Content

Intentional self-harm

Sometimes it can feel like life is too hard and difficulties can seem overpowering. It’s important to sort out the underlying problem. If you are hurting yourself then you need to let someone know so they can support you to cope.

If you, or someone you care about is in crisis and you think immediate action is needed, call emergency services (triple zero – 000), contact your doctor or mental health crisis service, or go to your local hospital emergency department.

To speak to someone immediately contact:

Lifeline WA 13 11 14 or www.lifelinewa.org.au/
beyondblue 1300224636 or www.beyondblue.org.au
Suicide Call Back Service 1300659467

Adapted from http://suicideline.org.au/at-risk/how-to-talk-about-suicide and https://www.youthbeyondblue.com/understand-what’s-going-on/self-harm-and-self-injury

Definition of intentional self-harm

Intentional self-harm means any behaviour which involves the deliberate causing of pain or injury to oneself, usually as an extreme way of trying to cope with distressing or painful feelings.1

Impact of Intentional self-harm in Western Australia

Who does it impact?

In Western Australia between 2011 and 2015, there were 1,696 deaths due to intentional self-harm.2

In Western Australia between 2011 and 2015 there were:2

  • 21,609 hospitalisations due to intentional self-harm.
  • 64.4% of hospitalisations for intentional self-harm were females.
  • people aged 25 – 44 had the highest incidence of intentional self-harm.

In Western Australia Aboriginal peoples make up 3.1% of the population, however between 2011 and 2015, 11.17% of intentional self-harm hospitalisations were Aboriginal peoples.2,3

Where does it occur?

In Western Australia between 2011 and 2015, the three regions with the greatest difference in hospitalisation rate for intentional self-harm compared to the WA State hospitalisation rate, were the Kimberley (146 higher%), Great Southern (31% higher) and Wheatbelt (25% higher).2

Impact on health system

In Western Australia in 2015, there were 3,666 hospitalisations for intentional self-harm, consuming an estimated 18,979 bed days at an approximate cost of $28,577,079.2

Determinants of intentional self-harm (Risk / Protective Factors)

Social Determinants

Socioeconomic status
Place of residence has been linked to intentional self-harm, with evidence indicating that individuals who live in the most disadvantaged areas of Western Australia are more likely to be hospitalised from intentional self-harm.1 Also when compared to men living in the least disadvantaged areas, men living in the most disadvantaged areas are twice as likely to die from intentional self-harm.4

Good mental health
Increased self-esteem and positive mental health has been associated with protective factors such as positive personal relationships, personal belief system and coping strategies.1

The concept of ‘social and emotional well-being’ is seen as more appropriate in Aboriginal communities than ‘mental health’. Within Aboriginal communities supportive environments typically include families, schools and organisations that support each other in placing a high value on social and emotional development, particularly of children.1

Stressful life events
The association of stressful life events with intentional self-harm such as interpersonal losses, legal or disciplinary issues is supported in research, with psychological studies indicating that between 70% and 97% of suicides are led by stressful life events.5 Despite this strong association it is important to remember that stressful life events are common and therefore the stressful life events may only increase the thought of intentional self-harm among individuals who are already vulnerable.5

Cultural dislocation, social exclusion, and racism
The increased risk of mental health problems, substance abuse and intentional self-harm among Aboriginal People are acknowledged to be associated with cultural dislocation, personal trauma and the ongoing stresses of disadvantage, racism, alienation and exclusion.1

Heterosexism, homophobia and transphobia
It is not sexual orientation and gender identity alone that elevate the risk of intentional self-harm among Lesbian, Gay, Bisexual, Transsexual and Intersex communities, rather experiences of heterosexism, homophobia and transphobia which are known to contribute to social isolation, poorer mental health outcomes, substance misuse, and other sociocultural and economic problems and conditions.1

Environmental, Community and Organisational Determinants

Location
Individuals living in remote and regional communities in Western Australia have a higher intentional self-harm rate than those residing in the metropolitan area, with residents of very remote WA having a 40% increased risk of suicide.4

Access to means of self-harm
It has been suggested that access to common instruments used to self-harm increases the rate of intentional self-harm.3 However the extent of this association remains unclear.

Workplace
The amount of time that the average West Australian is spending at work has grown over the past decade and with recent economic uncertainty, working can take a strain on an individual’s mental health. Combine this with a stressful and unsupportive work environment, the ripple effect that it can have on the whole workforce can increase the risk of intentional self-harm.5

History of child abuse
Intentional self-harm has been linked to child abuse, with sexual abuse in particular appearing to be an independent risk factor for intentional self-harm.5

Communities and social support
Having social support, whether it’s through a community, friends or family, can play a critical role in intentional self-harm prevention. They can provide social support to vulnerable individuals, ensure that follow-up care is received when required and collectively fight any stigma.5

Behavioural and Individual Determinants

Age
In Western Australia men and women in the 25-29 year age group totalled the highest rate of deaths from intentional self-harm. When viewing intentional self-harm rates across the lifespan, Western Australian women have a relatively constant rate from 30 years, while data indicates that men have a decline in the rate of intentional self-harm through the middle years and then peaks again at 85 years and over.4

Compared to non-Aboriginal people, Aboriginal peoples take their own lives at younger ages, with the majority of intentional self-harm incidents by Aboriginal peoples occurring before the age of 35.1

Gender
Women are more likely to be hospitalised due to intentional self-harm with 8,632 hospitalisations in Western Australia between 2008 and 2012, while 5,306 admissions were males.3 Contrasting this, deaths from intentional self-harm are more than three times likely for men than women, with 1,097 deaths compared to 313 deaths in Western Australia between 2007 and 2011.1

The reported stressors for Western Australian men and women who died from intentional self-harm are similar with life events such as relationship breakdowns, mental illness, substance misuse, conflict with family or friends, financial issues and physical illness commonly reported.1 Mental illness, the death of someone close and childhood abuse are reported more frequently by women.11

Past history of intentional self-harm
Compared with the general population, Western Australians who have previously attempted suicide are more likely to attempt suicide again, with 25% to 50% of those completing suicide having made a prior suicide attempt.5

Mental Illnesses Studies have shown that mental illnesses are present in between 80% and 100% of completed suicides.5 Depression, along with all types of mood disorders, schizophrenia and personality disorders, has been associated with intentional self-harm.5

Substance use issues
Research indicates that illicit drug use and alcoholism are associated with an increased risk of intentional self-harm. The factors relating to alcoholism also influence the individual’s risk of intentional self-harm, including early onset alcoholism, a long history of drinking, family history of alcoholism and depressed mood.12

Chronic illness
People with cancer, HIV/AIDS or a neurological disorder, such as epilepsy, spinal and brain injuries, have an increased risk of intentional self-harm.1

Family history of suicidal behaviour
It is suggested that a family history of intentional self-harm can be associated with an increased risk of intentional self-harm.12

Effective Interventions

Legislation, Policies, Standards and Codes of Practice

National and State Strategies
At a national level there are strategies for improving the mental health of Australians including the National Suicide Prevention Strategy: Living is for Everyone (LIFE) and the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy.1

Western Australia example

The Western Australia Suicide Prevention Strategy is aligned with the national strategy and aims to reduce the number of suicides in Western Australia by 50% over the next decade.11 The strategy is strongly evidence-based and is informed by the latest research and recommendations from recent reviews.

Restricting access to the means of self-harm
Legislation limiting access to the means of intentional self-harm (prescription pharmaceuticals and other drugs, sharp objects or firearms) has proven to be an effective intentional self-harm prevention method.12

Western Australian example

Firearms control in Western Australia falls under the Firearm Act 1973, which covers licensing procedures, ammunition sales and firearm safety and storage.12

Environmental, Community and Organisational Initiatives

Awareness raising and capacity building
School based intentional self-harm prevention programs aim to increase awareness, train participants to identify at-risk students, provide education on community mental health resources, and enhance the coping abilities of teenagers.12

Western Australian example

Beyond Blue aim to reduce stigma and myths about suicide, investigate barriers to help and contribute to the evidence base for what works in suicide prevention.12 Due to research indicating a strong association between mental health conditions and suicide, Beyond Blue raise awareness and promote broader public discussion across Australia.

Western Australian example

Headspace provide mental health, drug and alcohol, physical health and education and vocational support to young people aged 12 to 25.12 This is achieved through headspace centres and when reaching out to the community through local community groups and schools.

Western Australian example

“Suicide Prevention 2020: Together we can save lives” is a strategy for the prevention of suicide in Western Australian through the delivery of evidence-based prevention and intervention approaches.   

Direct screening
Early detection aims to identify persons at-risk for intentional self-harm and provide adequate referral and services. Direct screening is a common early detection method as it involves the systematic screening of school populations to identify individuals at risk for depression and intentional self-harm, and then the individual is provided with an adequate referral and services.12

Workplace intentional self-harm prevention
With many West Australians spending the majority of their day working and certain sectors reporting higher rates of intentional self-harm thoughts, targeting the working population is a growing intentional self-harm prevention method.

Western Australian example

MATES in Construction provide an industry approach to suicide prevention in workplaces in the construction industry. They aim to enhance support, open discussion of suicide and make better connections between workers and external professionals.

Western Australian example

The Black Dog Institute run a variety of evidence-based workplace mental health training programs that are delivered by experienced mental health clinicians and have a variety of online resources. 

Crisis centres and hotlines
Recognising that suicide is often associated with a critical stress event, crisis centres and hotlines aim to convince the caller that there are ways of solving the problem other than suicide.12

Western Australian example

Lifeline, Suicide Call Back Service, Veterans Line and Kids Helpline are all hotlines that support individuals who are feeling suicidal in taking steps to keep the individual safe.

Group and Individual Initiatives

Gatekeeper training
Gatekeeper training is a method of detection and management recognising that youth at-risk of intentional self-harm may come into contact with “gatekeepers” such as teachers, police, and coaches. It aims to reduce rates of intentional self-harm through a training program for gatekeepers that improves their ability to recognise at-risk individuals and improve their knowledge of the mental healthcare system.12

Western Australian example

Gatekeeper Suicide Prevention training programs have been actioned by The Western Australian Department of Education to develop teachers and other adults working in the school system’s ability to recognise the warning signs for suicide.12

Western Australian example

APPLIED Suicide Intervention Skills Training (ASIST) is a two day interactive workshop in suicide first aid. The program enhances a caregiver’s ability to help a person at risk to avoid suicide and includes ways that the caregiver can care for and support oneself.

Suicide bereavement for suicide survivors
Suicide bereavement for suicide survivors are important methods of treatment and follow up care when a stress event occurs, however they are not likely to be sufficient at preventing suicide at a community or population level.1

Key stakeholders in WA

Other Resources

Know Injury, ‘Preventing self-harm in young people’ webinar recording 

WA Department of Health, Injury Prevention in Western Australia: A Review of Statewide Activity for Selected Injury Areas

WA Department of Health, Incidence and costs of injury in WA

Life in Mind, Communities Matter – Suicide prevention for small towns and local communities

WA Mental Health Commission, Suicide Prevention 2020: together we can save lives

WHO, Towards evidence-based suicide prevention programmes

WHO, Public health action for the prevention of suicide: a framework

AIHW, Suicide and hospitalised self-harm in Australia: trends and analysis

National Mental Health Commission, The 2017 National Report on Mental Health and Suicide Prevention

ATSISPEP, Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project Report

Know Injury, 2015 suicide and self-harm fact sheet (2007 – 2011 data)

References

SANE Australia (2018). Self-harm. Retrieved from https://www.sane.org/information-stories/facts-and-guides/self-harm

2 Data generated using HealthTracks Reporting, by the Epidemiology Branch, WA Department of Health in collaboration with the Cooperative Research Centre for Spatial Information (CRC-SI), October 2017.
3 Australian Bureau of Statistics 2016, ‘Western Australia, People’, viewed 5 September 2017, <www.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/5?opendocument>
4 Ballestas T, Xiao J, McEvoy S, & Somerford P. (2011). The Epidemiology of Injury in Western Australia, 2000–2008. Perth: WA Department of Health. Retrieved from www.public.health.wa.gov.au/3/1496/1/injury.pm
5 World Health Organization. (2014). Preventing suicide: A global imperative. Retrieved from www.who.int/mental_health/suicide-prevention/world_report_2014/en/
6 Department of Health and Ageing. (2013). National Aboriginal and Torres Strait Islander Suicide Prevention Strategy. Retrieved from www.health.gov.au/internet/main/publishing.nsf/Content/mental-policy
7 Purdie N, Dudgeon P & Walker R.(eds). (2010). Working Together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. Department of Health and Ageing. Retrieved from www.healthinfonet.ecu.edu.au/key-resources/promotion-resources?lid=17709
8 Suicide Prevention Australia. (2009). Suicide and self-harm among Gay, Lesbian, Bisexual and Transgender communities: Position Statement. Retrieved from www.suicidepreventionaust.org
9 Australian Bureau of Statistics. (2012). Suicides Australia, 2010. Catalogue 3309.0. ; 2012. Retrieved from www.abs.gov.au/AUSSTATS/[email protected]/mf/3309.0/
10 Health Tracks Reporting. Epidemiology Branch, WA Department of Health. Perth: Department of Health, Western Australia; 2015.
11 Government of Western Australia, Mental Health Commission. (2015). Suicide Prevention 2020 – together we can save lives. Retrieved from http://v1224.vividcluster2.crox.net.au/Libraries/pdf_docs/Suicide_Prevention_2020_Strategy_Final.sflb.ashx
12 Arena, G., Cordova, S., Gavine, A., Palamara, P. & Rimajova, M. Injury in Western Australia: a review of best practice, stakeholder activity, legislation and recommendations. Perth: Injury Research Centre, The University of Western Australia, 2002
13 Department of Health and Ageing. Mental health policies. 2014. www.health.gov.au/internet/main/publishing.nsf/Content/mental-policy
14 Szumilas M & Kutcher S. Post-suicide intervention programs: a systematic review. Canadian Journal of Public Health. 2011; 102(1): p. 18–29.

Printable Fact Sheet

Click here to download a printable version of the Intentional Self-harm Fact sheet