Simple solution most effective in reducing self-harm

Simple, adolescent-focused interventions have shown greater success than costly, clinical strategies in reducing the incidence of one of the Caribbean’s biggest mental health challenges—rising youth suicide and self-harm—a leading international suicide prevention expert revealed.

Professor Christina Hoven of Columbia University on Wednesday shared compelling findings from one of the largest clinical trials in the world on adolescent suicide prevention.

“It included 11 000 children in ten countries,” Hoven told those gathered at the Lloyd Erskine Sandiford Centre for the Caribbean Public Health Agency’s 69th Annual Health Research Conference. “The expectation was that these interventions which were using the psychologists and the psychiatrists and very expensive interventions [would be most effective]. It turned out that the awareness intervention was, in fact, the most effective.”

The study, known as the SEYLE (Saving and Empowering Young Lives in Europe) Project, compared four approaches: immediate clinical intervention following screening, standard referrals, a World Health Organisation (WHO)-inspired classroom awareness programme, and a control group with no intervention. A year later, the simple classroom awareness strategy outperformed all others in reducing self-harm.

“We developed a very adolescent-friendly booklet. We did an intervention in the classrooms that took no more than half an hour, and then 12 months later… the most satisfying thing was to see that the kids were still carrying around this little booklet in their backpack. It, in fact, made a major reduction,” Hoven said.

She added that the success of the awareness campaign lay in its simplicity and ability to empower the youth themselves.

“It did not rely on fancy, expensive interventions,” Hoven said, stressing that for the vast majority, a simple awareness intervention can be transformative.

As youth suicide and self-harm escalate across the Caribbean, Hoven stressed that effective intervention must begin earlier and focus on the reality of adolescent communication.

“There are very simple things, like, if a kid is gonna hurt themselves, they usually or frequently have a very good friend that they talk to,” she explained. “They both agree, ‘let’s kill ourselves, let’s cut ourselves, let’s do something’. And then at one point, one of them decides tonight’s the night.”

The result, she warned, can be tragic: “The next day that child may be dead and that other child who knew about it has to live with that for the rest of their life.”

Simply having a conversation with young people about this dynamic can save lives, Hoven said. “If you truly are the best friend, you get help. It’s a very simple thing. Talk to somebody. An adolescent can clearly understand that.”

Addressing the broader challenge of public health delivery, Hoven criticised the global failure to translate research into action.

“One of the major deficits is that we have a wealth of literature out there… it’s the implementation and the adaptation to make it work in the different settings,” she said.

“You don’t have to start over again. It’s just not cost-effective for everybody to be doing the same thing,” Hoven added. “It’s a tragedy how much money we spend today on research that doesn’t get implemented.”

(SZB)