Factors influencing help-seeking for self-harm in young people

What’s the issue?

The prevalence of self-harm in young people is higher compared to other age groups.¹

Young people could benefit from support and resources to manage their self-harming behaviours but are often reluctant to seek help.

The researchers of this study define self-harm as any non-fatal act of injuring oneself deliberately, irrespective of the degree of suicidal intent. Self-harm is often seen as a mechanism for coping with distress and can occur with or without suicidal intent.

Help or support can come from formal or informal sources, with young people often preferring to seek help from informal sources such as friends and family. Some reasons why young people sought informal supports was they were worried about confidentiality, judgement, low respect, and having low mental health literacy. Other factors included stigma and being fearful of being seen as attention seeking.

Help-seeking pathways, motivators and barriers for young people experiencing mental health concerns or suicidal ideation may be very different for young people who self-harm. Limited research exists to inform effective support pathways suitable for young people who engage in self-harm behaviours.

The authors aimed to gain a better understanding of what influences help-seeking for self-harm in young people, taking a systems thinking perspective. A systems approach considers how young people seek support more holistically, rather than just focussing on a single part.

What was done?

Researchers conducted a systematic review of the literature to determine the facilitators and barriers that influence help-seeking for young people who self-harm.

Researchers examined the literature for studies where the primary sample involved young people with a history of self-harm, and where the study was related to help-seeking from formal or informal sources. All studies examined were in English and full-text versions were accessible. The age definition for ‘young-people’ was variable to allow researchers to capture data from a range of studies.

A total of 33 articles were included in the review.

Facilitators and barriers to help-seeking for self-harm were mapped against six levels of a “help-seeking system” hierarchy:

1. Government: Federal and state government agencies or policymakers.
2. Regulatory bodies and associations: Organisations that facilitate the regulations of support practices and healthcare.
3. Local area government and organisation management: Service management and local organisations (e.g., schools, hospitals, institutions).
4. Service delivery and social environment: Health professionals and the social support networks of young people who self-harm.
5. Individuals and processes: Perceived barriers and facilitators within young people who self-harm.
6. Equipment, infrastructure, and surroundings: The built environment and accessibility of support.

Mapping barriers and facilitators to the levels of a “help-seeking system” hierarchy can help to identify key areas in the system where prevention approaches could better support young people who self-harm.

What was found?

Of the studies included in the review, most were conducted in the United Kingdom, followed by Australia and America. The age of young people ranged from 11 to 30 years old.

An equal number of studies were qualitative or quantitative, and a smaller amount were mixed method research studies.

The most commonly reported facilitators to help-seeking behaviours identified in the review were:

• Young people feeling they that won’t face judgement for self-harm, and their self-harm is accepted by others
• Other people communicating to young people about self-harm in an appropriate and effective manner
• Young people having high health literacy to communicate their concerns
• Being able to access online support services
• Feeling assured of trust, privacy, and confidentiality from others.
  

There were twice as many barriers to help-seeking than there were facilitators. The most commonly reported barriers for young people to seek help for self-harm included:

• Feeling ashamed or embarrassed of their self-harm
• Feeling they can manage their self-harm on their own, and that their self-harm isn’t serious
• Fear that their self-harm is a burden for others
• Fear they will be judged or face stigma for self-harm
• Fear that trust and privacy will be breached by supports.

Why are the findings important?

Help-seeking pathways, facilitators, and barriers for young people who self-harm may be different to the needs of young people experiencing mental health concerns or suicidal ideation, yet at present, the pathways to help and formal supports available are somewhat blended.

With the review identifying that the majority of barriers and facilitators to help-seeking were related to service delivery and the conduct of health professionals, it is important these are considered when designing and delivering services. This ensures when a young person does engage with formal supports, they are not faced with wait times, are treated with respect, and re-assured about consumer health professional trust and confidentiality.

As the evidence tells us that engaging in self-harm increases the risk of dying by suicide, it is critical the support received by a young person, creates a positive experience that may encourages future help-seeking behaviours. Addressing societal and service level beliefs and communications to be sensitive and strength-based may support the experience of young people.

The research highlights a gap in literature around the impacts of organisational structures and government policy on young people who self-harm. Further research in this area is beneficial to inform approaches to support young people who engage in self-harm behaviours.