Enhancing understanding of mental health, mental ill-health, self-harm and suicide
A person can engage in self-harm where the intended outcome is death, referred to as a suicide attempt. Alternatively, self-harm can occur in the absence of suicidal intent, where the intended outcome is to cope with distress. Intent, therefore, is what differentiates non-suicidal self-harm from suicide and suicide attempts. The interventions required to respond to self-harm, irrespective of the intent, differ due to the distinctly different functions of the self-harming behaviour. Both require support from trained mental health professionals to address the complexities of the behaviour and appropriately respond to the associated risk.
Research has found that around 1 in 10 adolescents will have engaged in self-harming behaviour in the previous 12 months (Daraganova 2016). Self-harm is categorised as a symptom of underlying emotional and psychological distress rather than an illness in its own right. It is often a function of an underlying mental health condition (Be You – ).
Children under 12
The response required for children under 12 who are self-harming is different and requires increased sensitivity and compassion. Schools should seek support and guidance from Student Support Services or appropriately trained allied health professional.
Self-harm is not simply an act of ‘attention seeking’. People who engage in self-harm will typically do so in private and go to great lengths to conceal any evidence of self-inflicted harm. For this reason, signs that someone is engaging in self-harm can be difficult to identify.
The role of educators
The role of educators is to promote positive help-seeking behaviours, strengthen the awareness and development of safe coping strategies, and to enquire sensitively about what is going on for the student. Where an educator has concerns about the mental health and wellbeing of a student, referring to the wellbeing team for additional support is essential. Identifying self-harm early can help young people to develop other coping strategies and help prevent self-harm from getting worse.
Educators play an important role in noticing and identifying where a young person is suspected to be engaging in self-harm and then taking appropriate action to support the young person.
'Notice' is the first step in the NIP it in the bud! (Notice, Inquire, Plan) early intervention approach to recognising and responding to early warning signs of depression, anxiety and emotional distress communicated through self-harm ().
Social contagion may occur when other children and young people are aware of, and are influenced by, their peer’s self-harming behaviour, either through directly witnessing the behaviour or seeing photos or wounds after the event. This contagion may involve some encouragement among peers to join in the behaviour to increase their sense of belonging to a group or perhaps to demonstrate empathy for a distressed friend.
Research indicates that vulnerable young people (those already experiencing mental health difficulties) are at increased risk of perceiving the self-injurious behaviour as an effective coping strategy, particularly as adolescents identify strongly with their peers during this period of development and growth (Nock, cited in Jarvi et al. 2013).
It is recommended that the student is encouraged to hygienically dress and cover self-harm wounds, by using bandages and wearing long-sleeved clothing. This will protect their privacy and reduce the risk of self-harm being employed as a coping strategy.
Self-harm and suicide
Self-harm and suicide are sometimes directly linked, such as in the case of a suicide attempt. However, most people engage in self-harm without intending to end their life.
Determining intent requires a comprehensive risk assessment conducted by an appropriately trained staff member or professional (for example, mental health practitioner (MHP), staff trained in youth mental health, a Student Support Services (SSS) psychologist or social worker, a Doctors in Secondary Schools Program general practitioner (GP), a Secondary School Nurse, an external mental health professional, GP or hospital-based doctor or psychologist) to reveal what is underlying the self-harming behaviour and tasks required to ensure safety and restore wellbeing.
The importance of language
The language we use to talk about mental health, mental illness and suicide can contribute to stigma (Life in Mind – The 2018) and impact a person’s willingness to engage with services and seek support to manage and improve their mental health and wellbeing outcomes.
The National Communications Charter launched in 2018 by Life in Mind is a resource that promotes the safe and consistent use of language when talking about mental health, mental ill-health and suicide. It recognises that everyone has a role to play in tackling stigma and preventing harm.
The table below is a helpful resource for schools to promotes accurate and safe language about mental health.
National Communications Charter
Tool One: Language Guide – Suicide
Do say 'died by suicide', 'took their own life'.
Don't say 'successful suicide', 'unsuccessful suicide'.
Why? Because it suggests suicide is a desired outcome.
Do say 'died by suicide', 'took their own life'.
Don't say 'committed suicide', 'commit suicide'.
Why? Because it associates suicide with crime or sin.
Do say 'increasing rates', 'higher rates'.
Don't say 'suicide epidemic'.
Why? Because it sensationalises suicide.
Do say 'suicide attempt', 'non-fatal attempt'.
Don't say 'failed suicide', 'suicide bid'.
Why? Because it can glamourise suicide attempts.
Refrain from using the term 'suicide' out of context.
Don't say 'political suicide', 'suicide mission'.
Why? Because it is an inaccurate use of the term 'suicide'.
The Tool One Language Guide is presented in a table with 3 columns. The column headings are 'Do say', 'Don't say' and Why?' with their associated text listed beneath the headings.
Reviewed 10 January 2023