Self-harm and suicidality in young people

Helping with self-harm and suicidality in therapy with young people is a common and challenging task that evokes significant anxiety and concern for therapists and services. Striking the delicate balance between genuinely connecting and validating the concerns of young individuals while prioritising their safety proves to be exceptionally difficult.

What is self-harm and suicidality in young people?

One of the media misconceptions surrounding self-harm and suicidal ideation among young people is the belief that it is an attention-seeking ploy or a cry for help, and that youth who express thoughts of self-harm or suicide are exaggerating for dramatic effect. For clinicians it is the opposite, we need to see this as distress and make opportunities to discuss suicidal thoughts and self-harm. Responding to youth distress in a thoughtful manner is essential. Distress statements tell us the person is hurting, and we should attend to that, and then assess the risk. We never take a chance that it is ‘just talk’.

Self-harm and suicidality are related concepts but have distinct differences. Here’s a short explanation of each term:

• Self-harm: Self-harm, also known as self-injury or self-mutilation, refers to deliberate acts of physically harming oneself without the intent to cause death. It is often a way for individuals to cope with or express emotional pain, distress, or overwhelming emotions. Common forms of self-harm include cutting, burning, scratching, hitting, biting oneself, or substance abuse.
• Suicidality: Suicidality refers to thoughts, intentions, plans, or actions related to taking one’s own life. It encompasses a range of suicidal behaviours, from fleeting thoughts of suicide to active planning and attempts. Suicidal ideation involves thinking about or fantasising about suicide, while suicide attempts involve engaging in behaviour intended to cause self-harm with the intention of ending one’s life.

While suicidality and self-harm are distinct, there can be an overlap between the two. Some individuals who engage in self-harm may also experience suicidal thoughts or have a history of suicide attempts. However, it’s important to note that not all people who self-harm have suicidal intentions or vice versa. See also our general Self-harm, suicidality and ACT page.

How prevalent are these issues in young people?

Over the past few years, there has been a noticeable rise in the prevalence of mental distress amongst children and young people. In 2020, one in six (16.0%) children aged 5 to 16 years were identified as having a probable mental health concern, increasing from one in nine (10.8%) in 2017.¹ It is important to note that this increase in mental health concerns was observed across both genders, affecting both boys and girls alike.

In 2021, suicide was the second leading cause of death in the United States for people ages 10-14 and 20-34².

How ACT can be used to support children and young people in instances of self-harm or suicidality

Acceptance and commitment therapy (ACT), and more specifically the DNA-V youth framework, may be beneficial for young people who engage in self-harm or have suicidal thoughts. ACT is a form of psychotherapy that focuses on accepting difficult thoughts and feelings while committing to actions that align with one’s values. Here’s how it can help:

• Developing psychological flexibility: The ACT/DNA-V approach of being present in the moment, accepting unwanted thoughts and feelings, and doing what they care about helps young people develop resilience to cope with distressing emotions.
• Emotion coping skills: ACT/DNA-V incorporates emotion coping skills as well as mindfulness techniques to help individuals observe their distress, and practice actions that will help them self-care when they are triggered.
• Cognitive flexibility: ACT/DNA-V for youth uses practical strategies to help young people understand the function of distressing thoughts and gives them new ways to use their cognitions to help them live. It allows them to reduce the intensity of thoughts and see them as guides to action, rather than rules that must be obeyed.
• Values and vitality: By supporting a young person to know what is truly important to them, young people can build a sense of purpose and meaning in their lives. By helping a person connect to vital moments, which happen everyday, they can build activities into each day that are meaningful.
• Discovering action: By encouraging young people to see their habits, see their comfort zone, and use curiosity and willingness, we can help them broaden their repertoire, so they have more options and actions to take. This may serve as protective factors against self-harm and suicidal ideation.
• Self-identity: ACT/DNA-V helps young people create a broader sense of who they are, and see themselves as changing individuals, who can learn to move beyond their history, practice self-compassion, and see that they are able to change
• Social-connection: DNA-V is explicitly focused on how our relationships can be a source of distress, and how they are essential as a source of safety and hope. Social connection strategies can help a young person take bigger perspectives and take actions that help them seek out others.

It’s important to remember that ACT/DNA-V should be delivered by trained mental health professionals who specialise in working with young people with self-harm and suicidal ideation. They can tailor the therapy to the unique needs of young individuals and provide appropriate support throughout the treatment process.

For individuals:

If you or someone you know is struggling with self-harm or suicidal thoughts, it’s crucial to seek professional help as soon as possible. Visit our psychological therapy page to reach out and find a suitable specialist.

For professionals:

We offer a range of training courses covering ACT therapy, with sessions regularly added specifically focusing on how to support young people. To learn more about DNA-V and ACT also take a look at our knowledge and resources.

References

¹Mental Health of Children and Young People in England, 2020: Wave 1 follow up to the 2017 survey https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2020-wave-1-follow-up

²https://www.cdc.gov/suicide/facts/index.html