Self-harm increasing among girls

TEENAGE girls are more likely to be admitted to hospital for overdoses, slashed limbs or other forms of deliberate self-harm than for any other type of injury, including road accidents.

The alarming development, revealed in new national figures, illustrate the effects of intense academic pressure, changing family dynamics and rising drug and alcohol use, experts say.

The rate of self-harm among girls aged 13 to 19 has risen by one-third in the past eight years, moving in the opposite direction to the improved suicide rate, analysis from the Australian Institute of Health and Welfare shows. For every 100,000 girls in that age group, 300 were admitted to hospital after harming themselves last year, compared with 100 boys, the institute's report, Making Progress, says. The report brings together key measures of children's health and social wellbeing from several government sources.

Bruce Tonge, the head of Monash University's Centre for Developmental Psychiatry, said increasing academic pressure, even on high-achieving girls, was undermining their self-esteem at a vulnerable age.

Busy parents who set strict rules but did not put aside time to talk to their teenagers could be especially damaging. "There may be some alienation within families," Professor Tonge said.

Youth suicide rates were down, he said, probably as a result of suicide prevention programs and better treatments for depression, but while there was an overlap between suicide and self-harm, "they're not the same behaviour. [Self-harm is] a cry for help, a communication where other communications have failed."

There was also, "a copycat element, a cultural element," to

self-harming, Professor Tonge said, with the practice apparently more socially acceptable in some countries than others. And self-harm was promoted within some youth subcultures.

Patrick McGorry, the chairman of the executive committee of the National Youth Mental Health Foundation, which operates 30 youth mental health centres under the Headspace program, said the self-harm rates were indicative of worsening psychological health.

Young people already suffered, "the worst mental health of the whole life cycle", Professor McGorry said, and evidence from Britain and elsewhere suggested this was deteriorating with successive generations.

This might be because of, "the changing landscape of transition to adulthood … People are now in the mid-20s before they are financially and socially independent." Fees for higher education and debt created extra pressure, Professor McGorry said.

"Young people are not well equipped to deal with unbearable feelings and can be totally overwhelmed," he said.

Brain development was incomplete and this meant teenagers often could not manage intense emotions.

But self-harming could become, "recurrent or even a bit addictive", if it gave temporary relief from the negative emotion.

Increasing alcohol use was likely to be another factor, Professor McGorry said, because it lessened inhibitions that might otherwise stop young people from harming themselves.

We owe prisoners more than jail‏

Prisons are too important to be left to jailers, for the simple reason that the standard prison magnifies social problems. It is a congregation of people with an accumu–lation of risk factors for crime.

The prison experience generally adds to that accumulation. People's capacity to function in the community, including their parenting capacity, is weakened. Their children grow up with a bigger bundle of risk factors than their parents.

In this way prisons are at the centre of an inter-generational spiral of disadvantage and dys–function. In blunt terms, the more people who have experienced the standard prison the more will end up in prison in the future. Aus–tralia's prison population has been growing at an average of 5 per cent a year since 1984.The biggest challenge for the ACT is to see that the mental health of those who emerge from its new prison is better or at least no worse than when they entered.

Based on surveys of prisoners in NSW, it can be expected that ACT Corrections will have to cater for the 80 per cent of men and 90 per cent of women who will have experienced a major mental health disorder in the previous 12 months. Thirty-four per cent of women will have had an affective disorder like depression. The same percentage of men will have had an anxiety disorder; 40 per cent of men and 57 per cent of women will have had a personality disorder.

To cap all this off, 64 per cent of men and 75 per cent of women will have a substance use problem - overwhelmingly, dependence on an illicit substance rather than alcohol. Yes, sustance abuse and dependence are recognised as major mental health disorders.

The correlation between prison, drug dependence and other mental health disorders is no conci–dence. The rate of those with even severe mental illnesses like schizo–phrenia becoming mixed up in the criminal justice system is only slightly greater than the general population. The rate jumps through the roof when substance dependence is added to the mix. A big driver in the remorseless rise in the prison population is the fact that more and more people with other mental health problems are adding substance dependence.

The Government is committed to the prison being rehabilitative. If this is to be more than a pious wish, steps must be taken both in prison and after people leave to minimise recognised risk factors injurious to mental well-being. Within the prison there are barriers to people accessing the mental health treatment that is available. In the words of a prison psychiatrist, "Those who do seek mental health treatment are at risk of being seen by staff as attempting to evade the rigours of prison, and by fellow prisoners as weak and unacceptably alien." Somehow prison must compen–sate for the sudden loss of factors protective of mental well-being like beneficial social and family support. Strip searching is a com–mon practice. The Human Rights Commission found that a detainee on remand could expect about 10 such searches a week. This degrading practice can retraumatise the many women in prison who have experienced sexual abuse. In a Queensland prison survey, 37 per cent of women reported sexual abuse prior to the age of 16. Concern about radiation severely limits the use of X-ray scanners as a substitute for strip searches.

Seclusion is also pervasive in the standard prison. It commences with the 14∏ hours a day that remand prisoners presently spend in their cells. It can expand for any number of reasons, including unscheduled lock-downs. Separation and seclusion are all too often applied to troublesome prisoners who have a mental disorder.

Suicide can be prevented by placing someone threatening self–harm under surveillance in a bare cell devoid of hanging points. This is the reverse of therapeutic - human interaction is a key element in suicide prevention. Self-harm may be prevented in prison but not after release. A NSW study published last year found that the suicide rate for men was 3.87 times higher in the two weeks after release than after six months.

Then there are overdose deaths. Strip searching is just one of the draconian steps taken in the vain attempt to keep drugs out of prisons. In disregard of addiction being a chronic relapsing condition, prisons place a premium on abstinence. In many cases abstinence is achieved, only for the person, now with reduced tolerance to the drug, dying from an overdose upon relapsing after release. None of these mental health problems is insoluble. All we need to do is to deploy the knowledge we already have. The challenge is to change a mind set.

Bill Bush is secretary of the ACT Community Coalition on Corrections. He helped write its study "Healthy or harmful? Mental health and the operational regime of the new ACT prison" launched this week.

Bill Bush Canberra Times Wednesday 16 April 2008 p. 15

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