Kaleidoscope February 2018
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.
#MeToo is leading us through a necessary cultural
shift. The other day Formula 1 announced it will no longer
have “grid girls” from next season; well that only took thirty
years from Play Your Cards Right’s “Dolly dealers” – our children
will look back with the same bewilderment we feel when we see old
footage of people smoking on planes. A challenging but moving
editorial in the New England Journal of Medicine argues
that unacceptable behaviour is an issue beyond politicians and film
directors to occur also in healthcare. A second paper reviewed in
Kaleidoscope takes a related difficult topic: despite accounting
for the majority of undergraduate science and healthcare degrees at
University, women remain grossly under-represented at the most
senior professional levels. The authors went to multiple university
lectures and found that when women:men student ratios were equal,
women were two and a half times less likely to ask a question than
men; it got even worse if a man asked the first question. It argues
that women are literally less visible, and something needs to
change. Difficult but important conversations for us all. We’ve
recently recorded a highly stimulating podcast at the College with
some leading women in medicine and neuroscience, and will be
publishing that with the Mental Health Foundation next month; watch
out too for a forthcoming editorial in the BJPsych on the
Despite pharmacodynamic logic and early animal model success,
the first randomised controlled trial of cannabidiol in psychosis
failed to show any benefit over placebo.
Answer: False; the data look promising.
Analysis of behaviour following calls for gun control changes
and public health warnings after the ‘Sandy Hook’ school shootings
showed it was followed by an increase in gun sales.
Answer: True, sadly.
Data on unwanted sexual approaches towards female doctors from
male colleagues show these to occur at a similar rate to those in
society more generally.
Answer: True, sadly.