Black Dog Institute Media Alert

A landmark Lancet Commission report reveals cultural and societal issues are driving an increase in self-harm, underscoring the urgent need for governments to address this crisis.

Over the last five years, a global team of more than 40 experts has brought together new perspectives on self-harm, bringing knowledge from those with lived experience, low- and middle-income countries (LMICs) and First Nations communities to better understand the drivers of self-harm and provide transformative ways forward.

Launched in Australia today, the Commission paints a stark reality: 14 million episodes of self-harm are recorded globally every year, but this number is likely just the tip of the iceberg

“Self-harm must be recognised as a substantial public health issue. We are currently seeing escalating rates of self-harm, especially among young people. There is a prevailing belief that self-harm is a psychiatric diagnosis, but it is not, it is an intensely individual experience shaped by society, culture, and individual factors,” says Commission Co-Chair Scientia Professor Helen Christensen, University of New South Wales, and Black Dog Institute.

“Our review of the evidence found that treatment for self-harm remains highly variable and is often inaccessible, particularly within LMICs and for Indigenous peoples. In many settings, there is a lack of a caring, empathic response towards people who self-harm, a response that needs to be reversed.”

The Commission found that the online media industry must take greater responsibility for the safety of their users. The causes of self-harm are multiple and vary from individual to individual, and more needs to be understood about rising rates of self-harm in young people.

“Solutions to self-harm must reflect the needs of those most impacted by it. Culturally appropriate policies and treatments are vital to addressing longstanding poor care,” says Commission co-author Associate Professor Fiona Shand, Black Dog Institute.

“All self-harm interventions must be shaped by people with lived experience. Without the involvement of lived experience, we will fail to deliver effective solutions.”

The Commission was co-chaired by Professor Helen Christensen, who was joined by lead writers Professor Pat Dudgeon, from the University of Western Australia, Professor Jane Pirkis, from the University of Melbourne and Associate Professor Fiona Shand, from Black Dog Institute.

The Commission’s 12 recommendations offer a roadmap for governments, service providers, researchers and the media. These recommendations are an important step towards more effective self-harm policy, research and treatment in Australia.

About the Lancet Commission on self-harm

Access to the Commission and infographics is available via this link: https://www.thelancet.com/commissions/self-harm

Key facts:

Recommendations from the Lancet Commission on self-harm

For governments:

• Globally, a whole-of-government approach should address the upstream conditions that promote self-harm.
• Self-harm should cease to be punished.
• The prevention and management of self-harm in LMICs must be urgently prioritised.
• Colonisation and racism drive unequal power relations in society. These are the most frequently cited drivers of self-harm for Indigenous communities.

For the delivery of services:

• Better service integration and staffing will ensure that individuals who repeatedly self-harm receive the help they need.
• People with lived experience of self-harm must be supported to lead and participate in the design, delivery and evaluation of care.
• Health and social-care professionals should be trained in the compassionate assessment and management of self-harm.

For the media and wider society:

• Discussion about self-harm should focus on relatable stories of survival, recovery, coping and help-seeking.
• The online media industry must take greater responsibility for the safety of their users, particularly young people and other vulnerable users.

For researchers and research funders

• International research funding should be directed towards LMICs, where the burden is greatest.
• Robust and anonymised self-harm surveillance systems should be set up to monitor trends in self-harm across the world.
• Mixed methods biopsychosocial research applying social ecological approaches to understanding self-harm should be prioritised.