Self-harm The UK has the highest self-harm rate of any country in Europe with estimates of 400 in 100,000 people self-harm (Harrocks 2002). These figures are likely to be higher as many people who self-harm do not tell anyone about it. Self-harm can affect anyone however the majority of people who report self-harm are aged between 11 and 25. What is it? Self-harm is when you hurt yourself as a way of dealing with overwhelming, painful memories or difficult situations and experiences. Some people have described self-harm as a way to: express something that is hard to put into words turn invisible thoughts or feelings into something visible manage their anxiety or panic attacks change emotional pain into physical pain reduce overwhelming emotional feelings or thoughts have a sense of being in control escape traumatic memories have something in life that they can rely on asking for help without having to discuss their painful memories punish yourself for your feelings and experiences stop feeling numb, disconnected or dissociated counter balance greater pains in their life a coping mechanism to not lash out at others create a reason to physically care for themselves express suicidal thoughts without taking their own life The ‘iceberg model’ has fatal self-harm (suicide) as the highly visible tip overlaying the more frequent non-fatal self-harm seen by clinical services, which lies atop of an even larger base never contacting services. Although accepted in principle, few data have shown the relative sizes of these three groups, hampering potential preventative and educative programmes. A new paper in Lancet Psychiatry explored this in young people using national mortality and hospital monitoring self-harm data, and a schools’ survey. The data are harrowing: 171 adolescents (aged 12–17) died by suicide in England between 2011 and 2013; for each of these deaths there were about 370 hospital presentations with self-harm, and 3900 adolescents self-harming but unseen in the community. Ratios of non-fatal/fatal self-harm varied between genders – the former far higher in females, with males accounting for 70% of suicides. Hanging or asphyxiation were the most common cause of death, self-poisoning the most common hospital presentation and self-cutting the most common form of self-harm in the community. These figures are difficult to ignore, suicide is the leading cause of adolescent death in the UK. Every year an estimated 200,000 young people self-harm in England and are not seen; this suggests that out-reach of our services must be developed and the authors propose schools-based programmes as a key target. The British Journal of Psychiatry (2018) 212, 126–127. doi: 10.1192/bjp.2018.3 High rates of self-harm are reported by individuals who also have borderline personality disorder, depression and eating disorders. It is even more prevalent within the prison estate. Horrocks, J., House, A. & Owens, D. (2002). Attendances in the accident and emergency department following self-harm; a descriptive study. University of Leeds, Academic Unit of Psychiatry and Behavioural Sciences Haw, C., Hawton, K., Houston, K. & Townsend, E. (2001). Psychiatric and personality disorders in deliberate self-harm patients. Br J Psychiatry.178, 48–54.