7.4.6. Prevention of self-harm
Self-harm and suicide are other important causes of
premature death and hospitalisation. The issue of self-harm is closely related
to mental health and in particular to the prevention of depression. Suicidal
behaviour has a large number of underlying causes. It is associated with a
complex array of factors that interact with each other and place individuals at
risk. These include:
factors such as major depression, schizophrenia, alcohol and other drug use, and
factors or genetic traits (family history of suicide);
events (loss of a loved one, loss of a job);
factors such as interpersonal conflict, violence or a history of physical and
sexual abuse in childhood, and feelings of hopelessness;
and environmental factors, including availability of the means of suicide
(firearms, toxic gases, medicines, herbicides and pesticides), social isolation
and economic hardship.
Some risk factors vary with age, gender, sexual
orientation and ethnic group. Marginalized groups such as minorities, refugees,
the unemployed, people in or leaving prisons, and those already with mental
health problems, are particularly at risk.
However, the presence of sufficiently strong protective
factors may reduce the risk of suicide. Protective factors are related to
emotional well-being, social integration through participation in sport, church
associations, clubs, etc., connectedness with family and friends, high
self-esteem, physical and environmental aspects such as good sleep, a balanced
diet, physical exercise and a drug-free environment, as well as various sources
of rewarding pleasure (World Health Organization, 2005c).
In October 2005, the European Commission published a Green
Paper on Mental Health which emphasised suicide prevention. In this context,
actions to prevent suicides will be encouraged at local, regional, national and
Community level. Actions in the field of injury prevention should therefore
link up with the existing projects in the mental health domain, with the Green
Paper on Mental Health and with future action plans foreseen in this area (European
In the general school population, suicide prevention
programmes based on behavioural change and coping strategies were found to be
effective. In adolescents at high risk, school-based suicide prevention
programmes based on skill training and social support appeared to be effective
in reducing risk factors and enhancing protective factors. For adult patients
who have attempted suicide or deliberate self-harm, there is some evidence - in
a very controlled setting - of the benefits of cognitive behavioural therapy.
Trends towards benefits were also seen through the use of problem solving,
emergency cards, dialectical therapy and specific medicinal products.
As suicide is an outcome of complex interactions of
various risk factors and protective factors, it has been suggested that a broad
array of suicide preventive interventions addressing different risk factors at
different levels will be required to achieve an overall reduction in the
population suicide rate in the long term. Consequently, it may be necessary to
develop a conceptual framework when planning and establishing national or
regional suicide prevention strategies (Guo and Harstall, 2004).