Warning: This article is about suicide and may be distressing for some readers.
Throughout the Herald's Break The Silence series about youth suicide, we have published first-person pieces from individuals closely related to the issue and experts in the field.
Today, New Zealand's leading expert on self-harm, Professor Marc Wilson from Victoria University's school of psychology, says we need to take self-injury seriously and understand the function of harm. In his own words:
In the same way that all flamingos are birds, but not all birds are flamingos, it's true that suicidal behaviours might all involve self-harm, but not all self-harm is suicidal.
Our work has shown that perhaps almost half of our young folk hurt themselves at least once before they leave school, but we also know that many fewer young folk attempt suicide.
Which is not to say that we shouldn't take self-harm seriously. But we'll come to that.
While self-harm has always been with us, it has long been stereotyped as "deviant", something that people who have something wrong with them do. In fact, until 2015 the only place it appeared in psychiatric diagnosis was as a "symptom" of borderline personality.
It's only in the last 20 or so years that it's become clear that many "normal" people also hurt themselves, the majority of whom simply don't look at all like a borderline diagnosis.
While it's more common among adolescents, a smaller proportion of adults also hurt themselves.
People hurt themselves, but without any desire to end their lives, for many reasons. Most commonly, it's to deal with strong, unpleasant, emotions. Like sadness, anger, frustration, shame, and guilt, and because they may not have other tools that will do the trick.
Among young people the next most common reasons for self-harm are to punish themselves, and "anti-dissociation" - to feel something. It's similar for grown-ups, except that anti-dissociation comes in at fourth place after marking distress - communicating your distress to others through hurting yourself.
The first lesson, then, is that most self-harm is not about "attention-seeking", a nasty pejorative label that sounds really dismissive.
Most young people who deliberately hurt themselves may do so only once or a handful of times. Even those who self-injure chronically often stop of their own accord, without ever seeking help.
At the same time, anyone who has engaged in self-injury is at heightened risk for psychological disorder, not because they hurt themselves, but because of the underlying reasons they hurt themselves.
Problems managing your emotions and experiences are associated with other things like depression, anxiety and, yes, for a small number of people, personality disorder.
For this reason it's important to take self-injury seriously, even if it's more common than most people think, and most of the time it has nothing to do with suicidal thoughts.
If you're a parent, or a teacher, how should you respond when you find out a young person has hurt themselves? This is really important, because how first disclosure goes down can determine the success of what follows.
While there is no single sure sign that someone is hurting themselves, for both parents and teachers, it makes sense to pay extra attention when someone might be wearing clothes that are inappropriate for the weather; show unexplained injuries like burns, cuts or bruises; or are paying particular attention to self-injury-like themes in school work or leisure activities.
Pay attention to your own response - parents can often feel shocked and dismayed, and may understandably need to rally their support networks.
The International Consortium on Self-Injury in Educational Settings recently published a position paper providing guidance to schools in their discussions about how to handle self-injury.
We state that, because self-injury serves a purpose for people who do it, it's important to validate their experience upon disclosure - not that self-injury is okay, but rather that it can be understood as serving a purpose.
For someone who has come to rely on self-injury, it's not going to be easy to go cold turkey, so the initial focus should be on understanding the function of harm.
The experts in this area recommend a "respectful curiosity" - not freaking out (which can make people feel stigmatised or potentially "rewarding" the behaviour) but also not being dismissive (which can reinforce feelings of low self-worth).
For parents, this is going to be particularly difficult - talk to your young person's school, or go online and look for guidance (we've got some local resources, and links to international ones, at our Youth Wellbeing Study website.
I'd like to acknowledge that this is not an easy issue for schools, or even government ministries. Having a school suicide protocol doesn't also mean you're in the best position to respond to self-injury, because suicide and self-injury aren't the same thing.
We've spent a lot of time working with amazing pastoral care workers and they've made it clear that there is no one-size-fits-all, cookie-cutter approach to developing school response to self-injury.
But I think it's fair to say that everyone we've worked with would support us having the conversation about how our school and broader community are going to respond, so we have a shared understanding, as well as an idea of what each of our roles are.
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WHERE TO GET HELP:
If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call 111.
If you need to talk to someone, the following free helplines operate 24/7:
DEPRESSION HELPLINE: 0800 111 757
LIFELINE: 0800 543 354
NEED TO TALK? Call or text 1737
SAMARITANS: 0800 726 666
YOUTHLINE: 0800 376 633 or text 234
There are lots of places to get support. For others, click here.