As a high school teacher, I can tell you that self-injury is definitely on the rise. I see more cases now than I did 20 years ago.

And unfortunately, social media plays a big role in giving encouragement for the behaviour.

The isolated teen might choose to self-injure themselves 2 times in a day, then get on a Facebook page or a blog site, and then chat with other teens, and then they all make a pact to injure themselves 3 times the next day. So they end up encouraging each other and being  friendly with each other over the self-harming behaviour.

Self-harm is not new, but self-harm as a socializing behaviour on social media is new.

Self-harm was once done by nuns, monks, and priests. They would punish themselves for having "impure" thoughts. They would whip themselves, starve themselves, walk with pebbles in shoes. And this was seen as very pious behaviour; very disciplined behaviour intended to drive away impure thoughts.

But those nuns and priests could articulate why they were self-injuring: to become pious and closer to God and pure. Today's teens typically cannot articulate why they are self-harming. So the nuns and priests could be treated by telling them that their bodies are temples, and God doesn't want them to harm their bodies.  But today's teens cannot articulate their "cause" for self-injury, so it's so difficult to tell them anything that will cause them to stop.

Sometimes self-injury is purely a mental health thing. Sometimes it's purely a social media thing. Sometimes it's a family dynamics thing. But usually it's a mix of issues. If it's mostly a socail media thing for the teen, then the most effective thing might be to find a website or chatroom where the teen makes friends over positive behaviour, rather than destructuve behaviour. So then teen gets a feeling of belonging to a virtual community over something positive. There's a web community about "a butterfly effect," where teens encourage each other to draw butterflies on their bodies rather than self-injure. For some teens, a change of website communities is all it takes to stop self-harm.

For others, self-harm is more of a family dynamics thing. The teen feels neglected, and gets attention from parents by self-harm. As parents react to the self-harm, the teen does more self-injury to get more attention. And in an escalating case like this, the whole family dynamic needs to change, and that means hours of counselling by mental health professionals. Something our health systems don't have enough resources to deal with.

I don't understand the cutting thing. I worked with a girl a long time ago, maybe 15 years ago, who had scars (healed over) on her arm. She was 'goth'. I never asked her about it. It was just too uncomfortable. But maybe it is some sort of 'groupthink' trend that happens on a dare. There was no social media then. If it's about a trend- get them help and turn them onto healthy trends- if it's about deep personal issues, I would try to help teens (through a professional) find more proactive approaches to dealing with what's bothering them- first, find out what it is that is causing them pain enough to do that. I am not surprised that teens are feeling lost and hurting in today's world. That needs to be listened to.

I don't think people start because it's a trend.  It's like the pro-ana sites.  People have issues and find others who are expressing those issues in a similar way and encourage each other with the negative expression.  I don't think someone starts cutting because they know others who do.  It's also something that many feel shammed about and they hide.  Social media gives them a place to be open about it.

Anorexia (and other eating disorders) are a specific type of self-injury.

I do agree that teens don't start any form of self-injury as a trend.

But social media does play a role in perpetuating the behaviour and reinforcing it, which leaves a lot of professionals throwing up their hands in despair.

Example: a 14-year-old girl is starving herself. Her ribs are protruding. Her parents and doctor react in horror, and tell her that's dangerous. She posts photos of her ribs on her pro-ana site. She gets 14 positive comments from her on-line community: "Great!" "You're beautiful!" "Wow, you're awesomely powerful!" If you're a 14-year-old, which would be more motivating for you: a parent/doctor lecturing you, or dozens (if not hundreds) of positive comments from virtual peers?

I think I first noticed the "covens" of self-injurers at school when the "Illuminati" became a trendy word. In Dan Brown's "The DaVinci Code" there is a group of systemic self-injurers who call themselves the Illuminati. There probably were some teens who were self-injurers to try to deal with their problems and feelings. And when they saw the movie "The DaVinci Code," (or read the book), all of sudden they could adopt and imitate a name, and a symbol, and a systemic, ritualistic  way to self-injure. And then one school's "Illuminati" group hooks up with another on Facebook, and then another, etc.

How does a doctor/teacher/parent fight that? Do we contact the server (like GoDaddy) and pressure them to shut down those sites? Even if that could be done legally and quickly, more websites would spring up just as fast as others come down. Do we take away all electronics from the kid, and then only allow them internet time when we're standing over them to watch them? Not very practical. And even if the parent takes away all electronics, the kid can just borrow someone else's phone or I-pad at school or McDonald's or wherever there is wireless (on other words, pretty much everywhere these days.)

You can't fight social media, and when you're trying to separate a kid from virtual peers that reinforce that destructive behaviour, you ust throw up your hands in despair.

Hi Kaythecurler,

Disclaimer.  I have had personal interactions with one of the doctors responding in the article.  The interaction was not favourable.

Professor Lawrence Katz does make a comment which I can empathize with:

I would also like to qualify the professor's statement.  Many hospitals in Canada do not have a pediatric psych wing and when a youth in crisis is admitted there is serious concern about which bed in which wing that youth should be given.

Most hsopitals will not admit a 13 year old in crisis to a simple pediatric unit.  It isn't safe for the other children.  Nor will they place a 13 year old willingly on an adult psych unit.  It isn't safe for the 13 year old.

If my 13 year old goes into crisis in Brantford I can take them to the local emerg.  Their first course of action is sedation and discharge.  If the parents or guardians will not agree to that their only option is to reluctantly admit the child to an adult psych wing until a youth bed in London, On is available.  Hamilton is much closer and has youth facilities but in the stupid way boundaries are drawn for health intake Brantford (roughly 20 km away from Chedoke-McMaster) is closer to London (roughly 120 km away).

There is nothing to the south and I have not had opportunity to explore what options exist north.

It isn't that London's facilities or staff are second rate.  It is that they are not doorstep.

In the province of Newfoundland and Labrador the only pediatric psych unit is at the Janeway in St. John's.  While we were in St. Anthony that meant if our son was in crisis we were eligible for a one hour air ambulance flight to St. John's.  If they had a bed available.  More often than not they didn't.  Which means we are now looking at a 13 hour drive one way.  No hospital is giving up an ambulance crew for 26 hours.

So, hospitalization was in the maternity ward because there was no pediatric or adult psych wing in St. Anthony.  And the only psych on staff was barely competent.  Long story short we signed an order prohibiting him from treating our son.  The pediatrician on staff was far more competent medically.

While we were in Botwood we were within an hours drive of hospitals in Grand Falls-Windsor and Gander.  GF-W was at 140kmph less than a 20 minute drive.  Mercifully the highway is pretty straight.  At any rate GF-W preferred sedation and discharge which solved their problem of where to put the patient.  It never represented anything approaching help.

Highlights of care at GF-W was arriving at hospital to hear that they had put my son in their new quiet room.  So new there was no observation port into the room (how can anyone be so stupid as that) and when I said I was opening the door to check on him, since he was now quiet the absolutely stunning discovery of an empty room.  If you thought the lack of observation port was stupid tell me how brilliant a quiet room with another exit directly outside is.

This resulted in the local RCMP being dispatched on a hunt for a youth in crisis through Grand Falls-Windsor.  No problem it is February and he is without boots or coat so we should catch up with him before too long.

And while never able to verify the truth there was a rumour that on duty psychiatrists would turn their pager off and leave the hospital when ambulance was inbound with my son so that they would not have the emerg doctors sign him over to their care.

So I  have no trouble believing that things haven't gotten much better in terms of funding in the last 10 years.

Though my son has gotten better care here in ON and that has given him a better outcome.

Grace and peace to you.

John

I don't have any answers really, just an observation. In 2008 all ten provincial psychiatric hospitals in ontario were aborbed into the public hospital system and are now governed by the public hospital act.

I just wonder if by replacing the Mental Hospitals Act with the Public Hospital Act and closing down facilities that were primarily devoted to mental health issues, would have overburdened most hospitals? I would think that the average hospital has had to overly diversify and stretch limits to the point that it would be impossible to provide service properly for every one that comes through their doors.

I have a niece who has mental health issues primarily anxiety. A a teen she cut quite regularly

Kimmio, they cut because they feel numb. They want to feel the pain because for a short time it makes them feel better.

It is very troubling and like other mental health issues requires long term work form family, the teen and the medical folks.

No easy answers

Actually, I should say, one of the reasons they cut is to feel something. I suspect there are numerous reasons, that was my nieces issue

It is a substantial problem, and RevJohn's description of the admission conundrum is true, in my experience.  I would go so far as to say "most hospitals" do not have such paeds/adolescent beds available.  My hospital is almost 1,000 beds over 3 sites - none for paeds or adolescents with mental health issues.  They transfer to another nearby facility with a very limited number of beds - IF there is availability. 

One service that is starting to evolve & I'm a fan of it - walk-in mental health clinics.  In Halton Region , there is an excellent one for children, youth & families  http://www.rockonline.ca/  but its hours are still pretty minimal, considering the need.  I wish more of this was available. 

Ironic that this thread should appear the day after Seelergirl brought to my attention that Medicare (at least in this province) does not pay for mental health care for children and teens.  And a young person doesn't have to be cutting or anorexic to need mental health care.  Depression, bi-polar, personality disorders, etc. can manifest themselves in children.  The sooner diagnosed and treated the better.  But many families cannot afford the help they sense they need - so they put it off and hope the child will grow out of her moodiness or her temper tantrams, or anti-social behaviour.

My step-sister started 'splurging and purging' when we were teenagers. She was 15 I was 13-14. It was because someone in her group of friends heard that fashion models did it to stay skinny. The room we shared when I stayed there was plastered with photos from Vogue and Elle. I had heard it was dangerous, from somewhere. So, I told my dad and step-mom on her. In her case it had not become a regular thing or into habitual full blown bulemia- it was a few time thing- and she didn't end up with psych help- it resulted in my step mom giving her heck and watching her- but it could have progressed that far. Peer pressure had something to do with it, for sure. She may have been in more danger had there been social media. Cutting sounds like an even more complex problem.