“Self-harm is the deliberate act of causing physical or psychological harm to oneself, often as a form of escape or self-punishment,” explains Dr Su. “However, it does not solve the problem and can also develop into a maladaptive habit in the longer term,” he adds. More young females aged between 16 to 19 years old indulge in such behaviour compared to their male counterparts, but common risk factors include a history of unhappy childhood or trauma, living with other mental health disorders such as substance misuse or mood disorders, or physical disabilities that may induce stress or low self-esteem. Common tell-tale signs of self-harm include unexplainable scars, wounds, or bruises, as well as a tendency to ‘collect’ cigarette lighters or sharp objects such as razors, scissors, and pins. Individuals at risk often dress to cover up their arms and legs, where wounds are typically located. Additionally, their personalities may change — they become quieter, socially withdrawn, and display mood swings.
Although not as severe as suicidal behaviour, studies have shown that chronic self-harm is associated with an increased risk of suicide attempts.
A Rising Concern
Latest figures from the Samaritans of Singapore (SOS) reveal that while suicide rates in Singapore have decreased overall, more young individuals are taking their own lives. Suicide among those aged between 10 and 29 years old hit a record high of 112 cases in 2021 — accounting for one in three cases of suicide, and is an increase of 11 case from the previous year.
World Suicide Prevention Day, observed on 10 September, serves as a timely reminder that any suicide cases could have been offered lifesaving help and therapy with early detection. Such intervention is especially relevant for youths, as self-harming tendencies often emerge during adolescence and young adulthood. Empathy, help, and therapy during this critical stage can have a profound impact on the lives of these vulnerable and distressed young individuals.
Given the rise in youth suicide cases in recent years, Dr Su stresses the importance of raising awareness among the younger population and those who have close connections with young adults, such as teachers, family members, and friends. “Seeking help, including calling anonymous hotline numbers, can be essential to saving lives,” he emphasises.
Chronic self-harm can persist into adulthood, particularly if this behaviour has gone unnoticed, or here has been no intervention.
Triggers for self-harming behaviour tend to vary by age. For teenagers, these include academic stress, difficulty in relating to and bonding with other individuals, and issues at home. In young adults, bullying, peer influence, and relationship issues are common triggers. Older adults may struggle to cope with work or financial pressures, marital problems, mental and physical illnesses, or the loss of a loved one.
“When individuals at risk are overwhelmed by their stressors and develop an overwhelming sense of hopelessness, they may reach a conclusion that death is the only way to end the suffering,” says Dr Su. He urges people who are close to individuals at risk to pay careful attention to changes in their mood and behaviour. Some early warning signs that individuals at risk may be contemplating suicide include a withdrawn or sociallyisolated behaviour.
Another indicator is when they search the internet for ways to end their lives. Older adults may turn to alcohol to “drown their sorrows”, or speak of giving away treasured items to family and loved ones.
Here To Listen
According to SOS, one way to help individuals at risk is to show empathy, such as speaking to them in a non-judgemental and supportive manner. Having open conversations about mental health can also de-stigmatise the topic and help them understand that they are not alone.
“Talking to such individuals about their problems and trying to understand if they have suicidal tendencies will not worsen the risk — it is actually an opportunity to show them support. It provides a platform for them to feel relieved that they can talk to someone who cares,” says Dr Su.
Families and friends are key lifelines, as they are well-placed to help connect distressed individuals to support and resources available in the community. Professional support includes family service centres (FSCs), counselling helplines, and primary care doctors who are trained to manage mental health conditions.
At schools, there are teachers and counsellors who are assisted by REACH (Response, Early intervention and Assessment in Community mental Health) teams, and they can provide support to students at risk. REACH is a programme led by IMH. Those aged between 16 to 30 years old can also approach CHAT (Community Health Assessment Team) for mental health assessments and professional help.
Diverse forms of medical treatment are available to individuals in distress. At IMH, treatment is tailored to meet a patient’s needs, and involves a multidisciplinary, holistic approach by a team comprising psychiatrists, psychologists, nurses, medical social workers, occupational therapists, and case managers.
Recovery, says Dr Su, is not merely a relief from symptoms, but also about enabling these individuals to address their stressors and restore their functions in life and society.
Underlying these professional treatments is a need for strong family and community support. As Dr Su highlights, “Being there, either physically or virtually for one another, is important as ‘connectedness’ is a key protective factor against suicide. Being there for someone with suicidal thoughts can be life-saving.” LW
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