Tack­ling self-harm among young peo­ple

The Irish Times - Tuesday - Health - - Health Lifestyle - ÁILÍNQUINLAN

A school-based pi­lot pro­gramme which has been shown to coun­ter­act the in­ci­dence of de­pres­sion and self-harm among teenagers in Cork and Kerry should be rolled out across ev­ery sec­ond-level school in the coun­try, ac­cord­ing to one of the coun­try’s fore­most ex­perts on the is­sue.

We are not suf­fi­ciently pri­ori­tis­ing men­tal-health ser­vices for young peo­ple, ac­cord­ing to Prof Ella Arens­man, who has just pub­lished a guide to men­tal health, de­pres­sion, self-harm and sui­cide in Ire­land, An Un­der­stand­ing of Sui­cide and Self-Harm, in con­junc­tion with health in­surer Laya.

“The level of self-harm and sui­cide among young peo­ple is a very se­ri­ous is­sue,” warns Prof Arens­man, who is re­search pro­fes­sor with the School of Pub­lic Health, Univer­sity Col­lege Cork, chief sci­en­tist with the Na­tional Sui­cide Re­search Foun­da­tion (NSRF), and an ex­pert ad­viser to the World Health Or­gan­i­sa­tion.

She be­lieves a school-based in­ter­ven­tion, which has proved suc­cess­ful both on an in­ter­na­tional ba­sis and in two coun­ties in Ire­land, should be in­tro­duced to help coun­ter­act these prob­lems as a mat­ter of ur­gency.

Prof Arens­man pointed to a 22 per cent in­crease in self-harm in chil­dren and teenagers aged 10-14 years be­tween 2007 and 2016. Other statis­tics show the sui­cide rate among young peo­ple aged 15-19 in Ire­land is the sev­enth high­est of 33 Eu­ro­pean coun­tries, while in Ire­land, the high­est rates of self-harm are con­sis­tently recorded in young peo­ple, ac­cord­ing to the NSRF Na­tional Self-Harm Registry Ire­land 2017 An­nual Re­port.

Ire­land lacks “an ef­fec­tive men­tal-health pro­gramme at both pri­mary and sec­ond-level ed­u­ca­tion,” says Prof Arens­man.

Deep con­cern

Although at pri­mary-school level, more work needs to be done in terms of ef­fec­tive men­tal-health in­ter­ven­tions, she says in­ter­na­tional re­search has high­lighted the ef­fi­cacy of a sec­ond-level-school­based in­ter­ven­tion, Youth Aware of Men­tal Health (YAM), which had been as­so­ci­ated with a “sig­nif­i­cantly lower” num­ber of sub­se­quent sui­cide at­tempts and sui­ci­dal thoughts.

YAM, which is tar­geted at 14-17 year-olds, was orig­i­nally pi­loted in a num­ber of sec­ond-level schools across Cork and Kerry in 2009 and 2010, as well as across 10 Eu­ro­pean coun­tries, as part of a larger, in­ter­na­tional men­tal-health re­search ini­tia­tive.

A uni­ver­sal men­tal-health aware­ness pro­gramme, which in pi­lot form, was de­liv­ered in class­rooms over a four-week pe­riod, YAM in­cluded role-play ses­sions, in­ter­ac­tive lec­tures and work­shops.

“The find­ings in Ire­land were con­sis­tent with find­ings in other coun­tries – it re­duced de­pres­sive symp­toms and sui­cide at­tempts and im­proved help-seek­ing be­hav­iour,” Prof Arens­man says. “In the schools where YAM was im­ple­mented, there were bet­ter out­comes – YAM stood out in hav­ing the most ob­vi­ous sig­nif­i­cant out­comes.”

An im­por­tant as­pect of YAM was its em­pha­sis on role play, which, Prof Arens­man ex­plains, helps young peo­ple learn how to com­mu­ni­cate their dif­fi­cul­ties – and also how to en­cour­age a friend or peer to seek help.

“YAM is suit­able for wider im­ple­men­ta­tion and I would like to see YAM im­ple­mented across the en­tire sec­ond-level sys­tem be­cause of its proven ef­fec­tive­ness,” she says, adding she be­lieves the pro­gramme needs to be “ur­gently” im­ple­mented across all Ir­ish sec­ond-level schools, ide­ally in the orig­i­nal nine-week for­mat, which takes place in the class­room un­der the guid­ance of an in­de­pen­dent fa­cil­i­ta­tor.

This could be or­gan­ised by the HSE Na­tional Of­fice for Sui­cide Pre­ven­tion along with part­ners such as the Depart­ment of Ed­u­ca­tion, she says, adding that the pro­gramme ad­dresses dif­fer­ent themes in each ses­sion – cop­ing with stress or dif­fi­cult life events, im­prov­ing re­silience, re­duc­ing stigma re­lated to men­tal health, de­pres­sion and self-harm and im­prov­ing help-seek­ing be­hav­iour.

‘Pro­vide in­for­ma­tion’

“It would also pro­vide in­for­ma­tion to young peo­ple as to how and where they can find help in their lo­cal area in terms of avail­able ser­vices,” she says, adding that although there is a lack of ser­vices, Child­line and Jig­saw could be of help.

Other in­ter­ven­tions like cog­ni­tive be­havioural ther­apy (CBT) and di­alec­ti­cal be­havioural ther­apy (DBT) have also proved to be ef­fec­tive, she says, adding, how­ever, that there should be im­proved ac­cess to such ther­a­pies.

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