Over the last few years in critical care I seem to have encountered growing numbers of patients who have self harmed. This is borne out by a recent study published in Lancet Psychiatry.
Using data from the 2000, 2007 and 2014 Adult Psychiatric Morbidity Survey (an impressive sample size of 20,164) the authors identified a rise in prevalence of Non Suicidal Self Harm (NSSH) from 2.4% to 6.4% amongst those aged 16 to 74 years. Importantly, these increases were seen in both sexes and across all age groups.
The prevalence of non-suicidal deliberate self harm in male (A) and female (B) participants in the 2000 (green), 2007 (red) and 2014 (blue) Adult Morbidity Psychiatric Surveys*.
The most striking increase was seen in young women aged between 16 and 24 years of age. Between 2000 and 2014 the prevalence of NSSH in this group rose from 6.5 to 19.7%. The majority of this three-fold increase occurred between 2007 and 2014. Importantly, the study also revealed that less than half of those reporting NSSH had sought out any form of medical or psychological help.
The method of NSSH in male (A) and female (B) participants - cutting (red), other (blue), poisoning (purple) and burning (green). The majority of the increase in NSSH in 2014 was due to cutting.
These results have enormous implications for those working in mountain medicine.
First and foremost, there is now a rapidly increasing number of people in the UK who experience NSSH. This supports a growing awareness that levels of anxiety, depression and suicide have been rising in recent years, especially amongst young men and women. Second, there is the real risk that high levels of NSSH may lead to a "normalising" of behaviour and further increases in the prevalence of NSSH. In addition, there is the potential for those who have already self harmed to increase the frequency and severity of their actions. Since NSSH is a risk factor for suicide the number of deaths amongst young adults may also rise. Third, it is clear from this study that many of those who experience NSSH do not seek support. Therefore episodes of cutting, poisoning or burning are often absent from the patient's medical record. Unanticipated events are therefore likely to occur. Those that take place in the remote mountain environment will be challenging and require high levels of medical and psychological support. Much of this support will focus upon discussing NSSH sensitively with the individual and finding safer ways of coping in the future.
Perhaps its worth giving some thought to what you'd do if a member of your trekking group came to you for help after self harming?
If you have any thoughts about managing NSSH in the remote mountain environment please get in touch.
Here's Dr Tony Page's response...
"Some thoughts in response to your post on self-harm in a remote mountain setting. As a mountain medic you are obviously not going to 'cure' them but you can listen to their story non-judgementally. If they have approached you this suggests that they want to talk, and allowing them to do so might reduce the level of distress they are experiencing. Early on, you need to sensitively ask about suicidal ideation as If they are actively suicidal this is a different matter entirely. However, assuming that this is not the case it may turn out that something related to the trek is replicating one of the triggers for the self-harming behaviour back home, and you might be able to do something about it- another client may be bullying them, for example. You might indicate that you are willing to check out how they are coping once or twice a day, and it would be useful to find out what has helped in the past and, if appropriate and feasible, encourage them to try whatever it was. Some people find 'delaying tactics' reduce the frequency or severity of the self harm, and some people apparently plan ahead how long or deep the wound they make will be, putting limits on this. If they are cutting or burning, then make antiseptic wipes and dressings available to them. This isn't encouraging them, as they will be doing it anyway - but it might reduce the risk of a wound infection which will be unpleasant for them and will make your job harder. You might have to give some guidance on safer sites. It may be worth a mountain medic doing a bit of reading up before being confronted with such an issue - Northumberland,Tyne and Wear NHS Trust produced a self help leaflet for patients who self harm and this gives useful information for doctors too."
*McManus S, et/al. Prevalence of non-suicidal self-harm and service contact in England 2000-14: repeated cross sectional surveys of the general population. Lancet 2019.
The British Mountain Medicine Society (BMMS) are organising a Science Day in the Peak District on the 13th November 2019. Why not come along? Details can be found here.