Needs assessment of young people who selfharm: Insights from two Scottish studies

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• Needs assessment of young people who self-harm
  Insights from two Scottish studies
• Robert Young
• Medical Research Council, Social Public Health
  Sciences Unit, University of Glasgow
• Lanarkshire self-harm health needs assessment
  stakeholder consultation meeting Hamilton, 16
  July 2008

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Overview Outline

• BASICS/MEASURMENT
• Measuring need in self-harm Problems
  Definitions. Why focus on the needs of young
  people who self-harm?
• RISK/NEEDS
• Who is at greatest need? High risk-groups, high
  risk schools, different motives so different need
  for different people
• AWARENESS/SERVICE-USE
• Who is aware of the needs of YP who self-harm?
  Service use and who do YP confide in. What are
  professionals who deal with young peoples needs
  experience?
• INTERVENTION/MEETING NEED
• Who can and how can we address YP needs
  Interventions reasons for cessation

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MEASURING NEED IN SELF-HARMPROBLEMS
DEFINITIONS.
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Various terms used in self-harm research
Non-fatal self-harm
Self-destructive behaviour
Self-injury
Self-mutilation
Attempted suicide
Deliberate self-harm
Suicidal gesture
self-harm
Cutter
Harm to self
Suicidal behaviour
Non-fatal suicide
Para suicide
Repeated self-harm
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Prevalence suicidal behaviours cognitions
relationship with self-harm
7-14 lifetime self-harm 1-2 currently
self-harming 3/100 Complete suicide in next
15-years
lt 4/10,000 Completed suicide
3-6 Attempted suicide
20 Suicidal thoughts
20-30 Depressed mood-symptoms
70 not at risk
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Scottish Need Assessment Study (SNAP)Qualitative
study of professionals experience of working
with YP.N 1049, (25 experienced YP who
self-armed)
11-16 study region Quantitative study of YP,
age-19 N1256, 89 self-harm
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Prevalence suicidal-risk within age-15 year olds
in West of Scotland in 1999
Sample 1727 15-year old school children from
Central Clydeside Conurbation
6.1 attempted suicide
9.1 Attempted or seriously thought about suicide
41.5 Morbid thoughts about death and dying
49 No history of suicide-risk
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Reason for self-harm (ordered by frequency)16
study (1256 base, 89 cases self-harm)
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Crudely two self-harmers clusters

• TRANSIENT
• One-off event
• Reaction to temporary stressful circumstances
• Few long-term problems
• Few psychiatric problems
• External trigger

• CHRONIC/REPEATING
• Repeated self-harm
• Internalising behaviours
• Female
• Teenagers
• Require professional help
• Sexual abuse
• Depression
• Family difficulties
• Externalising behaviour
• Internal trigger for self-harm

SAME LEVEL OF SUICIDAL IDEATIONBUT VERY
DIFFERENT NEEDS
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INEQUALITIES IN RISK NEEDS
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UK Age distribution of lifetime rates of
self-harm attempted suicide(UK National
statistics, 2002 n8580)
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SNAP (2003), Young person with mental-health
need last most worrying case involving
self-harm.(1049 professionals working with young
people)
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SNAP (2003), Young person with mental-health
need last most worrying case involving
self-harm.(1049 professionals working with young
people)
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RISK/NEEDSHigh-risk groups risk factors
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Who is at greatest needRisk factors high-risk
groups

• LGBT
• Offenders (Prison delinquency)
• Goths alternative youth
• Ethnic minorities

• Female
• Depression
• Personality disorder
• Alcohol drug problems
• Stress Exam/academic pressure
• Major Life Events (bereavement, divorce/family
  break-up)
• Minor life events (bullying, relationship
  problems)
• Age
• Impulsivity
• Media/triggers?
• Friends/family who self-harm (risk/support
  network)?
• Isolation
• Deprivation (life-events)
• Poor coping skills

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Life-events and self-harm(UK National
statistics, 2002 n8580)
Life-events specific to young people
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Age (Cumulative) at which young people started
to self-harm (89 young people)
So 13-18 seems to be the age of most need
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Lifetime self-harm as a function of gender,
social class and labour market position
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Current self-harm as a function of gender, social
class and labour market position
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Percentage suicide attempt or ideation for 43
WoS secondary schools (Age 15)
High-risk/need schools?
Average Suicide-risk
low-risk/need schools?
Least
Most
School level Suicide-risk
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School-pupil perceptions
Suicide-risk by School predictors
School-level effect




statistically significant predictor
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Reason (kill self) for self-harm as a function
of gender, social class and labour market
position
Hi-rate of the Unemployed manual background
self-harm to kill self
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Reason (relieve anxiety) for self-harm as
afunction of gender, social class and labour
market position
Hi-rates for females, students middle class
background use self-harm to manage stress
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AWARENESS/SERVICE-USE
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Young person currently self-harming (who knows)
GP informal networks aware of need
Specialist formal networks unaware of need
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Rates of psychiatric disorder for self-harmers
vs. non-self-harmers
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Use of services since age-11, except GP (16,
n1256, of which 89 self-harm)
Heavy use of specialist services
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Self-harm case, Last most worrying case Need
professional help (SNAP)
Residential workers Teachers want professional
help
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Self-harm case, Most worrying case Good or bad
outcome (SNAP, n 209)
Residential workers Teachers want see poor
outcome
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Self-harm case, Most worrying caseSatisfied
with service (SNAP,n209)
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Focus of needs assessment filling the gaps
Tentative results
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INTERVENTION/MEETING NEEDEffective
interventions reasons for cessation
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NICE conclusions regarding Psychosocial
interventions for Self-harm 2004

• The evidence reviewed here suggests that there
  are surprisingly few specific interventions for
  people who have self-harmed that have any
  positive effect. The GDG came to the conclusion
  that, at the present time, there was insufficient
  evidence to support any recommendation for
  interventions specifically designed for people
  who self-harm.
• Self-harm The short-term physical and
  psychological management and secondary prevention
  of self-harm in primary and secondary care, p177

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Self-harm at 3, 6 12-monthfollow-up (63 cases,
pilot study)
20 typically self-harm repeat rate at
1-year (n1982) Bennewith, et al, 2002
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Reason for Stopping self-harm (ordered by
frequency)
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Thanks to my colleagues and co-authors

• Patrick West, Medical Research Council, Social
  Public Health Science Unit
• Helen Sweeting, Medical Research Council, Social
  Public Health Science Unit
• Michael van Beinum, Medical Research Council,
  Social Public Health Science Unit
• Eileen McCafferty, Glasgow Nurse-led Self-harm
  Service, NHS Glasgow
• Judy Furnivall, Institute for Residential Child
  Care, University of Strathclyde
• Philip Wilson, Dept of general practice,
  University of Glasgow