Deliberate self-harm (DSH) patients are a mixed group, made up of those who have 'failed' to complete suicide, those who are uncertain about whether they want to die, and those whose intention is not to die.
There are extremely high rates of DSH, with up to 1 in 100 young women being admitted to hospital at least once with DSH. It is the commonest single cause of acute medical admission to hospital for women, and second only to heart disease in men.
Around 90 per cent of DSH acts are drug overdoses. Of non-overdose DSH, cutting oneself is the most common.
Self-cutting
This can be of three forms:
deep and dangerous wound with high suicidal intent.
self-mutilation, ie deliberately causing oneself damage, perhaps due to a psychiatric illness.
superficial wounds. This is the largest group. Most commonly, young women with low self-esteem, poor control of their impulses, unstable moods, difficulty with relationships, and a tendency to misuse alcohol and drugs are affected.
DSH is more common in:
The young than the old.
Divorced, and single people.
The unemployed.
People who have a psychiatric illness account for 15-20 per cent of DSH cases.
The majority of those who self-harm have experienced major life events, problems with relationships, broken homes, criminal records, child abuse, social isolation, anxiety over job or housing, etc.
Most commonly, DSH is unplanned following a crisis in the person's life. Serious suicidal intent is present in up to 15 per cent of those who self-harm.
Reasons given for acts of self-harm include:
'cry for help'
'escape from intolerable situation'
'relief from state of mind'
'attempt to influence others'
'testing the benevolence of fate'.
There is a considerable overlap between those people who deliberately harm themselves and those who kill themselves. In addition, there are significant rates of psychiatric illness in DSH patients. The seriousness of DSH should never be underestimated. One to two per cent of people who deliberately self-harm kill themselves within one to two years.
Things that raise concern in those that deliberately self-harm:
the person expressing a clear intention to die, and remorse for having failed.
planning the episode in advance.
having taken steps to avoid being discovered.
not attempting to obtain help afterwards.
using violent methods.
undertaking 'final acts' such as paying off bills, or writing a will.
What to do if you feel suicidal
Speak to those around you about the reasons for feeling like this.
Go to see your family doctor (GP).
There may be a 'drop-in' service run by local psychiatric and/or social services with people who can call in and see you at home.
Contact NHS Direct by telephone: 0845 4647.
Contact The Samaritans. (They are available 24 hours a day on 0345 909090, or 08457 909192 for people with hearing and/or speech difficulties. You can email them at [email protected] and they aim to reply to all emails within 24 hours).
What to do if someone you know talks of a wish to die (or you suspect they feel that way)
Take the risk seriously (see above).
Speak to them about it.
Involve family and friends.
Contact any of the services listed above.
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