Self-harm and suicide in children and young people remain major public health priorities. Prevalence rates of self-harm in the UK have been estimated at 7-18%. Although self-harm is often categorised as non-suicidal self-injury, there are shared risk factors for both self-harm and suicide. Equally, self-harm has a strong association with suicidal thoughts and is a predictor of completed suicide. Suicide rates in children and young people are often not made available, and where national level data is issued, prevalence is usually underestimated. However recent World Health Organization data indicates that suicide is the second leading cause of death for 15-29 year olds.
Research has called for extensive investment in innovative school-based prevention of self-harm and suicide. Recent policy has promoted a similar focus, with both the Welsh Assembly Government’s 2015 policy 'Talk to Me 2: Suicide and Self Harm Prevention Strategy for Wales 2015-2020' and the Department of Health’s 2012 policy 'Preventing Suicide in England' identifying schools as priority places where preventative approaches should be focused, due to school staff members' routine encounters with at-risk young people.
Some progress has been made with regard to school-based suicide prevention intervention, with the multi-centre cluster randomised controlled trial of the Saving and Empowering Young Lives in Europe (SEYLE) programme (Wasserman et al., 2015).
However, to date there is no evidence-based approach for the assessment and treatment of self-harm in schools. A consultation conducted as part of the GW4 Initiator grant, combined with a recent meta-ethnography led by Dr Rhiannon Evans, has revealed that schools are engaged in a broad, often ad hoc range of non-evidence-based practices, and are keen to contribute to a programme of research orientated towards the development of effective self-harm prevention interventions.
The GW4 Children and Young People’s Self-harm and Suicide Research Collaboration aimed to build on these initial findings, to address the lack of an evidence-based approach for self-harm in schools. The six-month study was carried out by researchers in the GW4 partnership: the Universities of Bath, Bristol, Cardiff and Exeter. It was funded by the GW4 Building Communities Programme Accelerator Fund.
Three key research questions were addressed:
A survey consultation was conducted in secondary schools across South-West England and Cardiff to gather information on the schools' experience of students who self-harm, including their self-harm provisions and barriers to work around addressing self-harm. A total of 59 schools in England, and 94 in Wales, participated.
This was followed by eight focus groups run with school staff: four in England and four in Wales, to understand in more detail the activities schools had in place to prevent self-harm and the strategies used to intervene when self-harm was disclosed. The eight schools were sampled according to data provided by the electronic survey to ensure variation. This qualitative consultation involved in-depth group discussion with school staff to explore their experiences and needs in this area.
Schools were found to employ a variety of ad-hoc strategies to manage self-harm. 22% of schools provided mandatory staff training, 31% had voluntary training and 46% had no training on self-harm (or didn’t know).
Schools' initial response is reactionary to instances of self-harm disclosure: they apply first aid and manage escalation of the young person to accident and emergency, Child and Adolescent Mental Health Services (CAMHS) or other specialist services as appropriate. Sometimes schools feel able to manage young people “in house” if they have a counsellor on site. In almost all cases, schools inform parents of instances of self-harm.
The process that schools do use when a young person self-harms include informing the safeguarding lead, and keeping the management of the young person within a small team of key people (often the pastoral and support staff). Subject teachers are not often involved, although teachers who attended focus groups expressed a desire for more knowledge on the topic and the best way to manage or react to young people who self-harm.
Schools find that the self-harm that they consider as needing specialist intervention does not always meet the thresholds for access to CAMHS and other specialist services. They also have to manage the young person between referral and treatment (often several months) and feel under-equipped to do this.
Schools as a whole do very little work to prevent or raise awareness of self-harm. This is due to a lack of expertise and pervasive concern that by raising awareness they may cause young people to start self-harming.
Social media is perceived by schools to play a role in self-harm. Young people who self-harm are thought to use social media for negative purposes, and the management of this is something that schools have to deal with.
Read more about the research findings in the Research Project Summary (PDF).
Project outputs and impact
The research findings have been disseminated to schools through the termly Schools Health Research Network (SHRN) newsletter in Wales and a discrete newsletter tailored to participating schools in England. A webinar reporting the consultation and the strategic research plan for the GW4 community has also been produced.
As schools in Devon are not enrolled in a University-based network such as the SHRN, and do not have such routine exposure to dissemination activities, additional dissemination is being undertaken in this area to support knowledge translation. Two meetings have been arranged with school head-teachers or nominated school representatives to inform them of the outcomes of the consultation and involve them in the future research design.
A final report has been produced and is available on the University of Exeter website. In addition, a lay-term five page summary document has been produced, as well as a policy document with relevant information for schools, the Department of Health, Department of Education, CAMHS, GPs and commissioners.
Find out more in this news story on the self-harm in schools project.
Following completion of the final project report and submission of two articles to peer-reviewed journals, the research collaboration will consider further funding opportunities based on the outcome of the consultation. In response to consultation data indicating that schools are not currently sites where population-level self-harm prevention approaches can be acceptably delivered, the research collaboration will require some refocusing in terms of objectives and strategic planning for grant capture. Schools from the consultation will be engaged in the development of a future grant application.
Find out more
The project has also been featured as a case study on the GW4 website – read the article here.
- MBCT-YP: Mindfulness-Based Cognitive Therapy to prevent relapse in young people
Owens C, Sharkey S, Smithson J, Hewis E, Emmens T, Ford T, Jones R. Building an online community to promote communication and collaborative learning between health professionals and young people who self-harm: an exploratory study. Health Expectations 2015.
Newlove-Delgado T, Moore D, Ukoumunne OC, Stein K, Ford T. Mental health related contact with education professionals in the British Child and Adolescent Mental Health Survey 2004. Journal of Mental Health Training, Education and Practice 2015; 10 (3): 159 – 169
Owens C, Hansford L, Sharkey S, Ford T. Needs and fears of young people presenting at Accident & Emergency department following an act of self-harm: Secondary analysis of qualitative data. British Journal of Psychiatry 2015.