Can smartphone apps really help prevent self-harm?
According to their creators, mental health apps can help sufferers resist the urge to self harm. But do they really work and is it being used responsibly?
As a teenager, Ren*, now in his 40s, lied to his parents about the scratches.
“I struggled with self-harm since I was a very young teenager, my parents used to threaten me with a doctor like it was a punishment and it terrified me,” he says now. Beyond this threat, Ren’s mother and father would often lock him in his room as a punishment.
“They used to lock me in my room and deny me phone privileges, and as we were super-rural in the early 90s it literally cut me off from all human contact.”
The first time Ren self-harmed, it was in his bedroom after being sent there as a punishment after his parents accused him of lying. “I mostly self-harm out of panic, fear of abandonment, or uncontrollable self-hate,” he says.
Around 13 per cent of children between 11 and 13 self-harm in the UK, with the majority of sufferers aged between 11 and 25. With estimates that 400 in 100,000 people in the UK self-harm, the nation has the highest self-harm rate of any country in Europe.
Like Ren, I’ve suffered from self-harm and the issues surrounding it; I know that from the first time I had an urge to the last time I put down my razor, I would try anything to help me stop. And now – to paraphrase Apple’s old slogan – there’s two apps for that.
“At first I dismissed the apps as self-help kitsch…”
Both released last year, Calm Harm and distrACT offer information and activities to help self-harm sufferers across the world. While Calm Harm is made up of gentle colour schemes, mascots, and interactive elements such as breathing timers, distrACT is a bank of solid, key information explaining what self-harm is and what external resources there are that can be used.
Calm Harm was created by the charity Stem4 while distrACT was created by a private company, Expert Self Care. Both apps are free, and both aim to change the way we think about self-harm by pulling back society’s sleeve, healing rather than concealing.
In the same way that Ren’s parents’ landline gave him access to the outside world in the 90s, his smartphone is now a literal lifeline when he feels the urge to self-harm.
“I came late to the tech party. At first I dismissed the apps as self-help kitsch, but once I got into it… I realised that it really worked,” he says.
“Once I got past the simplicity of it, it was so incredibly comforting. It breaks tasks and distraction up into tiny time blocks to help let the urge pass.” While similar mental health apps could feel patronising to some, Ren believes Calm Harm avoids this.
“You can tell it was created by people who do care. It never makes me feel sick or like a freak, just like someone struggling.”
It’s no surprise that apps now offer mental health services. According to a recent Ofcom report, most people in the UK check our phones on average every twelve minutes.
“Most young people have a smartphone and it’s become part of their life,” Dr. Knut Schroeder, developer of distrACT tells me. “Apps are something that anyone can download at any time.”
Dr. Nihara Krause, creator of Calm Harm, agrees. “Often the urge to self-harm happens when you’re about to sleep, or on the weekend… with something like self-harm you need help immediately.”
With some NHS patients waiting up to two years for mental health treatment, apps allow help in minutes rather than months. They’re discrete, too. As Dr. Schroeder puts it: “You could use the app on a bus and someone sitting next to you wouldn’t really notice.”
This “anytime, anyplace” quality of apps renders old-school, word-art smothered leaflets fodder for the shredder. After all, apps can be updated at a click of a button. Leaflets, Schroeder opines, “are such an outdated thing to do…they go out of date almost immediately.”
Confidence in these kind of apps, however, is not universal. Earlier this month, Forbes reported on research from the Annals of Family Medicine which identified that adverts for mental health apps were both erroneously suggesting that “poor or fragile mental health is ubiquitous” and that “individuals can easily manage their own mental health problems with apps”. The researchers concluded that “developers offered very limited scientific evidence” about the benefits of their apps.
Naomi Salisbury, director of charity Self Injury Support, concedes that this is a problem with some apps. “There’s this normalisation that medicalises some peoples’ normal experiences and takes away from the impact of some peoples’ extremely difficult experiences,” she says.
For her, though, distrACT and Calm Harm avoid these problems. As well as being evidence-based, they “are only trying to do one thing.” Salisbury believes that some form of regulation of mental health apps would prevent distrACT and Calm Harm from being conflated with inferior solutions.
“You shouldn’t be able to claim stuff that you don’t have an evidence basis for – you can’t do that with other treatments that you bring into healthcare.”
The good news is that both of these apps are endorsed by the NHS, with Calm Harm being part of the NHS Apps Library and distrACT currently awaiting inclusion. The bad news? Because NHS funding for mental health hasn’t increased in real terms in the last six years, these apps are outsourced – created by private companies and charities.
While the NHS stamp of approval may be something to celebrate, it’s also indicative of a worrying deficit in public health services.
“This is the best type of distraction I can get”
Personally, my immediate concern was the paradox of using tech – often so damaging to our mental health – to try to improve it.
After all, it seems incongruous to have self-harm apps nestled next to sources of potential triggers for some people, like Instagram or Snapchat. Just last week, Facebook and Instagram introduced time limits to restrict negative impact on mental health, acknowledging that this is a problem with their own apps.
“It’s easy for policy makers to say that social media is why young people are struggling with mental health, but that’s part of a much wider society,” says Salisbury.
Although Dr. Schroeder acknowledges the problems that social media creates, he also sees it as something that can be positive.
“We actually had comments from people with lived experience of self-harm that social media can actually be a blessing for them…social media and chat forums can be a great help.”
He goes on to say that Calm Harm was almost solely “promoted through social media with people recommending it” and without social media adverts many wouldn’t be aware these apps exist.
Millie* noticed apps for self-harm long before noticing her own compulsions. “I’d seen several adverts for self-harm apps in my Instagram and Facebook feed, but never thought I’d actually use them, until the first time I got an urge to harm myself,” she remembers.
They proved to be invaluable. “The app really helped the first time, when I was really scared. Distraction is really important for me when feeling the urge, and when I have nothing else but my phone available, this is the best type of distraction I can get.”
Of course, for some people these apps simply don’t work. “Personally I don’t find them useful,” one user tells me.
“I thought Calm Harm was well designed and sweet… but I think the app couldn’t help me because although I thought I wanted help, at the same time I couldn’t really accept help,” they say. “I don’t feel comfortable when I’m doing something good for myself… I was just too negative to try some of these.”
Once again, it’s important for mental health solutions to focus on a pluralistic rather than singular approach, with individuality emphasised. Apps should be an additional source of support, not your only one.
But there’s no argument, now, that apps should be part of a collective solution. Sure, there may be tweaks to be made, and instinctive reactions against tech (such as my own) to overcome. But the future of these apps seems highly positive.
Both Calm Harm and distrACT have plans to create new offerings, the former hoping to release a new anxiety-focused app and the latter releasing one for eating disorder sufferers.
Apps for self-harm may not help everyone that tries them, but you can’t ignore how powerful it is when they do. As Dr. Krause says: “People write in saying ‘you’re saving my life’, which is incredible. It’s literally suicide prevention.”
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*All names have been changed
If you have been affected by any of the issues raised in this article please contact the Samaritans helpline on 116 123 or visit their website.
(Pics: Getty, Expert Self Care)