1. Prevention of Self-Harm and Suicidal Ideation Conference 26th March 2015

2. Young Person Chair of the Mental Health Anti Stigma Programme
Welcome
Emma Grinham
Young Person Chair of the Mental Health Anti Stigma Programme
David Loyd-Hearn Commissioning Manager Children and Young People Emotional Health and Wellbeing

3. Prevention of Self-Harm and Suicidal Ideation Conference
Setting the Scene
Self Harm and serious Case Reviews – lessons learnt
Acute self harm
Break
Northamptonshire Community & Toolkit
The real story in school
TaMHS – Mental Health in Schools - setting up an Emotional Health and Wellbeing Team
Action planning
Closing summary

4. Setting the Scene Self-Harm = Symptoms Self-harm across the spectrum

5. Why is Emotional Well Being and Mental Health for Children important?
Emotional wellbeing underpins being successful at school, making and keeping friendships and making the most of life.
Approximately 50% of lifetime mental illness starts before the age of 14 and it is estimated that potentially half these problems are preventable.
Self Harm can sometimes be a coping mechanism or fashion, but it can also lead to significant harm and occasionally suicide. It is not the act that matters, but the intent.
Around 1 in 10 children and young people may have a mental health problem at any one time.
Referrals have increased by 27% in Northamptonshire over the last 3 years with 6.5% of all children getting support
Self-harming admissions are higher in Northamptonshire than the national average. Research suggests self-harming behaviours are average.
In adulthood half of all women, and a quarter of men will be affected by depression at some stage in their life.
Recent Northamptonshire Public Health assessment suggests local wider costs £1347 million due to mental illness
When it comes to children and young people, 1 in 10 children self-harm, with suicide accounting for 20% of deaths in young people between the ages of

6. Key Findings from CYP Survey (775 Responses)
Unmet needs continue to feature which do not fit in defined Specialist CAMHS criteria e.g. challenging behaviour, self harm as a coping mechanism. We are working together to resolve.
73% of a significant sample of young people have body image concerns, this increases to 90% of the sample of CAMHS users. Young people suggest this is sometimes a cause for self-harm.
Behaviour Issues account for 52% of paediatric referrals and a significant number of CAMHS referrals. If untreated, sometimes these cases may lead to self-harm.
Anxiety and Depression is the number 1
reason for referral (and can lead to eating
issues or self harm as a coping
mechanism). Young People increasingly
find self harm is an acceptable coping
Mechanism.
We are a national outlier for self harm due to the adherence of NICE guidance, though we are about average in presentation numbers by NHS estimates.
There is a significant lack of knowledge of services, what is available and how to access. If in doubt, visit

7. What is self-harm? Self-mutilation
Self-destructive behaviours (compulsively pursued acts that causes self-harm e.g. head banging)
Self-harm without suicidal intent
Attempted suicide
Minority who self-harm attend A&E departments or specialist services
Most are supported in the community
Most young people who self-harm do not continue with this into their 20’s

8. How many young people self-harm?
Rarer in pre-teens (but locally this is growing)
10% of adolescents in the UK self-harm
At 14yrs; 25% Females & 14% Males experience suicidal ideation
Only 2-3% present to medical services
Huge number remain unknown (behaviour self harm has been anecdotally estimated at 50%)
Self Harm is not the issue, it is the cause and intent that matter most. Less than 4% of self harmers go on to have enduring mental health needs.

9. National and Local Statistics
72% of people who seek help for depression are female
75% of people who take their own lives are men.
National rates of self-reported self-harm are 7% for year olds but several times higher in those with:
emotional disorder (28%)
conduct disorder (21%)
ADHD (18%).
Applying national rates to Northamptonshire would mean that year olds would report self-harm. Our actual figure is lower, though in schools anecdotal evidence suggests the rates could be as many as 50%.

10. Northamptonshire A&E Admission Rates for Self Harm
Locality
Inpatient Admissions of 0-19's in
Inpatient Admissions of 0-19's in
Inpatient Admissions of 0-19's in
Inpatient Admissions of 0-19's in
Western Northampton 51 60 64 55
Kettering 35 40 49
East/Southern Northampton 30 48
Central Northampton 44 43 28
East Northants 15 19 20 26
Daventry North 23
Corby 29 24 25
Wellingborough 21 14
Daventry South 17 18
Oundle & Wansford 1 4
Not coded 12
Total
281
332
337
299

11. Hospital Admissions (Approx) East Midlands 2010
Under 10 yrs Low figures
10-14 yrs 350
15-19 yrs 1500
20-24 yrs 1300
25-29 yrs 1000
30-34 yrs 800
30-39 yrs 1100
40-44 yrs 1200
45-49 yrs 700
50-54 yrs 550
55-59 yrs 300
60-64 yrs 170
yrs figures reduce

12. Under 18’s Hospital Admissions by PCT East Midlands 2010
Derbyshire
Derby City
Nottinghamshire
Nottingham City
Northamptonshire Per 10,000 area population
Leicestershire
Leicester City
Lincolnshire
East Midlands Total

13. What are we doing about self-harm? Short Term
The conference highlights the new self- harm toolkits for Northamptonshire on
Web resources for young people by young people available on
We have redefined the acute self harm and suicidal ideation pathway
We are actively working with Northampton and Kettering Locality Forums to embed action plans with excellent examples of best practice at schools such as Northampton Academy & Kettering Buccleuch Academy.
Auditing Urgent Care Admissions
Developing questionnaires for acute self-harmers

14. What are we doing to reduce self-harm? Long Term
The Children and Young People Emotional Wellbeing and Mental Health Strategy looks at improving emotional resilience
The Partnership are working to improve outcomes relating to challenging sexualised behaviours, drug and alcohol misuse, parental mental health and interpersonal violence
Initiatives to improve family relationships, resilience and coping strategies
Five to Thrive
Targeted Mental Health in Schools (TaMHS)
Talk Out Loud Anti Stigma Programme
Working with School Nursing as a part of the National Call to Action
Support of adults with mental health concerns or harmful behaviours
Developing the Children’s Community Health Services

15. Priorities for the 2013-17 Emotional Wellbeing and Mental Health Strategy
The promotion of positive emotional wellbeing and early intervention
Improved integration in targeted and specialist services including a single point of access
Better support for children and young people who are chronically or acutely unwell
Strengthened thresholds and pathways for behavioural and neurological developmental issues
Focus on key groups of vulnerable children and young people to prevent poor emotional wellbeing outcomes and ensure there are appropriate interventions when they require additional support

16. Northamptonshire Children and Young People Community Health Transformation Programme

17. When to make Referrals

18. Integrated Children & Young People’s Specialist Health Service
Countywide
offer
delivered in
Localities
ADHD & ASD
Children’s
Specialist Nursing

19. Dealing with Child and Young People presentations within local settings
Doing Well – expected that universal services engage – e.g. the Talk Out Loud Anti Stigma programme/TaMHS work in schools to promote mindfulness
Doing alright or with a single issue. Targeted Services to cover –(largely NCC services) – Self Harm as a behaviour may fit into this. School Nursing or Health Visitors may be appropriate
Where professionals are uncertain, it may be worth contacting the CAF Co-ordinator and attending complex case meetings
SOME NOTICEABLE PROBLEMS – in more than one area. Variable functioning with sporadic difficulties or symptoms in several but not all social areas. Disturbance would be apparent to those who encounter the child in a dysfunctional setting or time but not to those who see the child in other settings. Targeted Plus services to cover e.g. Counselling services or some services by NCC
If the presentation is largely effecting children within school settings, it may be worth using the pupil premium to commission any support such as family support or education psychology services.

20. When to make a referral to the Referral Management Centre for CAMHS/Paediatrics?
Specialist Services (e.g. CAMHS) to cover - OBVIOUS PROBLEMS – moderate impairment in most areas or severe in one area - Moderate degree of interference in functioning in most social areas or severe impairment functioning in one area, such as might result from, e.g. suicidal preoccupations and ruminations, school refusal and other forms of anxiety, obsessive rituals, major conversion symptoms, frequent anxiety attacks, frequent episodes of aggressive or other antisocial behaviour with some preservation of meaningful social relationships.
SERIOUS PROBLEMS – major impairment in several areas and unable to function in one area Major impairment in functioning in several areas and unable to function in one of these areas, i.e. disturbed at home, at school, with peers or in the society at large, e.g. persistent aggression without clear instigation; markedly withdrawn and isolated behaviour due to either mood or through disturbance, suicidal attempts with clear lethal intent. Such children are likely to require special schooling and/or hospitalisation or withdrawal from school (but this is not a sufficient criterion for inclusion in this category).
If uncertain, there is a CAMHS PROFESSIONAL CONSULTATION LINE
Monday to Friday
9.30am—1.00pm
Tel:

21. When issues are treated as urgent?
Highly Specialist Services (e.g. Crisis team/Inpatient) - SEVERE PROBLEMS - unable to function in almost all situations - Unable to function in almost all areas, e.g. stays at home, in ward or in bed all day without taking part in social activities OR severe impairment in reality testing OR serious impairment in communication (e.g. sometimes incoherent or inappropriate).
VERY SEVERELY IMPAIRED -considerable supervision is required for safety Needs considerable supervision to prevent hurting others or self, e.g. frequently violent, repeated suicide attempts OR to maintain personal hygiene! OR gross impairment in all forms of communication, e.g. severe abnormalities in verbal and gestural communication, marked social aloofness, stupor, etc.
EXTREMELY IMPAIRED - constant supervision is required for safety Needs constant supervision (24-hour care) due to severely aggressive or self-destructive behaviour or gross impairment in reality testing, communication, cognition, affect or personal hygiene.Working as a self- harm team, consider peer support/supervision and confidentiality issues.

22. Websites and Links
Northampton Young Healthy Minds Gateway-
CAMHS-
Northampton Youth Forum-
Northamptonshire Parent Forum Group-
Out There-
Shooting Stars-
Talk Out Loud –
Young Minds-
Youth Space -
Northamptonshire CAMHS Review:
NORTHAMPTONSHIRE’S STRATEGY FOR THE EMOTIONAL WELLBEING AND MENTAL HEALTH OF CHILDREN AND YOUNG PEOPLE 2014 –2017

23. Websites and Links – Youth Counselling
Youth Counselling across the county -
Northampton -
Daventry -
Kettering and Corby -
Oundle -
Wellingborough -
ADHD Support -
Prevention of Self-Harm and Suicidal Ideation Toolkit
And new for supporting training in 2015/2016

24. Self Harm and serious Case Reviews – lessons learnt
Case Vignette
Maggie Beer

26. Was her death predictable or preventable?
Who was she?
She was bright, capable and articulate. She had experienced significant neglect in the first 5 years of her life and had been looked after since then.
She took her own life just before her 18th birthday.
Was her death predictable or preventable?

27. Was her death predictable or preventable?
What did we learn?
History was not shared and therefore her journey was not understood.
Agencies did communicate but it was limited and not followed through.
As an articulate young person she was able to ‘keep people away’ but her ‘voice’ was not present.
Who was she?
She was bright, capable and articulate. She had experienced significant neglect in the first 5 years of her life and had been looked after since then.
She took her own life just before her 18th birthday.
Was her death predictable or preventable?

28. Was her death predictable or preventable?
What have we done?
What did we learn?
History was not shared and therefore her journey was not understood.
Agencies did communicate but it was limited and not followed through.
As an articulate young person she was able to ‘keep people away’ but her ‘voice’ was not present.
Who was she?
She was bright, capable and articulate. She had experienced significant neglect in the first 5 years of her life and had been looked after since then.
She took her own life just before her 18th birthday.
Was her death predictable or preventable?

29. What have we done? Self-harm pathway developed
Challenged National protocol for leaving care in terms of the information shared when young people subject to leaving care legislation move from one area to another.
Reiterated the need to access young people’s history – this is a recurrent theme from local serious case reviews, where for adolescents or infants.

30. Small numbers of suicides in each local centre so learning impaired
Is it suicide?
27 different definitions and Coronial process apply rules subjectively across country so different rates-affects ONS data
Small numbers of suicides in each local centre so learning impaired

31. Nottinghamshire’s Experience
2012 audit
Majority of deaths were unpredicted
Minority were high levels of previous emotional health concern/deliberate self harm/child protection
So how do we PRECICT risk and learn?

32. Self-Harm – the acute story
Julie Quincey Named Nurse Safeguarding Children Northampton General Hospital

33. Young person up to 18 years presents at A&E following Deliberate Self-harm act
Triaged in A&E, and if no medical treatment is required, transfer to ward (Child or Adult setting) with child self-harm pathway documentation started by A&E staff
Patient refuses treatment and absconds from Hospital
Clerked on the ward and medically assessed
Ward ring Child and Adolescent Mental Services (CAMHS) to request risk assessment
Prior to midday Mon – Fri 9 – 5 call CAMHS Newland House,
Between the CAMHS CRISIS team can be contacted for consultation via Berrywood hospital reception on
Inform police (999) and ask for welfare check clearly record the incident number in the patient record
Police return with patient - continue with pathway
If patient admitted out of hours, they should be kept in overnight and CAMHS informed next working day
Patient refuses to return, inform GP and refer to children’s social services and ask them to consider referral to CAMHS
CAMHS undertake mental health risk assessment. If safeguarding concerns request ward contacts social care for joint assessment and inform Hospital Safeguarding team
Ensure Paediatric Liaison Form is completed and copied to school nurse and GP, or if Interagency referral to social services has been completed, a copy of this will be sent to GP and School Nurse. Ensure Safeguarding team is copied in. DOCUMENT EVERYTHING IN THE PATHWAY, COMPLETE SAFEGUARDING CHRONOLOGY.
Once assessment is completed, and medical review taken place, the patient can be discharged home. If there are safeguarding concerns then a joint discharge planning meeting with children’s social services should ensure safe discharge.

34. Why do we assess the next working day
As per NICE guidelines we do the following
First they need to be medically stable
Secondly they need time out to sleep, to reflect and to rest
Then CAMHS will come and assess

35. Catherine’s Story

36. Catherine’s story
Catherine was admitted to NGH having taken an overdose of 24 paracetamol, 8 ibruprofen, 3 nytal and her father’s anti-depressants 15 tablets were missing
I was present when Catherine was admitted she had come via ambulance
She was in secondary school, looked very thin, nicely dressed and otherwise looked well looked after
She came with her older brother, her father and her step-mother
Her father and step mother were distressed and were struggling to come to terms with Catherine’s actions, her brother seemed detached

37. The treatment
Catherine’s paracetamol levels were high and therefore she required a parvolex drip and stayed in over night
We weighed her and checked her eating pattern though thin she had a normal BMI and we observed her eating well on the ward
The next morning she was pronounced medically fit for discharge
CAMHS attended and did their assessment they felt she was not mentally ill but would follow her up in the community

38. Catherine and her family tell their story
I told Catherine she could go home but she refused she said her brother was hitting her and she was not going to go home anymore, she had not shared this with the CAMHS worker
As the safeguarding nurse I needed to understand more
It took the next three hours to unpick the story. Catherine had originally lived with her birth mother who struggled with mental health problems both children suffered emotional abuse and after a case conference were placed with their father
Catherine’s step mother was very calm and understanding but had found Catherine emotionally shut down and non-communicative

39. Catherine and her family tell their story
Catherine shared that her brother Toby was really hard to live with as he had behavioural problems
I had observed Toby for a number of hours and he struck me as being on the autistic spectrum, I discussed this with his father and step-mother and they agreed to a referral to CAMHS to have him assessed, I later found out he had been diagnosed with high functioning autism
Catherine agreed to go home once she knew Toby would get help

40. Catherine
With the parents agreement we referred Catherine as a child in need to social services, the family were assessed and were eventually signed posted to a life story worker who worked with Catherine
Though Catherine was not mentally ill she was struggling to make sense of her world as was her brother
The family had been through a lot of trauma they needed time and help to make sense of the many changes
To my knowledge Catherine did not self-harm again

41. Jack’s story

42. How Jack came to hospital
Jack was seen by the police he was standing outside his girlfriends house at 3 am in the morning it was snowing heavily, his head and shoulders were covered in snow
Jack was not making sense when the police spoke to him his words were slurred and his eyes looked dilated, he eventually admitted to the police he had taken an overdose
The police brought him to A&E and he was admitted to the children’s ward, he was 17 years old effectively homeless and sofa surfing he originally was from out of county

43. The treatment Jack also required a parvolex drip
He had also self harmed through cutting and required steri-strips to his arms and the cuts to his legs were cleaned up
He appeared to have a chest infection and bloods were taken
During the night Jack slept deeply
The next morning he was ready to see CAMHS

44. Jack takes his leave
I was rung by the ward, Jack was refusing to stay as he was worried about his girlfriend
We managed to calm Jack whilst we waiting for CAMHS Jack started to tell me that he had stood every night for the past week outside his girlfriends house, she and her mother didn’t know. He felt it was the only way he could keep her safe and he felt compelled to do it
Jack appeared to be highly distractible and appeared to be listening to something, I shared my concerns with the CAMHS worker I was beginning to wonder if Jack was manic or indeed psychotic

45. CAMHS assessed
CAMHS agreed that Jack was showing pressure of speech, had distorted thinking he believed his mobile was sending him messages but his mobile was completely dead and had been for a number of days
He was also stating if he left the hospital he would jump from a building
The CAMHS worker explained to Jack he was ill and said he needed to be admitted to psychiatric hospital

46. Jack ran

47. Jack Jack was returned to the ward by the police
Eventually Jack was transferred to psychiatric hospital by the police and the AMHP worker under section 3 of the mental health act
I do not know the outcome of Jack’s story

48. Kelsie’s story

49. Kelsie’s story
Kelsie had over 20 admissions to NGH in a three month period in her late teens
She allegedly took overdoses however the tox screen never showed toxic levels in her blood
She frequently self-harmed by cutting, burning and using ligatures
Kelsie during this time became looked after by social services
As her story slowly unfolded it was discovered she had been sexually exploited
Kelsie has learning difficulties

50. Kelsie to date Kelsie has been very hard to help
Though she is not mentally ill she does use self-harming behaviour to express her feelings
She frequently disappears from her foster carers
She will return to her mother’s and then go missing again
She is potentially at risk when she does not engage
Kelsie is now a young adult and continues to be admitted to NGH with self-harm

51. What can we learn These cases are pretty typical
Catherine’s was due to the effect of coping with emotional abuse
Jack had developed bi-polar
Kelsie has a troubled background, learning disability and is at risk of sexual exploitation

52. Catherine
Catherine had had many changes, her new school was aware of the troubles she had experienced with her birth family, but as Catherine was quiet and a good student it was assumed both by school and her parents that she was coping
Catherine’s history is a high risk for vulnerability to self harm
Parental mental illness
Child protection proceedings
Brother with emerging developmental disorder
Mentoring at school may have helped

53. Jack
Jack was homeless and only became known to services after admission
Though his girlfriends mother knew Jack was troubled he had hid the homelessness from her and his girlfriend agreed to keep quiet
The police responded really well, Jack has got an early diagnosis and if he follows his medical regime he should have better outcomes

54. Kelsie Kelsie had been permanently excluded on more than one occasion
She was well known to social services
Her learning difficulty had never been formally diagnosed
Her mother rarely reported her missing
Kelsie’s vulnerabilities made her ideal for men to sexually exploit
All workers should be familiar with the CSE toolkit to spot the risk factors and take action sooner

55. Break

56. The Community & Schools Pathway and Toolkit
Cazz Broxton CAMHS Community Liaison Lead Mike Simons Senior Educational Psychologist, NCC & Lead for Northamptonshire TaMHS Programme Annie Head Counsellor, Northampton Academy

57. What is Self-harm?
Self-harm in the literature is used to cover deliberate acts of injury which may or may not involve a wish to die.
One example is that of physical mutilation e.g. cutting the skin, repeatedly banging a part of the body etc.
Most people who injure themselves in what they call self-harm do not intend to intentionally risk their lives

58. Why do young people Self Harm ?
Act of self-harm or self injury can be symptoms of distress
The importance of the act is meaningful to the individual who carries it out
It is important not to generalise about young people who self-harm
It can be a way of coping with many different emotions

59. Explanation from people who Self-harm
A sense of control
To be able to feel anything
The pain proves your human
For the physical pain to overtake the emotional pain
It is like an addiction
To let the anger out
A way of punishing myself
To break numbness
I like watching the blood run

60. Cycle of self-harm Negative emotions Sadness, anger and despair
Tension
Inability to control emotions, maybe using dissociation to cope with tension
Self- harm act
Cutting, burning etc
Positive effects
Endorphins released, tension and negative feelings dispelled for a short period
Negative effects
Shame and guilt over self-harm act

61. Definition
‘Self-poisoning or self-injury, irrespective of the apparent purpose of the act’ NICE, 2004

62. Community & School Pathway
The Two Pathways
The Community & School pathway and acute pathway
Community & School Pathway
If necessary, Acute Pathway

64. The Community & School Pathway
Improved communication home, school and other agencies
Self- harm team
CAMHS consultation through liaison line
Checking with safeguarding protocols
Consideration of informing parent/carer
Risk assessments and forms

65. The Toolkit
Toolkit has been developed by Northamptonshire Multi-agency pathway development team and also includes guidance from other national and regional organisations
Guidance for schools to support children, young people and families at an individual and systemic level
Bringing a national perspective into the local framework including example policies for schools
Tools can be used in either a preventative or supportive capacity
Toolkit contains both practical and theoretical evidence based approaches to helping and supporting young people

66. Using the Toolkit and Pathway
Scenario....
You are approached by a young person who attends your organisation e.g. school/ community group who has indicated that they have self-harmed by cutting them self. They have shown you the cut on their forearm.
For five minutes on your tables, discuss how you would use the
pathway and toolkit to help you to support this young person
and decide on a plan of support...

67. Key aspects to consider
Working as a self- harm team, consider peer support/supervision and confidentiality issues.
Informing parents and use of scripts for telephone conversation/ letter to parents to arrange meeting
Any necessary further referral e.g. Safeguarding, CAMHS, Educational Psychologist, Community Support?
Tools that may be useful e.g. proactive support plan, script for talking to a young person, coping strategies and distractions, risk assessment, protective behaviours
Documenting the support- appropriately evidencing a plan of support in school and ensuring paperwork is clear and relevant should an ongoing referral need to be made
Consistent documentation to be handed over when relevant between the two pathways in order that all agencies recognise plans of support.

68. Look after you-supervision and team support are paramount!

69. The Real Story in School Northampton Academy
Responding to Self-harm Through an Emotional Health & Wellbeing Team
Annie Head
Counsellor
Northampton Academy

70. The Pastoral Support Team
The aim of the Pastoral Support Team is to meet the Social, emotional and Mental Health needs of students. The team consists of two Pastoral Support Managers, a Counsellor and an Early Intervention Coordinator who works with families through the CAF process. The Team works alongside the SEND team within the Inclusion faculty and is part of a graduated response

72. Responding To The Emotional Health and Wellbeing of Students
Good referral policies and procedures are key in developing and maintaining a well-functioning team and should be revisited termly to be consistently good.
They allow containment for students, staff and families.
They remove reactionary behaviours and the risk of catastrophizing which can potentially increase stress and anxiety.
They allow good communication and discussion. Confidentiality is always adhered to, yet a degree of transparency is required in the best interest of the student.
They involve good record keeping, tracking referrals, both internally and externally. This allows us to identify emotional needs through trends and patterns of behaviour. Preventative work can then be tailored to meet the needs of students.
They ensure the work is allocated appropriately to the right person with the right skill set who will assess the needs of the student accordingly and be able to make good onward referrals if necessary.

73. Self Harm Cases Presented To The PST 2013-2014

74. Self- Harm Cases Presented To The PST 2013-2014
92 students – 7% (1:14) engaged in a form of self harm; cutting, scratching, drug use, alcohol, group identity activities (99 scratches, ice cube challenge etc), sexual activity, risky behaviours, negative influences of social media
The most prevalent year group was 11 with 11% (1:9) of the year group presenting. This is very much in line with national trends. Of this, 48% were girls and 52% boys.
The second most prevalent year group was 9 with 10% ( 1:10) of students presenting. Again this reflects national trends and thoughts about the developmental conflicts at this age; self and identity. 87% were girls and 13% boys.
It is anticipated that figures for this academic year will be consistent with

75. Responding To Self Harm
To manage this challenge within school it was evident that in addition to the established referral procedures ,the efficacy of which had already been tested, a stringent self harm policy was required.
Following discussions with key staff in school, including the PST, the Lead Safeguarding manager, School Nurse and the NHS Nurse:
A pathway of support was drawn up
The Self Harm toolkit, launched in October 2014, was tailored to meet the needs of the school
Both documents were presented as one policy to the Governing Body who ratified it as a working policy.
All staff were made aware of this new policy.

77. A Case Study- Jane
Jane is 14 years old and is in year 9. Her friends took her to a member of staff as she had told them she had taken some tablets in school after her friends became concerned about her. She had become very anxious and was unable to catch her breath.
The member of staff followed the policy by immediately seeking medical assistance. Jane presented to the school nurse in an extremely agitated manner as her anxiety increased. Other students were present in the medical room. It was therefore important to contain any anxieties they may be experiencing.
Following immediate observations, the school nurse followed procedures by:

78. A Case Study - Jane Requesting paramedic support Contacting the PST
Contacting parents
Throughout this time, Jane was monitored and kept safe.
I attended the medical room to discover Jane in a very distressed state. She was however able and willing to inform us that she had taken some tablets from home from a family member. She still had the empty blisters packs on her. She also reported that she had disposed of some tablets in a bin in school. Jane was attended to by paramedics who once they had retrieved the tablets from school took Jane to NGH.
Jane’s friends were informed of events and supported, as was the member of staff who reported the event
Jane’s tutor, head of year, teaching staff, attendance, the Lead safe Guarding Manager were all informed.
I followed procedures by:
blister packs on her.

79. A Case Study - Jane
Jane was admitted to NGH and assessed by CAMHS. The school NHS nurse was referred to . On her return to school:
A risk assessment was drawn up and agreed with Jane and her family, to be reviewed monthly.
A CAF was initiated to support the family. As issues came to light that were impacting negatively on Jane’s emotional well-being it was evident that the family needed support. Concerns were also raised regarding Jane’s risky behaviours and those of her brother, who is now also being supported by school. The case is now being taken to complex case.
Counselling was arranged for Jane in school.
Discussions were held with CAMHS who are supporting Jane.
Jane has a cohesive support plan in place and we hope that through this she will make good progress.

80. Targeted Mental Health in Schools
A holistic approach to promoting MH addressing self-harm and other manifestations of child/young person distress
Capacity-building – through training, consultation and coaching.
Evidence-based – inc using learning from TaMHS Project
Collaborative & Multi-agency

81. Building-Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire
As informed by Northamptonshire
January 2015
Targeted Mental Health in Schools Project & Programme
More Targeted Programmes or Support - Wave 3 focused
‘Drawing and Talking’ KS1-4
Emotional Health / Wellbeing Team – to support students in KS3&4
Home-Focused Practitioner Trained in ASD, 123 Magic, Solihull Approach Parenting, Theraplay
Targeted Programmes or Support Wave 2 focused
Peer Support KS1&2
Peer Mentoring KS3&4
CBT based Group Work e.g ‘Growing Optimism’ or ‘RESPECT’
Support for child experiencing Insecure Attachment (inc Theraplay), Anxiety, Loss, Bereavement, Separation, ADHD, ASD, Self-harm & Domestic Abuse
Universal Programmes or Support Wave 1 focused
Building Resilience thru:
‘Zippy’s Friends’ KS1
‘FRIENDS’ KS2/3/4
Peer Massage or
Relaxation Techniques
Mind-ful
ness
Well-Being Wheels - interactive resource
Building Exam Resilience
Whole-School
Behaviour Management Approach e.g. 123 Magic
These are the building blocks that TaMHS is recommending as aspects of provision that can be recruited into schools through roll-out of the programme – just about to enter it’s 5th funded year. As shown – building knowledge in SH and having an EHWBT are 2 of the building blocks that are needed for schools. More about TaMHS included becoming a TaMHS accredited school at the TaMHS stall etc.
Just to say that Two localities Northampton and Kettering have SH as a top priority and so TaMHS are working with the chairs of those Locality Forums to look at how this can be addressed – perhaps by key reps from secondary schools in those areas joining with us, we can work out a plan to have a joint approach to addressing SH as part of your action plan...?
County PSHE Prog inc SEAL. Healthy Schools
Anti Bullying
(inc Cyber)
Shoe Box & Mental Health Handbook
Headteacher & Staff Well-being Programmes
Solihull Approach & or Protective Behaviours
Solution Focused Approach
Mental Health Team or Lead Person in School
Family SEAL
Parent Engagement – Best Practice
Essential Foundation Programmes & Approaches
Mental Health Stigma Programme (MHSP) inc Participation of Children & Young People
Children’s Workforce Core Competencies (from DCSF, ECM 2005)
Essential Underpinnings for work with children
For evidence base, see
For enquiries, please contact

82. A closing thought...
Remember you could be the one person who makes a difference... But you don’t have to help alone!

83. What will you do next? Action planning

84. Closing Summary

85. Remember self-harm is only part of people’s stories
Remember self-harm is only part of people’s stories...it does not define them as a person. For more information please see: