Deliberate Self Harm in Children-Call It What It Is Please!

Reading the Evening Herald tonight, September 24, 2009, page 2, I find the headline “Boy Aged Six Who Tried to Hang Himself” It says the HSE (Health Service Executive) has concluded there is an increase in “Deliberate Self-Harm” in children and adolescence. Now there’s a surprise for you! Anyone who works with children knows that there have always been higher rates of self-harm in children and teens then is recorded in official records. I am making a plea in this article to stop calling it “Deliberate Self-Harm” and use the proper terminology: Suicide in children and teenagers.

Clinicians have discovered long ago that children as young as six and under can attempt to take their own lives. The methods of choice often masquerade as accidents: running in front of cars, “falling” out of windows, “slipping” off balcony railings, “tripping” while balancing on a bridge wall and accidental drowning are all ways that children can attempt suicide. A frightening number of them succeed.  There is mass denial in this country that these things can actually happen. Nowhere is this denial more evident than in referring, in this report, to suicide attempts as deliberate self-harm.

I’m not denying the existence of deliberate self-harm. It is a well documented phenomenon, prevalent in more girls than boys, in which superficial cuts and burns are used as a means to “feel more alive”. This troubling symptom is typically seen in adolescents with Borderline personality disorder, a difficult to treat condition that usually appears in mid to late adolescence. But the report referred to in the Herald clearly states there was noted a serious intent to cause death in many of the cases documented. This is a suicide attempt by any definition and should be called by its rightful name to bring the issue full into the public eye.

There are many reasons why young children want to kill themselves. Often it is an attempt to escape the unbearable pain of life arising from abuse, severe neglect or living in chaotic, dysfunctional families. There are also cases of young people wanting to kill themselves because they have serious psychotic illnesses and hear voices telling them theyh are evil and should die. Whatever the motivation suicidal ideation and attempt in children and adolescents is a real and frightening issue confronting most modern, developed societies.

Ireland is no exception.

Every child who is treated for unexplained serious injury that is self-inflicted needs to be questions by a psychologist or psychiatrist who is fully experienced in assessing suicidal risk. Questions must be gentle but yet elicit answers that help determine if suicide was a motivation. I seriously urge parents, carers and teachers who have a concern to bring the child to a properly trained and experienced clinician; and I want to add a note of caution that many so-called “counsellors” lack this sort of training and experience. Don’t take chances with your child’s life.