Prasad & Owens Internet self-help for people who self-harm References NHS HEALTH ADVISORY SERVICE 1986) ö 1995) Together We Stand. London: Bridges OverTroubledWaters. A Report NHS Health Advisory Service. AUDIT COMMISSION 1999) Children in ö & GOWERS S. G. 1999) Use of an fromThe NHS Health Advisory Service original Mind: Child and Adolescent Mental adolescent in-patient unit. on Services for Disturbed Adolescents. Health Services. London: Audit Advances in Psychiatric Treatment, London: NHS Health Advisory Service. papers Commission. 5,192--201. DEPARTMENT OF HEALTH 1999) COTGROVE, A. 1997) Emergency National Service Framework for Mental admissions to a regional adolescent Health. Modern Standards & Service *Adrian Worrall Senior ResearchWorker, Anne O'Herlihy Research unit: piloting a new service. Psychiatric Models. London: Department of Worker,The Royal College of Psychiatrists' Research Unit, 83 Victoria Street, Bulletin, 21, 604--608. Health. London SW1H 0HW Psychiatric Bulletin 2001), 25,222^225 VIBHORE PRASAD AND DAVID OWENS Using the internet as a source of self-help for people who self-harm AIMS AND METHOD RESULTS CLINICAL IMPLICATIONS To describe the information and help The support that we found largely The unregulated sites of the internet available on the internet for people took the form of information about contain much materialabout self- who self-harm.We searched the suicide, self-injury and psychological injury. Although it is not possible at internet using a meta-search engine. issues. Less often, sites offered present to weigh up risks and Wevisitedsitesandfolloweduplinks e-mailsupport and online discus- benefits, many individuals and with e-mails and letters.We also sions.We found little information organisations plainly regard internet searched bibliographic databases, about self-poisoning, and most information about self-harm as a seeking published material about the about self-injury.There is little valuable service. internet and self-harm. published research about self-harm and the internet. Hospital contacts for self-harm in the UK are higher now We searched for DELIBERATE SELF HARM on three sepa- than at any time Hawton et al, 1997) and may account rate days to discover whether time lapse would yield for more than 150 000 hospital attendances in the UK significantly different results. We also searched the terms each year. Many more episodes do not lead to hospital ATTEMPTED SUICIDE and SUICIDE SELF HELP and attendance. In recent years the internet has been a performed a search for the phrase HOW TO COMMIT growing resource for information and communication, SUICIDE. In addition, we used the facilities provided by used increasingly by patients. Aware that many people http://www.about.com ^ a network of websites orga- who undertake self-harm seek and find ways of reducing nised by `expert guides'. their distress, we wanted to investigate, characterise and We visited a site if the annotations under the title of describe to medical professionals the help resources its page suggested that it would provide self-help for available on the internet for people who self-harm. We people who self-harm. We followed links within sites with attempted to search the internet systematically, rather as the same strategy. Where we obtained information that one might undertake a conventional systematic review of pointed to sources of further information we V.P.) published literature. contacted the sources by e-mail or letter, explaining the nature of the study and requesting further information. At no time did the searcher enter discussion forums The study because of the ethical considerations: these forums offer help and are not aimed at health professionals. In the Websearching Findings, set out below, we have selected, from the Our first step was to use the search engine metacrawler scores of sites found, a few examples that we think http://www.metacrawler.com). This is a `meta'-search illustrate the characteristics of self-harm related engine that works by querying the other search engines, websites, and ones that we think may be useful organising the results into a uniform format, ranking resources. them by relevance and returning them to the user. It combines the results of several search engines Searching for published literature about about.com, altavista, excite, goto.com, infoseek, self-help on the internet looksmart, lycos, thunderstone, webcrawler and yahoo!). We searched the term DELIBERATE SELF-HARM followed Medline was searched from 1997 to March 2000. The by DELIBERATE SELF HARM; they brought similar results. subject terms DELIBERATE SELF HARM, SELF-INJURIOUS 222 Prasad & Owens Internet self-help for people who self-harm BEHAVIOUR and SUICIDE, ATTEMPTED were searched in http://www.gurlpages.com/zines/grrrlyzine/ stages and then combined. A separate search of SELF cut2h.html is an example of a site that has a great many HELP and INTERNET was also combined. The results of links to poems, accounts of personal experiences and original these two search strategies were then combined. questions about self-harm, arranged in alphabetical order. papers We also searched ClinPSYC ^ produced by the This site also has a link to the message board that is part American Psychological Association and comprising of the Bodies Under Siege WebRing. Another site with references with abstracts from journal literature in clinical several self-harm related sites within it is http:// and medical psychology ^ between the dates 1989 and www.angelfire.com. One example of the kind of self-help March 2000 information about ClinPSYC can be viewed provided is a personal homepage that is written by through the Ovid Technologies website at http:// someone who self-harms. The author does not hold www.ovid.com/sales/medical.cfm). The terms DELIB- formal qualifications for providing psychological help but ERATE SELF HARM, SELF DESTRUCTIVE BEHAVIOUR and says he is qualified to do so by his experiential know- ATTEMPTED SUICIDE were searched. The term `self help' ledge. It sets out reasons why not to self-injure and gave an unsatisfactory response so we successfully offers advice for those who are going to injure them- searched the term SUPPORT GROUPS. This result was selves. There is provision for people to e-mail the author combined with those for the above three self-harm for online support or e-mail advice. terms. Search forATTEMPTED SUICIDE The search for ATTEMPTED SUICIDE gave 68 results. One Findings search engine, Google, `timed out'.The pages that were yielded by this search included http:// Websearching www.members.tripod.com/*kittn/index.html, whose Search for DELIBERATE SELF-HARM, DELIBERATE homepage sets out reasons why not to commit suicide. SELF HARM The page has a disclaimer: ``This page is for information The search for DELIBERATE SELF HARM yielded 31, 34 and only and is not intended to be used as a substitute for a 37 hits on successive occasions. Useful sites included the consultation with a medical professional.'' It goes on to young people and self-harm information resource ^ give information about what to look for in a friend who http://www.ncb.org.uk/selfharm/shgenaa.htm. This is may be suicidal, how to help such a person and phone a database containing listings of initiatives that relate to numbers, books and other links. Its links are mainly to children, adolescents and young adults aged under sites that give information about suicide and depression. 20 who physically injure themselves. We found these initiatives to consist mainly of individuals and groups who Search for SUICIDE SELF HELP wanted to share their experience of self-harm, research This search yielded 50 results and the search teams and many who were involved in self-harm related engine Lycos timed out. The results included the clinical projects within health services particularly within Suicide Prevention Triangle SPT), http:// the NHS). We V.P.) wrote for further information about www.suicidepreventtriangle.org, which has a number self-help availability to appropriate entries in the of self-help tools; such as their SPT assessment ^ to database. assess one's current need for counselling; a satisfaction We found many self-harm related sites on the scale that measures the wish to live; and a measure of Bodies Under Siege WebRing to be found by searching significant loss that measures the triggers of distress. http://www.webring.org). Among them are sites giving Once again it offers up a number of quotes from personal accounts of self-cutting and personal webpages survivors. of those who self-harm. For example, http:// The site called the `self-help corner' http:// www.geocities.com/wellesley/garden/7998/index.html www.queendom.com/selfhelp) offers links to a variety is a webpage about someone's personal experience of self-help sites aimed at psychological needs. It draws of self-harm ^ coping the best you can. This page also particular attention to self-help for those considering a has a link to another page ^ secret shame http:// suicide attempt. The reader is directed to appropriate www.palace.net/*llama/psych/injury.html), which gives links from a banner heading: ``If you are suicidal ...read advice and has a self-help section. The self-help advice is this first . .''.The reader is then given supportive practical, including advice on how to stop self-harming, information and there are links to other organisations obtaining helpful first aid and avoiding post-traumatic including the Samaritans and Befrienders Inter- stress disorder. An example of the sort of guidance given national), suicide helplines and suicidology helplines. is, ``you are doing nothing shameful''. In order to place The Befrienders International site, http:// readers into categories the page asks the user to answer www.befrienders.org, states that they have 31000 a list of questions about what they feel like doing, such volunteers in over 40 countries. They are able to give as: ``what are you feeling .