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St Stephens Centre, 171 Nineveh Road, Handsworth, Birmingham B21 0SY
Jessica Kingsley, 2006, £17.99 pb, 264 pp. ISBN: 1 84310 230 7
The book examines the nature of self-harm in adolescents and its management in the context of the international evidence base. At the centre is the authors’ own community-based study of 6000 adolescents which is a part of a Europe-wide collaborative effort.
The book begins with a useful overview of the key methodological issues in research and goes on to look at the extent and nature of the problem, including the characteristics of adolescents who engage in self-harm. The motives and means of self-harm are discussed at length, as are issues of risk and resilience.
The strengths of the book lie in the community focus and in the strong emphasis on prevention. It succeeds in exploring the hidden extent of the problem and the challenges in developing adequate, effective and responsive services. It highlights the difficulties that adolescents have in accessing services and discusses alternative approaches, including self-help literature, the internet and helplines. The focus is firmly on generalist interventions in schools and primary care, with only a minority of adolescents considered to need specialist services. The qualitative aspects of the authors’ own study make the recommended strategies both sensitive and robust.
There is a finely judged appraisal of both positive and negative aspects of the media. The book, however, echoes the inherent difficulties in separating self-harm from suicide based on fatal outcome alone. This is reflected in the various operational definitions that crowd the literature, including self-harm, attempted suicide, suicidal ideation and suicidal phenomenon, all of which may be used for overlapping but distinct domains. The review of the literature hovers uneasily over these various terms, making the task of separating the impulsive from the compulsive and communicative intent difficult.
The book is aimed at ‘teachers, social workers, mental health professionals, policy makers and researchers’. The wide remit ensures accessibility but eschews detail. The blurb that promises the books usefulness in ‘developing training programmes’ is ambitious at best unless the ‘Guidelines for school’ (Appendix III) is meant to do this. Moreover, comparing the relative merits and availability of the various clinical interventions might have been more useful than merely listing them.
In the authors’ own study the omission of any questions regarding developmental comorbidities is surprising, as comorbidity can reasonably be assumed to affect coping styles. More worryingly, the authors asked questions specifically about sexual and physical abuse but were unable to follow these because of the anonymous nature of the reporting. Providing contact information and the ‘safety net’ arrangements that the authors detail seem an inadequate response to potential child protection concerns.
However, on balance the book fulfills its remit. The emphasis on user friendly information, guidelines and factsheets ensures that it engages its target audience. The authors append both a useful contact list and provide an extensive bibliography. The final chapter provides recommendations for both clinical practice and research. The unique insights into the world of adolescents and their values will be appreciated by clinicians, researchers and service providers alike.
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| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| British Journal of Psychiatry | Advances in Psychiatric Treatment | All RCPsych Journals |
