Children and Young People who Self-Harm Satveer Nijjar Harm-ed Training

Housekeeping Mobiles on silent please. Respect for other participants. Confidentiality. Look after yourself. A copy of the slides shall be provided

Quiz 1. What percentage of the general population are estimated to have self-harmed? Approx. 6% but the vast majority do not disclose. 2. What is the most common form of self-harm? Self- poisoning and cutting account for most ED attendances however behaviours such as hair pulling, scratching, biting are more difficult to measure as rarely require ED admission. 3. Who self-harms more – males or females? Statistically women, 1:3 male to female ratio. There are issues in relation to males not disclosing or the form of self-harm not being recognised. 4. At what age do we see the most self-harm? Teenage / adolescent years, but remember self-harm can start at any age. 5. How many young people are estimated to self-harm in any one year? Estimated 1 in 10. 6. Where do young people feel most comfortable going to seek information, support and advice for self-harm? 76% Internet, 61% a friend, 27% G.P., 17% teacher and 16% parent.

What is self-harm? ‘Self-poisoning or self-injury, irrespective of the apparent purpose of the act’

Signs and Indicators No specific signs and indicators – look for a change in usual behaviour for the child and investigate.

What can lead to self-harm?

Experiences include… Abuse: Physical, sexual, emotional, financial and domestic Neglect Loss including bereavement Body image Relationship difficulties Family breakdown Bullying/discrimination Identity issues: cultural, sexual, gender Academic pressure Peer pressure Any experience that the young person is finding difficult to deal with …

Your bad day…

Functions of self-harm As a coping mechanism – to manage the distress. Control – it’s the only thing they feel they have control of in their life in that moment. Relief of feelings – anything, including pain feels better than how they are feeling at that point in time. A Release – a way of release pain / distress/ frustration / anger etc. A Distraction – from the distress they are going through. To feel / be numb Self punishment/Prevention of pain to another – they feel they deserve to hurt / it’s better to hurt themselves than someone else (physically or emotionally) Communication of emotional pain – in the first instance to themselves and for some it may be to let others know

Feelings that these experiences can lead to… Anger, Frustration, Tension Fear, Panic, Anxiety Powerlessness, desperation Hopelessness Self-hatred, guilt, shame Feeling unheard Feeling unsupported Feelings of unreality, numbness, deadness

Functions of self-harm As a coping mechanism – to manage the distress. Control – it’s the only thing they feel they have control of in their life in that moment. Relief of feelings – anything, including pain feels better than how they are feeling at that point in time. A Release – a way of release pain / distress/ frustration / anger etc. A Distraction – from the distress they are going through. To feel / be numb Self punishment/Prevention of pain to another – they feel they deserve to hurt / it’s better to hurt themselves than someone else (physically or emotionally) Communication of emotional pain – in the first instance to themselves and for some it may be to let others know

Use of language…be aware of the impact of certain phrases: ‘Self-harmer’ ‘It’s a teenage girl thing’ ’I can’t help because I have never self-harmed’ ‘There was no self-harm when I was younger.’ ‘It’s just a phase/trend/copycat’ ‘It’s just superficial/not as bad as last time’ ‘When was the last time you self-harmed?’ ‘It’s just a cry for help’ ‘It’s just attention seeking’

“To gain relief from a terrible state of mind” “Some people do it for attention… that doesn’t mean they should be ignored. There are plenty of ways to get attention, why cause yourself pain? And if someone’s crying for help, you should give them it, not stand there and judge the way they’re asking for it.”

Responding to self-harm – professionals perspective Calmness Acceptance Confidentiality Respect and Reassurance Hope Acknowledgement Concern Understanding Information

What do young people want? To talk to someone they can trust To be listened too To be involved in decision making / care plan For staff / carers not to be shocked or angry Honesty re confidentiality To be helped to explore reasons for self-harm. Education and information on self-harm in schools Peer support Accessible services For staff/carers to be informed about self-harm

Coping strategies Emotional distress techniques are still of benefit so should be suggested: Music – listening to / playing Art – drawing thoughts Exercise Writing down thoughts Pets Bath/shower Delay tactics

Coping strategies Specific harm minimisation strategies include: Elastic bands Blu-tac Writing on the body with pens Ice cubes Remember these are not a like-for-like or a substitute for dealing with the underlying distress. Promote the similarities in the functions e.g. elastic band = distraction, focus, control.

Barriers to disclosure/seeking support Low self-confidence and self-esteem Worry Shame and embarrassment Lack of awareness Fear they won’t be believed or taken seriously Fear of the consequences of disclosure Loss of control

‘…one of the biggest fears young people told us about, and the biggest obstacle to getting help, was the fear that self-harm, the only coping strategy that had been keeping them going, might be taken away from them’

Thank you! Training enquiries: training@harm-ed.co.uk Join us on Facebook at: www.facebook.com/pages/Harm-ed Follow us on Twitter: @harm_ed

Useful websites YoungMinds.org.uk – mental health awareness for young people but with sections for parents too. YoungMInds also run a free parent helpline providing general advice around mental health worries in a young person - 0808 802 5544. Mind.org.uk – general mental health awareness, downloadable factsheets. TheCalmZone.net – male specific support around emotional distress. Childline.org.uk – support for young people in emotional distress, online/phone. BBC Radio 1 Advice – Google this phrase to take you to BBC Radio 1’s section looking modern day issues facing young people and advice on how to come through them. Topics including relationships, exams, alcohol, drugs, self-harm, mental health etc. NHS MoodZone – providing information on common mental health concerns including dealing with anger, exams etc. Healthtalk.org / Youthhealthtalk.org – A new website developed in conjunction with Oxford University. If you search for ‘self-harm’ it shall lead you to pages giving parents experience of self-harm, young peoples explanations of self-harm and how to support your child. Also provides information on common mental health conditions aimed at both adults and young people.

Websites / Free Apps. Bigwhitewall.com – an award winning early intervention service for people 16+ in psychological distress. It combines social networking principles with a choice of clinically informed interventions to improve mental wellbeing. It can be accessed 24/7 and has staff who ensure full engagement and anonymity of all members. It costs £24 p/m or is free on prescription (in limited areas), for members/vetrans of the UK Armed Forces or their families. Head Talks - www.headtalks.com providing videos discussing all aspects of mental illness and recovery. Calm Harm App – award winning app that provides delay tactics for individuals who self- harm. For Me App – created by ChildLine to support young people up to the age of 19 with a range of issues including self-harm and suicidal thoughts.