Factors influencing prevention and support in relation to self-harm and suicidal behaviours in schools and youth organisations: A Qualitative Study of Frontline Staff and External Support Providers in England

<p>BackgroundSelf-harm and suicide among young people are pressing public health challenges in the UK. Schools and youth organisations can act as key settings to provide early intervention and support. This study explored the barriers and facilitators experienced by education and youth organisation staff as they respond to young people’s self-harm and suicidal behaviours, the support that is available to them and perceived gaps in this support. MethodsWe conducted 29 individual interviews and one focus group with a total of 34 professionals across schools, youth organisations, public health teams, NHS staff (e.g. educational psychologists and mental health support teams) and third-sector support services during September 2024–May 2025. Purposive sampling ensured variation in role, geography, and type of organisation. Transcripts were analysed using the Framework Method, with inductive coding refined through team discussion and matrix comparison to identify themes across stakeholders.ResultsFive overarching themes were identified: (1) strengthening knowledge, communication, and training; covering staff awareness, education and confidence and up-skilling and involving parents; 2) systemic gaps and barriers in provision; covering lack of early intervention strategies, resource limitations and a need for joined-up agency working; (3) role ambiguity and responsibility gaps; covering unclear role expectations across sectors, staff vulnerability, thresholds and ringfencing; (4) fear, shame, and stigma; including fear of liability, blame, reputational risk, stigmatising attitudes, myths and taboos and open dialogue and trusted relationships; and (5) social, cultural, and community considerations; covering peer support opportunities, role of community environment and inclusion/reaching marginalised groups. ConclusionsThis study provides qualitative insight into how self-harm and suicide risk are managed across schools, youth organisations, and external support providers. It highlights that staff often work within fragmented systems characterised by uncertainty, emotional burden, and inconsistent access to external support. Youth organisations were identified as important, accessible spaces where trusted relationships can facilitate early support and disclosure. Extending prior quantitative research, it shows how these challenges are experienced in practice across sectors. Overall, findings emphasise the need for clearer referral pathways, sustained cross-sector coordination, and strengthened staff training to enable more consistent, confident, and effective responses to young people at risk.</p>