In suicide prevention work, one of the first things mental health professionals are trained to ask is: “Are you in danger of hurting yourself or others?” If a youth responds with a “yes,” it is common practice to automatically send them to an inpatient or outpatient mental health facility. This is standard practice due to legislation in the U.S. regarding mandated reporting.
Unfortunately, this response can have unintended negative consequences on young people. This is because equating self-harm with the intent to end one's life is misunderstood. Rather, it is important to understand the intentions behind self-injurious behaviors before jumping to conclusions about intent and risk.
As a facilitator of our LGBTQ+ Youth Advisory Council, students have asked me to speak on behalf of their mental health struggles within the context of self-harm. This article aims to give a voice to youth experiences after being placed in various outpatient/inpatient programs in the northwest suburbs. Hearing their stories, my hope is for our society to be able to provide alternative approaches to self-harm intervention before resorting to hospitalization.
According to the most recent 2020 IYS Cook County data, approximately 13 percent of 10th and 12th graders have considered suicide in the past 12-months. Considering this, some students in our service areas may struggle with self-harm, especially LGBTQ+ youth. Research from the Centre for Suicide Prevention demonstrates that individuals who engage in non-suicidal self-injury (NSSI) often do so as a coping mechanism in order to avoid suicidal ideation, or in an effort to show others that they are in crisis (Behavior Health News). Furthermore, less than 50% of students reporting past NSSI reported accompanying suicidal ideation. Thus, NSSI can be seen as a coping strategy and a protective factor against suicide (Discovery Mood). Due to stigma and misinformation, social service providers may have missed opportunities to meet students where they are at when experiencing a mental health crisis.
While hospitalization can help certain individuals recover, many students have expressed that the environment quickly becomes a competitive and toxic space for them. This competition looks like “oppression Olympics” - comparing personal ways of harming, trauma, stories, and even scars. From my experience, I have seen how this can increase self-harm, self-silencing, and make students live in fear of being dismissed.
In addition, hospitalization can last anywhere from weeks to months, which can set youth back academically. The number of rules and expectations in these programs can keep more at-risk youth in the system longer than they need to be. In my experience, students have expressed that they feel like they are being punished.
In order to prioritize student mental health and wellness as well as reduce the stigma around self-harm, this system of immediate hospitalization needs to change. This begins by differentiating suicidal self-harm and non-suicidal self-harm, implementing harm reduction intervention strategies, looking into the context of youth’s lives, and developing alternative and effective coping strategies.
As community agencies, we can implement these strategies in our own work with youth to provide them with adequate therapy, resources, and school support services so that youth are truly empowered to heal and recover. With the proper training and education on NSSI and suicidal ideation, community agencies can have the tools to aid in our students' recovery together.
If you cite any sources, please use APA citations here using a guide.
A. (2019, September 17). The Difference Between Self-Harm and Suicide - Discovery Mood. Discovery Mood & Anxiety Program. https://discoverymood.com/blog/difference-self-harm-attempted-suicide/
Centre for Suicide Prevention. (n.d.). Self-harm and Suicide. Retrieved August 3, 2021, from https://www.suicideinfo.ca/resource/self-harm-and-suicide/
Curtis, S., Thorn, P., McRoberts, A., Hetrick, S., Rice, S., & Robinson, J. (2018, May 10). Caring for young people who self-harm: A review of perspectives from families and young people. International journal of environmental research and public health. Retrieved October 6, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5981989/.
Grinley, T. G. (2020, October 1). Suicide and Non-Suicidal Self Injury in LGBT Youth. Behavior Health News. https://behavioralhealthnews.org/suicide-and-non-suicidal-self-injury-in-lgbtq-youth/
Oladunjoye, A., Oladunjoye, O. O., Ayeni, O., Olubiyi, O., Fuchs, A., Gurski, J., Yee, M., & Espiridion, E. (2020, October 6). Seasonal trends in hospitalization of attempted suicide and self-inflicted injury in united states adults. Cureus. Retrieved September 30, 2021, from https://www.cureus.com/articles/42105-seasonal-trends-in-hospitalization-of-attempted-suicide-and-self-inflicted-injury-in-united-states-adults
Williams, D., & Gilligan, R. (2011). Irish Journal of Applied Social Studies - Arrow@TU Dublin. Irish Journal of Applied Social Studies . Retrieved October 6, 2021, from https://arrow.tudublin.ie/cgi/viewcontent.cgi?article=1157&context=ijass.