Medical services response to self-harm patients ‘negative and damaging’: Orygen report

The treatment young people who self-harm face in emergency departments is so damaging and discriminatory it would not be tolerated in any other medical setting, says the first ever national report on this “largely hidden and misunderstood behaviour”.

Almost one quarter of young women and a fifth of young men aged 20-24 years have self-harmed, a 2010 survey of 12,000 Australians published in the Medical Journal of Australia found. Yet half of them do not seek help due to stigma and lack of community understanding says the new report from Orygen, the National Centre of Excellence in Youth Mental Health.

Once-bitten by such “negative and damaging” responses from medical professionals, they are “unlikely to seek out support a second time”. They are accused of “just attention seeking”, says the Orygen report. Orygen is a not-for-profit partnership of the Colonial Foundation, the University of Melbourne and Melbourne Health headed by Professor Patrick McGorry AO. It claims to be the world’s leading research organisation in mental ill-health among youth.

“Young people told us some terrible stories about being stapled without anaesthetic by medical staff. That wouldn’t be acceptable in any other form of medicine so why is it seen to be OK here?” said Jo Robinson, head of suicide prevention at Orygen. Taken together with shame and stigma, it’s no wonder rates of help-seeking are so low, she said.

The report calls for urgent measures to address the “crippling” impact of self-harm on the 12-25 age group and the “gaping holes” in treatment.

The taboo around the topic needs to be broken, the report says. Emerging evidence indicates there is no risk in getting young people who self-harm to talk about the behaviours. “Indeed it is the reluctance by so many in the community to talk to young people who are self-harming that is likely to be causing the greatest injury,” the report says.

Cutting is the most common reported self-harm behaviour, but poisoning, particularly overdosing on analgesics such as paracetamol, is the most common method resulting in hospitalisation. Just over 9000 young people were hospitalised for self harm in Australia in 2013-14.

Almost one quarter of young women and a fifth of young men aged 20-24 years have self-harmed, a 2010 survey of 12,000 Australians published in the Medical Journal of Australia found. Illustration: michaelmucci.com 

The behaviour often occurs in response to intense emotional or physical pain and psychological distress, says the report. The young person may be experiencing overwhelming negative feelings, thoughts or memories, and feel a sense of hopelessness.

For some, there is an addictive element, “possibly due to the natural release of endorphins in response to pain, and possibly due to a lack of alternative coping strategies”. Rates for self-harm among Indigenous youth aged 15-24 are five times that for the same non-Indigenous youth of the same age group.

In some instances, self-harm is accompanied by suicidal thoughts, but the links between self-harm and suicide need further investigation, Dr Robinson said.

Hospitalisation rates were highest among 15-24 years olds in 2010-11. There has been an upward trend in the rates for 15-19 year olds, both male and female, since 2000. But hospitalisation rates “reveal only the very tip of the iceberg” because there is no reporting system for self-harm episodes which don’t result in going to hospital.

Young people told us some terrible stories about being stapled without anaesthetic by medical staff. That wouldn’t be acceptable in any other form of medicine so why is it seen to be OK here?

Jo Robinson, head of suicide prevention at Orygen

Almost half those who seek help approach a school-based service. Even though schools are often in the front line, “there is no evidence-based guidance to help them best identify and support these young people”, so schools parents, schools and community members are struggling to respond, the report says. This should be addressed as an urgent priority, Dr Robinson said.

But evidence for effective interventions is limited. Australia needs to develop national standards for an appropriate and acceptable response to this significant public health issue, says the Orygen report. A whole-of-system approach needs to deliver better awareness, guidance and strategies and it is important that young people themselves are part of the reform process, said Dr Robinson. “Young people want to be part of the solution. They want to tell their stories.”

Better responses than looking the other way

The report urges urgent measures to improve the poor community response to self-harm. They include:

• Train for health professionals and first responders so young self-harming people receive acceptable standards of care
• Develop systemic early intervention approach delivered within existing mental health services
• Set up multi-site studies to test effectiveness of interventions for self-harm
• Give schools evidence-based guidelines and programs to help staff, students and parents prevent and respond to self-harm
• Improve referral between schools and community mental health services in response to self-harm
• In partnerships with young people who have self-harmed and their parents, develop resources for parents and community to address stigma and help understand the behaviour and how to respond effectively provide web-based program and mobile apps so health professionals, young people and their families can easily access good information.

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