Written evidence submitted by the Centre for Suicide Research, University of Oxford (CYP0007)
I would like to comment on measures needed to tackle increasing rates of self-harm and suicide among people.
Preventive initiatives are clearly required. This has become all the more evident given recent marked increases in self-harm and suicide in young people and also the fact that increasing numbers of relatively young children are known to be self-harming. Prevention initiatives must inevitably partly focus on what can be done in schools to ensure that these are focused on the whole population of children and adolescents. School mental health programmes need to become standard throughout all schools in the UK. It would make sense to have these based on a standard common module, with perhaps adaptations appropriate for particular local circumstances and populations (e.g. areas of marked social deprivation, high density of ethnic minority groups etc.). There is reasonable evidence from studies internationally for the design of such initiatives (see, for example, the Seyle Report: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61213-7/fulltext). It is crucial, however that programmes focused on prevention of self-harm and suicide are incorporated in overall mental health programmes in schools.
Given the fact that self-harm is now occurring more and more in younger age groups it is clearly necessary to begin mental health programmes in schools at a relatively early age, say 8 or 9 years. These then need to be provided in modified form in later years. Also, given that the factors leading to self-harm and suicide in males and females may differ somewhat, programmes need to include elements relevant to each gender.
For children and adolescents who are beginning to face specific difficulties there should be ready access to supportive counselling in schools, with at least one member of staff trained and with sufficient time to provide such support.
Consideration should also be given to how parents can be supported to play their own role in prevention, including detection of indicators that problems may be developing. This will necessitate availability of support organisations for parents to provide advice on how they can help their children.
Where children and adolescents had begun self-harming and present to clinical services, especially general hospitals, there need to be particular standards of care established. While there are NICE guidelines on provision of care for people who are self-harming (and these are being updated in the near future), I believe that there is currently a need for development of specific guidance on provision of care for children and young people, especially as their needs may differ in some ways from those of adults. This should include guidance on the most appropriate content of psychosocial assessments to be conducted by clinicians. There should also be guidance on the most appropriate aftercare that might help prevent further self-harm and possibly suicides. Unfortunately, current evidence does not provide an indication of the most effective types of intervention in children and young people (as shown by our current Cochrane Review on this topic). However, there are commonsense elements that should be incorporated in basic interventions, with adaptation necessary to the needs of individuals. Involvement of parents and possibly other key individuals throughout the processes of assessment and aftercare should be prioritised.
Research that can contribute to understanding the needs of young people and the most effective policies and interventions that can help them should be a government priority.
Recent years have seen improvements in working relationships between CAMHS services and schools. This is clearly an area that would benefit from future development.
Many young people will rely on electronic media for getting information and help priority should therefore be given to funding an evaluation of such initiatives.
Professor Keith Hawton FMedSci CBE