Blog entry by Rcgp Learning
As the campaign to overcome the stigma attached to mental health continues, self-harm is one of many symptoms of mental health issues that may present in primary care, particularly in children and young people. According to the Royal College of Psychiatrists, around 1 in 10 young people at any age will self-harm at some point (1). Incidence may be even higher than this, as many patients don’t seek help.
When they do seek help, GPs are likely to handle the initial conversation with the young person, taking a history, finding out their methods and how often they self-harm, whilst trying to establish possible triggers and underlying causes. This may seem like an impossible feat during a 10-minute appointment, but up to date numbers on self-harm show the importance of effectively dealing with self-harm at the first presentation.
According to a recent study published in the BMJ, there was a 68% increase between 2011-2014 in the number of girls aged 13-16 who reported self-harm to their GP (2) with a three times higher incidence rate than in boys. As shown before, those who self-harmed were at greater risk of suicide than those who didn’t. Out of the 16,912 records of self-harm that were examined in the study, the main methods were drug overdoses (84.1%) and self-cutting episodes (12.3%) (2). With these statistics in the media, they may raise awareness and subsequently encourage patients and/or their parents to visit their GPs. Self-harm has recently featured in popular TV programmes aimed at a younger audience: the teen soap opera Hollyoaks recently focussed on a group of female friends who turn to self-harm to cope with their personal struggles and looked at the impact this had on their lives. The subject was also touched upon in the controversial 2017 Netflix series 13 Reasons Why, which was criticised earlier this year for potentially glamorising suicide. Whilst the series primarily follows a suicidal teenager, it also makes reference to self-harm.
With a new spotlight on self-harm, it’s important for GPs to be aware of how to best manage these patients safely in primary care. The NICE clinical guideline on ‘Self-harm in over 8s: short term management and prevention of recurrence’ provides recommendations for all healthcare professionals and gives an overview of the next steps after a patient is referred.
For more information about how mental health issues in children and young people can be managed in general practice, we created the ‘Child and adolescent mental health’ course. The course is FREE to access for all healthcare professionals and will give you 1 hour towards your CPD. If you’re an RCGP member, you can also access the following resource:
(1) Royal College of Psychiatrists, 2016. ‘Self harm’ [Online] Available from: http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/self-harm.aspx [Accessed 25 October 2017]
BMJ. 2017. ‘Incidence, clinical management, and mortality risk following self-harm among children and adolescents: cohort study in primary care’ [online] Available at: http://www.bmj.com/content/359/bmj.j4351 [Accessed 25 October 2017]