Self-harm is poorly understood in society even
among those who in their working lives as school teachers, pastors,
social workers, housing officers, police, prison officers and even
nurses and doctors encounter people who harm themselves. People who
harm themselves are subject to stigma and hostility. In contrast to
the trends in completed suicide, the incidence of selfharm has
continued to rise in the UK over the past 20 years and, for young
people at least, is said to be among the highest in Europe. This
high level of self-harm among different age and social groups is a
worrying feature of our society.
The focus of this report is to enquire into
and report on why people harm and kill themselves and to consider
the role (including the limits of the role) that psychiatrists and
other mental healthcare professionals play in their care and
treatment. The experiences and views of people who harm themselves
as well as those of their carers, health professionals and
third-sector workers are central to this enquiry. As there is much
policy and guidance on self-harm and suicide prevention, the report
does not attempt to retrace this same ground but rather examines
the evidence of practice on the ground, including the
implementation of the National Institute for
Health and Clinical Excellence (NICE) guidelines on self-harm
(National Collaborating Centre for Mental Health, 2004).
The report is divided into three parts. In
Part I, we give some background information on self-harm in the UK
and on understanding why people harm themselves. In Part II, we
examine some of the public health policy issues, and in Part III we
concentrate on the practice of healthcare professionals and others
who work with people who have harmed themselves and are at risk of
harming themselves, as evidenced particularly by a survey and
consultations with College Members and Faculties. The important
role of the third sector is also examined.