Children as young as seven drawn to trend for self-harm

With hospitals treating thousands of young people, a two-year inquiry gets under way. Sophie Goodchild reports

Britain has the highest rate of self-harm in Europe, with children as young as seven deliberately mutilating their bodies, according to new research.

Britain has the highest rate of self-harm in Europe, with children as young as seven deliberately mutilating their bodies, according to new research.

A report published this week by the Mental Health Foundation reveals that one in 10 teenagers self-injures as a way of expressing the pain endured from bullying, sexual abuse or family break-up. An increasing number of children are resorting to cutting themselves, burning their skin or swallowing toxic substances. The average age this damaging behaviour begins is 13.

Figures collated from accident and emergency departments show that each year more than 24,000 young people aged between 13 and 18 are admitted to hospital in this country after deliberately harming themselves. So great is the problem that the Mental Health Foundation is launching the first inquiry in the UK into self-harm among young people.

The two-year investigation, which is backed by MPs and health experts and will focus on 11- to 25-year-olds, aims to draw up a list of policy recommendations for ministers in an attempt to reduce self-harm among children.

Catherine McLoughlin, of the King's Fund, a public health foundation, and the Nursing and Midwifery Council, will chair the inquiry, which has been funded by the Camelot Foundation.

David Hinchliffe, Labour MP for Wakefield and chairman of the Commons Health Committee, said he would be looking at ways the committee could help the inquiry.

"Self-harm is a problem that appears to have worsened," Mr Hinchliffe said. "We need to look at our policies to see if they are properly geared to identify those who self-harm."

The Royal College of Psychiatrists lists common examples of deliberate self-harm as hitting, cutting or burning as well as pulling out hair or picking off bits of skin. The problem mainly affects women, but rates of self-harm among young men and boys have almost doubled since the 1980s.

According to the National Institute for Clinical Excellence, deliberate self-harm is one of the top five causes of acute medical admission. Experts believe people self-harm as a way of gaining temporary relief from feelings of profound self-hatred or anger.

There is no direct link between self-harm and suicide, although a study carried out in 2001 by the Samaritans revealed that 50 per cent of people who commit suicide have self-harmed in the previous 12 months.

Hilary Freeman, an agony aunt for COSMOgirl!, receives a "constant stream" of around 20 letters a week from girls aged between 14 and 17 who self-harm, the majority through cutting themselves.

Ms Freeman said that often these readers will write to her about another problem such as bullying or a failed relationship, only mentioning the fact that they harm themselves much lower down in their letter.

The worrying increase in self-abuse, she says, is a response by young people, especially girls, to factors such as social isolation, the pressure to be successful with boys and to achieve career success.

"I don't think it's attention-seeking," Ms Freeman said. "Most people are very embarrassed and try to hide it. It's taking their anger out on themselves. Once you get into that mentality it's hard to stop. This is not a black and white issue but there are definitely more pressures on young girls today. It's society that is the problem and we need to reduce pressures on young people."

Margot Waddell, a child psychoanalyst at the Tavistock Clinic in London, said casualty departments were often too overstretched to cope with people who self-harm.

"This inquiry is needed because A&E departments are extremely busy and they just stitch people up and send them out again," she said. "Services in the NHS are sadly lacking and people do need counselling."

Amanda Ellard, from the children's charity NCH, said the figure of 24,000 young people being admitted to hospital as a result of self-harm is an "underestimate" because many people manage to hide their scars and wounds under long sleeves and do not present themselves at casualty departments.

"Some self-harmers are very private and there is a taboo so people don't talk about it," she said. "People are terribly ashamed. For some it's a mechanism to test how much people care.

"You can understand it from both sides - healthcare workers would say self-harmers have a choice. But those who self-harm do it because they feel bad about themselves and it's going to make them feel worse if people are not sympathetic."

Case Study: 'I didn't tell anyone - I felt like it was my fault'

At first, Katie Foulser, then aged 14, used only her fingernails to make herself bleed as an outlet for her tormented feelings about being bullied and her parents' unhappy marriage.

But within two years her self-harm had escalated so badly that the teenager was cutting her stomach and legs with a kitchen knife, sometimes up to 10 times a day, as well as burning herself with cigarettes, pulling out her hair and taking overdoses.

After receiving psychiatric treatment, Ms Foulser, now aged 20, no longer mutilates her body. But as a teenager, she explains, it was the only way she could express her feelings of self-loathing and anger.

"I was being picked on at school because I was quite different from the others, because I rode and won trophies," says Ms Foulser, who lives in Cheltenham, in Gloucestershire. "When I first started harming myself it was a distraction after a bad day at school. My parents didn't know what I was doing."

In October 1999, Ms Foulser was raped while staying away from home, training to be a riding instructor in the Forest of Dean. She was too ashamed to tell the police or her family, and her self-esteem plummeted. It was then that her self-harming became uncontrollable.

"I didn't tell anyone - I felt like it was my fault and I felt very dirty and bad," she explains. "I wasn't the sort of girl who wore skirts, so I could hide the marks well. I had very low self-esteem to the extent where I would not want to make a phone call. The rape made me feel out of control of my body."

Eventually, she went to see her doctor, who referred her for psychiatric treatment, which gradually helped her overcome her self-destructive behaviour.

Today, Ms Foulser runs a self-help group called the Self Harm Alliance. She also works with mentally ill people.

Most of the 700 people she is helping are aged between 15 and 19 but Ms Foulser has also noticed a rise in people contacting her in their twenties and even in their fifties.

There is a desperate need for more resources for those who self-harm, she explains.

"When you are young you are quite naive, and I didn't realise that this [self-harm] was something other people did," she says. "Young people will go two to three years before anyone is aware of their problem. More and more are turning to this as a way of coping. And anyone, whatever their class, age or colour, can be affected."

The Self Harm Alliance: 01242 578820 or www.selfharmalliance.org