This blog is presented by Dr. Paul Hain, Blue Cross and Blue Shield of Texas Chief Medical Officer.
Mental health issues seem to be in the news on an almost daily basis across the nation and the Lone Star State. Mental health has even gained the attention of our political leaders. For instance, Texas Governor Greg Abbott declared the establishment of the Texas Mental Health Consortium as an “emergency item” during his 2019 State of the State address, allowing the Texas Legislature to act on the matter without delay.
One piece of the mental health care crisis is self-harm. Self-harm is the act of purposely harming one’s own body, such as cutting or burning oneself. It's typically not meant as a suicide attempt.
To aid in the efforts to establish effective behavioral health care, Blue Cross and Blue Shield of Texas (BCBSTX) believes it is important to share the insights we have gained from our health data, so stakeholders across the state will be better equipped to help those at risk for self-harm.
In 2016 and 2017, more than 15,000 Texans who we cover were treated for issues related to self-harm. More than 88,000 claims were submitted for the care of those Texans in that two-year period, suggesting many members were treated more than once for self-harm. More than 7,800 of these cases resulted in a hospital admission.
The most common method of self-harm is to intentionally attempt a drug overdose. In Texas in 2016 and 2017, we saw more than 56,000 instances of intentional drug self-poisoning, affecting more than 9,500 members. Some of the most common drug types used in self-harm incidents are anxiety medications, pain relievers and medications used to treat depression.
Through our data we are also able to track the demographics of our members who self-harm. Our data shows that a person’s race does not predict the method of self-harm a person may choose to undertake. For example, drug poisoning makes up about 60 percent of all episodes of self-harm for each race, followed by smaller numbers for injury by a sharp object and chemical poisonings.
A person’s income does, however, predict whether a person may be inclined to self-harm. Our data shows self-harm is mostly affecting higher income populations in Texas. More than 70 percent of our members affected by self-harm live in households that have an income of more than $62,750 per year.
There is also a gender gap in the self-harm epidemic—women make up nearly double the number of men who self-harmed. Men and women also choose different methods of self-harm. For instance, males use firearms and asphyxiation to harm themselves more often than females. On the other hand, women often use other methods, including drug poisoning and injuries with a sharp object.
Age is also a predictor of the potential for self-harm. Self-harm is a problem that affects some of our youngest members. Those who are 13-19 years old make up about a third of all of members who engage in self-harm. Drug poisoning is also the most common method teenagers used; however, we see much higher rates of using a sharp object to cause injury in this group. This is most commonly known as the practice of “cutting,” or making many small cuts to the body, most often the arms and legs. Teenagers make up about half of all injuries with a sharp object due to self-harm.
The trends we see in our data mirror what researchers are seeing across the United States. According to one study, about one in four girls deliberately harmed herself in the previous year, compared to about one in ten boys. Overall, about 20 percent of all teenagers harmed themselves, a trend that has been constantly ticking upward since 2008.
While the primary cost is the emotional toll self-harm takes on those affected and their families, there is also a financial cost. Self-harm incidents in Texas cost more than $146 million in 2016 and 2017. The Centers for Disease Control and Prevention (CDC) estimates that self-harm injuries cost the U.S. about $10.5 billion a year in combined medical and work loss costs.
All of these statistics may make the self-harm epidemic seem too daunting to tackle, but there are ways to work toward prevention. The CDC has named several factors that protect people at risk for self-harm. These factors include having effective behavioral health care and family or community support, among others.
For their part, several Texas lawmakers have filed several bills addressing the mental health issues Texans face. In addition to the establishment of the Texas Mental Health Consortium, efforts include expanding mental health services in schools and better tracking for public school mental health services.
If someone you know shows warning signs of self-harm, please reach out for help. You can reach the Crisis Text Line by texting CONNECT to 741741 or the S.A.F.E. Alternatives at 1-800-DONTCUT. You can also find additional resources and information at www.selfinjury.com.
If someone you know is showing these signs, call 1-800-DONTCUT or seek help from a medical or mental health professional.
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