The experiences and perspectives of young people who self-harm in general practice: a qualitative study

Problem

Self-harm in young people is a major public health concern. Suicide is the leading cause of death in young people (16-25 years) in the United Kingdom, and self-harm is the strongest risk factor for suicide. Reducing rates of self-harm is a key national priority. Over half of young people who die by suicide have a history of self-harm. There are estimated to be around 200,000 young people who self-harm in the community and do not present to hospital. Self-harm in young people presenting to general practice is rising, and general practice is the healthcare setting young people with self-harm attend for help most often. There is, however, no published evidence on young people’s experiences and views of care received for self-harm in general practice, and on access to general practice services. This study aimed to explore the experiences and perspectives of young people (16-25 years) receiving care for self-harm in general practice, and barriers and facilitators to accessing general practice care.

Approach

Semi-structured, face-to-face or telephone interviews with 13 young people in England were conducted from April-November 2019 to attain rich insights. Sampling was purposive to achieve maximum variation in age, gender, practice location, and socio-demographic status. Interviews were audio-recorded and transcribed verbatim. Transcripts formed the data and are being analysed by inductive thematic synthesis using principles of constant comparison.

Findings

Preliminary analysis has identified emerging themes including a hierarchy of self-harm behaviour, with method of self-harm changing over time. Young people report that stigma around self-harm behaviour hinders them from openly talking about self-harm with GPs, which is then further exacerbated when self-harm is overlooked by GPs. Young people felt GPs can be dismissive when self-harm is mentioned in the consultation. Young people describe how past experiences of GP care influence future help-seeking for self-harm. For young people who had positive experiences of GP care, continuity with the same GP was important, and acts as a facilitator for accessing future general practice care. Full analysis will be presented, and all themes agreed upon by the research team.

Consequences

This is the first study to report on young people’s experiences of care received for self-harm behaviour in general practice. These findings will be crucial for improving the care young people receive for self-harm in primary care, and help to reduce repeat self-harm and prevent suicide. This study will inform the development of integrated primary care self-harm models outlined in the NHS Long Term Plan and clinical guidelines for self-harm.