Sixty Second Interview

Sixty Second Interview with Andrew McCulloch

A two-year national inquiry on self-harm amongst young people in the UK reported its findings last week. The inquiry, run by the Mental Health Foundation and the Camelot Foundation, found that self-harm was widespread and that many professionals were not confident about dealing with the issue. Amy Taylor talks to Andrew McCulloch, chief executive of the Foundation about the research.

The inquiry revealed that one in 15 young people in the UK have self harmed, the highest rate in Europe. How can this rate be brought down?

It is difficult to control self-harm rates by public policy or practice interventions because the causes are many. Issues which impact on self-harm include young people’s own coping skills, levels of mental distress, and environmental factors such as exam stress, early experience with sex, drugs or alcohol and family breakdown, for example. The most promising way to deal with self-harm rates is probably mentally health promotion strategies generally and mentally health policy, including teaching children coping strategies, reducing pressures in the educational system and encouraging “whole schools” approaches to health and mental health. In addition, we have called for a specific awareness campaign on self-harm in order to raise understanding and start to change negative response to disclosure by young people.

Why do you think the UK has a higher level than other European countries?

Many of the risk factors for self-harm are more marked in the UK than some other countries, including substance misuse, educational stresses and family and community stability. However, further research is needed on whether UK rates are definitely higher, and crucially, why.

The inquiry found that professionals working with children are taking the wrong tack in response to disclosures of self-harm by focusing on children’s behaviour rather than the underlying causes. How can this be changed?

As I have said we are calling for a national awareness campaign so that professionals understand basic information about self-harm and the appropriate response. This also needs to be built into the basic education and continuing professional development of all relevant professionals.

I have to say however, that some of the stories we have heard from young people simply indicate unprofessional practice which must be dealt with vigorously through professional supervision and regulatory agencies. Some response to young people have been so inappropriate that mere ignorance can be no excuse. Relevant professionals should already know that minimum standards of listening skills and a non-judgemental approach are expected.

Widespread misunderstandings about self harm amongst professionals and relatives are preventing young people who self-harm from seeking and getting support it was found. What needs to happen to improve on this?

As well as improving professional education we need to define pathways to appropriate support for young people. This needs to include pathways from generic settings to specialist mental health advice as well as websites, telephone helplines etc. Although much more research is required on interventions, young people giving evidence to the Inquiry supported talking treatments as the first line response. CBT is promising for the generality of cases and DBT for cases where extreme personality traits and other long standing problems are present; and some other forms of focused counselling will also help some young people. Research needs to go hand in hand with opening up pathways to this kind of support. At a less specialist level, young people particularly value peer support, and this can be provided as part of a whole schools approach.

Do you think information should be provided in schools?

Yes, of course. Information provision needs to be part of the awareness raising campaign. It needs to be tailored to the audience (young people, parents, generic professions, mental health workers), timely and relevant. It must be delivered through a number of media.

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