Black, Asian and disadvantaged young people less likely to receive support after self-harm, researchers warn

Black and Asian young people and those living in deprived communities are less likely to receive psychological therapies after self-harm than their peers, a new major study has found.

Researchers from the University of Cambridge, the National Children's Bureau (NCB) and partners analysed more than 101,000 referrals to NHS mental health services and found significant inequalities in access to support.

The study, funded by the National Institute for Health and Care Research (NIHR),  also found that therapies - or “psychosocial interventions” - were associated with reduced risk of repeated self-harm and improved mental health outcomes, strengthening calls for wider and more equitable access to support.

Of almost 10,000 children and young people with recorded self-harm, the study found that fewer than one in five received a psychosocial intervention.

According to NHS England, almost one third of 17-24 year olds have self-harmed or attempted to self-harm at some point and the recently published Independent Review into the prevalence and support for mental health conditions, ADHD and autism found self-harm has risen substantially over the last decade.

An effective response to self-harm is also an important component of any comprehensive, system-wide approach to suicide prevention. Between 2013 and 2023, over a quarter of all people who died by suicide in the UK had been in contact with mental health services within 12 months of their death. Of these, nearly two-thirds (61%) had a history of self-harm, according to the 2026 annual report from the National Confidential Inquiry into Suicide, Homicide and Safety in Mental Health. 

Part of the COACHES research collaboration, this study examined which psychological therapies are available to young people who self-harm and how effective they are, particularly for underserved groups. Psychosocial interventions include cognitive behavioural therapy (CBT), creative therapy and dialectical behaviour therapy (DBT).

The research team examined the availability and effectiveness of these therapies for children and young people with recorded self-harm within NHS mental health services. 

The study, which analysed referrals involving children and young people within a large NHS mental health trust, was co-led by an expert-by-experience co-investigator and shaped throughout by experts-by-experience convened by NCB.

It found that:

• Of the referrals studied, 10% or 9,876 included documented instances of self-harm. Just under 20% of these young people received psychosocial therapies and there were variations in access to support according to a range of sociodemographic, clinical and social care characteristics.
• Black and Asian young people were less likely than their white peers to receive a form of therapy. When individual therapies were examined, Asian, Black and multi-heritage young people were less likely to receive CBT, while Asian and Black young people were also less likely to have DBT recorded in their clinical notes.
• Young people facing multiple disadvantages were less likely to receive therapy. Young people living in areas of greater economic deprivation were less likely to receive therapies than those living in less deprived areas. Similarly, young people with social work involvement were less likely to receive therapies, particularly CBT.
• Young people referred through A&E were less likely to receive therapy: Particularly concerning given the sharp rise in emergency mental health presentations in recent years, young people referred through A&E departments and social care pathways were less likely to receive therapies than those referred through primary care.
• Therapy was associated with improved outcomes. Young people who received psychosocial interventions had lower odds of recurrent self-harm and improved mental health outcomes over time. These improvements remained significant after adjusting for demographic, clinical and social care factors.
• Some groups remain at higher risk of repeated self-harm: Certain children and young people are at higher risk of recurrent self-harm, including female young people, young people with physical disabilities and young people with neurodevelopmental differences.

These findings support the existing guidance from the National Institute for Health and Care Excellence (NICE) and the recommendations of the All-Party Parliamentary Group (APPG) on Suicide and Self-harm Prevention, emphasising the importance of timely psychosocial assessment, person-centred care, continuity of support, and equitable access to evidence-based interventions. 

Based on these findings and with support from the young people and parent groups consulted on this research, NCB is making the following recommendations and urges the Department of Health and Social Care to use the forthcoming Mental Health Strategy and Suicide Prevention Strategy refresh to set out how it will work with Integrated Care Boards and mental health providers to:

1. Ensure every child and young person presenting with self-harm receives a timely psychosocial assessment, in line with a “No Wrong Door” approach so assessment is available regardless of where a young person enters the system.  

2. Improve access to evidence-based psychosocial interventions, including CBT, DBT and other therapeutic approaches. 

3. Take action to reduce inequalities in access to psychosocial support following self-harm. 

4. Address the holistic needs of children and young people at highest risk of recurrent self-harm.

5. Embed meaningful participation in service design and accountability. 

6. Strengthen communication and support for young people while waiting for treatment. 

7. Improve outreach to underserved groups. 

8. Make services flexible, trauma-informed and culturally responsive.