Two researchers from The University of Western Australia were among 46 international authors who contributed to a global report on self-harm, which found at least 14 million episodes yearly worldwide, with the biggest burden felt in low and middle-income countries and higher incidence among young people.
But this figure is likely an underestimate as people who self-harm often do not present to health services, there are few routine surveillance systems, and self-harm with suicidal intent is still a criminal offence in some countries, according to the report. Attitudes lacking empathy, including in healthcare settings, can compound stigma and keep people from seeking help.
Published today, the Lancet Commission on self-harm is the product of a substantial team effort that has taken place over the past five years and consolidates evidence and knowledge derived from empirical research and the lived experience of self-harm.
Image: Indigenous psychologist Professor Pat Dudgeon AM.
Leading Indigenous psychologist Professor Pat Dudgeon AM and Research Fellow Dr Kate Derry, from UWA’s School of Indigenous Studies, were among 12 Australian authors and nine Indigenous authors who contributed to the report, which included the voices of Indigenous communities and the role of colonisation in self-harm rates.
Self-harm refers to intentional self-poisoning or injury, irrespective of apparent purpose, and can take many forms, including overdoses of medication, ingestion of harmful substances, cutting, burning, or punching.
According to the report, drivers of self-harm have been neglected by governments and self-harm is not a psychiatric diagnosis; it is a behaviour shaped by society, culture, and individual factors.
The social determinants of health, particularly poverty, heavily influence the distribution of self-harm within communities and further research is needed to understand how an individual’s self-harm evolves and to bring about more timely and effective interventions, it says.
Professor Dudgeon, Director of The Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention at UWA, said two major structural drivers of inequality among Indigenous peoples were colonisation and racism.
“They are the most frequently cited factors in the causes of Indigenous health crises, including suicide and self-harm, by Indigenous researchers,” she said.
“These two factors drive unequal power relations in society and have complex ripple effects at economic, political, and cultural levels.”
Professor Dudgeon said biomedical and psychocentric models dominated suicidology and intervention science.
“Indigenous health researcher critiques recognise the role of individual biological or psychological factors, but point to their limitations,” she said.
“Best-practice Indigenous suicide prevention must be grounded in human rights frameworks that acknowledge and address the root causes of suicide, not the symptoms.”
Dr Derry said imposing ethnocentric views of mental health and determinations of what constitutes appropriate interventions had resulted in institutional racism and created barriers to treatments.
“Further, by lacking cultural respect and a historical perspective, these interventions often contribute to individual suffering by failing to promote collective dignity and psychological liberation and unintentionally inflicting further psychological oppression by promoting social conformity and supporting existing power structures,” she said.
“Though there is substantial diversity across and among Indigenous communities, all share trans-generational experiences of colonisation and racism, which are the source of the wound, as well as a holistic view of health and wellbeing, which must be the source of healing.”