Associate Professor Penelope Hasking - Curtin University - Addressing Non-Suicidal Self-Injury...

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Associate Professor Penelope Hasking

Addressing Non-Suicidal Self-Injury

(NSSI) on campus



Outline

What is self-injury?

NSSI among Australian university students

Crises on campus

What can we do to better address NSSI on campus?




“The deliberate destruction or alteration of

one’s own body tissue

without conscious suicidal intent”

NSSI = non-suicidal self-injury




Methods: cutting, burning, punching things, severe scratching (esp

with an implement), self-battery, pinching, biting, etc

Frequency: 1-300+

DSM-5 suggests on 5 days in the last 12 months

NSSI is not: tattooing, body piercing, hair pulling, reckless behaviour,

substance abuse, eating disorders etc



Challenging some myths



Who self-injures?

0

5

10

15

20

25

10-17years

18-24years

25-34years

35-44years

45-54years

55+years

% s

elf

-in

jure

at

each

ag

e

Age group

Males

Females

Martin et al (2010). The Australian National Epidemiological Study of Self-Injury (ANESSI). Centre for Suicide Prevention Studies. Brisbane: Australia



Who self-injures?

• 1 in 5 adolescents

• 13-15% of young adults

• 5% of adults

• 30% of uni students

•There are no gender

differences in the rate of NSSI

BUT

•There are gender differences

in the method



Rates of self-injury have not changed over the last 25 years

What has changed?

• How people talk about it

• Public awareness

• More open representation in movies, books, songs etc

− although it has always been there

• Celebrity disclosure

• More media coverage

• Methods of assessment in research

• Much more research, and research is growing at an

exponential rate

A new fad?



Psychological correlates

NSSI is associated with:

• Anxiety

• Depression

• Eating disorders

• Borderline personality disorder

• Alcohol and substance use disorders

• Suicidal behaviour

But

• Youth who self-injure can be functioning well, and possess none

of the known risk factors

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=q2MX6aQ9FHANxM&tbnid=B8hFdzwNEzxsjM:&ved=0CAUQjRw&url=http://www.huffingtonpost.co.uk/sarah-brennan/self-harm-awareness-day-campaign_b_2780814.html&ei=g5lDUuGQB8X9lAW-pIG4Cg&bvm=bv.53217764,d.dGI&psig=AFQjCNErWLhLREH5R7tezu8azkNhtmC-RQ&ust=1380247790991436

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=q2MX6aQ9FHANxM&tbnid=B8hFdzwNEzxsjM:&ved=0CAUQjRw&url=http://www.huffingtonpost.co.uk/sarah-brennan/self-harm-awareness-day-campaign_b_2780814.html&ei=g5lDUuGQB8X9lAW-pIG4Cg&bvm=bv.53217764,d.dGI&psig=AFQjCNErWLhLREH5R7tezu8azkNhtmC-RQ&ust=1380247790991436



NSSI < self-harm < suicidal thoughts/behaviour < suicide

Most individuals who self-injure do not have suicidal thoughts at the

time of self-injury.

But NSSI is a significant risk factor for further severe self-injury and

later suicide

We are just starting to gather evidence to help us determine who is

most at risk

Psychological correlates

Intrapersonal

Vulnerability Factors

High aversive emotions

High aversive cognitions

Poor distress tolerance

Interpersonal

Vulnerability Factors

Poor communication skills

Poor social problem-solving

Integrated Theoretical Model of the Development and Maintenance of NSSI

NSSI-Specific Vulnerability

Factors

Social learning hypothesis

Self-punishment hypothesis

Social signaling hypothesis

Pragmatic hypothesis

Pain analgesia/ opiate hypothesis

Implicit identification hypothesis

Stress Response

Stressful event triggers

over- or under-arousal

or

Stressful event presents

unmanageable social

demands

Regulation of affective experience

Regulation of social situation

NSSI

Distal Risk

Factors

Genetic

predisposition

for high

emotional/

cognitive

reactivity

Childhood

abuse/

maltreatment

Familial

hostility/

criticism

X

Nock, 2009



• Every young person we have talked to agrees that

self-injury is not about ‘seeking attention’

What young people say




NSSI on campus Early studies reported lifetime rates as high as 43-47%

Hasking et al (2008). Archives of Suicide Research

Williams & Hasking (2010). Prevention Science



NSSI on campus

N = 2261 Australian university students

In the last week:

• I thought of hurting myself = 22%

• I hurt myself = 7.6%

(most commonly up to 3 times in the last week)

Slight tendency for women to think about it more, but no gender

difference in who actually self-injures



NSSI on campus

Students who self-injure report:

• More rumination

• Trouble expressing feelings

• Poor ability to regulate emotions

• Greater psychological distress

• Prior suicide attempt (~44%)

No demographic differences

No differences in academic ability or academic misconduct



Crises on campus

Campus staff have reported greater numbers of students

presenting to them for assistance during periods of peak

psychiatric symptom severity, known as a psychological crisis (e.g.

Everly, & Lating, 2013).

Campus staff and students may vary in their understanding and

experience of a psychological crisis, and may also express

differing views on how such a presentation is handled

effectively.

Discussion of both common and disparate perspectives, may be

useful to inform a structured approach for staff when providing

assistance to a student in crisis.



Crises on campus

We interviewed:

6 students• Female, undergraduate, aged 18-24 years

6 psychologists • Working in the University Counselling Service

6 other staff with student support roles• ie Safer Communities; Student Rights



Crises on campus

Students said:

1. Crises occur when students are overwhelmed;

2. Staff need to listen rather than just act; and

3. Students value the assistance of staff during a psychological crisis.

..she would just check in

every so often. Make sure

I was ok, that I was still

getting help. That was

really all it took for me to

want to stay on track.

All I really want [staff] to do is

listen, and just let me know

that other students have felt

like this too, and that they

have gotten through it.

That general feeling that just

everything is going wrong. I tried to

manage it [distress] but there’s

always something that tips you

over, and in this case is was getting

a crap mark [on an assignment].

you look for help and the

person [helper] makes it

worse. I’m freaked out, then I

see they’re freaked out, and

they just don’t want to hear it.

Before that [seeking help] I

was suicidal, but after they

[staff] get involved then I’m

suicidal AND angry.

the one thing I know is

when to take myself to

hospital. I can do that. I

don’t need [staff] to do it

for me.



Crises on campusStaff focused on:

1. Role contingent understanding of crises;

2. Duty of care;

3. Student crises deleteriously impact staff wellbeing;

• Collegiate support

4. An absence of protocols and guidelines;

5. Difficulty accessing external psychiatric resources;

• Funding cuts

6. The need for prevention, early intervention and college-based

resources.

• Student-centred learning

• Mental health literacy

• ‘Safe’ or ‘quiet’ rooms on campus

• Campus-based treatment



Crises on campus

“Parents put their kids in our care. There’s no magical transition from

high school to uni when you arrive here and become adjusted.”

“What I find difficult [about a crisis] is the anxiety…that this person is at

risk and what I do …will have…some bearing on whether they hurt

themselves, or potentially even whether they live or die”

“We do a lot of debriefing…we will have two of us in the room with the

student…this kind of shares the burden. And it enables two staff

members...to support each other”

“Guidelines would be good…to have something that is standardised”

“There should be formal procedures”

“I’ve had clients waiting for an ambulance for 2+ hours, so we need a

room for this purpose”

“There’s a need for the institution to step back and ask…’is there

anything environmentally around here that is putting people at greater

risk…?’” Meaney, Hasking & Reupert, under review



What can we do to better address NSSI?

Our findings from university studies mirror those we see in

school-based studies:

• Young people want to be listened to and treated with

respect

• Staff want to assist young people but lack knowledge about

NSSI and are unsure what to do

• Staff are calling for more education and training, and clear

policies and guidelines regarding management of NSSI




Safety first

Is an ambulance needed?

Talk to the student on their own

Remove from lecture/tutorial if possible

Let them know the they can come back when ready

Be non-judgemental and empathic

Low-key dispassionate demeanour

Respectful curiosity




Listen to what the student has to say

Most often they will be looking for an opportunity to de-escalate and

need some time and space and someone to just listen

Offer to take them to the counselling service

Let them know you are there for them

Avoid asking the student ‘why would you do this?’

Avoid the temptation to demand a student stops the

behaviour – until an alternate coping strategy is in place




Guidelines for Managing a

Psychological Crisis on campus

Meaney, Hasking & Reupert, in prep



About these Guidelines

Who are the Guidelines For?

The following guidelines were developed for the use of both

mental health professionals, and other university staff.

When should they be used?

The guidelines contain information that may be of use during

and after a student psychological crisis. There is also general

information about this event that may be useful as background,

and recommendations for further reading.

How were the Guidelines developed?

The content of the guidelines represent a synthesis of feedback

from university students and staff, relating to the experience of a

crisis on campus, and the broader literature on attending to

psychological crises.



Berger, Hasking & Reupert,

in press



Thank you!

[email protected]

www.self-injury.org.au

Ph: 08 9266 3437

mailto:[email protected]

http://www.self-injury.org.au/



Contagion



It made me empathise and understand why people self-harm

Turns me even further off the behaviour, through actually seeing the image rather than just hearing about it

Watching films such as Thirteen made me feel like my behaviour was OK

When the character had a good outcome it felt like a good outcome was possible for myself and that contributed to me stopping

Watching the character who engaged in self-harm made me curious and wanted to feel…. ‘What if I actually do it? Would it relieve the emotional pain?’



Seeking solutions



Research Reports

Associate Professor Penelope Hasking - Curtin University - Addressing Non-Suicidal Self-Injury...

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