People who self-harm: rapid evidence review and survey of practitioner perspectives

Introduction

This report investigates if engaging in self-harm can be a barrier to accessing support and services, and what measures can be taken to overcome these barriers. To explore this a rapid evidence review, and a survey with practitioners who support people who self-harm were conducted. The evidence review examined the research evidence for barriers and facilitators to accessing and engaging with self-harm support. While the survey collected insights on a broader range of support and services from practitioners.

Background on Self-Harm

Self-harm is not a mental health condition or illness but a range of behaviours that can be an indicator of poorer mental health and wellbeing. Self-harm can affect people of any age, gender, or background, but is more prevalent among specific groups, including young people, young women, and people from marginalised communities (O’Connor et al., 2009; Cassidy et al., 2020; Sanders, 2020; Scottish Government, 2022).

The reasons people self-harm are deeply personal and varied, however, self-harm can serve a variety of functions which can include helping an individual to cope with distress, regulate emotions, communicate feelings, or gain control (Scottish Government, 2023). Many people do not seek support for self-harm for a variety of reasons, including misunderstandings about self-harm; fear of stigma or discrimination; and previous negative experiences when seeking help (Long, 2018; Bailey et al., 2019; Mughal et al., 2021).

While self-harm is recognised as a key risk factor for suicide, it is important to note that most people who self-harm do not intend to end their lives. Instead, self-harm can be a way for people to manage difficult emotions and circumstances (Scottish Government, 2023).

Scottish Government’s Self-Harm Strategy and Action Plan

In 2023, the Scottish Government and the Convention of Scottish Local Authorities (COSLA) published a dedicated Self-Harm Strategy and Action Plan, believed to be the first of its kind globally. The Strategy sets out a vision in which anyone who has self-harmed or is thinking about self-harming to receive compassionate, recovery-focused support free from stigma and discrimination. The Self-Harm Strategy and Action Plan has been shaped by insights from people with lived experience of self-harm, as well as support providers and experts in data and evidence. To achieve the Strategy’s vision, three key priorities have been identified which aim to:

• Priority 1: Continue to expand and deepen knowledge and embed compassionate understanding of self-harm and tackle stigma and discrimination
• Priority 2: Continue to build person-centred support and services across Scotland to meet the needs of people affected by self-harm
• Priority 3: Review, improve, and share data and evidence to drive improvements in support and service responses for people who have self-harmed, or are at increased risk of doing.

The work of the Self-Harm Strategy aligns with Scotland’s broader Mental Health and Wellbeing Strategy, which aims to promote positive mental health for all and address the root causes of poor mental health, which often overlap with those associated with self-harm.

Focus of the Report

This report primarily supports Priority 3 in the Self-Harm Strategy: Improve data and evidence, with a central focus on:

• Action 2.f – Investigating whether self-harm can act as a barrier to accessing support and services, and identifying measures to overcome these barriers.

In addition, the report contributes to broader goals within Priority 3 of gathering and applying data and evidence on self-harm, supporting:

• Action 2 – Taking steps to gather existing and new data and evidence to improve support and service responses.
• Action 2.a – Identifying existing and new research and learning on self-harm, and ensuring this evidence is shared and incorporated into support and service practice where relevant.

How This Research Will Be Used by the Scottish Government

This research has been carried out with the intention that the findings support partners working across a range of settings in identifying barriers to accessing their services and taking action to reduce them. Additionally, the findings will directly inform the ongoing implementation of the Self Harm Strategy and action plan.