Research

The self-harm/suicide field: Collective action, personal hope

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By Katherine Brown.

World Suicide Prevention Day (WSPD) 2021 is upon us. Although this day is already one which unites people across the globe in reflection, this year’s theme – ‘Creating hope through action’ – has especially got me thinking. WSPD was established eighteen years ago. I’ve been in the field of self-harm/suicide for a much shorter time, but it definitely feels like progress has been made. Why? In what ways has the field developed over recent years? This blog is not meant in any way meant to be a formal review; it is just a brief and personal reflection on why work in the field gives me hope for the future.

The importance of language in relation to self-harm and suicide appears more fully acknowledged. Terms which were once common, such as ‘committed suicide’ and ‘deliberate self-harm’, are now understood to have harmful and stigmatising connotations – and our collective vocabulary seems to be moving away from these. Although these terms are still used by some (including in papers published this year and clinical notes), the overall progression towards more appropriate terminology is positive. The importance of language within a digital context is starting to be explored in a variety of ways, such as for: detecting early signs of self-harm on social media [1]; identifying self-harm in electronic care records [2]; and predicting whether those posting on online support communities will be help or harmed by subsequent interactions [3]. This is necessary given the (cliché of an) increasingly-digital world.

Suicide reporting guidelines are gaining wider attention across the globe. Studies into reporting guideline adherence have recently been conducted in non-western countries such as Korea [4], Iran [5] and India [6]. This adds a wider perspective to an evidence base that could otherwise become western-biased, and in some parts of the world adherence to reporting guidelines seems to be increasing. For example, Wu et al. (2021) analysed suicide reports from Taiwan between 2010 and 2018 and found statistically significant improvements in adherence to 11 of 12 WHO guidelines items [7]. Nonetheless, improvements remain necessary as a substantial proportion of media reporting still does not adhere to guidelines. For instance, both Chun et al. (2018) and Chandra et al. (2014) found less than 3% of reports included signposting to suicide prevention hotlines. Until adherence to reporting guidelines increases, it is necessary to continue holding media organisations accountable and demanding greater responsibility from the industry.

Harm minimisation approaches are also receiving increased attention, in both research and clinical practice. The increased research is warranted, as harm minimisation has previously been under-studied and remains controversial. Some studies have similar findings, offering the first signs of a potentially reliable evidence base. For instance, both Davies et al. (2020) [8] and Wadman et al. (2019) [9] found that some young people reported any benefits of harm minimisation techniques as being short-lived and situation-specific. However, much work remains to be done. The evidence-base around about harm minimisation is still relatively small, philosophical and often focused on staff experiences. The increasing clinical use of harm minimisation approaches is therefore contentious. NICE guidelines currently advocate “strategies aimed at harm reduction” if “stopping self-harm is unrealistic in the short-term”, but give little specific advice on how to do this other than advising that there is no safe way to self-poison [10].

Overall, in my opinion, there has been clear progress in the fields of self-harm and suicide. More appropriate terminology is being used, and our understanding of language’s importance is increasing; research into topics such as media reporting guidelines and harm minimisation approaches is growing; and more media coverage of suicide is adhering to guidelines. This ultimately all helps to save lives, and is a testament to the hard work done by a range of passionate people. By continuing this work, and listening directly to those with lived experience, we can keep building a world that is compassionate and supportive for those who self-harm.

References

  1. Naderi, N., Gobeil, J., Teodoro, D., Pasche, E. & Ruch, P., (2019), A Baseline Approach for Early Detection of Signs of Anorexia and Self-harm in Reddit Posts, CLEF. Retrieved from: http://ceur-ws.org/Vol-2380/paper_111.pdf
  2. Ayre, K., Bittar, A., Dutta, R., Verma, S. & Kam, J., (2021). Identifying perinatal self-harm in electronic healthcare records using natural language processing, BJPsych Open, 7(S1), S4-S5, DOI:10.1192/bjo.2021.74. Retrieved from: https://www.cambridge.org/core/journals/bjpsych-open/article/identifying-perinatal-selfharm-in-electronic-healthcare-records-using-natural-language-processing/5B317DB24596B7D1158910A4D5FDEAEE
  3. Soldaini, L., Walsh, T., Cohan, A., Han, J. & Goharian, N., (2018), Helping or Hurting? Predicting Changes in Users’ Risk of Self-Harm Through Online Community Interactions, arXiv preprint arXiv:1804.07253. Retrieved from: https://arxiv.org/abs/1804.07253
  4. Chun, J., Kim, J. & Lee, S., (2018), Fidelity assessment of the suicide reporting guidelines in Korean newspapers, BMC Public Health, 18(1115), DOI: 10.1186/s12889-018-6014-4. Retrieved from: https://link.springer.com/article/10.1186/s12889-018-6014-4
  5. Nabardi, M., Vazirinejad, R., Ahmadinia, H., Rahmani, A. & Rezaeian, M., (2021), A Survey on the Frequency of Suicide News Published in Newspapers and National News Agencies in Iran in the Year of 2018 and Its Concordance with the Suicide News Publishing Guideline in the Media, Journal of Suicide Prevention, 3(1) pp. 3-16. Retrieved from: http://isssp.ir/browse.php?a_code=A-10-1-13&slc_lang=en&sid=1
  6. Chandra, P., Doraiswamy, P., Padmanabh, A. & Philip, M., (2014). Do newspaper reports of suicides comply with standard suicide reporting guidelines? A study from Bangalore India, International Journal of Social Psychiatry, 60(7), pp. 687–694, DOI: 10.1177/0020764013513438. Retrieved from: https://journals.sagepub.com/doi/abs/10.1177/0020764013513438
  7. Wu, C-Y., Lee, M-B., Liao, S-C., Chan, C-T. & Chen, C-Y., (2021), Adherence to World Health Organization guideline on suicide reporting by media in Taiwan: A surveillance study from 2010 to 2018, Journal of the Formosan Medical Association, 120(1), pp. 609-620, DOI: 10.1016/j.jfma.2020.07.012, Retrieved from: https://www.sciencedirect.com/science/article/pii/S0929664620303235
  8. Davies, J., Pitman, A., Bamber, V., Billings, J. & Rowe, S., (2020), Young Peoples’ Perspectives on the Role of Harm Reduction Techniques in the Management of Their Self-Harm: A Qualitative Study, Archives of Suicide Research, DOI: 10.1080/13811118.2020.1823916. Retrieved from: https://www.tandfonline.com/doi/abs/10.1080/13811118.2020.1823916
  9. Wadman, R., Nielsen, E., O’Raw, L., Brown, K., Williams, A., Sayal, K. & Townsend, E., (2020) “These Things Don’t Work.” Young People’s Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach, Archives of Suicide Research, 24(3), pp. 384-401, DOI: 10.1080/13811118.2019.1624669. Retrieved from: https://www.tandfonline.com/doi/full/10.1080/13811118.2019.1624669
  10. National Institute for Health and Care Excellence, (2011), Self-harm in over 8s: long-term management [CG133], https://www.nice.org.uk/guidance/cg133

Katherine Brown (@Kat_E_Brown) is an assistant psychologist who has worked in the field of self-harm in low security inpatient and digital outpatient settings, as well as with the Self-Harm Research Group (SHRG) at the University of Nottingham, England. Email:

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