Self-harm and suicide

What is self-harm?

Self- harm, also known as self-injury, is when a person deliberately causes physical harm to themselves. Self-harming behaviour often takes place in secret and can therefore go on for a long time before it is noticed. The act is not usually intended to result in death but sometimes when a person self-harms (without meaning to end their life), they go too far and death results, this is called accidental suicide. If a person self-harms and does not receive help, they are likely to continue self-harming and are at an increased risk of accidental death or intentional death.

In Aboriginal and Torres Strait Islander communities, some cultural practices may be misread as self-harming behaviours. It is important that people working in the area of social and emotional wellbeing understand the differences between ‘ceremony’ or ‘sorry business’ and self-harm. For example, ‘sorry cuts’ are often practiced as a sign of grief for the loss of a family member. It is important that the warning signs for self-harm in individual communities are understood.

Self-harming behaviours can include:

  • cutting , scratching, or tearing the skin
  • burning the skin with cigarettes, matches, or hot water
  • banging or punching to cause bleeding or bruising
  • pulling out hair and eyelashes
  • overdosing on medication
  • eating or drinking toxic products.

Why do people self-harm?

People who self-harm usually find it hard to talk about their feelings; often they have not been taught how to cope with their emotions, so self-harm becomes a way of:

  • releasing tension or pressure
  • easing emotional pain (the physical pain helps people to forget the emotional pain they’re experiencing)
  • punishing oneself due to feelings of shame or guilt
  • having a sense of control over things happening in one’s life
  • escaping from a difficult or unbearable situation
  • revenge or getting back at someone.

Some of the difficult situations people may find themselves in, which can lead to self-harming include:

  • the break-up of a relationship
  • experiencing violence or sexual abuse
  • experiencing trauma
  • loss of a job
  • alcohol and substance misuse
  • poor health
  • poor living conditions or homelessness
  • being in prison.

What are the warning signs and symptoms for self-harming behaviours?

People who self-harm often report feelings of hopelessness, anxiety, rejection, and low self-esteem. Other warning signs include:

  • noticing injuries on a person that cannot be explained
  • wearing clothing, which is not suitable for the weather (e.g., jumpers in summer)
  • not wanting to go to places where more revealing clothing is needed (e.g., the pool or beach).

How common is self-harming behaviour among Aboriginal and Torres Strait Islander people?

The nature of self-harming behaviour, and the stigma and secrecy connected to it, makes it hard to get a true picture of how common it is among Aboriginal and Torres Strait Islander people. As a result of the social, emotional, and economic disadvantage faced by Aboriginal and Torres Strait Islander people, self-harm is more common among Indigenous people than it is among other Australians. In the period 2005 – 2007, Aboriginal and Torres Strait Islander people were hospitalised for intentional self-harm injuries at more than twice the rate of other Australians. It is important to remember that these figures are likely to underestimate how common self-harming is because not all self-harm injuries require hospitalisation; some injuries can be treated by a general practitioner or nurse at the local medical service and other injuries may not require any medical treatment.

How do you help people who are self-harming?

It is very important to take self-harming behaviour seriously and not react in a negative way. Medical treatment may be required if there is a risk of permanent harm or death (for example, from an overdose of medication, eating or drinking toxic products, too much bleeding, or injuries to the eyes). If the self-harming behaviour is not life threatening, health workers should support the person to get specialised professional help; doctors, counsellors, or behavioural therapists may be able to help the person to cope with their feelings and emotions. Protective factors which can act as a buffer against self-harming behaviours include:

  • seeking support
  • getting involved in community activities to keep busy
  • looking after one’s health (e.g., healthy eating and limiting alcohol intake)
  • seeking cultural and spiritual support
  • connecting with cultural and traditional beliefs
  • talking to family and friends
  • avoiding isolation (e.g., having the company of a family member or friend).

References and further reading

Auseinet (2004) Healing our way – self harm – a culturally appropriate resource for the Indigenous people of Yarrabah. Brisbane: FNQ Suicide Prevention Taskforce

Australian Institute of Health and Welfare (2010) Australia’s health 2010: the twelfth biennial report of the Australian Institute of Health and Welfare. (AIHW Catalogue no AUS 122, Australia’s health no. 12) Canberra: Australian Institute of Health and Welfare

Australian Institute of Health and Welfare (2009) Measuring the social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples. (AIHW Catalogue no. IHW 24) Canberra: Australian Institute of Health and Welfare

Freeman D, Freeman B (2009) Aboriginal social and emotional wellbeing fact sheet series. Campbelltown, NSW: Campbelltown Community Mental Health Service (SSWAHS)

Living Is For Everyone (LIFE) (2007) Living is for everyone (LIFE) resources. Canberra: Living Is For Everyone (LIFE)

Mental Health First Aid Training and Research Program (2008) Suicidal thoughts and behaviours and deliberate self-injury: guidelines for providing mental health first aid to an Aboriginal or Torres Strait Islander person. Melbourne: Mental Health First Aid

Queensland Department of Communities (2008) Responding to people at risk of suicide: How can you and your organisation help? Brisbane: Queensland Department of Communities

What are suicidal behaviours?

Suicidal behaviours include:

  • Suicide: when a person physically hurts themselves with the aim of ending their life and which results in their death.
  • Attempted suicide: when a person physically hurts themselves with the aim of ending their life but the act does not result in death.
  • Suicide ideation: when a person has thoughts about ending their life – which they may or may not have a plan for – but does not act on these thoughts.

Attempted suicide and suicide ideation are much more common than suicide.

What are the signs of suicidal behaviour?

Suicidal behaviour can be different in different cultures, so it is important to consider a person’s spiritual and cultural background. For each Aboriginal or Torres Strait Islander community, there may be unique or specific behaviours that are warning signs for suicidal behaviour.

It is not always easy to tell when someone is feeling suicidal and the warning signs may not be very clear. The following signs may help you to decide if a person is suicidal:

  • attempting suicide
  • threatening to hurt or kill themselves
  • talking or joking about death or suicide
  • communicating thoughts of death or suicide through drawings, writing, or songs
  • looking for ways to kill themselves (e.g., trying to get pills or weapons)
  • saying goodbye in a meaningful way to friends and family
  • giving away personal belongings
  • settling old or ongoing problems they may have with others
  • increasing the amount of alcohol and other drugs taken
  • withdrawing from friends, family, and the community (including running away)
  • taking part in risky, reckless behaviour without thinking of the outcomes
  • expressing feelings of hopelessness, or of being trapped and feeling there is no way out
  • feelings of anger or rage
  • not looking after themselves physically, or after their appearance
  • an obvious change in sleeping and/or eating habits
  • loss of interest in activities that once made them happy
  • changes in levels of mood, sadness, or anxiety
  • feelings of happiness or calmness after long periods of sadness
  • making arrangements for after their death, such as writing a will.

What are the risk factors for suicide?

Difficult events or situations in a person’s life may put them at risk of suicide. These can include:

  • suffering from mental illness, such as depression or bipolar
  • having a family member suffering from anxiety, sadness, or depression (e.g., mother, father, or grandparents)
  • harmful use of alcohol or other substances
  • having problems with family members
  • experiencing a relationship breakup
  • having experienced sexual, emotional, or physical abuse in the past or present
  • having known family, friends, or community members who have been suicidal or intentionally hurt themselves
  • experiencing grief or loss (e.g., children being separated from their parents)
  • having problems with the law, including being in prison
  • experiencing financial trouble(e.g., no money, unemployment, or loss of a job)
  • experiencing social problems (e.g., homelessness, inadequate housing)
  • experiencing physical health problems
  • living in a rural or remote location, particularly if living in isolation.

Age is also a major risk factor for suicide. In the Aboriginal and Torres Strait Islander population, people under the age of 35 years are at the greatest risk of suicide.

How common is suicide among Aboriginal and Torres Strait Islander people?

There has been a dramatic increase in the number of suicides in some Aboriginal and Torres Strait Islander communities in the past decade. The evidence shows that the rate of suicide among Aboriginal and Torres Strait Islander people is around two and a half times higher than the rate for other Australians. Aboriginal and Torres Strait Islander people aged between 25 – 34 years have the highest rate of suicide when compared with all other age groups.

Aboriginal and Torres Strait Islander people in any form of custody (e.g., lock-up or prison) are three times more likely than other people to commit suicide.

How do you help people who are at risk of suicide?

It is extremely important to never ignore a person if they are expressing feelings of suicidal behaviour. Often the hardest, but most important thing to do, is to ask if they are thinking of taking their own life. It is also important to take the person seriously and act immediately to keep them safe. Actions for helping someone who may be at risk of suicide include:

  • never leaving the person alone
  • talking to the person about how they feel without being judgemental or making the person feel shame
  • during a crisis, getting help from a professional by ringing ‘000’, or going to the nearest doctor, hospital, or mental health service
  • after a crisis, assisting the person to seek help from a mental health professional, family, friends, Elders, or community counsellors or services.

Finally, it is important that mental health workers never promise to keep a secret about a client’s suicidal behaviour or plans, instead workers should talk to the client about who else can help.

Please note the term ‘mental illness’ has been used in place of ‘mental disorder’ and ‘psychological disorder’ because it is a more common term.

References and further reading

Lifeline Australia (2009) Aboriginal suicide prevention information. Wollongong, NSW: Lifeline Australia Inc

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