Dr Peter Byrne: People feel greater pressure to succeed

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"The increase in self-harm lead us to key questions about social changes: is it harder to be an adolescent in today's society? We are a society of unequals, and health inequalities will continue to fuel the rise. Illegal drug use, family disintegration, crime and the toxic effects of city living aggravate it further. The largest group increase was in women aged between 16 and 24. There are considerable pressures on them to succeed. Self-failure is self-punished.

"Only part of the rise in self-harm rates reported here can be explained by improved hospital reporting methods. It could be that people who self-harm are more likely to attend for treatment. But the evidence does not support this: similar proportions of people who self-harm keep it secret. The rise in admissions means either more serious self-harm or that some were admitted to avoid breaching the four-hour A&E wait. Another reason could be down to policies that reduced access to suicide methods – suicide rates have fallen by 14 per cent since 1999, which may have converted potential fatalities into self-harm episodes.

"Some years ago as a junior doctor, I took my consultant to see one of the many overdoses on the ward. When he learned that a healthy 21-year-old student had deliberately taken a toxic dose of painkillers, my boss snapped: 'Take me to someone who's really sick.' His inability to understand why someone could self-harm is shared by some health professionals even today. Their friends and families cannot explain it, and frequently, people who self-harm don't know why either."

Dr Peter Byrne, consultant liaison psychiatrist at Newham University Hospital, London, and director of public education at the Royal College of Psychiatrists, looks at the reasons for the dramatic rise in self-harm

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