Self-harming is much more widespread than has previously been thought, with high-profile people such as Kelly Holmes admitting their own "secret" habit of cutting themselves.

But, how can we, in families and in society, help tackle this problem? Angela Kelly reports.

THOSE involved in primary care, including GPs, need to be made more aware of the scale of self-harming because it is so big. So says David Duffy of the Bolton, Salford and Trafford Mental Health NHS Trust.

Mr Duffy has been a mental health nurse for the past 26 years and has become an expert on suicide and self-harm. He is also keen to explain that there is an important distinction between the two.

"People often lump them together, but the reasons behind suicide and self-harming can be quite different," he said.

"Self-harming is a method of coping, of dealing with feelings or a situation. It is a symptom of other underlying difficulties.

"While self-injury can be associated with a wide range of mental health problems, self-harming is not automatically linked to them. There could be mild depression and anxiety involved, but it is more often concerned with typically teenage problems. In fact, teenage girls are the most common sufferers."

Mr Duffy said self-harming involved a frightening number of methods, with most self-harmers cutting themselves.

A significant number burn themselves, often with cigarettes. Others hit themselves, prevent wounds from healing, pull out their hair, or horrifyingly a percentage break their own bones, even using hammers and other implements to do so.

Much of his findings will be published in a medical journal shortly and are likely to cause a stir in both the medical and non-medical worlds because self-harming has generally so far been a hidden problem.

It is estimated that around 100,000 visits to hospital accident and emergency departments are linked to self-harm. Experts like Mr Duffy fear there are many more harming themselves in secret.

"They would not normally need to come to our attention by going to hospital for treatment, unless a wound became infected, for example," he said.

"Normally, self-harm is something done privately and often for years. And, of course, such long-term cutting can leave scarring which itself can cause further difficulties, especially for women."

Public personalities help to bring the subject into the public arena. Olympic gold medallist Kelly Holmes admitted last year that despair over her sports injuries caused her to cut herself during a dark period in her sporting life, and Princess Diana was also reported to have self-harmed.

But some of the main difficulties lie in a lack of understanding of exactly why people harm themselves and how to deal with it.

Mr Duffy urges parents who discover a child is doing this to try to be "non-shocked". Instead, they should to try to gently find out the reasons why and address these, seeking help if possible.

Society also needs to find out more about self-harming, he believes.

Locally, there are already some positive and effective services available, with more planned. Martin Patrick, emotional health and well-being development officer at the Bolton Primary Care Trust, said Bolton was now building from strong foundations.

"Our Children and Adolescents Mental Health Services (CAMHS) department, based at the Royal Bolton Hospital, is among the best in the North-west and provides an excellent service for young people with the most serious and complex problems," he said.

"But we also want to make sure that youngsters who self-harm are well-supported at school, at home and in community settings."

Mr Patrick added: "Self-harm is an issue we take very seriously. Our priority is to make sure that all the agencies who work with young people respond appropriately, when they spot the signs that it is happening, and that the specialist services are in place when they're needed."

New investment in this local service will include a case manager to provide a service for chidren and young people who come into accident and emergency or who are referred to the hospital with serious self-harm injuries or who are at risk of suicide.

The PCT also provides a programme of suicide prevention training which is being given to people in a wide range of agencies working with young people.

Initially, 20 people have been trained as trainers including people who work in accident and emergency, in the educational psychology and social work fields, and in CAMHS to spread practical expertise among colleagues.

Probably the biggest hurdle to get over, though, is public perception of the problem.

As Diana Leigh, from the self-harm support group at Bolton's mental health befriending service Mhist, says: "Most people really do not want to think about anyone, especially their own children, deliberately harming themselves.

"It is a lot to take in and everyone involved needs help and support."

l To find our more about this group, contact Mhist on 01204-527200 or email