Does Self-Harm Only Matter in Relation to Suicide?

I usually don’t try to line up posts and newsletters with awareness days, partly because there are generally lots of people out there with more interesting and thought-provoking things to say than me, partly because I’m in the ‘every day should be suicide prevention/self-harm awareness/mental health awareness day’ camp and partly because I’m just not organised enough to write to a deadline.

World Suicide Prevention Day

However, I do think there’s a very important conversation around suicide and suicidality that we are not having and if there’s a good day to ask my networks their views, then it’s got to be today.

Suicide and suicidality are complex and wide-ranging topics and I know however many people I talk to and however much I read, there will always be more to learn and understand about prevention in the moment, and equally importantly prevention that’s much further upstream, and support after a suicide attempt or death by suicide. These are all experiences that need to be attended to, validated and heard.

BUT, and I know not everyone will agree with me here, which is absolutely valid, I think we also need to attend to and think more about the relationship between suicide and self-harm. When I say this I don’t just mean the relationship that is most talked about, where self-harm can be a predictor of suicide. Although this relationship is important at an individual and population level, it’s not the only relationship that matters.

Relationship with Suicide

Frequently when reading policy documents, healthcare guidance and academic research I see self-harm framed as a public health issue, and the reasoning that often follows is because self-harm is correlated with death by suicide. Research has repeatedly demonstrated this relationship, and it is important we pay attention to this.

What I find somewhat frustrating though, is that this can be the end of the conversation, implying that the only reason we should be concerned about self-harm is because of the correlation with suicide. To me, this is a classic case of focusing on pulling people out of the river, rather than going upstream to find out why they are falling in in the first place.

Suicide, suicidality and self-harm are not homogenous experiences. There are many commonalities, but everyone gets to these places in their own way, for their own reasons. If we consider that many people who self-harm talk about it as a way to survive and to protect against suicidality, already it’s clear that the relationship between the two is not straightforward. In my personal and professional lives I have seen that for many people self-harm is never about suicide, for some they are not clear which or are ambivalent about the outcome and for others there is an intent to die.

Conflation of Self-Harm and Suicide

In policy and research there is often a conflation of all of these experiences, meaning that the opportunity to examine the differences and relationship beyond self-harm being a potential predictor of suicide is lost or sidelined.

I am especially interested in the policy, research and service conflation of self-harm and suicide and the more cultural (including healthcare) perspectives which seem to see suicide as more ‘noble’, tragic and in need of prevention at all costs, but self-harm as attention seeking and ‘icky’. Quality of life seems to feature very little in these discussions and understanding that benefits people who are external (e.g. narratives of suicides, demands to know/assumptions about ‘why’ someone self-harms) are often centred.

Living or Alive?

Fundamentally, why is it that there is such a focus on suicide prevention at crisis point, without the same focus on quality of life either after intervention or in relation to self-harm? Are we saying as a society, we want to save lives because it makes us feel better, so you should stay alive, no matter how impossible that feels? Are we asking people to keep on living or supporting them to be alive?

Wouldn’t it be better to not just think about self-harm as a potential predictor of suicide, but to validate and listen to experiences of self-harm as clear indicators of struggle right now. It means being brave and taking a leap of faith to ask questions you might not want to hear the answers to or have the solutions to. It means acknowledging that self-harm and suicide are part of wider societal and systemic issues including discrimination, adversity, trauma and oppression, in places you might not expect. It means listening to people who feel unconnected, unvalued and isolated and offering validation and connection, rather than empty reassurance or dismissal.

Although there are differences, neither suicide or self-harm are events that come out of nowhere and starting to pull people out upstream is the only way things will change.

Important points to note:

Self-harm does not mean that someone will inevitably attempt suicide. It is a predictor of suicide in the sense that a higher rate of people who attempt or die by suicide have also self-harmed, but the vast majority of people who self-harm do not attempt or die by suicide.

Self-harm is not necessarily a suicide attempt – and the only way to know the difference is to ask someone and to take them seriously whatever the answer.

Talking about suicide and self-harm does not cause people to self-harm or attempt suicide. There are many complex reasons that lead to self-harm and suicide and talking about it makes it more possible for people feel safe, open up and seek help.

Self-harm without suicidality is valid and people should be supported and listened to in the same way as someone who is suicidal. Self-harm is not for attention and research shows that the majority of people who self-harm do not tell others or seek medical help.

Resources Around Suicide Support:

https://www.samaritans.org/how-we-can-help/if-youre-worried-about-someone-else/how-to-interrupt-someones-suicidal-thoughts-guide/ – Samaritans support guidance

https://www.ripplesuicideprevention.com/guide/how-to-talk-about-suicide – Ripple Guidance

https://bodyandsoulcharity.org – support services

http://www.thecalmzone.net/ – helpline, webchat and resources

https://www.papyrus-uk.org – helpline for young people

https://www.stayingsafe.net – personalised safety planning including Free e-learning: Email: in**@***********th.com to access training

Resources Around Self-Harm Support:

https://selfharmnetworkscotland.org.uk – training and resources

https://www.selfinjurysupport.org.uk – helpline, training and resources

https://www.selfharm.co.uk – online course for young people

https://www.battle-scars-self-harm.org.uk – face to face and online peer support and training