Nikki Smith started self-harming when she was 11, and now provides support to others. Picture: Rick Liston

“It was really hard for me because at the time I felt so undeserving and him saying he wasn’t going to stitch me up was almost like I wasn’t worthy of care,” she says.

Alice, who started self-harming at the age of 15, has also experienced being sutured at a Melbourne inpatient unit without enough anaesthetic. Despite protesting that she still felt pain from the needle, Alice was ignored. She understood this response as a “punishment.”

“It’s almost like you did this to yourself, so therefore this is the consequences,” she says.

Unthinkable as this seems, it’s all too familiar to Dr Jo Robinson, a senior research fellow at Orygen, the National Centre of Excellence in Youth Mental Health in Melbourne. As part of in-depth research for the recent Looking the Other Way report, Jo and her colleagues interviewed 15 young people with a history of self-harm.

“Young people were telling us stories like being stapled or sutured without any form of anaesthetic,” Dr Robinson says.

“They felt criticised and judged by emergency department staff and first responders, such as police and ambulance.

“If you have a response like that you are very unlikely to go and seek help again,” she says.

Shockingly, Dr Robinson goes on to explain “damaging responses from services” can lead “some young people to help stitch each other up … rather than go to hospital or see a mental health professional or a medical professional.”

Self-harm can be defined as intentional injury to oneself, with a non-fatal outcome. It may include behaviours such as: cutting or burning oneself, self-poisoning, self-battering and risk taking.

According to the Orygen report mentioned above, 24.4 per cent of young women and 18.1 per cent of young men aged 20-24 have self-injured in their lifetime.

They’re astounding statistics and confronting to think about. That’s a nearly quarter of young women and one in five young men.

While half of these young people never seek help, the report states that more and more young people are being hospitalised for self harm.

“The majority of hospitalisations are for self-poisoning, however the majority of reported self-harm in the community is self-cutting,” the document says.

Dr Robinson stresses self-harm is not an attention-seeking behaviour, but can be seen as coping mechanism for “acute, deep distress.”

“It can be confronting to see somebody hurt themselves on purpose, it can be confronting to see the scars and those wounds and those injuries.

“But actually if you look beyond those, at a very distressed and frightened young person, all that young person generally needs in the community is compassion and understanding.

“People don’t self-harm unless there is something wrong,” Dr Robinson continues, “it’s a sign that somebody needs some help.”

Alice is a case in point. Seven years ago her parents separated and her mother moved interstate. She ended up living with her father, who neglected to buy her food and was physically abusive.

“He was very angry, especially about the separation so he tended to take that out on me,” Alice says.

She remembers feeling both “scared that he was going to hurt me” and “scared because I felt very out of control.”

Alice had heard of other children at her school self-harming; she wondered if it might be a way to help her cope.

“I just felt so full of … emotions and thoughts that I didn’t know what to do with them. The only way to make it stop was to self-harm,” Alice says.

At the start, Alice’s self-injury was “very minor” but “the more frequently it happened, the more frequently it needed to happen and the worse it needed to happen to get the same effect.”

“There was a point when I was in emergency maybe two or three times a week getting stitches,” Alice says, adding: “I also used not eating as a form of self-harm.”

Although Alice hid her self-harm from everyone apart from a few close friends and a trusted teacher, it was still a cry for help.

“It was my way of saying: ‘Please I need help. I don’t know to ask for it’,” Alice explains.

Psychologist Dr Rohan Borschmann, NHMRC Early Career Fellow at the Murdoch Children’s Research Institute, is also an expert in the field of self-harm. Alongside previous research, his work shows that self-harm is much more common in adolescent girls than boys.

Dr Borschmann says most self-harm starts between the ages of 12 and 16 and the prevalence reduces by the age of 19 or 20. However, he believes we need to be cautious about believing the problem simply resolves itself.

“It’s literally a matter of life and death because even if someone’s self harming without the intension of dying, unfortunately the outcome is not entirely up to them.

“They might accidentally do something that leads to them dying,” he says.

Dr Robinson concurs, adding that self-injury puts young people “at risk of a whole range of negative outcomes later in life” and is “the single biggest predictor of future suicides.”

When I ask Alice if she ever saw her own self-harm as a suicidal behaviour, she laughs.

“It’s the opposite,” she says, “it was almost like if I self harm, then I will feel better and I can get through today.”

Somewhat startled, I ask: “You’re self-harming to stay alive?”

“Yeah, that’s how I would explain it,” she replies.

The first time 30-year-old Nikki Smith turned to self-harm, she was 11 years old. Her memory of it is hazy.

“In a way, it’s a bit of a blackout for me … and I don’t realise I’m doing it until after the fact,” she says.

“I don’t make a decision when I go into self-harm,” Nikki says, “it kind of just happens.”

Nikki Smith, who has started a support group for people who self-harm. Picture: Rick ListonSource:news.com.au

Sitting alongside Nikki for support is her psychologist, Fiona Mason, who explains Nikki’s “blackout” as “a form of dissociation.”

About 20 minutes after harming herself, Nikki describes coming out of this state.

“Initially I feel a bit of a relief and I’m little bit in control of my body. And then a whole different thing takes over my body with the shame and the guilt that I did that to myself,” she says, “I have always covered myself up so no one knew.”

Nikki explains that she never hurt herself so badly that she ends up in hospital.

“It’s just enough for me to feel something,” she says.

Over nearly two decades, the methods Nikki used to self-harm became more severe and frequent. Reflecting on why this was the case, she says: “That’s a very hard question.”

“In a way, for me, it’s kind of like a drug. You’re not satisfied until you get that fix. But I never ever did it for attention, ever.

“I just didn’t feel like I was good enough. I was feeling so much pain, and the only one way that I could release that pain and anger that I felt was to self-harm,” she says.

Much like Alice, the house Nikki grew up in was “complicated.” She describes an upbringing steeped in tension and fighting. The older she got, the more Nikki hid herself away from the world.

“I was a lot safer in my own bedroom, because then I didn’t have to deal with people talking to me or pretending that I’m okay when I’m not,” she says.

After speaking to me for nearly an hour, Nikki finally gathers the courage to tell me about the “complex trauma” she carries around.

“I was seven [years old] when I was sexually assaulted.” she says.

In retrospect she sees this as major contributing factor to her self-harm, as well as her recent diagnosis of bipolar II disorder.

Nikki only sought help from health professionals with some coaxing.

“To be honest with you, I didn’t see there was an issue with it myself. Because I’d been doing it for so long, I just thought it was normal.

“It wasn’t till my best friend and my partner had a bit of an intervention with me in 2013 and said: ‘No, you need help’,” Nikki says, “so if it weren’t for them, I don’t know where I would be now.”

This isn’t just a throwaway line. In 2014-15, Nikki came to a crisis point.

“It was pretty bad, where I was self-harming every day,” she says, “I seriously thought it was going to kill me at one point.”

Nikki credits Ms Mawson for putting her on a path to recovery. To date, she hasn’t self-harmed for 18 months.

“I’m not completely out of it, out of the woods. I don’t think it’s just something that you can just switch off automatically,” she says.

These days though, Nikki is better able to “recognise the triggers that I have and to get on top of that before I actually have that blackout moment when I do self-harm.”

In the end Alice also got the support she desperately needed. She became so unwell that her mother was notified by the school. Alice then moved across the country to live with her mum and stepfather.

“Things escalated further and I sought private care. That’s when I started doing a therapy that actually worked for me. And that was when I started getting better.

“I would be dead if I didn’t have private health insurance,” she says.

Orygen’s research states “evidence for effective interventions is limited” — a fact widely acknowledged by those working in the field. However, Dr Robinson stresses that even limited medical assistance is better than none at all.

“Of those that seek professional help, those that get assessed properly and referred on and get some mental health support do better than those that don’t,” she says.

She’d also like to see emergency departments collect comprehensive data, like in the United Kingdom.

“‘What are the trends and what’s driving it? We don’t know because the data isn’t there,” she says.

Dr Borschmann says that in his experience “rates of self-harm are much higher in any kind of vulnerable or marginalised population.”

He says this may include people who: have mental health problems, involvement with the justice system, are LGBTI or indigenous or those who have been trafficked, abused or bullied.

“Sadly, bullying is really common in adolescence too … so it coincides with the time of most vulnerability to self-harm,” Dr Borschmann says.

As in Alice’s case, Dr Borschmann points to “the contagious effect of exposure to self-harm by peers” as an “important contributor” to the onset of this behaviour.

(This is also why self-harm is so difficult for journalists to report on. We have therefore followed the Mindframe reporting guidelines and avoided explicit discussion of self-harm methods used by the individuals in this story.)

Dr Robinson acknowledges that online blogs and chat groups can be “triggering” for those that self-harm. At the same time, she’s hopeful that social media could form part of the solution to supporting vulnerable young people. She’s currently starting a research project into this area.

Dr Borshmann and Dr Robinson are both calling for the urgent destigmatisation of self-injury, especially when it comes to health professionals.

“Many of those people who present to emergency departments will leave before they ever get seen properly,” Dr Robinson says.

“Some may well go home and very unfortunately take their own lives when they were in an emergency department only a few hours before.

This is as vital “opportunity for intervention that’s just not being capitalised on,” she says.

When approached about claims that people who self harm were sometimes being turned away by doctors, the Australian Medical Association Vice President Dr Tony Bartone said, “I am not aware of any such occurrences and furthermore find the premise is unfair in labelling the exceptional and high quality care our members provide irrespective of race, creed, religion and socioeconomic circumstances.

“Our members would treat all patients presenting with respect and decency.

“We are professional and take our ethical and social reponsibility seriously. Our goal is whole patient outcome and preventing any reason for re-admission or re-presentation.”

Meanwhile Fiona and Nikki have together started their own Facebook support group called The Lines Project Australia.

“I want people to know that no matter what age they are, that they can get help, and that they’re not alone,” Nikki says, adding: “If you have that support, then you can definitely come out of the other side.”

*Not her real name

If you or someone you love needs help or support for self-harm, use these numbers below. In an emergency, call 000.

Kids Helpline — (24 hours) for young people aged 5 to 25 years 1800 55 1800.

Headspace — (8am until 1am) 1800 650 890 or online chat.

SANE Helpline — mental illness information, support and referral 1800 18 SANE (7263)

Lifeline — 24 hours 13 11 14

Reach Out — Interactive website to help young people www.reachout.com.

Ginger Gorman is an award winning print and radio journalist, and a 2006 World Press Institute Fellow. Follow her on twitter @GingerGorman