Abstract
London has unexpectedly low overall rates of self-harm in public health data and contains highly deprived areas with these paradoxically low rates. Qualitative data were collected via interviews and focus groups with 26 individuals living and working in one such area. Using the Stress Process Model, we explore why this ethnically diverse community, which is exposed to multiple, chronic stressors, might nonetheless appear to have low rates of self-harm. Participants described significant impacts of stressors on the mental health of people locally. These were partly buffered by social resources related to community solidarity and a culture of self-reliance. However, identifying oneself as mentally ill through being known to have self-harmed was seen as highly risky, diminishing a person’s social status and exposing them to additional stressors from the community and services. Consequently, people tended to hide distress, respond with behaviors less linked to mental illness, and avoid mental health services.
Highlights
Self-harm is a behavior that occurs in response to distress, often but not necessarily as a symptom of a range of mental disorders (Haw et al, 2001)
We focus on a specific, local area within London where rates of self-harm are low compared with the surrounding city despite very high levels of socioeconomic deprivation
The Stress Process Model was used to inform the creation of the topic guides used for data collection and thematic maps produced during analysis, structuring them around stressors experienced by the community, resources available to cope and to buffer their adverse effects, and the way these elements interact over time to influence mental health and self-harm
Summary
Self-harm is a behavior that occurs in response to distress, often but not necessarily as a symptom of a range of mental disorders (Haw et al, 2001). Rates of self-harm, both non-fatal and suicide, are known to vary substantially between geographical areas and populations of different social statuses (Cairns et al, 2017; Platt, 2016) and are consistently associated with individual- and community-level socioeconomic deprivation (Cairns et al, 2017; Congdon, 2013) indicating an important role for social context. Within the United Kingdom, London has above national levels of socioeconomic deprivation and so would be expected to have high rates of self-harm. Quantitative studies using routine clinical data from 2009 to 2016 for South London to examine geographical patterning of small-area rates of self-harm within the city have shown that patterns were not explained by area-level socioeconomic deprivation and that some deprived inner-city areas had these paradoxically low rates (Polling et al, 2019a; Polling et al, 2019b)
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