Mary-Kate Evans looks like any typical 18-year-old first-year university student, with a quick smile, glasses and thoughtful eyes. It would be hard to suspect she has struggled for years with self-harm.
But Evans started cutting herself when she was only 12. Her tool of choice, she said, was usually an X-Acto or utility knife. If there wasn't one at home she would head to the store to buy one.
"I would wait for hours and hours until the end of the day and I would count down the minutes until I could find a knife at home and cut," Evans told CBC Radio's Mainstreet.
Incidents of self-harm are responsible for a large proportion of hospitalizations among young people. According to a report from the Canadian Institute for Health Information, one in four hospitalizations among youth aged 10 to 17 is due to self-harm of some kind.
Dr. Alexa Bagnell and Dr. Stan Kutcher are two psychiatrists in Halifax who often see the problem.
Bagnell, the interim chief of child and adolescent psychiatry at the IWK Health Centre, said studies show 15 to 25 per cent of young people engage in some kind of self-harm or self-injurious behaviour.
"Because it's a relatively new behaviour to measure, we don't actually know if it's increasing or not," she said. "We do know that more youth are coming and seeking help and talking about it. So we do know that there's an increased need for us to help these youth."
Kutcher, who holds the Sun Life Financial chair in adolescent mental health at the IWK Health Centre, said self-harm was rarely seen when he first started in medicine 30 years ago.
Of particular concern, both doctors said, is the "contagion factor" that can arise through group chat sites and websites on the internet.
"It's really concerning for us because we know that our youth are very vulnerable. They are constantly in touch with each other," said Bagnell.
'More common than people want to admit'
Evans's friend, Nikki Mageau, has struggled with cutting and hair pulling since she was 14. Mageau said she discovered cutting through her best friend who struggled with untreated mental illness.
"I had watched her do it frequently and it scared me a lot, but I couldn't control it," she said. "And then one night when I was extremely upset, I realized that I couldn't control her cutting, but I could control mine. And rather than deciding to control it by stopping it, I controlled it by doing it."
Both Evans and Mageau have anxiety disorders and believe self-harm is on the rise among their peers.
"I might know one person who's never tried it," Mageau said. "Almost everybody in this age bracket has at least considered doing it."
"It's much more common than people want to admit," Evans said.
Hiding it from family
Both women also kept it secret from their parents.
"You harm with any utensil or tool you can because you want to exert power and you want to seem like you have a bit of your life under control because the rest of it seems like it's spinning out of control," said Evans.
She said she always felt better after cutting, however the good feelings were short-lived.
"Immediately after I'd go, 'That's gone. But this is a high I want to chase again for whatever reason,'" she said.
The women said when they started harming themselves, they were dealing with a myriad of problems ranging from relationship stress to low self-esteem.
Mageau said her parents eventually found out when she was hospitalized at the age of 16 with a mental health condition.
"They were scared more than anything," she said. "They didn't know what to do. They didn't understand why I was self-harming or why I felt the need to do this.
"Mostly they didn't understand why I couldn't just stop because I wanted to stop."
Mageau said her parents took away her utensils, but she resorted to other methods of self-harm, such as hair pulling.
Kutcher said there's no one treatment for self-harm. Each case is unique, but often a combination of medication and talk therapy helps.
"One of the primary goals here is that we want young people to understand there are good ways, positive ways, useful ways of coping," he said. "And there are ways that are not. And self-harm behaviour is one of the ways that is not useful."
Bagnell admits some people may be reluctant to come forward and ask for help because they know there's a long wait list for mental-health services. But she believes services are moving in the right direction and there is improvement, even from five years ago.
"Our school systems are doing amazing things in terms of increasing resources," she said. "We are also working within our health-care system to increase access for that first appointment. We have also increased mobile crisis and emergency room services for youth who are acutely at risk."
As for Mary-Kate Evans and Nikki Mageau, neither said they have conquered their self-harm behaviours, but they're doing much better.
"I definitely can't say it's behind me," said Mageau. "I tend to think it's behind me until something goes wrong.
"It's something that can always come back and I think that's the hardest part of getting started at such a young age is that you don't realize that you're making a decision for life."