0:00 welcome to this webinar which is on understanding self-harm and suicide this is part one of this webinar i'm dr krisha patel and i'm the mental health lead for the company so the target audience of this webinar are hcp so healthcare practitioners so that's doctors nurses paramedics or other healthcare practitioners who work with clients with mental health issues we're going to define what self-harm is and then we're going to understand how and why people self-harm so deliberate self-harm which we often shorten to dsh and self-harm sh are essentially the same thing people who
0:47 do self-harm sometimes prefer the term s h so self-harm over deliberate self-harm and that's because they often do not feel in control of their self-harm when they are engaging in that behavior so self-harm is really common in the uk and it's also common globally so just to define what self-harm actually is it's a broad category covering any deliberate self-injury so it doesn't matter whether the person has suicidal intent or not it doesn't matter what the motivation behind self-harm was it's just any deliberate self-injury and that means it can occur with or without suicidal intent we'll talk a bit about that later
1:34 but there are many reasons why people self-harm and sometimes it's a true desire to end their life other times it's because they are in so much emotional distress and that is their coping strategy so rates of self-harm appear to be increasing and particularly so amongst the children and young people group so this is a question over to you how do people self-harm i'd like you to pause the video and write down at least five different methods or ways that people self-harm there are more common methods and then there are less common methods things like overdose of tablets or medications cutting yourself cutting your wrists hanging
2:19 or using a ligature around the neck jumping from a height punching yourself head banging neglecting to take essential medications biting scratching or hitting yourself swallowing toxic chemicals or corrosives swallowing objects like knives or batteries burning yourself stabbing oneself hair pulling scolding oneself so there are many different ways that people self-harm some are more common some are less common so why do people self-harm i'd like you to pause the video and write down some reasons why people self-harm and if you're in small groups discuss these in your groups so as i've already mentioned when people
3:06 self-harm it can be with suicidal intent so with a true desire to end their own lives or it could be without suicidal intent and it could be due to many other reasons so it could be that this is their way of expressing distress that that person cannot describe in words it could be to release tension and release that distress so that's their learned coping strategy it could be to feel a sense of control over their lives when everything else seems out of their control it could be to punish themselves because they feel guilty about something or feel shame about something it could be because they're feeling emotionally numb and want to feel
3:51 something want to feel physical pain and of course when people self-harm it could be with true suicidal intent so a real attempt to kill themselves so this is quite a useful diagram to show how people can get into this cycle of self-harm so let's start with any point of the cycle so emotional suffering or emotional distress and that can lead to emotional overload for that person and they cannot cope with that they can become panicked they can self-harm the self-harm might temporarily give them some relief might temporarily make them feel in control of that situation and release that tension but after a
4:37 period of time they'll feel shame and grief and again that leads to emotional suffering emotional overload panic self-harm temporary relief and shame so the cycle can obviously continue so one key point about self-harm is in itself it's not a diagnosis so self-harm is not a diagnosis in itself but it is of course associated with many psychiatric diagnoses so a person who self-harms may have depression they may have anxiety a learning disability and often when it comes to things like challenging behavior or self-harm when somebody has a
5:23 learning disability it's their way of communicating distress when they cannot verbalize things it could be due to personality disorder so emotionally unstable personality disorder is associated with self-harm behavior it could be due to psychotic disorders like schizophrenia substance misuse disorders like drug and alcohol dependencies and eating disorders are also associated with self-harm and suicide and obviously there are many more psychiatric conditions associated with self-harm saying that there may not be a true psychiatric diagnosis when somebody presents with self-harm so
6:09 they may not fit the criteria for any psychiatric diagnosis so the self-harm or suicidal thoughts may be due to the social factors instead so we have to think about the social history and that social context and this is particularly so with those who are young so children and young people as i've mentioned self-harm rates in children and young people are increasing so we have to think about their social context it may be due to difficulties in their upbringing or difficulties in their home life and that might be their way of showing their distress so the relationship between self-harm and suicide is complicated of course self-harm is a risk factor for completing suicide and
6:56 many people who have gone on to complete suicide will have self-harmed in their past saying that we meet in our professional work many people who report suicidal thoughts or suicidal ideas and many people who have attempted suicide and self-harmed in the past not all of them will go on to complete suicide throughout their lives so clearly there is a complicated relationship between self-harm and suicide where self-harm is a risk factor for suicide but of course there are lots of people who self-harm and have suicidal ideas who never go on to complete suicide and just to demonstrate how complicated this relationship is
7:44 in the past some people have thought about self-harm and suicide as being two distinct groups but this is not the case and there's massive overlap between the groups and i'm just going to try and show that in this slide people in the past used to think about the self-harmers as those who have done something very impulsive they've invited discovery and used a method that's unlikely to be dangerous so the picture that sometimes pops into your head is your female with emotionally unstable personality disorder who has impulsively cut her wrists or impulsively taken an overdose but they've invited discovery so they've done it in their own home where they know people are present and they know they're going to be found and they've done something like
8:30 superficial cuts on their wrists something that's unlikely to be dangerous and then in the past people thought as those who complete suicide as those who have planned the attempt they've made preparations like settling their financial affairs or writing a will they've taken steps to avoid discovery so they've decided to complete suicide at a time in their own home when they know nobody will be around or they've driven many miles to a remote area where they don't believe people members of the public will see them and they've used a dangerous method like a rope or a gun and of course they're not distinct groups there's massive overlap so somebody may do something impulsively
9:17 that invites discovery but use the dangerous method and then ends up ultimately completing suicide so over to you again this is a question for you how many people died by suicide in the uk in 2018 there are approximately 66 million people living in the uk so how many people do you think died by suicide in the uk in 2018 so the answer is two so it's actually approximately six and a half thousand in a population of about 66 million and so there's a age standardized mortality rate that they've recorded in the ons statistics it's
10:02 about 11.2 in every hundred thousand people so the reason i've brought this up is because we often get really worried about people going on to complete suicide because so many people in the police station and in the sexual assault referral centers where we work report suicidal thoughts and suicidal ideas however if we're trying to put this into perspective and think about it objectively the majority will not go on to complete suicide because looking at the statistics roughly 11 in every 100 000 people was their age standardized mortality statistic so about six and a half thousand people in a population of 65 million will go on to complete suicide every
10:48 year and if you compare that with the number of people with suicidal thoughts or some sort of suicidal ideas or some sort of history of self-harm in the past that's a real really small number it's a real minority but of course i don't want to minimize these deaths and every death from suicide is a tragedy for that person and that immediate family as well as many other people who are close to that person so family and friends i just wanted to put it in perspective here that we worry about it a lot we get anxious about it when we're doing self-harm risk assessments when people tell us they're feeling suicidal thinking about it objectively we need to remember that it's a minority who will go on to complete suicide and all we can do is do our best try and identify those
11:35 who are high risk and need more support but it isn't always possible because suicide is rare and unpredictable so that takes us to the end of part one and the next session is going to be on suicide risk assessments and how we complete those
