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:

·          psychiatric factors such as major depression, schizophrenia, alcohol and other drug use, and anxiety disorders;

·          biological factors or genetic traits (family history of suicide);

·          life events (loss of a loved one, loss of a job);

·          psychological factors such as interpersonal conflict, violence or a history of physical and sexual abuse in childhood, and feelings of hopelessness;

·          social 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 Commission, 2006).

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).