commissioners have had less of an incentive to invest in these services. </p>
<p><strong>Stigma.</strong> A lower level of awareness or stigma around mental health may have contributed to lower prioritisation of CAMHS in the past, and today’s decisions are constrained by the previous pattern of spending. </p>
<p><strong>New technologies.</strong> Patients, doctors, private companies and even researchers may all have reasons to want new technologies to be adopted in healthcare. The lobbying for and adoption of new technologies may favour innovations, such as surgical instruments and drugs, over treatments that are labour intensive, such as talking therapy.</p>
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Read more:
<a href="https://theconversation.com/key-to-lifelong-good-mental-health-learn-resilience-in-childhood-99776">Key to lifelong good mental health – learn resilience in childhood</a>
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<h2>More, please</h2>
<p>Things are improving. NHS England has started to collect new data, <a href="https://www.england.nhs.uk/mentalhealth/wp-content/uploads/sites/29/2016/07/2.-Children-and-young-people%E2%80%99s-mental-health.pdf">introduced</a> a target to increase the number of young people receiving help and allocated extra funding to help local CAMHS transform (we are also trying to understand how much of a difference the <a href="https://bmjopen.bmj.com/content/8/12/e024230">transformation</a> of local services makes). But a target of 35% of people in need receiving support is alarmingly low and many young people are still waiting too long for help.</p>
<p>Meanwhile, austerity in the UK is <a href="http://www.social-policy.org.uk/50-for-50/austerity-children/">known</a> to have hit children and lone parents particularly hard. Many services previously available to young people, such as children’s centres, have been cut following substantial reductions in local government budgets. This is expected to result in more young people needing support from specialist services.</p>
<p>The chance to intervene early is fleeting. Doing so requires a sea change in funding for young people both from within the NHS and other budgets.</p><img src="https://counter.theconversation.com/content/124315/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Rocks receives funding from the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford Health NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.</span></em></p><p class="fine-print"><em><span>Apostolos Tsiachristas receives funding from Oxford NIHR CLAHRC and Oxford NIHR BRC. </span></em></p>New research uncovers the reasons for the chronic underspending on young people’s mental health services.Stephen Rocks, Researcher, Health Economics, University of OxfordApostolos Tsiachristas, Senior Researcher, Health Economics, University of OxfordLicensed as Creative Commons – attribution, no derivatives.