Around one in six adolescents worldwide report having self-harmed at some point in their lives. In England, an NHS mental health survey of 2,370 children and young people found that more than one in three young adults aged 17 to 24 had self-harmed. Typically, responses to self-harm focus on the individual – diagnosis, treatment and risk management. Mental health support is clearly essential, but a large and growing body of global research points to wider, social factors contributing to self-harm. Young people across different cultures describe self-harm less as a symptom of a specific “mental illness” and more as a response to unbearable pressures often linked to intense social challenges, relationship difficulties and changes as they develop into adulthood. These issues are raised in India, Pakistan and China. Even if these social drivers are well acknowledged, there is a lack of alignment between how distress is understood and how it is addressed. This mismatch has real consequences. Responses to youth self-harm that prioritise the individual may reduce immediate danger. However, approaches that prevent distress from …