1. SESSION 3 (1)
SELF HARM 79

2. WHAT IS SELF HARM? Self harm is a behaviour and not an illness.
Self harm is a maladaptive coping strategy.
People who self harm are not necessarily suicidal.
Self harm can range from minor injury through to potentially
dangerous and life-threatening forms of injury. 80

3. THE RANGE OF SELF HARMING BEHAVIOURS
Highly lethal methods of self harm: hanging, shooting, jumping, poisoning, drowning, stabbing.
Less lethal methods of self harm: Overdose, cutting, burning.
Highly visible methods of self harm: Cutting, burning, self-biting, scratching, gouging, carving into skin, sticking sharp objects into skin, interfering with wound healing.
Less visible methods of self harm: Self-hitting, banging head, pinching, pulling hair, breaking bones. 81

4. REASONS FOR SELF HARM To escape from unbearable distress
To change other people’s behaviour
To escape from a difficult situation
To show distress to others
To get back at other people and make them feel guilty
To get relief of tension
To get help from others 82

5. RISK FACTORS FOR SELF HARM
Personal characteristics:
Social disadvantage
Sexual orientation
Social and family environment:
Adverse childhood experiences
Social isolation
Psychological characteristics:
Impulsive
Poor problem solving
Prone to emotional distress 83

6. RISK FACTORS FOR SELF HARM (cont’d)
Biological factors:
Genetic vulnerability
Brain functioning
Situational factors:
Adverse life events
Media influence
Self harm in peers
Alcohol intoxication 84

7. MHFA Action Plan for Self Harm
sk about suicide L
isten non-judgmentally G
ive reassurance and information E
ncourage the young person to get appropriate help E
ncourage self-help strategies 85

8. A Action: sk about suicide
People who self harm are at an increased risk of suicide.
Some harm themselves to combat thoughts of suicide.
About 2% of people who are treated in hospital for an episode of self harm end up killing themselves within one year.
If you think the person is at risk of suicide, follow the steps of How to help a suicidal person 86

9. A Action: sk about suicide
People who self harm can kill themselves accidentally.
Call an ambulance, regardless of the person’s intent, for:
Self-poisoning and overdose
Severe bleeding and arterial bleeding
Self harm can result in permanent disability. To minimise the risk:
Offer physical first aid for injuries
Ask the person if they require medical attention
If in doubt, seek medical advice
If the person is not at risk, move onto Action L: Listen non-judgmentally. 87

10. Action: isten non-judgmentally
Self harm can be hard for a person to talk about.
Respond calmly and avoid anger.
Check your own reaction to self harming behaviour.
Remember that self harming behaviour is a maladaptive coping strategy and that the level of distress is genuine.
Listen and support without judgement.
The person should not be dismissed as manipulative or attention seeking. 88

11. Action: ive reassurance and informationG
There are usually underlying mental health problems, such as depression or substance use disorder in someone who is self harming.
There are effective treatments for these underlying disorders.
With treatment they can feel better. 89

12. Action: ncourage the young person to get appropriate help
Most young people who engage in self harming behaviour do not seek any professional help.
You may need to assist them to seek help and keep appointments.
The sources of professional help rated most satisfactory by people who engage in self harming behaviour are GPs, psychiatrists, psychologists or counsellors. 90

13. E Action: ncourage the young person to get appropriate help
What sorts of professionals? E
Psychologists
Psychiatrists
General practitioners
Counsellors and school counsellors
Allied health professionals 91

14. E Action: ncourage the young person to get appropriate help
What sorts of treatments? E
Important to treat the underlying condition
Important to assess for risk of suicide
Dialectical behaviour therapy for people with borderline personality disorder
Focus on alleviating distress, not on changing behaviour 92

15. Action: ncourage self-help strategies
Support from family and friends
Avoidance of alcohol and other drugs
Self-help strategies for underlying mental health problems
When feeling the urge to self harm, talk to someone about it
Action E
- Encourage self help strategies 93

16. SESSION 3 (2)
PSYCHOSIS 94

17. WHAT ARE PSYCHOTIC DISORDERS?
Psychosis is a mental health problem in which a person has lost some contact with reality.
There may be severe disturbances in thinking, emotion and behaviour.
Psychosis can severely disrupt a person’s life.
Relationships, work, study and self-care are difficult to initiate and/or maintain. 95

18. MAIN PSYCHOTIC DISORDERS
Schizophrenia
Bipolar disorder
Psychotic depression
Schizoaffective disorder
Drug-induced psychosis 96

19. COMMON SYMPTOMS WHEN A PSYCHOTIC DISORDER IS DEVELOPING
Changes in emotion & motivation
Depression
Anxiety
Irritability
Suspiciousness
Blunted, flat or inappropriate emotion
Change in appetite
Reduced energy and motivation 97

20. COMMON SYMPTOMS (cont’d) CHANGES IN THINKING AND PERCEPTION
Difficulties with concentration or attention
Sense of alteration of self, others or the outside world (e.g. feeling that self or others have changed or are acting different in some way)
Odd ideas
Unusual perceptual experiences (e.g. a reduction or greater intensity of smell, sound or colour)
CHANGES IN BEHAVIOUR
Sleep disturbance
Social isolation or withdrawal
Reduced ability to carry out work and social roles 98

21. IMPORTANCE OF EARLY INTERVENTION FOR PSYCHOSIS
Some of the consequences of delayed treatment include the following:
Slower and less complete recovery
Poorer long-term functioning
Increased risk of depression and suicide
Slower psychological maturing
Slower uptake of adult responsibilities
Strain on relationships and loss of social support
Disruption of study and employment
Increased use of alcohol and drugs
Loss of self-esteem and confidence
Greater chance of problems with the law
Increased risk of homelessness 99

22. SYMPTOMS OF SCHIZOPHRENIA
Delusions
Hallucinations
Thinking difficulties
Loss of drive
Blunted emotions
Social withdrawal
100

23. BIPOLAR DISORDER
A person with bipolar disorder has episodes of depression as well as episodes of mania, a type of psychotic state.
101

24. COMMON SYMPTOMS IN MANIA
Increased energy and overactivity
Elated mood
Need less sleep than usual
Irritability
Rapid thinking and speech
Lack of inhibitions
Grandiose delusions
Lack of insight
102

25. OTHER PSYCHOTIC ILLNESSES
Psychotic depression: a severe depression can have psychotic features.
Schizoaffective disorder: has symptoms of both schizophrenia and depression, and does not meet criteria for bipolar disorder.
Drug induced psychosis: is a psychosis brought on by drug use. Drugs that can cause psychosis are cannabis, cocaine, ecstasy, amphetamines and magic mushrooms.
103

26. POSSIBLE CAUSES OF PSYCHOTIC DISORDERS
Genetics – a family history of psychotic disorder
Biochemical factors – chemical messengers in the brain are thought to be involved in changes in the brain caused by schizophrenia
Stress – can bring on episodes of psychotic disorder
Other factors
104

27. MHFA ACTION PLAN FOR PSYCHOSIS
sk about suicide L
Action:
isten non-judgmentally
Action: G
ive reassurance and information
Action:
ncourage the young person to get appropriate help E
Action: E
ncourage self-help strategies
105

28. Psychosis

29. A Action: sk about suicide
Young people with psychotic disorders are at increased risk of suicide.
Two factors that may increase the risk of suicide while the young person is psychotic are:
Hearing voices which command the person to hurt themselves.
Having multiple episodes and feeling that they cannot continue to live with the illness.
Young people who have experienced multiple episodes of psychosis
but are currently well are also at increase risk.
If you think the person is at risk, follow the steps of How to help a
suicidal person.
106

30. A Action: sk about suicide
When the young person is at risk of harming others:
A very small percentage of people with psychotic disorders may appear threatening.
Violence accompanying a mental illness is not common.
Violence is more common if alcohol or other drugs are involved.
If the person is agitated, unpredictable or perceived as threatening violence, follow the steps of what to do if a person appears threatening.
If the person is not at risk, move onto Action L: Listen non-judgmentally.
107

31. WHAT TO DO IF A PERSON APPEARS
THREATENING
Do not get involved physically.
Adopt a neutral stance and a safe position.
Try to create a calm, non-threatening atmosphere.
Try to get the person to sit down.
Do not try to reason with acute psychosis.
Express empathy for the person’s emotional distress.
Comply with reasonable requests.
Call the police if required.
108

32. Action: isten non-judgmentally
Listen in a non-judgmental way.
Do not be critical of the person.
Avoid confrontation.
Speak calmly, clearly and in short sentences.
Do not argue with the person.
Accept the delusions and hallucinations are real for the person but
do not pretend they are real for you.
Do not try to humour the person.
109

33. G Action: ive reassurance and information
It may not be appropriate to provide information about psychosis, until the young person has become more lucid.
Try to help the young person realise that:
You want to help them.
They have a real medical condition.
Psychosis is not a common illness, but is well
known and researched.
Psychosis is not a weakness or character defect.
Effective help and treatments are available.
Do not make promises you cannot keep.
110

34. E Action: ncourage the young person to get appropriate help
What sorts of appropriate help? E
To treat the pychotic disorder, a mental health team including:
GPs
Psychiatrists
Mental Health Services
Family and friends
111

35. E Action: ncourage the young person to get appropriate help
What sorts of appropriate help? (cont’d) E
For optimal quality of life and good long term outcomes:
Clinical /educational psychologists
Counsellors
Vocational counsellors and case workers
Allied health professionals
Family and friends
112

36. E Action: ncourage the young person to get appropriate help
What sorts of treatments? E
To treat the positive symptoms of psychosis, medication is required.
Anti-psychotic medications
Mood-stabilising medications
For improved functioning and quality of life, psychological counselling can be helpful
Treatment of other mental health problems
113

37. WHAT TO DO IF THE YOUNG PERSON DOESN’T WANT HELP?
Seek advice from:
The local mental health crisis team
A mental health carers’ support group
Make an appointment with GP or mental health professional to talk about the problem
Find out about involuntary treatment
If the person has had episodes of psychosis in the past, it can help to write an advance directive
(‘All Wales child protection procedures’ can be obtained online:
114

38. Action: ncourage self-help strategies
Many young people with a psychotic disorder also have depression &/or an anxiety disorder
Many of the self-help strategies for depression and anxiety disorders are also appropriate for people with psychosis
Avoid exercise when mania is developing
Avoidance of alcohol and other drugs
Support groups may be very helpful
115