People who self-harm ‘face medical ping-pong over mental health services’


People who self-harm without wanting to take their own life are being excluded from mental health services in a form of “medical ping-pong”, a report has found.

A quarter of adults in England polled by Samaritans said they sought NHS mental health support after self-harming, but commonly described feeling caught between services or receiving ineffective care.

The charity said people who self-harm are considered too high risk to access common mental health services, such as Improving Access to Psychological Therapies (IAPT), based on a “blanket perception of suicide risk”.

But they are deemed not ill enough to be treated by community mental health teams, which have a high threshold for access.

Its new report, Pushed from pillar to post, also found “too many” people are being let down when they do receive NHS services, which too often ban or ignore self-harm or do not recognise its link to trauma.

This means people struggle to develop coping mechanisms or address the underlying reasons behind their self-harm.

The charity surveyed 585 adults aged 16 and over who have experience of self-harm between September and December 2019, and conducted 17 in-depth interviews.

It said: “People who have self-harmed but do not have an enduring mental health condition are either too high risk for one service, or not ill enough for another.

“Services must do much more to provide support after a person makes the first difficult step to get better.”

Assistant director of research and influencing, Jacqui Morrissey, said: “Self-harm is a strong risk factor for suicide – however, the majority of people who self-harm do so without wanting to end their life and as a way of trying to cope with distressing feelings.

“What our research shows is that people in serious emotional distress who self-harm are slipping through the cracks in NHS support.

“Having found the courage to reach out for help, this vulnerable group are being denied support because the current system is not set up to help them. Mental health services such as IAPT need to be able to support people who self-harm.”

Government investment is needed “much sooner than is currently planned”, she said, adding: “Given that demand was already outstripping capacity before Covid, we are really concerned about the system’s ability to cope in the current circumstances.”

Rates of self-harm in England have more than doubled over two decades, and in 2019, self-harm was discussed in more than 272,000 calls for help to Samaritans volunteers.

Fresh analysis of the Adult Psychiatric Morbidity Survey suggests that 48% of people who self-harmed in the past year did not have severe levels of anxiety or depression when interviewed.

Amelia, aged between 35-44, said: “Generally, my self-harm has not been regarded as serious as I have carried on working and functioning, so my mental health is not considered as being bad enough for NHS help.”

The charity found that few of those who did access healthcare found it useful for self-harm.

A third (32%) of Samaritans volunteers said callers who are concerned about their mental health most frequently talk about NHS mental health treatment not being effective.

Tabby, aged 18-20, said: “(In group therapy) you’re not allowed to say the words self-harm, and you’re not allowed to talk about any situations, like, you can’t use examples, using self-harm. So, it’s another way of, stigmatising it.”

A recent report from the All-Party Parliamentary Group on Suicide and Self-Harm Prevention, also found that those who self-harm are struggling to get appropriate support.

It found young people are suffering alone and reaching crisis point before being offered help, or being “bounced” from one service to another while in crisis.

A Department of Health and Social Care spokeswoman said: “We are absolutely committed to supporting everyone’s mental wellbeing, especially during this unprecedented time, and NHS mental health services have adapted to continue to provide support, including by using digital appointments and face-to-face consultations where possible.

“Our commitment in the NHS Long Term Plan will see two million more people able to access mental health services by 2023/24 and we will continue to work with the NHS, Public Health England and others to support the public’s mental health and wellbeing.”