Staff perceptions of self-cutting and suicide risk among high school adolescents

Background: Self-cutting among adolescents is a matter of increasing clinical and social concern. This behavior has an ambiguous relationship to suicide risk. Purpose: To describe high school personnel's perceptions of self-cutting among their students. Significance: Self-cutting is increasingly prevalent and has been associated with several psychiatric conditions. Public health professionals could assist high school personnel in addressing this serious mental and physical health issue. Methods: For a study of an urban school district's Youth Suicide Prevention Program, high school personnel (n=42) from 11 schools were interviewed about their school's suicide prevention activities. Participants were asked about identification and management of at-risk students. Findings: Self-cutting was discussed in 31 out of 42 (74%) interviews, by all types of personnel, indicating widespread familiarity with the issue. Self-cutting was described as popular and on the rise in high schools. Many participants were unclear as to whether to classify self-cutting as suicidal or non-suicidal. They described their idiosyncratic ways of identifying “cutters,” e.g., by students' clothing choices. Many participants called for assessment tools and strategies for detecting and addressing self-cutting; they expressed confusion as to “what to do” with students who may not be at risk for suicide but who engage in self-injurious behaviors that may indicate psychological risk. Conclusions: Self-cutting and other self-injurious behaviors are on the rise, especially among young women. Because they are in a unique position to intervene in this adolescent-concentrated phenomenon, high school counselors and other staff need education, information, and protocols to address these behaviors in their students.