Self harm strategy and action plan 2023 to 2027: equality impact assessment

Key Findings

A full EQIA has been carried out. It has shaped the development of the strategy and will inform delivery of the action plan.

In summary, some of key findings gathered from the evidence, against each protected characteristic, include:

Age

• Scottish Health Survey (2021) revealed that 16% of those aged 16-24 had ever self-harmed, when compared with 0% of those aged 75 and over.
• PHS DBI Datasets (2020) similarly revealed that self-harm was most common in the two younger age groups of under 18 and 18-25.
• In a British Journal of Psychiatry systematic review of self-harm in older adults (60+) (2019), it was found that socio-demographic elements such as relationship status, living alone and being a younger older adult (aged 60-74), were all significant risk factors for self-harm repetition.
• An Alzheimer's Association Study (2023) revealed that there were strong links between self-harm and dementia diagnoses, especially among men.

Disability

• An increased risk was also reflected in a cross-sectional study by Emerson, E. et al, which showed that adolescents with a disability were 50% more likely to self-harm than their non-disabled peers.
• A Journal of Autism and Developmental Disorders publication (2020) revealed that autistic adults are significantly more likely to experience non-suicidal self-injury (NSSI) compare to the general population.

Sex

• The Scottish Health Survey (2019) revealed that 18% of women aged 25-34 had ever self-harmed, compared with 5% of men of the same age.
• This was also reflected in a British Journal of Psychiatry publication, which suggested that girls were approximately 3.4 times more likely to report self-harm than boys.
• This same publication outlines bullying, worries about sexual orientation and anxiety as some of the reasons given for self-harm in both girls and boys.

Pregnancy and Maternity

• The University of Manchester conducted the largest ever UK study to examine self-harm risk around pregnancy. This showed that in 1000 women, 4 were likely to self-harm over a year and this risk halved in pregnancy to 2.
• This study also revealed that mothers aged 15-19 were 66% more likely, 20-24 40% more likely and 25-29 15% more likely to self-harm between 3-6 months after giving birth, when compared with women of the same age who were not pregnant.

Gender Reassignment

• The 2017 LGBT Youth Scotland survey reported that 59% of transgender young people said they had ever self-harmed, with 11% currently self-harming.
• The Scottish Trans Mental Health Study (2012) specifically discussed the impact of transitioning on self-harm prevalence, with 63% of respondents saying they had self-harmed before transitioning and only 3% harming themselves afterwards.
• This same study indicated that trans people experienced much higher rates of self-harm and suicide both in comparison to the general population and to the rest of the LGB+ community.
• A 2018 NHS Greater Glasgow and Clyde Health Needs Assessment of LGBT and non-binary people revealed that 35% of non-binary people and 31% of trans people in Scotland had deliberately harmed themselves in the previous year.

Sexual Orientation

• The 2018 LGBT Youth Scotland Survey and the 2019 Scottish LGBT Rural Equality Report both suggested that that 43% of LGBT young people had self-harmed.
• The 2018 Health Needs Assessment, mentioned above, also indicated that the prevalence of self-harm varied considerably across LGBT+ groups, with more than 4 in 5 trans masculine and non-binary people saying they had self-harmed, compared to 3 in 10 gay men. Bisexual women had a particularly high rate of self-harm (70%).

Race

• Hate Crime Scotland Report (2020) states that post-migration stress and experiences of hate crimes are key triggers of self-harm in racialised groups.
• A UK Primary Care Study (2021) revealed that the concept of izzat (tr. honour/ respect) is a major influence in Asian families on negative attitudes towards self-harm.
• A 2018 study on the racialised impact of self-harm across three English cities, revealed that young Black females were at an increased risk of self-harm and were less likely to receive specialist psychiatric assessment and follow-up services than the White population.
• A 2015 study on self-harm and ethnicity, revealed that Asian males were least likely to self-harm and Black females were most likely to self-harm. There were differences in repeated self-harm, with Black and South Asian individuals being less likely to repeat self-harm. Religion and coping styles were identified as potential protective and predisposing factors.

Religion or Belief

• An Orthopsychiatry study (2020) revealed that some, but not all aspects of religiosity/ spirituality (RS) were associated with lowered risk of self-harm.
• A 2021 study into Clinicians' Perspectives on Self-Harm in Pakistan, revealed that stigma, financial constraint and religion were perceived as barriers that prevented people from accessing help after self-harm.